From custom-milled abutments to hybrid overdentures, LMT's latest Implant Survey covers the market's hottest trends.
Thanks to proven, long-term success rates; patient awareness; and technical advances like custom-milled abutments, implant planning software and guided surgery, the implant market continues to thrive. In fact, despite the fact that many lab owners are feeling the effects of the economic slowdown in other areas of their business, 73% of respondents to LMT's latest implant survey say the economy has not affected their implant departments (see chart 1).
Sixty-three percent of all respondents also report that their implant business is either "good" or "booming," with the most positive feedback coming from larger labs. Ninety percent of labs with six or more employees rate their implant business as "good" or "booming" compared to just 45% of smaller labs (those with one to five employees); see chart 2 below.
This niche area continues to be a steady source of revenue in an otherwise uncertain market: Respondents say, on average, 66% of their clients are sending them implant cases which make up about one quarter of their total workloads--numbers that are consistent with findings from our 2012 and 2010 implant surveys.
Ranked as the number one technical advance in the field, patient-specific, custom-milled abutments and bars continue to grow in popularity. Eighty-seven percent of respondents offer patient-specific, custom-milled abutments--5% more than a year ago--and of that percentage, the majority (61%) design them in-house but have the milling done by another laboratory or manufacturer. "Custom-milled abutments have brought custom abutments into everyone's price range," says Lee Scullin, Owner, Scullin Dental Laboratory, Westlake, OH. "The designs we are able to offer now are far superior to any stock abutment and the cost is lower; everyone wins."
When analyzed by lab size, larger laboratories are more likely to offer custom-milled abutments and bars than smaller labs. For instance, while 55% of all respondents offer milled bars, labs with six or more employees are more than twice as likely to offer them than labs with one to five staff members. Forty percent of smaller operations continue to rely on stock abutments compared to just 22% of larger labs.
Single-tooth implants are the most common type of case. Of the 87% of respondents who offer fixed implant work, single-tooth implants make up three-quarters of their cases (see chart 3 below). Full arch cases make up just 7% of respondents' workloads and, of the one-quarter of respondents who say the economy has affected their implant business, this is where they're seeing the biggest impact. "We've seen a move from larger, more intricate cases to more individual units and small bridges," says Stan Bookstaber, Owner, Dentprod, LLC, Marlton, NJ.
Hybrid overdentures are hot. Of the 13% of respondents who offer removable implant work, 36% of their cases are hybrid overdentures (including All-On-4, etc.). Touted for their high stability--typically with just four implants--ability to be immediately loaded and cost savings to the patient, many participants acknowledge that these restorations have taken the market by storm and expect them to be a huge growth area.
"All-On-4 has made a full-arch, implant-supported prosthesis available at a significantly lower price," says Tom Wiand, Owner, Wiand Dental Lab, Scottsdale, AZ. "You used to place six to eight implants restored with ceramic bridges for $40,000 to $60,000; with the All-on-4 procedure, the cost to the patient is $20,000 to $25,000. It maximizes the use of fewer implants and avoids additional costly and time-consuming surgeries such as sinus lifts or bone grafting."
Respondents are split on use of aftermarket implant parts. Nearly half of respondents say they don't use generic or aftermarket implant parts, concerned that doing so may increase the laboratory's liability or void the manufacturer's warranty. "Anybody can get anything to fit but the question is 'Do aftermarket parts fit as well as the genuine parts?' Laboratories don't want dentists compromising their standards by using a cheaper, lower-quality lab, and we shouldn't either," says Wiand.
The number of survey participants using generic implant parts has increased by 6% since our 2012 survey. Of those 51% of respondents, 34% say it's only on occasion--when the implant system and its parts are no longer available, the doctor specifically requests it or if they're trying to keep prices down for a cost-conscious account. "We prefer not to use them, however we have doctors who love to squeeze every penny out of a case," says a C&B respondent from the West South Central region.
Dentists want your implant input. Nearly three-quarters of our participants say dentist-clients are seeking their advice on implants--such as potential problems, materials and design--more than they have in the past. "As our doctors have come to know and trust my knowledge and experience with implants, they readily accept my suggestions and insight," says Jeff Anderson, Implant Specialist, Unique Dental Group, Sandy, UT.
On the other hand, some lab owners still struggle to be involved in the process before the implants are placed. "I still don't have my clients trained to get lab input prior to implant placement," says a C&B respondent from Ohio. "We still have to bail them out more than we should at this point in time."
Two-thirds of respondents say implant cases are more profitable than other prosthetic work--provided they are priced correctly to factor in the additional labor--and one common frustration among technicians is the extra work that results from a dentist who is inexperienced or veers from the case plan. "I've had to initiate an additional fee for when a case wasn't properly planned by the doctors," says Tom Wade, CDT, New Horizons Dental Lab, Broomfield, CO. "If it requires more of my time, how can I afford not to? I don't worry about competing with everyone else on price. I'd rather pass on a case than set myself up for failure."
A Bright Future
Across the board, respondents agree that the implant market is well positioned for a bright future. "Implants are only going to become more mainstream," says Martin York, CDT, Manager, Legacy Dental Lab, Fairport, NY. "The costs for the patient will come down, making it more accessible. For our lab, implants are now--and will continue to be--our bread and butter, along with cosmetic work."
Lab owners are most excited by the continued application of digital technology to implants and all the benefits it offers. "The fact that the specialist can use a scan body and intraoral scanning to do a case is going to be a great advancement," says Mark Frichtel, President, Jesse & Frichtel, Inc., Pittsburgh, PA. "We will be able to provide them with a temp and abutment that can be immediately loaded or add a coping to make it simpler for the referring doctors to restore. This will increase the number of implants placed."
LMT received 155 responses--a 10% response rate--from laboratory owners, managers and department heads. Here is a breakdown by lab type, number of employees and region:
Full service ......30%
Number of Employees:
Over 50 ......7%
New England (ME, NH, VT, MA, RI, CT) ...............................5%
Middle Atlantic (NY, NJ, PA) ...............................................13%
East North Central (OH, IN, IL, MI, WI) .................................11%
West North Central (MN, IA, MO, ND, SD, NE, KS) .................6%
South Atlantic (DE, MD, DC, VA, WV, NC, SC, GA, FL) ............21%
East South Central (KY, TN, AL, MS) .....................................5%
West South Central (AR, LA, OK, TX) ....................................8%
Mountain (MT, ID, WY, CO, NM, AZ, UT, NV) .........................12%
Pacific (AK, WA, OR, CA, HI) ................................................19%