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A Rejuvenation of the Removable
The influx of aging baby boomers may be offering a new pocket of revenue
For a growing number of general dentists and laboratories, the removable prosthetic segment of dentistry is being heralded as an underdeveloped profit center poised for rejuvenation. Driving the interest and market is the growing numbers of aging baby boomers, the increased demand for implant-retained prosthetics, and the introduction of digitized denture-manufacturing processes. Added to that is an educated public with higher esthetic and functional expectations than their parents. This combination of factors has enabled laboratories and dentists to push prices for high-end removable products well into the realm of the higher-priced fixed reconstruction market and beyond.
“The economy has also contributed to a rejuvenation of removable prosthetics market,” comments Craig Nelson, CDT, Senior Technical Manager, Heraeus Kulzer. “Today, the fact that 75% of practices say they are seeing 30% fewer patients has dentists rethinking the types of cases they are willing to treat and welcoming patients needing removable prosthetic care.1” The economy also has impacted the business proposition for many laboratory owners. Laboratories that were strictly crown-and-bridge businesses have restructured their established business strategies to include removable products.
Patients, who for economic reasons had postponed dental care until their economic conditions improved, are opting for more economically priced partial solutions versus fixed. In addition, many of the 30 million to 40 million2 in the US who have already been fitted with conventional full dentures are seeking implant solutions to stabilize one or more arches to improve functionality. “The fastest growing area in our laboratory right now is our removable department and implant overdentures,” says Dennis Urban, CDT, COO of Nu-Life Long Island Dental Laboratory.
Despite a 10% decline in edentulism in the US since 1970,3 the demographics promise strong business opportunities for laboratory owners offering a full line of removable prosthetic products.
Growth of Implant-Supported Appliances
Patient demand for implant-retained removable prosthetics, fixed detachables, and All-on-4® appliance solutions are the primary drivers of today’s removable market. “We see the implant side of removable prosthetics continuing to grow and see a need in providing specific products and materials to address the durability and esthetic requirements of these cases,” says Eric Kibler, Ivoclar Vivadent Marketing Manager, Removable Prosthetics. “The demand has piqued the overall interest of laboratories and clinicians as they see new opportunities for removable products as a profit center.”
Patients’ increased awareness about the availability of more functional solutions also has both denture and crown-and-bridge technicians seeking classes to help fill in their knowledge gaps due to the complexity of these cases. “Of the courses I have given over the past few years, half of the attendees are crown-and-bridge technicians wanting to understand denture setup techniques from different occlusal schemes and the basics on setting denture teeth, to locating anatomical landmarks,” says Urban. The entry of the heavily populated crown-and-bridge segment of the industry into the now potentially more profitable removable side, Urban says, may just mitigate the current shortage crisis facing the industry as the remaining older skilled denture technicians continue to retire.
Growth of Digital Dentures
Whether being fitted with a conventionally fabricated denture, an implant-retained solution, or digitally manufactured prosthetic, patients tend to have high restorative expectations. Financial situations, of course, play a major role in the restorative solution that a patient chooses and the esthetic outcome achieved. Laboratories currently supplying clients with economy-line prosthetics will be challenged in the future, Urban believes, by the entry of CAD/CAM into the removable arena. “There are pockets in the country that have the need for an economy denture and with the shortage of denture technicians in the field, CAD/CAM may fill that need.” Urban is impressed with the progress being made by digital-denture manufacturers in terms of milling a full denture out of a single-polymer acrylic puck. The esthetics and occlusal accuracy are much improved compared with a couple of years ago. “Patients are very knowledgeable and demanding today in terms of their expectations for the esthetics and functionality of the final appliance,” says Urban. “The denture-teeth esthetics of a digitally produced denture compared with individual high-end esthetic denture teeth set by a technician are not there yet but may fulfill the needs for corporate or lower-end dental patients needing a restorative solution.” As automated production of dentures becomes more widely accepted and a larger number of companies enters the fray, the price of the final product will decrease and with the introduction of new solutions such as automated production of implant overdentures should, according to Urban, grow in popularity.
The digital arena will also open the door for small laboratories to become involved, Nelson says. The labor and time-intensive aspects of creating removable products has kept small laboratories from offering removable services, but digital design and outsourced production should offer them an attractive business solution.
The entry of CAD/CAM into the removable arena is the reason that most believe laboratories that are invested in financially growing their removable departments need to sell on value, not on price, and combine that value with support, consistency, and the development of partnerships with clients. The key ingredient to growing a more robust removable profit center, as Kibler sees it, is for laboratories to diversify their product lines. “If you offer only one type of denture, look at specializing in implant-retained, or offer a higher-tier denture with high-performance teeth and precision processing.” These, he says, provide tangible benefits that clinicians can offer their patients.
Nelson agrees and believes the entry of removable prosthetics into the implant arena provides laboratories the opportunity to add further value to their services by helping their clients case-plan and troubleshoot. With the advent of 3D imaging, technicians have the opportunity to support the dentist and surgeon at the beginning of a case with implant-placement planning, which is an area Nelson sees exploding because of the demographics. “Dentists coming out of school find they have to rely more than ever on their technicians because they have had little-to-no experience in school or in practice when it comes to removable prosthetics or even implants,” Nelson says. “This is a great opportunity to begin the conversation with clients on how you can help them build their businesses. And these cases are great moneymakers for all team members involved.” The most difficult part of the denture process for clinicians to do accurately, he says, is record taking. If technicians can help the client correctly report the patient situation, then that will result in a well-fitting appliance and few adjustments, which will lead to establishing a long-lasting relationship.
It also opens the door for the laboratory to help the client upsell the patient on a more premium product and increase the patient’s treatment-plan acceptance and satisfaction with the final prosthetic. “An esthetic denture mockup or even a digital smile-design image are great tools to provide clients, so they can have the conversations with their patients on appliance preferences,” says Randy Bailey, VP of Sales Shofu Dental.
Custom characterizing the denture base or adding custom stains to the denture teeth is another differentiator for laboratories and adds real value for both clients and patients, says Bailey. With the materials available today, these custom touches can be accomplished with little increase in cost to the laboratory either in materials or labor but does make a big difference for the bottom line.
Educating clients on the benefits of a premium removable appliance is also key to client buy-in, says Kibler. “In the past, laboratories that have invested in creating value in their removable departments have found it difficult to communicate the service and benefit to the clinician and, in turn, the clinician has not been equipped to communicate those benefits to the patient. If patients are not presented with a choice in the different levels of removable products that are available, they often are disappointed with the end result.” Raising patient awareness of appliance options by offering clients targeted patient-education tools can help practitioners increase patient-treatment acceptance and satisfaction levels, says Kibler.
Bailey says, “In the end, the patient is the driver of this business. They want a natural-looking and highly functional prosthetic.” If that can be achieved, he says, the patient is the dentist’s best advertiser and everyone wins. A satisfied patient refers other patients to the practice, and both the practice and laboratory grow their businesses.
1. Levin R. Economic outlook: deja vu for 2014. Inside Dental Technology. 2013;4(12):29-30.
2. Dr. Michael Sinkin, DDS Web site. Dental implants vs. dentures – a lot to consider. http://www.michaelsinkindds.com/blog/dental-implants-vs-dentures-a-lot-to-consider. Accessed June 3, 2014.
3. iData Research 2013.