Inside Dental Technology
Moving the Denture Industry Forward
Increased patient demand for esthetics and function in removable prosthetic solutions has created a growing profit center for laboratories
Traditional removable prosthetics have been a less than appealing treatment option for patients who are in need of extensive dental work, but unable to afford more expensive procedures, such as implants or a fixed full-mouth reconstruction. In the past, patients had low expectations for the esthetic and functional outcome of conventional denture prosthetics. Today, however, expectations have changed. Society has put a high value on maintaining a youthful and natural appearance, resulting in unnatural-looking treatment outcomes becoming less acceptable, even for patients who are watching their wallets. As patients have grown more demanding, the dental industry has risen to the occasion and developed more complex removable options and innovative materials that look and function more like natural dentition. These new options, which involve complex implant procedures and new material innovations, have allowed the clinical and technical removable team to provide prosthetic solutions previously only thought possible through fixed prosthetic procedures. Laboratories now have an expanded range of options in treatment protocols, material selection, and improved lines of communication to meet the needs of this rapidly-growing sector of dental patients.
Seizing a Business Opportunity
The demand for removable prosthetics is projected to increase over the next 20 years. According to the US Census Bureau, the number of people in the United States aged 65 or older will double by the year 2050.1 In 2012 the United States denture market was valued at more than $2.6 billion, an increase of 4.9% over 2011.2 The market is expected to experience continued growth, exceeding a value of $3.6 billion by 2019.2 This phenomenon represents a unique opportunity for laboratories wanting to expand their businesses by positioning themselves as a resource for dentists looking to serve this potentially growing edentulous and partially edentulous population base.
The Value of Education
Clinicians graduating from dental school today receive less emphasis on removable prosthetics than their predecessors 20+ years ago, including how to manage removable prosthetic cases. According to Alice Sager, CDT and technical sales representative for Synca, this gap in the clinicians’ skill set is in part due to the lack of patients entering the dental school clinical facilities for treatment. This provides technicians knowledgeable in both the clinical and technical aspects of removable prosthetics an opportunity to share their expertise and become an integral part of the diagnostic, treatment planning and prosthetic restorative process. And increasingly, technicians are finding themselves in this position as dentists rely more heavily upon them to troubleshoot, plan, and design removable cases. However, in order to optimize a successful case outcome, technicians must be able to interact with the dentist on a clinical level. “It is so important for laboratory technicians to have a full comprehension of the complete procedure from both the clinical and technical sides,” she explains. Sager believes that one of the best ways for technicians to integrate into the removable prosthetic process and make themselves invaluable to the diagnostic and treatment planning process is to seek out continuing education courses that cover removable prosthetics from both the clinical and the technical point of view. “Everyone needs to maintain a standard of continuing education. It is essential that technologists know and understand what transpires in the clinical setting as well as in the laboratory. It gives them an inside view of what skill sets they need to improve in order to better help their clinicians ensure the best case outcome for the patient.” Sager also says that being able to learn and experience denture procedures from a clinical perspective gives technicians a deeper understanding of the challenges their clients face in the operatory and provides insight and opportunity on how best they can contribute to elevating the overall outcome of the case.
The quality of information provided by the dentist to the dental laboratory has significant impact on the accuracy of the end result. The more comfortable and familiar dentists are with removable procedures, the more thorough and accurate the patient information provided to the dental laboratory. Equipped with the necessary key denture information, laboratories have greater ability to optimize results. Kimberly Yanavitch, senior marketing communications manager at DENTSPLY Prosthetics, says that today, clinicians rely on their technicians when looking for assistance and guidance in even routine removable cases. In order to optimize results, there must be open communication between the two parties. “As dentists and laboratory technicians develop closer, more in-depth relationships, the lines of communication are opened and the quality of the patient information being exchanged can be improved. This translates into improved production efficiencies, driving enhanced satisfaction throughout the entire value stream,” she says. Yanavitch is referring to the increased satisfaction of not only the dental team, but also the patient. “The shared, most important goal is improved patient care. Patient benefits from facilitated communications include reduced time spent in the dental chair, improved denture fit and esthetics, and a positive clinical experience.” Technicians who are able to communicate effectively with their clients to produce optimal final results are in demand for their expertise and in a position to grow this segment of their business. This trend is projected to increase, despite shortage of technicians today who specialize in removable prosthetics.
Implants and Digital Technologies Driving Growth
Advances in digital technologies and increased demand for more complex removable solutions are also helping drive the market. Clinicians with patients opting for implant retained prosthetics are being aided in the implant planning stage of treatment by technologies that capture vital case information. Craig Nelson, AAS, CDT, and technical manager at Heraeus Kulzer, LLC says that because impressions, vertical dimension, centric relation, and other information pertaining to tooth placement is so critical when planning removable cases, digitizing patient records is an excellent way to eliminate guesswork and improve accuracy in removable cases. “CBCT scans in particular can give clinicians and technicians critical information regarding bone and tissue placement that was previously unavailable. Having this information on hand can drastically improve success rates,” says Nelson. These technologies also allow the clinician and the technician to work better together—as they are both able to look at the patient’s intraoral scans at the same time. In a similar vein, Nelson says that one of the greatest tools at the dental team’s disposal is the Internet itself. “There are so many tools out there that allow clinicians and technicians to increase knowledge and share information. Photography allows the team to communicate ideas, see and share concerns, and prevent future problems. E-mail, workshops and meetings can also all play a part in planning and executing a successful denture case,” he explains.
Nelson’s colleague, Stephan Berger, global technical advisor at Heraeus Kulzer, also considers digital technologies to be integral to the expanding removable prosthetics market. “Technology-based tools and workflows lead to more predictable results with fewer errors. It will be much more efficient for the entire dental team, and will make the entire clinical/technical process shorter and more accurate. This saves time and money for both the dentist and technician,” says Berger.
There are also software programs and mobile applications available that save the information for each case, allowing clinicians to share information with the laboratory more quickly than ever before, even while the patient is still in the dental office. Kimberly Yanavitch explains that this capability can have far-reaching, very positive consequences. “Clinicians who use chairside aids to capture patients’ key denture prescription information ensure that laboratories receive the necessary case details to produce great fitting, quality dentures.”
Patient Expectations Driving Life-Like Esthetics
One of the defining features of the generation currently pursuing removable prosthetics as a treatment option is that they are demanding a more esthetic solution to their oral health issues. In response to this shift in expectations, manufacturers have developed new, esthetic, natural-looking materials for fabricating removable cases. Jim Collis, CDT, owner of Collis Prosthodontic Laboratory and technical advisor at Shofu Dental Corporation, says that with he availability of thesenew options, it is possible for laboratories to make highly esthetic dentures without having to invest much more money upfront for materials. “It does, however, take more time to take a denture to that next esthetic level,” explains Collis. “And that will ultimately drive up the cost of the restoration.”
While many patients looking for a removable solution are conscious of the amount of money they are spending, Collis believes that when these patients know that they are getting value for their money, they are much more likely to shoulder the cost of a more expensive end product. Part of Collis’s business strategy involves creating colored wax-ups so clinicians can demonstrate to patients the natural-looking outcome that can be achieved. “The first question that patients ask when they see a colorized wax-up is, ‘Are my real dentures going to look like that?’ Yes, it can, if they are willing to invest the money into the restoration.” The colorized wax-up also helps the clinician increase patient acceptance. Collis continues, “We, as technicians, must provide value to our customers, which in turn will make that product worth more, make people want to pay more for that product, and then deliver on our promises to create something with a high value.”
Today, the removable prosthetic industry offers a much wider
range of options for edentulous patients and for patients with existing removable prosthetics. In 2012 more than 6.2 million denture units were sold in the US, representing a 3.5% increase over the previous year.2 For the next 6 years, that number is expected to increase
on average 3.1% each year with sales approaching 7.7 million units
in 2019.2 Laboratories should be looking at this resurgence of interest in removable prosthetics as an opportunity for continued business growth.
1. US Census Bureau. Population Estimates and Projections. Updated 2010. Accessed May 15, 2013. Available at: www.census.gov/population/international/data/idb/estandproj.php.
2. 2012 iData Research Report.
Filling A Need
Addressing the lack of removable technicians
The current boom in the removable prosthetics industry is being driven by a patient demographic that will continue for the next two decades. Today, the shortage of experienced removable technicians in the dental technology industry challenges the industry’s ability to meet this ever-increasing demand. Jim Collis, CDT suggests that laboratories take the initiative and begin to institute training programs for younger technicians to teach them the ins and outs of designing and executing removable prosthetics. “Removable technicians are at a premium right now, and we really need to do everything we can to increase those numbers and take advantage of this business opportunity,” he says.