Removables: Full-speed Ahead
Posted Apr 28, 2011 in Management
Industry analysts have long predicted that developments in fixed prosthetics and better overall dental care would spell the demise of the removables market. But if you're worried about the future of this specialty, don't be.
Thanks to a growing demand from an aging population, an increasing consumer awareness of esthetic dentistry, and product and technological developments, the market is thriving. "It's a wonderful time to be in the removables market and there are many reasons to be optimistic about the future," says Tom Zaleske, owner of Matrix Dental Lab in Bensenville, Illinois and a technical consultant/product manager for Keystone Industries.
Respondents to a recent LMT e-mail poll concur: more than two-thirds of the laboratory owners/managers report that their removable business is either "good" or "booming." "We just ended our fiscal year and denture and partial sales are up 20% from the prior year—that's without a price increase," says Amy Chapman, sales and marketing manager, Udell Dental Laboratory, St. Louis Park, Minnesota.
Hand-in-hand with the rising demand, product developments from manufacturers are helping laboratories produce stronger, more esthetic, more comfortable restorations in less time. Some of the most noted advances in the last 10 years are continued improvements in acrylic denture teeth; colored clasps; the resurgence of interest in lingualized occlusion which makes teeth setup easier and provides stability and balance; and light-cured materials that offer cleaner fabrication procedures.
Thermoplastics and advances in injection processing are also touted for their time savings and ability to reduce distortion and shrinkage, so it's no surprise that flexible RPDs are one key growth area in the removables market. Sixty-one percent of our respondents say they've seen a significant increase in the demand for these restorations in the past decade.
For example, just five years ago, the caseload at Liberty Dental Lab was split about 50/50 between cast and flexible partials. Today flexibles make up 85-90% of its RPD work and the lab has slowly been phasing out metal framework partial dentures in favor of flexible restorations with tissue-colored clasps. "Flexible RPDs are easier to insert, have less breakage, are more comfortable and have a higher rate of patient acceptance. When the dentist puts a flexible partial denture in one of the patient's hands and a steel partial denture in the other and asks 'which one do you want?,' the patient always chooses the flexible one," says Gary Spadaro Sr., co-owner of the Schenectady, New York laboratory.
Three-quarters of respondents are also seeing a surge in demand for implant-retained overdentures, thanks to the improved predictability and success of implants and the public's increasing awareness of their benefits. "In the past, a patient could fight a lower denture for the rest of his life," says Karen Crace, president of Lab One, Norfolk, Virginia. "Now that implants have come along and the failure rate has dramatically dropped, the fight is over because the restoration simply snaps into place. Today about 25-30% of the dentures cases we process are implant retained. Five to 10 years ago we only did about 5%."
This is good news for laboratories given the higher fees commanded by these types of restorations. For example, Lab One's fee for a simple snap-type attachment is about $200 more than a standard denture, while a more complex bar overdenture can go for an additional $500 to $600.
This trend creates an ideal opportunity for more technicians to get on board with this growing, profitable area. "Many technicians are not producing what the market is buying," says Tom Bormes, owner of Preat Corp. in Santa Ynez, California who lectures on removables across the country. "I tell most people at my courses that if they are skilled in combination cases the first thing they should do when they go home is raise their rates. Dentists can get good ceramics on any street corner, but that's not true with removables."
Another profitable area is the high-end esthetic market. As one survey respondent puts it, "The aging baby boomers are demanding something better than conventional dentures and they're willing to pay for it."
Zaleske, who specializes in high-end removable prosthetics, agrees. "There's always been a segment of the edentulous population that wanted a great-looking denture, but that segment is now growing as the "esthetic revolution" that started with fixed restorations is trickling down into removables," he says. "The buzz is natural and cosmetic. Edentulous patients are tired of flat smile lines and they want a more esthetic look." Zaleske is able to charge a premium for his work by using techniques such as the golden proportion of esthetics—typically used for C&B—as well as concentrating on the finer details of base contouring, polychromatic base coloring, palatal contouring and creating natural tooth emergence profiles.
Manufacturers are helping technicians tap into this trend by offering an increased number of esthetic denture products such as more natural-looking denture teeth, whiter shades, and kits to color characterize the denture base and denture teeth. They're also demonstrating the techniques at hands-on courses held at their facilities and trades shows around the country. However, warns Zaleske, don't try to incorporate everything you learn at once. "Do one thing at a time, like concentrating on making the contours and emergence profiles of the teeth look natural," he says. "Once your tooth-setting parameters are in place you can move on to color characterization and enhance from there."
While high-end prostheses are growing in popularity, there remains a need for economy dentures. Many in the burgeoning denture-wearing population are low-income patients or those without dental insurance who can't pay a general practice's fees. This is the niche into which Affordable Dentures Dental Laboratories (ADDL) is tapping. ADDL provides same- or next-day Affordable Dentures® to its affiliated network of over 118 dental practices in 33 states; each practice has its own on-site laboratory. The group's typical patient has a total annual income of less than $30,000.
"Our business is booming due to the huge number of underserved people who can't afford regular denture service," says Loren Edwards, COO. "Our network of practices is growing—we went from 45 practices to 118 in eight years—and we're growing right along with it. We fabricated over 300,000 arches last year and overall our production is up 25%."
In addition to the current boon, statistics bode well for future market potential. It is expected that the adult population in need of one or two complete dentures will continue to rise, increasing from 33.6 million in 1991 to 37.9 million adults in 2020, according to Chester Douglass, DDS, author of Will There be a Need for Complete Dentures in the United States in 2020, published in the Journal of Prosthetic Dentistry's January 2002 issue.
However, our industry's chronic personnel shortage is hitting removable labs particularly hard as skilled removable technicians are retiring and many of the too-few newcomers and trainees are opting for the glamour and higher wages they've come to associate with C&B. With no solution to the personnel shortage in sight, the pressure is on to hire and train new technicians to handle the work.
This is especially true given that the two phenomenon that can potentially help alleviate the staffing drought in the fixed market—automated technology and outsourcing—are not expected to have the same impact on removables. CAD/CAM technology is not yet applicable to removable restorations and, with the exception of cast partial frameworks, it's not cost- or time-efficient to outsource complete dentures.
Laboratory owners are using a variety of strategies to ensure they're properly staffed and geared up for the future. For instance, many realize that attracting good employees means paying a fair and competitive wage. "We recognize that some labs want to pay minimum wage, but we want to get the right people that will stay with us, so we've increased our wages considerably," says Edwards. For example, a technician with either a dental technology degree or three to five years of experience now starts at $12 an hour, up from $9.50.
In addition, since Crace has found that Lab One's retention rate is better when it hires people who already have even a very basic understanding of the industry, she's targeting the dental assisting schools in the local area. "We ask the instructors if anyone stood out on basic laboratory processes like pouring impressions or even mixing gypsum. That's the approach we always try to take and, for us, it's worked," says Crace.
Nearly half of our survey respondents say they're making efforts to increase training, including cross-training between departments, and spending more time developing mentoring programs and fostering an "apprenticeship" mentality in their young technicians. For instance, new technicians at Tassi Dental Studio get paired with not one, but two experienced technicians. "Getting more than one perspective on procedures and techniques gives a new staff member a better opportunity to create his own style for properly and efficiently doing the work," says Albert Tassi, owner of the Elmhurst, Illinois laboratory.
But—as in all areas of the dental laboratory market—it's not just technicians that laboratory owners need to educate about removables, it's also their dentist-clients. Due to the increasing number of dentists uncomfortable with dentures and RPDs because of limited to no training in dental school, more labs are seeing the value of stepping up to become a technical resource to their clients. For instance, more than ever before, Crace is getting requests from dentists—particularly younger ones—to visit the office and consult on tooth position, shade, shape and size. She says, "They realize that they have limited knowledge of removables but that this is what I've been doing every day for 25 years."
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