High-tech dental products proliferate in a changing market
By JEFFREY BERG, PhD BBI Contributing Writer
An intraoral camera (IOC) provides a magnified view of the teeth, gums and oral cavity in multicolor video images. These images are used to graphically display dental health and hygiene problems to patients and serve as a sales aid in obtaining patient acceptance of proposed treatment. IOCs are also used to print pictures that serve as a permanent record and for obtaining reimbursement from third-party payers.
An estimated 40% to 45% of all dental practices in the U.S. have IOCs, with about 40,000 IOCs installed in dental offices. However, the level of market penetration is about 15% to 20%, since many sales are to practices that already own an IOC and are equipping additional operatories. Sales of IOCs have grown from $54 million in 1994 to about $75 million in 1997. The number of units sold has increased at a higher percentage rate than sales during this period since the average cost of IOCs has decreased. The U.S. market for intraoral cameras is mature and will be saturated in four to five years. Most of the growth is coming outside the U.S., most notably from Europe, Japan and Australia.
A crowded marketplace
About 18 to 20 companies market IOCs. The leading products are TeliCam II from Dental/Medical Diagnostic Systems (DMD; Westlake Village, California) and AcuCam from New Image Industries, a subsidiary of Dentsply (York, Pennsylvania). Additional IOCs include the Reveal SLR from Welch Allyn (Skaneateles Falls, New York), VistaCam from Air Techniques (Hicksville, New York), UltraCam from Ultrak (Carrollton, Texas), CDRCam from Schick Technologies (Queens, New York), Easy Cam from Henry Schein (Melville, New York), Oral-Vision 6000 from Cygnus Imaging, a subsidiary of Zila (Phoenix, Arizona), Viola II from American Electromedics (Amherst, Massachusetts), and ProScope from ProDen Systems, which was acquired recently by AFP Imaging (Elmsford, New York).
The FDA recently imposed a requirement that all manufacturers of IOCs file 510(k) submissions with the agency. This may lead to the dropout of some of the smaller players in this crowded market.
The cost of IOC systems varies widely. DMD, which completed its public offering in May 1997, has gained market share by selling its cartbased IOC system (camera, printer, monitor and cart) at a lower price than the competition, $5,590 for a TeliCam II system, as compared with $6,295 for the AcuCam, $8,000 for the UltraCam and $9,895 for the Reveal SLR. As an alternative to cart-based systems, networking systems are used to provide a video-electronic information link among multiple operatories of a dental office, with a monitor installed in each operatory. The cost varies with the number of operatories that are connected and starts at $9,000 to $10,000 for two operatories, increasing in increments of $2,000 for each additional operatory.
Intraoral cameras are sold by direct sales forces, mail solicitations, telemarketing, advertising in professional publications and exhibitions at dental conferences. About half the sales of intraoral cameras are to dental practices that already own one or more units. Sales of IOCs tend to be seasonal, with higher sales in the last quarter of the year, presumably for tax writeoffs which allow a maximum expenditure of $17,500 in annual equipment purchases.
IOCs are differentiated by their various features, such as size (portability and wall-mount capability), printer (individual unit for each operatory or centralized unit), camera (focal area, frame grabber for “freezing” images and automatic on/off light), networking system (video-electronic link with one or more patients simultaneously) and, of course, price. Focusing is a particularly noteworthy feature. The TeliCam II and AcuCam Concept III IOCs can focus close-up (at a 2 mm distance) or far away (outside the oral cavity), whereas other IOCs require a lens change to achieve comparable resolution from different distances. The new TeliCam II system has enhanced features and will ultimately replace the earlier version. Telicam II provides more light, better depth of field, and is easier to use (e.g., a desirable position and focusing of the camera can be performed using only one finger).
Curing dental materials with lights and lasers
There are more than 20 manufacturers of dental curing lights worldwide. The leading companies are Demetron, a subsidiary of Kerr, in turn a unit of Sybron International (Romulus, Michigan); the Caulk division of Dentsply; and Celabauer, a German firm. The U.S. market for dental curing lights is growing at about 12% annually, stimulated by the expanding use of cured composites and fillers in place of mercury amalgams due to environmental concerns for the disposal of mercury and by fear of a health hazard from the mercury that leaches out of the amalgam.
The vast majority of dental offices are equipped with dental curing lights. These products typically have a five-year lifetime. According to a review of trends in dentistry published in Dental Products Report, 29% of dentists purchased an average of 1.6 curing lights in 1995.
DMD is the exclusive distributor in the U.S. and Canada of the Apollo 9500, a subsecond dental curing and tooth-whitening device which is licensed from Ion Laser Technology (ILT; Salt Lake City, Utah). It is the fastest non-laser device for curing dental composites, adhesives and sealants. Curing speed is important because it saves valuable time in the dentist’s chair. The Apollo 9500 was launched earlier this year and sells for $6,000. It uses a high-powered, proprietary actinic ray discharge tube as a light-energy source which activates dental materials in less than a second, reducing the curing time for a single-tooth procedure to less than 3 seconds. The typical xenon-lamp curing light used in dental offices requires more than 90 seconds of curing time for a single-tooth procedure.
In March, DMD introduced its Apollo 95E curing device in Europe. It provides a cure of a single tooth in 9 seconds. DMD acquired this device from S.E.D. Gerant, a French company. It will be sold by distributors to dentists for $4,500. It was developed by Dr. Francois Duret, a prolific inventor with more than 30 patents who developed the first dental CAD/CAM system for making 3-D images of teeth and automating the fabrication of crowns.
ILT, Premier Laser Systems (Irvine, California) and HGM (Salt Lake City, Utah) make lasers for dental curing applications. ILT and HGM, in collaboration with Kreativ (Albany, Oregon), market an argon laser for curing dental materials in about five seconds. Their list prices range from $9,500 to $20,000.
Teeth whitening, bleaching expanding rapidly
Cosmetic and aesthetic dentistry are areas of increasing appeal to the U.S.’s 100,000-plus general dental practitioners. This encompasses cleaning, whitening and bleaching of teeth as well as restorative dentistry.
An increasing number of consumer and professional dental products have been introduced into the market in recent years in response to rapidly growing interest in whitening and bleaching of teeth. This includes dentifrices, peroxide-containing in-home and dental office products, and laser-based systems. Tooth whitening is considered a cosmetic procedure and is not covered by most insurance plans.
ILT has more than 100 installations in 30 states and five countries of its BriteSmile Laser Tooth Whitening (LTW) systems. This system employs a carbon dioxide laser and an argon lamp. Its cost has been sharply reduced and currently sells for $14,000. A teeth-whitening treatment with the LTW system takes an average of two hours to complete. Dentists charge $800 to $1,200 per patient for the LTW procedure.
The Apollo 9500 also can be used for teeth whitening in one hour or less at a cost of under $300, and can be operated by a dental assistant or hygienist. The Apollo 9500 device provides four or five shades of whitening, whereas the LTW procedure provides an average of eight shades of whitening. The Apollo 95E gives whitening results similar to the Apollo 9500.
Digital X-ray imaging equipment market
Digital X-ray imaging equipment is a rapidly growing new business area in the dental marketplace. The equipment uses computerized radiography to provide large and clear X-ray images of a patient’s mouth. Digital X-ray imaging is filmless. It employs a sensor that is placed in the mouth and reacts to X-ray emission. The results of this reaction are transferred to a computer, where they are translated to digital data and displayed instantly as an image on a monitor. The image can be highlighted in colors, enlarged, transmitted over telephone lines and stored on a hard disk.
Digital X-ray systems are designed to improve the efficiency of dental practices. They save time and effort by displaying X-ray images in real time on a computer screen. Also, the film development process and the need for disposal of chemicals and lead wrappers used for developing conventional X-ray films are eliminated, which should drive the growth of filmless systems. Digital X-rays can be used to generate pictures for submission to a referring dentist or to an insurer to substantiate a dental claim. They provide the security of picture archiving with a tape backup. Digital X-rays offer an important safety advantage because patients are exposed to only about 10% of the radiation received from film X-rays.
Digital X-ray imaging systems are targeted at a larger group of dental professionals than intraoral cameras and include, for example, periodontists and orthodontists. Digital X-ray systems have been installed in about 3% of the nation’s 125,000 dental practices.
Schick Technologies, which completed an initial public offering in July 1997, is the dominant supplier of digital X-ray systems, with a 91% market share. Sales for its digital X-ray systems were $31 million in 1997. Schick received FDA clearance for its CDR (computed dental radiography) digital X-ray imaging system in 1992 and has more than 3,200 installations in dental offices, hospitals and universities. In its public offering prospectus, Schick estimated the potential market for dental digital radiography products to exceed $4 billion.
About 6,000 digital X-ray systems were sold in Europe in 1996, where the market is growing at a 35% annual rate. These systems sell in Europe for $14,000 to $18,000, a premium price compared to the U.S. Several companies compete in the European digital X-ray market, including France’s Trophy Radiologie, Norway’s Digora, Schick Technologies, Dentsply’s New Image Industries and AFP Imaging.
Digital X-ray systems are more widely used in Europe than in the U.S. This is because dentists in Europe typically work alone in a single operatory and develop their own X-rays without using an assistant. They are attracted to the time savings offered by digital X-ray systems and are not concerned about the need to equip multiple rooms. There also is a greater sensitivity in Europe for disposal of chemical waste from developing X-ray films.
U.S. market has new entrants
Trophy Radiologie (Paris) is a leading manufacturer of dental X-ray systems that specializes in digital technology. Its RVG digital X-ray system has a small market share in the U.S. The company was recently acquired by Trex Medical (Danbury, Connecticut). New Image Industries introduced its NiDx system early last year. It is the third time that the company has entered the market with a digital X-ray system. AFP Imaging’s Dent-X subsidiary recently launched in the U.S. its portable Sens-A-Ray 2000 system that it acquired from Regam Medical in Sweden. ProVision Dental Systems (Palo Alto, California) is another newcomer to this market with its Dexis portable system which the company says has the first X-ray sensor that can be used for horizontal and vertical imaging of up to three molars in a single exposure and the first system to use an external PC data capture card. Cygnus Imaging markets the Cygnus-Ray2 system developed by Japan’s Panasonic.
DMD acquired an exclusive worldwide license to a digital X-ray imaging system being developed by Suni Imaging Microsystems (Mountain View, California). Suni, a private semiconductor company that specializes in system-on-a-chip CMOS and CMOS-CCD image sensor products, pioneered the development of the first film-sized image sensors produced for digital X-ray systems. The sensor is a key component in a digital X-ray system. DMDwill offer sensors in three sizes that are thinner (a maximum 3 mm vs. 5 mm for Schick’s CDR sensor), easier to place in the mouth and more comfortable for patients than other sensors presently used in the marketplace. The sensors will provide more light (8 to 20 line pairs vs. 8 to 10 line pairs for Schick’s sensors) and yield better contrast between white, gray and black. DMD plans to price its sensors at 25% below the price of sensors currently in use.
The company expects to launch its digital X-ray imaging system in Europe in 3Q98 and in the U.S. by the end of this year, upon receipt of FDA approval of its 510(k) to be submitted in mid-year. Digital X-ray imaging systems can be integrated into IOCs by using the same video monitor.
Renaissance in air abrasion systems
Air abrasion systems use a spray of microscopically fine powder for painlessly removing dental decay and for etching teeth to enhance the bonding of sealants and restoratives. Air abrasion systems, also known as sand blasters and kinetic cavity preparation instruments, were introduced almost 50 years ago but have only gained in popularity as an alternative to the dental drill in the past two to three years, due largely to the increased use of composite materials in place of mercury amalgams. Their main advantages are eliminating the need for any anesthetic for the majority of patients and that only the dental carie is removed, leaving behind more of the tooth structure than when using a dental drill. Generally speaking, a drill has more tactile feed-back for the dentist and an air abrasion instrument for more visual feedback. About 3% of dental practices in the U.S. are equipped with an air abrasion system.
American Dental Technologies (Southfield, Michigan) has led the resurgence of air abrasion systems and is the market leader, with 7,000 units installed. Other companies in this growing and increasingly competitive market include Lares Research (Chico, California), Danville Engineering (San Ramon, California), Kreativ, American Dental Technologies, SpectraVu (Dublin, California), Midwest Dental Products (Des Plaines, Illinois), Medidenta (Woodside, New York), Crystal Mark (Glendale, California) and Prep Tech (Fremont, California).
Their cost ranges from $4,000 to $18,000, depending on which features are offered, such as power levels, particle sizes (usually 27 microns and 50 microns), cavity detector, built-in light and evacuation system. A competing product is the Centauri Er:YAG dental laser sold by Premier Laser Systems (Irvine, California). It is the only currently approved laser for use on hard dental tissue and sells for $45,000.
Virtual reality a newcomer to dentistry
AFP Imaging has exclusive rights in the U.S. to the DentSim simulator developed by DenX (Jerusalem, Israel). Prototype systems are being used for training students at the dental schools of Boston University (Boston, Massachusetts) and the University of Pennsylvania (Philadelphia, Pennsylvania). The software enables the user to have tactile simulation with visual correlation when removing decay from a tooth on a mannequin.
Milestone Scientific (Livingston, New Jersey) has introduced The Wand, a computer-controlled local anesthesia delivery system that is designed to eliminate the anxiety and pain associated with needles and injections. It sells for $995, which includes 150 disposable units. The product has been very well received by dental professionals, with 2,700 systems sold to date. The success of this product is likely to attract competitors which could cause some price erosion. (c) Copyright 1998 by American Health Consultants (r). Unauthorized photocopying or distribution is strictly prohibited by law.
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