Implantology: dentists’ perceived quality and patients’ new needs

Several quantitative and qualitative surveys carried out internationally by Key-Stone to analyze the perceived image of the main implantology brands have highlighted how the quality perceived by dentists has undergone a real transformation: the dentists are showing new needs and a change in the value system driving their choice of the implant brand, as well as their purchasing behavior.

The shift in the implantologists’ expectations and in the selection process

Change in patients’ demand and stiffened competition among dental practices, well noted by many manufacturers and distributors in the sector: these are the main drivers that have strongly changed the market of implantology. The shift in the needs and expectations of implantologists has led to a change in the relationship between dentists and suppliers, thus impacting the entire process of implants selection. It is in this dynamic picture that in the last pre-pandemic years we have observed both an increase in the number of practices offering implantology treatments and a strong turnover of brands used (about 40% of dentists have changed brands in the last five years), a sign of some tacit dissatisfaction with the value proposition of the brands or the evidence of the not-always-met implantologists’ expectations.

Quality perceived by implantologists: from the technique to the sphere of relationship and customer care

Through various studies carried out at European level, we have analyzed the dentists’ perception about their own dental practice business development, as well as their purchasing activity, their satisfaction with the main brands and their choice behavior, not to forget the coverage and performance of the leading brands.

In the patterns of the perceived quality experienced by implantologists, we move from purely technical and functional considerations to opinions involving more the relationship and assistance given by the supplier, its services and its brand image.

The concept of “expected quality”

Through the analysis of the implantologist’s satisfaction with the manufacturer, Key-stone’s research shows how the concept of “expected quality” by dentists is based on four macro-areas:

  • Innovation and scientificity
  • Technical benefits
  • Training and customer care
  • Convenient price

Innovation and scientificity

The items concerning the first area of interest “innovation and scientificity” are related to the concept of reliability of the supplier. This is an area often associated with longstanding and highly prestigious international brands. The items are mainly related to the reputation of the manufacturer and the brand, than to the product.

Technical benefits

The items of the “technical benefits” area depend on the intrinsic characteristics of the products themselves rather than on the brand. In this area, the experience gained by the implantologist with that specific product is relevant. This is true in the relationship not only with well-known brands, but also with less prestigious suppliers the implantologist is already familiar with.

Training and customer care

The “training and support” area concerns items such as clinical and technical training, but also aspects relating to the personal relationship with brand representatives and suppliers, as well as to the customer support services provided by the manufacturer.

Convenient price

The “convenient price” resulted as an essential factor of implantologists satisfaction. However, the research also reported that dentists prefer a price aligned with the perceived benefits and not necessarily cheap. In general, an “excessively affordable” price positioning, even if judged positively by a large number of dentists, is nearly always associated with the concept of “necessary compromise”, rather than total quality.

The concept of “total quality” in implantology

As shown in the image, the items determining the dentists’ purchasing process (excluding price) fall under a concept of “total quality”, characterized both by technical and innovative aspects, and by elements more related to the technical-clinical support and to the personal relationship.

International players vs Local champions

If we observe the horizontal axis referring to the quality as proposed in the image, we see how if large companies (“international players”) are more often positioned in the area of innovation and of the scientific and technical aspects, local companies (defined ” local champions “) cover the area of training and customer care, which is closer to the personal relationship with dentists. Their positions are independent from the vertical axis, which indicates the perception of a more or less convenient price as offered by the manufacturer.

Changes in the needs of implantologists

Key-Stone’s recent international surveys show that frequently, the driving factor to evaluate implant solutions different from those currently adopted (when these choices are not dictated by purely economic reasons) comes more and more often in pursuit of greater ease of use, training, customer care and close relationship provided by the supplier. An improvement that is therefore needed no longer only from the point of view of technical performance, but through quality aspects relating to the simplification of procedures and company closeness to the dentist, in terms of support and training.

The new post-pandemic scenario

Patients’ needs

The outbreak of the pandemic has led to a change in the patients’ needs, with a focus on the demand of the low-middle class population. A quality treatment offered nonetheless at affordable prices involves the development of systems characterized by an excellent value for money. In this market segment, characterized by the so-called “value” brands, the local champions – if present – stand out, generally identified with competitive prices (although not cheap), perception of high quality and solid scientific literature.

Opportunities for producers

This results in a competitive scenario where international players, in order to maintain their position, will have to focus on a diversified portfolio. The mid-range brands or local champions, instead, will have the opportunity to seize this opportunity to their advantage, exploiting this increased need for quality systems at convenient prices.

 The dentist’s offer

From the dentist’s point of view, it will be increasingly frequent to diversify the offer by combining an innovative and “no compromise” implant with more affordable options with adequate quality, to meet the aforementioned greater demand for this type of implants.

In this scenario, technical support, training and close relationship with the clinicians will therefore play a key role.

Confidence and vision towards the recovery

There is no doubt that the economic uncertainties due to a post-pandemic economic and social crisis will be of medium duration. It would be unthinkable to suddenly emerge from this crisis that leaves millions of jobs lost on the battlefield but, just as happened in the five-year period 2009-2013, those who have confidence and vision today will be more likely to thrive in the near future. A not-so-dark future for the dental sector, currently showing negative data, but which already proves to be on the recovery path: this is the time for confidence. From Spain, an example of the trend in the dental sector.

Consumables and equipment: trends 2020

The market for dental products and equipment reflects quite faithfully the performance of the overall dental sector.

In particular, the purchase of consumable products is strongly correlated with the demand for services, while the purchase of equipment and technologies in general represents an investment strongly connected to the professionals’ confidence in the future.

The final results of the research conducted by Key-Stone in Spain on behalf of FENIN (Federación Española de Empresas de Tecnología Sanitaria) are explanatory: the industry and distribution market lost 20%, in particular 18% in consumable products and 27% in sales of equipment.

However, some considerations must be made while looking at these trend data. In fact, an aggregate analysis of this kind, without going into details of the segments making up the two sectors (consumables and equipment) can be misleading. Therefore, let’s now look at the results of this research in greater detail.

The impact of Covid-19

Although the consumables sector is undoubtedly a direct indicator of demand for dental services, during 2020, due to the pandemic, the value of disinfectants and Personal Protective Equipment (PPE) purchases increased disproportionately, thus generating a strong increase in sales -and therefore in costs for clinics- not directly related to the demand for services. Therefore, in order to analyze the value and trends of consumables as a performance indicator of the entire sector, it is necessary to deduct the value of hygiene and disposable products in general.

It should be considered that the sector of consumables, including also implantology and orthodontics (without aligners), had a total value of 605 million (VAT exempt) in 2019, which became little less than 500 in 2020. Among these 500 million, the share related to hygiene and disposable products was approximately 47 million (with a weight of 9%), while it was 30 in 2019 (with a weight of 5%). All this leads us to affirm that these products have undoubtedly positively conditioned the sales of consumable products, but with a limited weight, since the whole Consumables sector not counting the “Covid products” decreased by 21%; a sector trend that we can consider very plausible.

Within the heterogeneity of the consumable product families, implantology shows the strongest decrease, with a trend of -28% (with a third less implants placed), while the contraction of orthodontics is quite limited, with a reduction of 19%. Even products for prostheses faced a reduction of just -17%, but this is due to the fact that, even before last spring’s confinement, there were hundreds of thousands of patients which had undergone implant surgery shortly before, on whom a prosthesis would have been placed in the following months. The long wave of negative effects reflecting on the prosthetics will likely be more evident in these first months of 2021.

The sharp drop in equipment sales, except for some devices strongly related to the health emergency (autoclaves, sanitizers and handpieces), is rather clearly due to strong economic and health uncertainty, which caused a temporary standstill of large part of the investments aiming at the renovation of clinics and technologies.

Negative data already attesting a recovery

The cumulated quarterly data (where Q1 refers to the trends of the first three months of the year, Q2 to those of the first six months, etc.) show a very positive recovery of the market, almost as if to tell us about a sector that traumatically experienced more than two months of total confinement in spring 2020, but which is recovering rather quickly his usual rhythms.

In particular, the recovery trend in equipment sales has a constant rate even though it closed the year 2020 with a very negative sign.

If it is true that the great uncertainty of last spring has led many dentists to suspend their investments, it is equally true that the indispensability of dental care for the population has ensured that dental clinics return to work at full speed. Not only there was a physiological positive rebound in the months from June to August 2020, but also in the period between October and December the activity returned to values only slightly lower than in the same period of 2019.

The competitive advantage of proactive dentists

This new situation of full recovery and a certain optimism when thinking about the phase following the vaccination campaign have led some dentists, certainly the most positive and proactive ones, to reconsider their intentions of renovation and relaunch of the activity, resuming their investments in technologies. Not only digital technologies, but also renovation of clinics, replacement of dental chairs, X-ray equipment, etc.

We must consider that this very serious crisis could change the competitive scenario, as dental clinics financially weaker or run by dentists close to retirement are certainly considering the hypothesis to sell or close the dental practice, while other dentists and entrepreneurs are strongly motivated to invest, in order to make available to citizens more modern, well-equipped and organized clinics.

If it is true that it will be quite normal to see a strong recovery in investments by dentists and technicians in the second half of 2021, it should be also taken into account that those who already lay a certain trust in a coming recovery of the dental activity today and are investing during these current uncertain months, can only achieve a strong competitive advantage over the others.

The article has been published on Gaceta Dental in Spanish.

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