Since their debut on the market – in the late 1990s and early 2000s – it was evident that invisible aligners would revolutionize the world of orthodontics or at least make significant changes in the way we mean it.
First of all, this is due to the fact that in the aligners market the weight of services is greater than the weight of products, which is the opposite of what happens in traditional orthodontics.
Aligners vs traditional orthodontics
The graph below shows the progressive increase in the weight of aligners over the years, compared to traditional orthodontics (brackets, bands, wires, etc): in 2011 it was 27%, while in 2019 it exceeded 60%.
Furthermore, although the market is still dominated today by a large player – deserving the credit for having introduced the “Invisalign system” all over the world and for having built a previously nonexistent market -, other players from the orthodontic domain joining the market could change some dynamics.
Some of these companies, in fact, have a strong know-how in both digital and orthodontics. The business will therefore tend to shift the focus from the appliance to the planning system. The clinician will work with an increasingly integrated single digital system, which will let him approach orthodontic treatments (either with aligners, traditional solutions or hybrid ones) according to the complexity of the case and his/her level of competence (orthodontist or GP).
The offer of aligners: a “liquid market”
The offer varies widely: from the multinational corporation already operating in the dental sector and specialized in orthodontics (range extension), to the company focused on other specializations such as implantology (range diversification); from the local manufacturer with centralized production to the dental laboratory (sometimes organized in the form of a network), equipped with all the technologies necessary for the production of aligners.
We are therefore facing a “liquid market“: the boundaries between organizations and along the supply chain are becoming blurred. It is a business in which manufacturers and laboratories with different levels of production centralization operate and compete. On the one hand, there are companies featuring a centralized and industrialized production system where the structure of the processes is controlled, repeatable and organized process design. On the other hand, there are more local companies or those characterized by peripheral organizational and process dynamics.
Penetration of the aligners technique
A first survey carried out by Key-Stone in October 2020 on a sample of 400 generalist dental practices to evaluate the penetration of the technique and the main brands revealed a 79% of respondents who claim to suggest – even occasionally –aligners to their patients, even if only occasionally. Please consider that this percentage was 61% in 2018, according to a previous study in the same topic.
A more in-depth analysis of the most used brands shows how the laboratories supply channel covers 28% of the dental practices procurements (although only 10% exclusively). Through the analysis of the brands mentioned by those clinicians supplied by laboratories, it emerges that most of them refer to in-house handcrafted productions.
The aligners market in Italy in 2020
It is estimated that more than 80,000 cases were performed in Italy in 2020, excluding purely handcrafted processes, which were not taken into consideration in the research conducted by Key-Stone at the end of 2020 on the aligners market in Italy. The market value is estimated at just under 85 million Euros (at sell-out level, at value to the dentist and VAT excl.), leaving out purely handcrafted manufacturing.
The growing trend in Italy
The most relevant growth was recorded in 2019, thanks to both Invisalign’s entry into the world of GPs and the commercial development of some companies relying on a very extensive sales network.
In fact, aligners deserve credit for making orthodontics “accessible” also to general dentists. Accurately supported by an excellent tutoring service, increasingly advanced and intuitive softwares, training courses and marketing activities made available by companies, dentists have decided to expand the range of treatments offered to their patients.
In the research conducted by Key-Stone at the end of 2020, the main positioning drivers emphasized by companies in their value proposition were analyzed as well. From this study it emerged that, in addition to the transparency and comfort of the aligners (now essential conditions), the positioning drivers are:
- duration of treatment: if too long, the patient’s compliance decreases, as well as the revenue of the dental practice. If we consider the concept of time as applied to logistics, the companies are striving to reduce the time involved in planning treatments, manufacturing and shipping aligners to customers.
- the service offered in different areas. Companies have invested enormously in assisting dentists in the design and set-up phases, but also in training (classes, webinars, presentations, certifications, etc.) and consulting, making available to the dentists teams of clinicians and / or specialized technicians throughout the treatment period.
- the treatment planning and management software and the data sharing platforms can be owned by the company and therefore developed and implemented internally or multi-client, then purchased from external providers (3Shape, Age Solution etc.) and sometimes adapted to specific needs.
- technological innovation represents a real differentiation driver. Companies of the sector with an industrial approach generally have a processes organization which is a great competitive advantage per se. Moreover, technologies available to manufacturers, due to the large investments required, are generally not found in laboratories or small companies: the gap on production quality is therefore widening.
Some future trends
A phenomenon that we are witnessing and that Key-Stone will try to monitor in the future is the “direct to consumer” business model, which involves physical stores or solutions that are directly delivered to the patient’s home, thus bypassing the dental office. In the USA, their diffusion has been successful, while in Europe the legislation on devices is more stringent, so the business model designed is different.
There is no doubt that artificial intelligence applied to orthodontic planning tools and the implementation of the digital workflow with the use of suitable technologies fosters these phenomena, making it nowadays possible to perform:
- 3D diagnosis
- virtual rendering of the treatment progress and outcome
- design and production of the appliances
- supervision – even remotely – during therapy
- analysis and re-processing of the results for continuous improvement as well as for statistical purposes.