Dental Tribune USA

New technologies guide paradigm shifts in dental prosthetics industry

By Dr. Kamran Zamanian and Jeff Wong, B.Sc, iData Research Inc.
January 30, 2012

The economic recession has had a dramatic impact on the dental prosthetics industry in the United States, however the market is expected to rebound in 2012 and see strong growth through 2018. Despite this recovery, many patients are still choosing to delay expensive restoration procedures or opt for more affordable alternatives.

Recent record-setting gold prices have had a significant impact on the cost of precious alloy restorations and as a result, monolithic restorations have gained popularity as a more affordable alternative to full-cast and PFM.

In addition, the CAD/CAM market, which depends heavily on the strength of prosthetic sales, is expected to continue to see strong growth through 2018. The majority of this growth will be driven by sales of chairside CAD/CAM systems as the number of dental laboratories throughout the U.S. sees a rapid decline.

High impact of gold market on precious alloy restorations

Precious and semi-precious restorations have become much more expensive to manufacture, which is affecting the price of crowns and bridges fabricated from full-cast or porcelain fused to metal (PFM) materials. For a full-cast or PFM restoration to be considered precious or “high noble” it must contain a minimum of 60% precious alloy, with 40% requiring to be gold. “Noble” or semi-precious alloys on the other hand must only contain a minimum of 25% precious alloy.

Precious metals include gold, palladium and platinum. All three metals have experienced significant price increases over the past five years, with gold experiencing the highest at an average increase of 26% annually since 2005. Due to the fact that precious alloy restorations require such a large quantity of gold, the recent inflation in this particular market has caused average selling prices of such restorations to soar. Gold prices are expected to continue increasing into the future, which will impact the cost of precious alloy restorations and make them unaffordable for many patients. The result will be an ever-increasing demand for less expensive alternatives such as all-ceramics.

Conversely, semi-precious alloy restorations can have varying compositions, granted that they meet the minimum requirement of 25% precious metal. Due to this lenient definition, palladium is often used for semi-restorations as it is the least expensive precious metal. However, palladium has also experienced a significant price increase of over 166% since 2005. As a result, the price of semi-precious restorations has also been on a steady climb.

Monolithic restorations driving trend toward all-ceramics

The increasing price of full-cast and PFM restorations has consequently positioned all-ceramic restorations as a more affordable alternative. However, a more prominent driver behind this trend is the demand for monolithic restorations. Unlike PFM restorations which are bi-layered in design, monolithic restorations are composed of solid ceramic material and have been able to demonstrate superior strength, durability and aesthetic quality compared to traditional manufacturing methods.

Monolithic restorations can be fabricated in two ways. In one method, a vacuum-pressing system is used where the all-ceramic restoration is first waxed to full contour. The wax is then removed and the remaining device is hot-pressed to create a solid ceramic restoration. The second method requires the use of CAD/CAM technology, thus automating the fabrication process and allowing laboratories to increase their level of productivity.

Popular full contour blocks include Glidewell Laboratories’ BruxZir full contour zirconia block and Ivoclar Vivadent’s full contour lithium disilicate IPS e.max block. These two blocks were responsible for the majority of the growth in the all-ceramic segment of the dental prosthetics market in 2011. Furthermore, the increased demand for monolithic restorations has also resulted in an increased adoption rate for CAD/CAM technologies as more laboratories wish to participate in this lucrative business.

Dental industry to experience rapid decline of dental laboratories and technicians

In 2011, there were approximately 11,000 dental laboratories in the U.S, a 23% decrease compared to the estimated 13,000 laboratories that existed in 2010. The rapid decline in the number of laboratories exhibits the volatility of this industry. However, the vast majority of those that closed down were smaller sized labs with three to five employees.

Along with the rapid consolidation and shutdown of laboratories is a corresponding decline in the number of employed laboratory technicians. Over the last five years, the industry has experienced a decline of approximately 10,000 technicians in the domestic workforce. In addition, a number of dental laboratory schools are shutting down, with only six remaining in 2011.

The most prominent reason for the decline in both dental laboratories and technicians is demographics. Of the remaining 33,000 technicians working in the U.S., over one third are over 50 years of age. As a result, there will be a mass exodus of technicians over the next five to ten years simply due to retirement. With a majority of these retirees being laboratory owners, the number of laboratories will be equally affected as most will simply shutdown their businesses. Since the number of dental schools has dwindled, there will be fewer technicians entering the job market in the future, which will not be sufficient to replace those leaving the industry.

In 2011, Sirona led the overall CAD/CAM device market in the United States. This was due to their presence in four segments: full in-lab systems, standalone desktop scanners, chairside systems and intra-oral scanners. The company competed in these segments with its CEREC and inLab product lines which encompass both lab and chairside solutions. Aside from leading the overall CAD/CAM device market in the U.S., Sirona was also the market leader in chairside CAD/CAM systems both domestically and globally. Their success in the chairside segment can be attributed to being the first in the market, for which they held a monopoly over the past two decades. Sirona’s share in the chairside CAD/CAM market will greatly strengthen its position as a global market leader in the overall CAD/CAM industry.

Other prominent leaders in the U.S. CAD/CAM device market include 3M ESPE, DENTSPLY and 3Shape. 3M ESPE is a highly reputable company in the dental CAD/CAM industry with its Lava product line, which is recognized globally. The Lava line includes their popular full in-lab system, a standalone desktop scanner, as well as an intra-oral digital impression-taking system, the C.O.S. (Chairside Oral Scanner). DENTSPLY, another world renowned competitor, offers their own in-house system, the Cercon. The company also provides outsourcing options through its Smartsourcing services and Prident production facility. 3Shape, a Danish company, quickly penetrated the standalone scanner market to become a top competitor as a result of its open architecture business model; which allows their scanners to be compatible with a variety of systems.

Aside from the conventional method of milling restorations through CAD/CAM, emerging technologies in the dental industry include rapid prototyping systems that utilize an additive manufacturing process. The majority of competitors in this segment have years of experience with the technology but have just recently entered the dental market with their systems. Competitors in this segment include 3D Systems and envisionTEC, two global leaders in the rapid prototyping industry.

Additional information is available

The information contained in this article is taken from a detailed and comprehensive report published by iData Research titled “U.S. Markets for Dental Prosthetics and CAD/CAM Devices.” Additionally, reports have been completed for the same industries in Europe, Asia-Pacific and Emerging Markets. More information and a free synopsis of the above report is available by contacting iData Research at


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