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Dental Market Trends
Panel Intelligence, LLC
May 2008
Quantitative Research
Qualitative Research Intelligence Reports
Panel Intelligence, LLC, 150 Cambridgepark Drive, 7th Floor, Cambridge, MA 02140 617 532 5700 www.panelintelligence.com
2
Dental Market Trends
QUANTITATIVE RESEARCH
Project Objectives
Understand trends in case starts since January of 2007.Quantify impact of the downturn of the national economy on case starts.Estimate future volume of patient visits.
Primary Objective: To understand patient trends in the past year and to estimate future trends.
3
Dental Market Trends
QUANTITATIVE RESEARCH
Recruitment & Study Methodology
QUANTITATIVE RESEARCH
Quotas and Recruitment Criteria for Survey: 101 dental professionals Mix of solo and multi-dentist practice Geographical mix Practices with annual revenues greater than $200,000
Quotas and Recruitment Criteria for Survey: 101 dental professionals Mix of solo and multi-dentist practice Geographical mix Practices with annual revenues greater than $200,000
Survey Detail: Self-administered survey Approximately 30 minutes’ duration 101 total respondents Fielded online from April 23, 2008
to April 25, 2008
Survey Detail: Self-administered survey Approximately 30 minutes’ duration 101 total respondents Fielded online from April 23, 2008
to April 25, 2008
Summarize resultsand key findings for final report
Deliver finalanalysis and
results
STEP 3: Wrap-Up
Clean andanalyze finaldata set
Participants respond to surveywhile Panel Intelligence monitors data for integrity
STEP 2: Fielding
Respondentquota(s) reached;
Survey closed
Inviteparticipants
Kickoff: clarifyclinical orbusiness-relatedissues
Panel Intelligence draftsinitial survey &recruitment criteria
Program andtest online
survey
STEP 1: Setup
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Dental Market Trends
QUANTITATIVE RESEARCH
Solo practitioners: 58.4% n = 101
Multi-dentist practice: 41.6% [Mean: 18.3 Range: 2 - 200]
Respondent Background Information
Annual Revenues % of Physicians (n=101)
$1,000,000 or more 39.6%
$500,000 - $999,999 39.6%
$200,000 - $499,999 20.8%
Primary Specialty % of Physicians (n=101)
General Dentistry 71.2%
Oral/Maxillofacial Surgery 11.9%
Periodontics 6.9%
Orthodontics 5.9%
Prosthodontics 3.0%
Dental Implantology 1.0%
Questions S1 - S5
Region % of Physicians (n=101)
Northeast 31.7%
Midwest 29.7%
West 19.8%
South 18.8%
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Dental Market Trends
QUANTITATIVE RESEARCH
Key Findings: Trends in Dental Cases & US Economy Impact
Dentists expect volume of routine and non-routine visits to increase in 2008
compared to the same quarter in 2007.
For dentists expecting a decrease in visits in 2008, 90% indicate the state of the economy is a factor.
Dentists predicting an increase in visits in 2008 cite practice growth as a factor.
Nearly 80% of respondents currently have a negative to strongly negative perception of the general US economy.
67% of dentists indicate the economy is currently having a negative impact on their practice.
Nearly 60% indicate that the US economy will have a negative on their practice impact 12 months from now.
Currently 15% of dentists feel the US economy is having a positive impact on their practice, yet over 30% indicate the economy will have a positive effect 12 months from now.
While respondents were split on awareness of new tax incentives, almost 32% will make an equipment technology purchase in 2008 because of the tax incentives.
The tax incentive will influence respondents to purchase new equipment, digital x-rays, large ticket items, and replace failures instead of fixing them.
Close to 63% of those making new equipment or technology purchases will spend $50,000 or more, which for 60% of respondents represents an increase in spending from 2007 by an average of 70%.
6
Dental Market Trends
QUANTITATIVE RESEARCH
Key Findings: Consumables, Basic Equipment, and High Tech Equipment
72% of consumables purchased are from primary distributors; Henry Schein is most
commonly used.
Over 80% of dentists will not change the percent of total purchases supplied by their primary consumables distributor.
68% of dentists purchase 16% of their consumables directly from manufacturers.
Choice of distributor is primarily driven by price (mean rank 1.8) followed by most consumable SKUs (breadth of
products) (mean rank 3.1).
Over 65% of total basic equipment purchases are made from primary consumables
distributors.
80% of high-tech equipment is purchased through either primary consumables
distributors (53%) or direct from the manufacturer (27%).
Digital x-ray (mean rank 1.5) is considered the most important high-tech equipment to dental practices, followed by the
intra-oral camera (mean rank 2.3).
Outside of digital x-ray and CAD/CAM, respondents indicate laser dentistry, cone beam/CT, electronic records, and
digital impressions as being the most promising new technologies in the next 5 years.
7
Dental Market Trends
QUANTITATIVE RESEARCH
Key Findings: Digital X-Ray
76% of dentists are performing intra-oral imaging, 65% are doing panoramic, 11% are
doing neither.
Both intra-oral and panoramic users indicate digital is more beneficial than film, panoramic users slightly more so, 63%
to 61% respectively.
Respondents estimate nearly a third of US dentists are currently using digital x-ray.
A 26% CAGR expected in digital x-ray use over the next 3 years.
Of the 42% of respondents without digital x-ray, 19% anticipate purchasing a system
in 2008.
Over 68% of respondents are aware of 3-D x-ray systems, 60% of them see a need within their practice for one and
34% of those who see a need plan to purchase a system within the next 3 years.
8
Dental Market Trends
QUANTITATIVE RESEARCH
Key Findings: Trends in Dental Implant Cases
Respondents perform an average of 7.8 implant cases per month, 60% of which are non-
elective.
For the 15% of respondents that switched implant brands, most are leaving Nobel Biocare, going to either Straumann, or Astra, for
various reasons.
77% of dentists said price was not the most significant factor in choosing an implant manufacturer, ease of use and reliability are
indicated as factors influencing selection.
Respondents report a consistent increase in the number of dental implant case starts over
2007, (16.5 in Q2 07) and they project the number to continually increase reaching 20.1 case
starts per month by Q1 in 09.
The economy and energy prices are indicated as factors for those anticipating a decrease in case starts in Q2 2008 compared to Q2
2007.
Advertising/marketing and increased awareness are factors given for seeing an increase in case starts from Q2 2007 to Q2 2008.
70% of dentists have not seen a change in outward referrals for dental implants in the past 12
months.
26% have seen an increase by 26%. Reasons indicated for the increase include better patient education and awareness.
5% have seen a decrease in outward referrals by 33%. Primarily because they are capable of doing implants themselves instead of
referring out.
9
Dental Market Trends
QUANTITATIVE RESEARCH
Key Findings: CAD/CAM
65% of respondents feel the average 29 crown restorations they perform a month will
not change over the next 12 months. 32% believe they will see an increase by 12%.
Respondents recognize a mean difference of $785.67 between the amount charged
per crown and the amount paid in lab fees per crown. More dentists are paid cash by
patients than through managed care.
While all respondents are aware of CAD/CAM 60% are not using it.
60% of respondents indicate cost as the primary reason they have not purchased an in-office CAD/CAM system,
followed by lack of necessity for 27%.
Of the 16% considering purchasing CAD/CAM, it would be in an average of 3.3 years.
25% of those are considering the E4D from D4D.
A 15% CAGR is expected for in-office CAD/CAM system use over the next 5 years.
10
Dental Market Trends
QUANTITATIVE RESEARCH
DETAILED FINDINGS
SECTION ONE: TRENDS IN DENTAL CASES
11
Dental Market Trends
QUANTITATIVE RESEARCH
Surveyed Practices Currently Manage an Average of 5,854 Patients
Q1. In total, how many patients is your practice currently managing/treating?
The median number of patients respondents are managing is 2000.
n=101
Mean Median Range
Number of Patients Practice Currently Managing/Treating 5,853.7 2000.0 100 – 50,000
12
Dental Market Trends
QUANTITATIVE RESEARCH
Volume of Visits to Increase in 2008 Compared to the
Same Quarter in 2007
Q2. Please estimate the number of dental visits your practice experienced in the following time periods:
Q3. In the table below, please estimate the number of visits you expect your practice to have in the following time periods.
Patient visits in 2008 for routine and non-routine care are expected to increase from the same quarter in 2007.
n=101
Mean Number of Visits
Q2 2007(April – June 2007)
Q3 2007 (July – September
2007)
Q4 2007(October –
December 2007)
Q1 2008(January – March
2008)
All patient visits 1490.9 1484.4 1497.5 1509.9
Non-routine care visits only 206.3 205.5 209.7 218.3
Mean Number of Visits Expect to Have
Q2 2008(April – June 2008)
Q3 2008 (July – September
2008)
Q4 2008(October –
December 2008)
Q1 2009(January – March
2009)
All patient visits 1548.5 1613.1 1547.8 1600.1
Non-routine care visits only 212.7 216 215.2 230.7
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Dental Market Trends
QUANTITATIVE RESEARCH
Q4. You indicated that you expect a decrease in the number of visits in second quarter 2008 compared to second quarter 2007. Which of the following factors, if any, do you feel may contribute to the decrease in patient visits?
n=22
For over 90% of 22 respondents who predict a decrease in visits from Q2 2007 to Q2 2008, the state of the economy is a factor.
The State of the Economy Greatest Reason for a Decrease in Visits
Factor Percent Responding
State of the economy 90.9%
Energy prices 63.6%
Real estate prices 54.5%
Job loss 50.0%
Decline of the stock market and/or lower interest rates 45.5%
Consumer confidence 40.9%
Scaling back practice 13.6%
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Dental Market Trends
QUANTITATIVE RESEARCH
Q5. What other factors not mentioned above, if any, may contribute to the decrease in patient visits?
Respondents indicate a number of other reasons for an anticipated decrease in patient visits from Q2 2007 to Q2 2008.
Other FactorsDifficulty finding good employees
People losing insurance to do job loss, saving money
General dentists trying to perform all procedures in their office rather than referring to specialists
Work fewer days
Economy
Tighter credit
Ins benefits are not enough to help pt decrease out of pocket costs and more patients are moving to DMO/network plans in
which we do not participate
Patient no shows/cancellations
We are focusing on cosmetic and implant treatments, and less hygiene and general dentistry
Scale back of insurance, nervousness on the economy
Gas
Many more offices in town
Uncertainty about war in Iraq and presidential election
Election year
Less hiring at Microsoft
n=22
Other Factors Contributing to Decreasing Patient Visits
15
Dental Market Trends
QUANTITATIVE RESEARCH
Q6. You indicated that you expect an increase in the number of visits in second quarter 2008 compared to second quarter 2007. What factors do you feel are contributing to the expected increase in patient visits?
Almost 29% of respondents indicate practice growth as the reason they will see an increase in the number of visits in Q2 2008 from Q2 2007.
n=35
Increases in Visits Due to Practice Growth
Factor Percent Responding
Practice growth 28.6%
Marketing 17.1%
Added staff 14.3%
Patient referrals 11.4%
Better internal processes 11.4%
Increase in population 8.6%
Less vacation 5.7%
Economy is getting better 5.7%
16
Dental Market Trends
QUANTITATIVE RESEARCH
Q7. You indicated that you expect a decrease in the number of non-routine care visits in second quarter 2008 compared to second quarter 2007. Which of the following factors, if any, do you feel may contribute to the decrease in non-routine care visits?
n=22
For respondents anticipating a drop in non-routine care visits in Q2 2008 from Q2 2007, the state of the economy (86%) and job loss (64%) are factors seen as having the greatest impact.
State of the Economy and Job Loss Drive Drop in Non-routine Care Visits
FactorPercent
Responding
State of the economy 86.4%
Job loss 63.6%
Energy prices 59.1%
Consumer confidence 54.5%
Real estate prices 45.5%
Decline of the stock market and/or lower interest rates 40.9%
None of above 13.6%
Scaling back practice 9.1%
17
Dental Market Trends
QUANTITATIVE RESEARCH
Q8. What other factors not mentioned above, if any, may contribute to the decrease in non-routine care visits?
Respondents indicate changing budgets for patients and the election as other factors contributing to an anticipated decrease in non-routine care visits.
n=22
Patient Budgets and the Election Also Factors for Declining Non-routine Care Visits
Other Factors
I still think the continuing war in Iraq and presidential elections are negatively affecting the numbers
Many more offices in town
Gas
Normal fluctuation and HSA spending accounts
Work fewer days
Doing better work
People being cash strapped and no dental insurance
Patients doesn’t want to do expensive procedures
Summer cycle, people on vacation
Priorities changing concerning spending on elective procedures
I think the main reason is the economy, it will change after the election
18
Dental Market Trends
QUANTITATIVE RESEARCH
DETAILED FINDINGS
SECTION TWO: US ECONOMY IMPACT
19
Dental Market Trends
QUANTITATIVE RESEARCH
Negative Perception of the General US Economy
Q10.On a scale of 1 to 7, with 1 being a “Strongly Negative” and 7 being a “Strongly Positive”, what is your current perception of the general US economy?
Nearly 80% of respondents currently have a negative to strongly negative perception of the general US economy.
3.0% 76.2% 10.9% 9.9%
Strongly Negative (1) Negative (2-3) Neutral (3) Postive (5-6) Strongly Positive (7)
Perception of the General US Economy
n=101
% of Respondents Selecting Answer
Mean
2.9
20
Dental Market Trends
QUANTITATIVE RESEARCH
US Economy Currently Having Negative Impact on 67% of Practices
Q11.On a scale of 1 to 7, with 1 being a “Strongly Negative” and 7 being a “Strongly Positive”, how much of an impact, if any, do you think the general US economy is currently having on your business?
4.0% 63.4% 17.8% 12.9% 2.0%
Strongly Negative (1) Negative (2-3) Neutral (3) Postive (5-6) Strongly Positive (7)
Impact General US Economy is Currently Having on Your Business
n=101
% of Respondents Selecting Answer
While the majority of respondents indicate the economy is negatively impacting their practice, 15% say it is having a positive impact on their business.
Mean
3.3
21
Dental Market Trends
QUANTITATIVE RESEARCH
Anticipate Economy Will Have Less Impact 12 Months From Now
Q12.How much of an impact, if any at all, do you think the general US economy will have on your business 12 months from now?
Nearly 60% of respondents indicate that the US economy will have a negative on their practice impact 12 months from now, but over 30% indicate it will have a positive effect, twice as high as current impact.
3.0% 55.4% 10.9% 30.7%
Strongly Negative (1) Negative (2-3) Neutral (3) Postive (5-6) Strongly Positive (7)
Impact General US Economy Will Have on Your Business 12 Months From Now
n=101
% of Respondents Selecting Answer
Mean
3.6
22
Dental Market Trends
QUANTITATIVE RESEARCH
While Not Well Known, Tax Breaks In New Stimulus Bill Will Make An Impact On Purchases
Q 13. Are you aware of the new provisions in the recently-passed stimulus bill that increased the write-off a maximum of $250,000 on equipment and technology purchases installed and operational by the end of the 2008 calendar year?
Q 14. Will this tax incentive for small businesses influence you to make an equipment technology purchase in 2008?
While respondents were split on awareness of the new tax incentives, almost 32% will make an equipment technology purchase in 2008 because of the tax incentives.
% of Respondents Selecting Answer
48.5%
51.5%
0%
20%
40%
60%
80%
100%
Awareness of New Provisions in Stimulus Bill
n=101
Aware of New Provisions in Stimulus Bill
Not Aware of New Provisions in Stimulus Bill
% of Respondents Selecting Answer
68.3%
31.7%
0%
20%
40%
60%
80%
100%
New Provisions Influence on Making An Equipment Technology Purchase in 2008
Will Make an Equipment Technology
Purchase in 2008
Will Not Make an Equipment Technology Purchase in
2008
23
Dental Market Trends
QUANTITATIVE RESEARCH
Q14.a Will this tax incentive for small businesses influence you to make an equipment technology purchase in 2008?
If Yes, how so?
The tax incentive will influence respondents to purchase new equipment, digital x-rays, large ticket items, and replace failures instead of fixing them.
n=32
Purchases Will Include New Equipment and Digital X-Ray
FactorNumber of Mentions
Will purchase new equipment 13
Digital x-rays 4
Large ticket items 2
Will replace equipment failures instead of fixing 2
New office 1
Keep my taxes in check 1
Save money 1
Will spend $ now I may have waited to spend 1
We are currently looking into a costly ct scanner and this will help to make the decision easier 1
May purchase icat 1
24
Dental Market Trends
QUANTITATIVE RESEARCH
More Than 60% Will Spend Over $50,000
Q 15. How much do you anticipate you will spend on new equipment or technology in 2008?
44% of respondents who anticipate making a new equipment or technology purchase in 2008 will spend between $50,001 - $100,000.
% of Respondents Selecting Amount
37.5%
43.8%
12.5%
3.1%3.1%
0%
20%
40%
60%
80%
100%
Anticipated Amount Spending in 2008
n=32
$50,001 - $100,000
< $50,000
$100,001 - $200,000
$200,001 - $250,000
> $250,001
25
Dental Market Trends
QUANTITATIVE RESEARCH
Compared to 2007, 60% Will Increase Spending by 70%
Q 16. a Does this reflect a change in spending on new equipment or technology from the previous year?
In 2008 60% of 32 respondents will increase their spending on new equipment or technology from 2007 by an average of 70%.
% of Respondents Selecting Answer
15.6%
25.0%
59.4%
0%
20%
40%
60%
80%
100%
Change From Spending In Previous Year
Increase By: 70.3%n = 18 (with 1 outlier excluded)
Decrease By: 35.6%n = 5
No Changen = 8
n=32
26
Dental Market Trends
QUANTITATIVE RESEARCH
Q16.b Please highlight some of the technologies you will be investing in (CAD/CAM, digital imaging, etc.):
n=32
Dentists Plan to Invest In Digital Technologies
Technologies Dentists Will Invest In
X-ray imaging and processing. Digital intraoral camera; computer in the office; upgraded operatory equipment
Would like to do digital radiography but not at this time Digital imaging, PT education software
Win oms 3D digital panorex Digital imaging, networking computers to rooms, cameras, so far
Software, electric hand pieces Digital imaging, CT scan or tomogram
Paperless charting, icat Digital imaging, and radiographs, also paperless office.
New operatory. Digital imaging. digital imaging chairs laser
Just installed digital imaging and digital iintraoral photography; need more monitors and patient education programs
Digital imaging
Intraoral camera, Digital camera, intra oral camera. Ceph
Digital imaging, Digital camera, New delivery systems Digital
Digital xray, laptop computer Dental chairs
Digital xray, crt at ops CT scanner with mobile dental unit; additional computers, maybe another cerec machine
Digital X-Ray, CAD/CAM Cone Beam CT scanner
Digital radiographs(newer),computers in each operatory, Computer upgrade,implant engine
Digital radiograph Computer systems
Digital photography, practice management software Chairs, Delivery systems, new intraoral x-rays
Digital pano, remodel, Xray unit, electric hp? CAD/CAM prosthetic technology, practice software, perhaps a digital pan
Several dentists indicate digital x-ray, and digital imaging as areas of investment in 2008.
27
Dental Market Trends
QUANTITATIVE RESEARCH
DETAILED FINDINGS
SECTION THREE: CONSUMABLES
28
Dental Market Trends
QUANTITATIVE RESEARCH
Q17. How many distributors do you currently use for purchasing consumable products?
Q18. Who is your primary consumables distributor, and what percent of your total consumable purchases are from that distributor?
Dentists use an average of 4 distributors for purchasing consumables.
n=101
Henry Schein Most Commonly Used Primary Distributor; 72% Of Purchases Are From Primary Distributors
Primary Consumables Distributor
Percent Using Distributor
Henry Schein 45.5%
Patterson Dental 14.9%
Darby dental 10.9%
Benco Dental 8.9%
Pearson 2.0%
Atlanta dental 2.0%
Mean Median Range
Number of Distributors Currently Used For Purchasing Consumables 4.2 3.0 1 – 20
Percent of Total Consumables
Purchased from Primary Distributor:
72.1%
29
Dental Market Trends
QUANTITATIVE RESEARCH
Over 80% Will Not Change Percent of Total Purchases Supplied By Primary Distributor
Q 19.a Do you anticipate this percentage to increase, decrease, or stay the same in the future?
Less than 20% of respondents will change the percent of total purchases bought from their primary distributor.
% of Respondents
9.9%
81.2%
8.9%
0%
20%
40%
60%
80%
100%
Anticipated Percent Change in Total Consumable Purchases from Primary Distributor
IncreaseN = 9
DecreaseN = 10
Remain the Same
N = 82
n=101
30
Dental Market Trends
QUANTITATIVE RESEARCH
Increasing patient loads supports more purchases, while decreases in patients and increasing prices are reasons for decreases in purchases.
n= 9 increasen = 10 decrease
Patient Load Drives Changes In Purchasing Behavior
Reason for Increase (n = 9) Reason for Decrease (n=10)
Companies are being bought out by this company and merging Prices
More production Too expensive
Hope to see increase in practiceI probably would purchase equipment from Patterson
Starting/opening more offices in the group Patterson giving more incentives
Satisfaction Fewer pt visits
Due to more patients Less patients
More patients New products from a competing company
Increase in patient care Their prices are high
More patient visits Seeing fewer patients
Price increases
Q 19.b If you anticipate this percentage to increase or decrease, what is the primary reason for the change?
31
Dental Market Trends
QUANTITATIVE RESEARCH
68% of Dentists Purchase 16% of Consumables Directly From Manufacturers
Q 20. Do you purchase any consumables product directly from the manufacturer? If so, what percentage of total consumables purchases does this represent?
While 32% of dentists make no purchases from manufacturers, nearly 16% of total consumable purchases made are direct from the manufacturer.
% of Respondents
31.7%
68.3%
0%
20%
40%
60%
80%
100%
Percent Purchasing ConsumablesDirectly From the Manufacturer
Average of 15.6% of Total Consumables Purchased Direct from Manufacturer
n=101
Do not
32
Dental Market Trends
QUANTITATIVE RESEARCH
Although having a breadth of products is important (3.1 mean rank), price (1.8 mean rank) is still the most important factor in deciding on a consumables distributor.
n=101
Price Drives Distributor Choice
Q 21. Please rank the following factors by order of importance when selecting a distributor for consumable products. (1=Most Important, 2=Second Most Important, etc.)
FactorMean
Rank
Lowest price (unit cost) 1.8
Most consumable SKUs (breadth of products) 3.1
Value-added services (consultative approach) 4.1
Ability to sell and/or service basic and high-tech equipment 4.8
Size of distributor 5.5
Electronic ordering capabilities 5.5
Contract terms/payment options 6.1
Ability to sell and/or service dental practice management software systems 6.6
Proximity to office (location) 7.4
33
Dental Market Trends
QUANTITATIVE RESEARCH
DETAILED FINDINGS
SECTION FOUR: BASIC EQUIPMENT
34
Dental Market Trends
QUANTITATIVE RESEARCH
Most Basic Equipment Is Purchased From Primary Consumables
Distributors
Q 22. When purchasing high tech equipment, what percentage of purchases are made from the following vendors:
Over 65% of total basic equipment purchases are made from primary consumables distributors.
% of Respondents
4.4%
10.2%
19.8%
65.5%
0%
20%
40%
60%
80%
100%
Percent of Basic Equipment Purchases Made by Vendor Type
Direct from Manufacturer
Other*
Secondary Consumables Distributor
n=101
Primary Consumables Distributor
Others Specified: pens, paper products; local full service dealer; Equipment Supplier; equipment service contractor; Dental repair technician; dart; appropriate
distributor; already present when purchased this practice
.
35
Dental Market Trends
QUANTITATIVE RESEARCH
DETAILED FINDINGS
SECTION FIVE: HIGH TECH EQUIPMENT
36
Dental Market Trends
QUANTITATIVE RESEARCH
More Than Half of High-Tech Equipment Purchases Are Made
From Primary Consumables Distributors
Q 23. When purchasing high tech equipment, what percentage of purchases are made from the following vendors:
Over 80% of high-tech equipment is purchased through either primary consumables distributors or direct from the manufacturer.
% of Respondents
2.7%
16.8%
27.2%
53.3%
0%
20%
40%
60%
80%
100%
Percent of High-Tech Equipment Purchases Made by Vendor Type
Direct from Manufacturer
Other*
Secondary Consumables Distributor
n=101
Primary Consumables Distributor
Others Specified: On line or retail stores; local full service dealer; Equipment Supplier; distributor of particular item; dart; copiers, printers, computer.
37
Dental Market Trends
QUANTITATIVE RESEARCH
With a mean rank of 1.5 digital x-ray is considered the most important high-tech equipment to dental practices.
n=101
Digital X-Ray and Intra-Oral Camera Are Ranked As the Most Important High-Tech Equipment
Q 24. Please rank the importance of the following types of high tech equipment to your practice (i.e., enhancing the customer’s experience, improving productivity, minimizing employee turnover, etc.) (1=Most Important, 2=Second Most Important, etc.)
High Tech Equipment Mean Rank
Digital x-ray 1.5
Intra-oral camera 2.3
Dental lasers 3.5
Chairside CAD/CAM (CEREC) 3.9
3D Cone Beam CT 3.9
38
Dental Market Trends
QUANTITATIVE RESEARCH
Over the next five years, respondents indicate laser dentistry, cone beam/CT, electronic records, and digital impressions as being the most promising new technologies.
n=101
Laser Dentistry and Cone Beam/CT Seen As the Most
Promising New Technologies
Q 25. Outside of digital x-ray and CAD/CAM, what do you view as the most promising new technology expected to impact the dental market over the next five years?
Promising Technologies in Dental Market Number of Mentions
Laser dentistry 31
Cone beam / CT 21
Electronic dental records /paperless/ hand pieces 17
Digital impressions 15
Immediate load implants 8
3-D Imaging / scanners / radiography 7
Bone grafting 6
Don’t Know 7
39
Dental Market Trends
QUANTITATIVE RESEARCH
DETAILED FINDINGS
SECTION SIX: DIGITAL X-RAY
40
Dental Market Trends
QUANTITATIVE RESEARCH
Awareness of Digital X-Ray Is Over 90%
Q 26. Are you aware of digital x-ray systems for oral imaging (as compared to the traditional film based imagers)?
Less than 9% of dentists were unaware of digital x-ray systems for oral imaging.
% of Respondents
8.9%
91.1%
0%
20%
40%
60%
80%
100%
Percent Aware of Digital X-Ray SystemsFor Oral Imaging
Yes
n=101
No
41
Dental Market Trends
QUANTITATIVE RESEARCH
More Dentists Practicing Intra-Oral Imaging Than
Panoramic Imaging
Q 27. Which of the following types of imaging, if either, do you currently perform?
76% of dentists are performing intra-oral imaging, 65% are doing panoramic, 11% are doing neither.
n=101
Imaging Percent Currently Performing
Intra-oral imaging 76.2%
Panoramic imaging 65.3%
None of the above 10.9%
42
Dental Market Trends
QUANTITATIVE RESEARCH
Both Intra-Oral and Panoramic Users Indicate Digital Is More Beneficial Than Film Based
Imaging Type Relative Value of Imaging Systems
Digital Is More Beneficial Than Film Based
Both Are Equally Beneficial
Film Based Is More Beneficial Than
Digital
Intra-oral imaging 61.1% 32.2% 6.7%
Panoramic imaging 63.3% 33.3% 3.3%
Q 28. For the following types of imaging, please indicate the relative value of digital as compared to film based imaging.
One-third of respondents indicate equal benefits among digital and film based imaging.
n=90
43
Dental Market Trends
QUANTITATIVE RESEARCH
Q29. Approximately what percentage of U.S. dentists do you think currently use digital x-ray for patients?
n=101
Estimated 33% Dentists Using Digital X-Ray
Percent Median Range
Percentage of US Dentists Currently Using Digital X-Ray 32.7% 30.0 5% - 75%
44
Dental Market Trends
QUANTITATIVE RESEARCH
Digital X-Ray Use Expected To Increase To Over 65% Three Years From Now
Q30.What percentage of U.S. dentists do you predict will use digital x-ray:
Respondents expect steady increase in digital x-ray use from 33% now to 65% 3 years from now (26% CAGR).
39.1%
50.7%
65.4%
0.0%
25.0%
50.0%
75.0%
100.0%
Percent of US Dentists Who Will Use Digital X-Ray
Pe
rce
nta
ge
of
Ph
ys
icia
ns
One Year From Now Two Years From Now Three Years From Now
n=101
Percent of US Dentists Anticipate Will Use Digital X-Ray in Next 3 Years
45
Dental Market Trends
QUANTITATIVE RESEARCH
58% of Respondents Have Digital X-Ray Systems
Q31. Do you currently have a digital x-ray system?
Q32. Do you anticipate purchasing a digital x-ray system in 2008?
Of the 42% without digital x-ray, 19% anticipate purchasing a system in 2008.
% of Respondents
41.6%
58.4%
0%
20%
40%
60%
80%
100%
Percent That Currently Have a Digital X-Ray System
Yes
n=101
No
19.0% (n=8) without digital x-ray systems anticipate purchasing one in 2008.
Brands mentioned: Kodak (2), Gendex (1), Dexis (1)
46
Dental Market Trends
QUANTITATIVE RESEARCH
3-Dimensional X-Ray System Demand Is Increasing
Q 33. Are you aware of the next generation 3-dimensional (3D) x-ray systems?
Q 34. Do you see a need for 3D x-rays in your practice?
Q 35. Do you expect to purchase a 3D x-ray system within the next 3 years?
Over 68% of respondents are aware of 3-D x-ray systems, 60% of them see a need within their practice for one and 34% of those who see a need plan to purchase a system within the next 3 years.
% of Respondents
31.7%
68.3%
0%
20%
40%
60%
80%
100%
Percent Aware of Next Generation 3-Dimensional X-Ray Systems
Yes
n=101
No
59.4% of those aware see a need for 3D x-rays in their practice
34.1% of those who see a need plan to purchase a 3D x-ray system within the next 3 years*
* Planmeca (4 mentions), I-Cat (3 mentions), Sirona (2 mentions), Kodak 9000 (1 mention)
47
Dental Market Trends
QUANTITATIVE RESEARCH
DETAILED FINDINGS
SECTION SEVEN: TRENDS IN DENTAL IMPLANT CASES
48
Dental Market Trends
QUANTITATIVE RESEARCH
Q36. How many dental implants cases do you currently start/perform per month?
Q37. What percentage of your dental implant cases are:
n=100
More dental implant cases are done on a non-elective basis than elective.
Of the 7.8 Mean Implant Cases Per Month, 60% Are Non-Elective
40.3%
59.7%
0%
20%
40%
60%
80%
100%
Non-elective (i.e. patientswould otherwise seek analternative solution suchas a crown or bridge)
Elective (i.e. patientswould otherwise gountreated)
Types of Dental Implant Cases
7.8
0
1
2
3
4
5
6
7
8
9
10Mean # of
Dental Implant Cases
Per Month
Perc
en
tag
e o
f D
en
tal Im
pla
nt
Cases
n=94n=7 have 0 implant cases
49
Dental Market Trends
QUANTITATIVE RESEARCH
Q38. Has your practice changed the brand of dental implant used in the past 12 months?
Q39. Please indicate the former and new manufacturer:
For the 15% of respondents switching implant brands, most are leaving Nobel Biocare, going to either Straumann, or Astra, for various reasons.
85% of Respondents Have Implant Brand Loyalty
85%
15%
0%
20%
40%
60%
80%
100%
Changed Brand
Did Not ChangeBrand
Changes in Dental Implant Brands Used in Practice
Perc
en
tag
e o
f R
esp
on
den
ts
Changes in Implant Brand Carriers
From: To: Because:
Zimmer Nobel Biocare More versatile
Strauman Nobel Specialist's preference
Nobel replace select Astra Tech Internal connection
Nobel Biocare Biohorizons Decline to answer
Nobel biocare Implant direct Cost
Nobel BioCare Astra Easier technique
Nobel Biocare 3i Poor service
Nobel biocare AstraToo many changes from nobel
Nobel biocare Straumann Better support
NB Astra Surgeon
Biocare n Stramun OS choice
Bicon 3i Referal patterns
Bicon StraumenChanged surgeon, better system
3I Strauman Failure rate increase
n=14
n=94n=7 have 0 implant cases
50
Dental Market Trends
QUANTITATIVE RESEARCH
Q40. Is price the most significant factor influencing your choice of implant manufacturer?
Ease of use and reliability are indicated as significant factors influencing implant manufacturer selection.
Price Not the Most Significant Factor Influencing Implant Selection
77%
23%
0%
20%
40%
60%
80%
100%
Yes
No
Price Significance in Vendor Selection
Perc
en
tag
e o
f R
esp
on
den
ts
n=72
Most Significant FactorFactor Mentions
Ease of use 10
Reliability 10
Oral surgeons preference 8
Quality of product 6
Successful track record 6
Support 6
Service 5
Research/ evidence based literature 4
n=94n=7 have 0 implant cases
51
Dental Market Trends
QUANTITATIVE RESEARCH
Number Implant Case Starts Increased Over 2007 and Expected to Continue Through 2008Respondents report a steady increase in the number of dental implant case starts over 2007 and they project the number to increase throughout 2008.
Mean Number of Dental Implant Cases Started
Q2 2007(April – June 2007)
Q3 2007 (July – September
2007)
Q4 2007(October –
December 2007)
Q1 2008(January – March
2008)
Your practice 16.5 16.7 16.8 17.6
Mean Number of Dental Implant Cases Expect to Start
Q2 2008(April – June 2008)
Q3 2008 (July – September
2008)
Q4 2008(October –
December 2008)
Q1 2009(January – March
2009)
Your practice 18.3 18.9 19.5 20.2
Q41. Please estimate the number of dental implant cases your practice started/performed in the following time periods:
Q42. Thinking ahead for the next year, what change, if any, do you expect to see in the volume of dental implant cases your practice will start/perform?
n=94n=7 have 0 implant
cases
52
Dental Market Trends
QUANTITATIVE RESEARCH
For the 18 respondents who project a decrease in case starts in Q2 2008 compared to Q2 2007, the two greatest factors indicated as contributing to the decrease are the economy and energy prices.
State of the Economy Primary Reason for Decrease In Case Starts From Q2 2007 to Q2 2008
Factors Contributing to Decrease in Number of Cases2nd Quarter ‘07 Vs. 2nd Quarter ‘08
Factor Percent Responding State of the economy 72.2%
Energy prices 50.0%
Job loss 44.4%
Consumer confidence 44.4%
Real estate prices 33.3%
Decline of the stock market and/or lower interest rates 27.8%
Scaling back practice 11.1%
None of the above 11.1%
Q43.You indicated that you expect a decrease in the number of case starts in second quarter 2008 compared to second quarter 2007. Which of the following factors, if any, do you feel may have contributed to the decrease in case starts? n=18
53
Dental Market Trends
QUANTITATIVE RESEARCH
Various Other Factors Are Noted as Contributing to a Decrease In Case Starts
Other Factors Less hiring at Microsoft
More offices in town
Gas
Patients not ready in tx plan
Expendable income eaten up by increasing prices, bleak economics
Decline in economy
Concentrating on fewer procedures
Availability of cases
Treatment planning
Q44. What other factors not mentioned above, if any, may contribute to the decrease in case starts? n=18
54
Dental Market Trends
QUANTITATIVE RESEARCH
Q45.You indicated that you expect an increase in the number of visits in second quarter 2008 compared to second quarter 2007. What factors do you feel are contributing to the expected increase in patient visits? n= 40
Advertising/marketing, increased awareness, becoming a more acceptable treatment, and increased referrals are factors given for seeing an increase in case starts from Q2 2007 to Q2 2008.
Increases In Case Starts Due To Advertising and Increased Awareness
Factors Contributing to the Expected Increase in Patient Visits
Number of Mentions
Advertising/Marketing 7
Increased awareness 6
Becoming more accepted 5
More referrals 5
Practice operating better 4
Patient education 4
More demand 3
Post Presidential stability effect on business usually stabilize insurance problems1
I indicated an increase in implant cases, not an increase in patient visits. I believe patient visits will be down for 2008 relative to 2007.
1
Patients saving money for implants. 1
patients feeling economy is bad with prospect of loss of job, many patients want to have implants placed before loss of employment
1
Pricing 1
Economic improvements 1
55
Dental Market Trends
QUANTITATIVE RESEARCH
Q46. Has your practice experienced a change in volume in the number of implant restorations performed in the past 12 months? n= 39
Respondents indicate implant restoration frequency has either remained the same, 50%, or increased, 37% by and average of 18%.
Only 4% Of Respondents Have Seen a Decrease In Implant Restorations In the Past 12 Months
4%
9%
37%
50%
0%
20%
40%
60%
80%
100%
No, remain the same
Yes, increase by
Do not perform implantrestorations
Yes, decrease by
Change in Volume of Implant Restorations in Past 12 Months
18.4%
15.0%
Perc
en
tag
e o
f R
esp
on
den
ts
56
Dental Market Trends
QUANTITATIVE RESEARCH
Q47. Has your practice experienced a change in the volume of referrals outward for dental implants in the past 12 months? n= 101
While 70% of dentists have not seen a change in referrals for implants in the past 12 months, 26% have seen an increase in referrals by 26%. For the 5% seeing a decrease in referrals, it is by 33%
70% of Dentists Have Not Seen A Change In Referrals For Implants
5%
26%
69%
0%
20%
40%
60%
80%
100%
No, remain the same
Yes, increase by
Yes, decrease by
25.5%
33.0%
Perc
en
tag
e o
f R
esp
on
den
ts
Change in Volume of Referrals for Dental Implants in Past 12 Months
57
Dental Market Trends
QUANTITATIVE RESEARCH
Q48.You indicated that your practice has experienced a decrease in the volume of dental implant referrals in the past 12 months. Which of the following factors, if any, do you feel may have contributed to the decrease in referrals?
Q49. What other factors not mentioned above, if any, may contribute to the decrease in dental implant referrals?
n=5
For the dentists who indicate a decrease in implant referrals, capability of doing implants themselves instead of referring out is commonly mentioned.
Decrease In Implant Referrals Due to Changing Practice Abilities
Factor Percent Responding
None of the above 60.0%
State of the economy 20.0%
Energy prices 20.0%
Consumer confidence 20.0%
Real estate prices 20.0%
Decline of the stock market and/or lower interest rates 20.0%
Scaling back practice 20.0%
Factors Contributing to Decrease in Volume of Dental Implant Referrals for Past 12 Months
Factors Contributing to Decrease in Dental Implant ReferralsSame as above
I am a general dentist. I answered that I have decreased the referral outward because our practice continues to place more implants ourselves.
Decline in economy
The general dds is doing bridgework instead
I am doing implants in my office, thus fewer referrals out.
58
Dental Market Trends
QUANTITATIVE RESEARCH
Q50.You indicated that your practice has experienced an increase in the number of dental implant referrals in the past 12 months. What factors do you feel are contributing to the increase in referrals? n= 26
Greater patient education and awareness contribute to dentists getting more dental implant referrals in the past 12 months.
Better Patient Education and Awareness Increasing Dental Implant Referrals
Factors Contributing to Increase in Dental Implant Referrals
Number of Mentions
Patient education/awareness 13
Better technology/increased skill 6
Cost 4
Promotion 3
Patient acceptance 3
Satisfaction with technology 2
Study group that I am part of that is sponsored by implant company I use 1
More implants to be performed 1
Different mix of patients. I have the same surgeons as before and the same confidence in treatment 1
Increased diagnosis and treatment planning 1
Factors Contributing to Increase in Volume of Dental Implant Referrals for Past 12 Months
59
Dental Market Trends
QUANTITATIVE RESEARCH
DETAILED FINDINGS
SECTION EIGHT: CAD/CAM
60
Dental Market Trends
QUANTITATIVE RESEARCH
While 65% of respondents do not feel the mean number of crown restorations they perform a month (29) will change over the next 12 months, 32% believe they will see an increase by 12%.
Dentists Average 29 Crown Restorations Per Month; Expected to Increase Over Next 12 Months
4%
32%
65%
0%
20%
40%
60%
80%
100%
No, remain the same
Yes, increase by
Yes, decrease by
Anticipated Change in Volume of Crown Restorations in 12 Months
11.5%
13.3%
28.5
0
10
20
30
40
50
Mean # of Crown
Installations Per Month
Perc
en
tag
e o
f R
esp
on
den
ts
n=100
Q51. How many crown restorations do you currently perform per month?
Q52. Do you expect the number of crown restorations you perform per month to change over the next year?
n=79n=22 perform 0 crowns/month
61
Dental Market Trends
QUANTITATIVE RESEARCH
Q53. On average, how much do you charge for a crown?
Q54. On average, what are your lab fees for the crown?
Q55. What percentage of your business is cash pay versus managed care (PPO, DMO, Medicare, Other)?
Respondents recognize a mean difference of $785.67 between the amount charged and the amount paid in lab fees per crown. More patients pay cash than through managed care.
Difference Between Mean Charge Per Crown and Mean Lab Fees Per Crown is $785.67
62.3%
37.7%
0%
25%
50%
75%
100%
Cash Pay Managed Care
Payment Types
Perc
en
tag
e o
f P
aym
en
ts
$961.92
$176.25
$0.0
$200.0
$400.0
$600.0
$800.0
$1,000.0
Mean Charge Per Crown Mean Lab Fees Per Crown
Price Per Crown Charged to Patient Vs.Price Per Crown Paid to Lab
n=79n=22 perform 0 crowns/month
62
Dental Market Trends
QUANTITATIVE RESEARCH
Q56. Are you aware of CAD/CAM technology for dental restorations?
All Respondents Are Aware of CAD/CAM Technology
100%
0%
20%
40%
60%
80%
100%
Aware
Perc
en
tag
e o
f R
esp
on
den
ts
CAD/CAM Technology Awareness
n=79n=22 perform 0 crowns/month
63
Dental Market Trends
QUANTITATIVE RESEARCH
Q57. Describe your current use of CAD/CAM technology?
Only 5% use CAD/CAM in their office.
While All Respondents Are Aware of CAD/CAM, 60% Are
Not Using It
1%5%
34%
60%
0%
20%
40%
60%
80%
100%
Do not use in either setting
Use via a dental laboratory
Use in my office
Use both via a dental laboratory and in my office
CAD/CAM Current Use
Perc
en
tag
e o
f R
esp
on
den
ts
n=79n=22 perform 0 crowns/month
64
Dental Market Trends
QUANTITATIVE RESEARCH
Q58. What has been the main reason you have not purchased an in-office CAD/CAM system?
60% of respondents indicate cost as the primary reason they have not purchased an in-office CAD/CAM system.
Cost and Lack of Necessity Keep Dentists From Purchasing CAD/CAM Systems
4%
9%
27%
60%
0%
20%
40%
60%
80%
100%
Cost
Unnecessary based oncurrent process forperformingrestorations
Other
Limited number ofrestorations performedin my practice
Reasons for Not Purchasing CAD/CAM System
Perc
en
tag
e o
f R
esp
on
den
ts
Other Specified (n = 7)Tooth reduction
Scheduling would have to change and we have not made that decision yet but it is in the planning stages
Not as good as my lab
Have own on-site lab
Fit, finish an sturdiness of final restoration
Cost, but also technology not good enough yet
Cost, aesthetics, maintenance of system, stocking blanks
n=79n=22 perform 0 crowns/month
65
Dental Market Trends
QUANTITATIVE RESEARCH
Q59. Do you anticipate purchasing an in-office CAD/CAM system?
Q60. Are you considering the E4D from D4D Technologies? If Yes, How does E4D compare with CEREC (from Sirona)?
n=12
Of the 16% considering purchasing CAD/CAM, purchase time averages 3.3 years; 25% of them are considering the E4D from D4D.
A Majority of Dentists Do Not Plan To Purchase CAD/CAM In the Future
Yes (3 Comments): am researching this new
product now No powder necessary.
Software probably immature.
no powder
75.0%
25.0%
0%
20%
40%
60%
80%
100%
Yes
No
Considering E4D from D4D Technologies?
Perc
en
tag
e o
f R
esp
on
den
ts
83.8%
16.2%
0%
20%
40%
60%
80%
100%
Yes
No
Perc
en
tag
e o
f R
esp
on
den
ts
In 3.3 years
Planning to Buy CAD/CAM in the Future?
n=74n=5 already use in office or in office
& lab
66
Dental Market Trends
QUANTITATIVE RESEARCH
Q61. What percentage of U.S. dentists who perform crown restorations do you think currently use an in-office CAD/CAM system for crown restorations?
Q62. What percentage of U.S. dentists who perform crown restorations do you expect will have an in-office CAD/CAM system within the next 1, 3, 5 years?
A 15% CAGR is expected for in-office CAD/CAM system use over the next 5 years.
Respondents Estimate 12% of Dentists Currently Use In-Office CAD/CAM Systems and Predict This Number to Double in 5 Years
13.9%
18.2%
24.3%
0%
10%
20%
30%
40%
50%
1 Year 3 Years 5 years
12.1%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
Perc
en
tag
e o
f D
en
tists
Usin
g C
AD
/CA
M
Dentists Who Use CAD/CAMSystem for Crown Restorations
Dentists Who You Think Will Have CAD/CAM in the Future
Perc
en
tag
e o
f D
en
tists
Wh
o W
ill U
se C
AD
/CA
M
n=79n=22 perform 0 crowns/month