Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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839 Implants Around the World with Marco Gadola, CEO of Straumann : Dentistry Uncensored with Howard Farran

839 Implants Around the World with Marco Gadola, CEO of Straumann : Dentistry Uncensored with Howard Farran

9/10/2017 10:23:48 AM   |   Comments: 0   |   Views: 464

839 Implants around the World with Marco Gadola, CEO of Straumann : Dentistry Uncensored with Howard Farran

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839 Implants around the World with Marco Gadola, CEO of Straumann : Dentistry Uncensored with Howard Farran

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VIDEO - DUwHF #839 - Marco Gadola

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AUDIO - DUwHF #839 - Marco Gadola

Marco Gadola has a strong executive track record in a broad range of global businesses. He rejoined Straumann in 2013 as CEO, having previously served as Chief Financial Officer and Executive Vice President Operations from 2006 to 2008, when he left to pursue a career development opportunity at Panalpina, a world leader in supply chain management. Having started as Panalpina’s Chief Financial Officer, he became Regional CEO Asia / Pacic in 2012, with overall responsibility for the regional business.

Prior to his first term at Straumann, he spent five years at Hero, the Swiss-based international food group, where he was also CFO and responsible for IT and operations. Previously, he spent nine years at the international construction tool manufacturer Hilti, where he held a number of senior commercial / sales and nance-related positions in various countries. Before that, he worked for Sandoz International Ltd, as Audit Manager, and for Swiss Bank Corporation, Basel, in Corporate Finance.

Mr. Gadola graduated from Basel University in business administration and economics. He also completed various programs at the London School of Economics and at IMD in Lausanne.

Marco Gadola is Vice Chairman of the Board of Calida Group and heads its Audit Committee. He is also a member of the Board of MCH Group, Switzerland, and heads its Audit Committee, in addition to being a panel member of the Swiss-American Chamber of Commerce. 

This year, Marco was ranked seventh in the ‘Incisal Edge’ most influential people in dentistry.

Howard: Marco, can you hear me?

Marco: Yes Howard, I can hear you perfectly.

Howard: Alright, hello.

Marco: Hello from Switzerland.

Howard: I’ve got to tell you my embarrassing story about Switzerland.  The first time I lectured there I lived in a beautiful mountain and the guy said to me that’s the Matterhorn. I said ‘wow, do you know Disneyland, has a roller coaster ride called Matterhorn’ and he said ‘really, are you that dumb?  Anyway, so we are talking today to Marco Gadola, CEO of Straumann based in Switzerland.  Marco Gadola has a strong executive track record in a broad range of global businesses.  He rejoined Straumann in 2013 as CEO, having previously served as Chief Financial Officer and Executive Vice President Operations from 2006 to 2008, when he got to pursue a career opportunity at Panalpina, a world leader in supply chain management.  Having started as Panalpina’s Chief Financial Officer, he became Regional CEO Asia / Pacific in 2012, with overall responsibility for the regional business.  Prior to his first term at Straumann, he spent five years at Hero, the Swiss-based international food group, where he was the CFO and responsible for IT and operations.  Previously, he spent nine years at the international construction tool manufacturer Hilti, where he held a number of senior commercial / Sales and finance-related positions in various countries.  Before that, he worked for Sandoz International as Audit Manager, and for Swiss Bank Corp, in Corporate Finance.  Mr. Gadola graduated from Basel University in Business Administration and Economics.  He also completed various programmes at the London School of Economics and at IMD in Lausanne.  Marco Gadola is Vice Chairman of the Board of Calida Group and heads its Audit Committee.  He is also a member of the Board of MCH Group, Switzerland, and heads it Audit Committee, in addition to being a panel member of the Swiss-American Chamber of Commerce.  This year Marco was ranked seventh in the ‘Incisal Edge’ most influential people in dentistry.  Congratulations for making that list.  That was amazing Marco.  Thank you for joining us today.

Marco: You are welcome.

Howard: We are in Ottawa, Ontario, Canada.

Marco: Round of applause.

Howard: They are all drinking maple syrup and I did not realize that.  So man, you are, you are amazing.  I am so glad that to get you on the show.  

It seems like when you go around the world the two fastest growing segments are placing dental implants and invisalign and I think one of the reasons is because when I lecture around the world like you go to three of the greatest civilizations ever, Tokyo Japan, Paris France, London England.  The government schemes only give them $100 for a molar root canal and it is hard to do a molar root canal if you want to do it on your best friend for $100.  But implants and orthodontics are two procedures that are not covered by government intern schemes.  Like, I was lecturing in Cambodia and Malaysia and Indonesia and they say ‘ Well we loose money on our fillings, cleanings, exams and xrays but if we place one implant only or do one orthodontic case only, we’re a rich dentist.’  So, you’re in the hottest, fastest growing part of dentistry and implants.  How do you see the implant market around the world?

Marco: The implant market around the world is actually not as fast growing as the orthodontic side, so the clear-alignment side so we are going to have a chance to talk a little bit more about this.  Overall, globally the dental implant market is growing at a rate of 3 to 4% percent.  If you take out the growth of Straumann, it’s more around 2% and 2%, this is actually not that exciting however, however, if you look at the different  geographies and obviously all the independent created markets like China.  So, the Chinese market then (04:13 unclear ) market is growing by more than 30% on an annual basis.  The Indian market even growing 50%.  Even the US market is still growing 5 to 6% but you also have a large, already quite high penetrated markets, like the German market, like the Italian market, like the Swiss market or the Scandinavian market, there you don’t see any growth.  So, in general, 3 to 4, without Straumann is a relatively modest growth but we still have economies with a lot of potential to grow in the treatment rate with implants.

Howard: Marco, why do you think in some countries like South Korea and Germany, 3 out of 4 general dentists placed an implant last month. But then you go to markets like United States where half the dentists have never placed an implant.  Do you see that changing but  moving forward?

Marco: You know that, obviously the more dentists knowing about implants, the more dentists able to place implants, the more implants will actually be recommended as the treatment of choice to patients and the higher the penetration rate is.  Now let me talk a little bit about Korea.  So, Korea is the most penetrated market with dental implants worldwide.  Roughly 2.2, 2.3 million implants on an annual basis.  If you translate that into the number of implants placed per 10 000 inhabitants, and that’s actually the rate which we use to compare country by country if there is still a potential to grow or not.  In Korea, we have more than 400 implants placed per 10 000 inhabitants per year.  If you compare that to the US, the US they are 75.  So, the US is actually by a fact of not even 20% of the implant penetration rate of South Korea.  There are worse countries, China is 7, India is 2.  You mentioned Germany, Germany is around 140.  Now, what is specific about South Korea.  In South Korea, all dentists place implants.  And nobody does endo work.  As you pointed out.  They don’t believe in endo.  Ok, they just take the tooth out and they place an implant.  You can have different views about this.  

Howard: We have an Endodontist in the room.

Marco: Probably Korea is not the country where this lady wants to live but it’s a fact, you know there are almost no root canal treatments in Korea.  That is explaining the extremely high rate of implants placed in that country.  If you go to …

Howard: Can I interrupt for one thing though.  

Marco: Yeah sure, absolutely.

Howard: The dentist won’t tell me this on a podcast, but they will tell me while they are drinking beer and talking at the bar and if the government will only give them $100 for a normal root canal in Tokyo, Seoul, Paris, London.  So, in London.  You know in America the average root canal is $600 to $1200 .  So, if I am like only going to get $100 and that root canal is going to cost me at least 300, why would I lose $200 in root canal.  So, they just say, they just say, well, you know, I can’t fix this, we need to pull this and do an implant.  Do you think implants are taking over molar endo, when the government makes the fee, sets the fee and makes you, forces you to do it at a loss?  That if you want to see more of something you make it profitable or you want to see less of something you make it lose money.

Marco: I will say that this might be one contributing factor, but you mentioned Japan.  You also mentioned that Japan was actually similar to South Korea but when it comes to the reimbursement for endo treatments.  In Japan, the implant penetration rate is 43, so it’s almost ten times lower than in Korea.  If you go to the UK, you know you have 35.  So, the UK is one of the most under penetrated markets with dental implants.  Ok, it has a lot to do there with National Health Insurance.  In the UK, traditional crown and bridge work is reimbursed, whereas, when it comes to dental implants it’s not.  So, opposite this place, a row or two.  But I will also say, it has a lot to do with the philosophy of the dentists.  You know, Japanese dentists, or Japan, in general, they are very cautious and they actually believe in maintaining the natural tooth.  That’s very deep in their mindset and despite the fact that they only get 100% contribution to a root canal treatment, they still first try to save the tooth.  Whereas, the South Korean dentists, they are, I would say you know, maybe more pragmatic, more money driven and you know, they go for the immediate implant solution.

Howard: So, you were saying earlier that you thought that the invisalign clear retainer market was growing faster than the implant market?

Marco: Oh yes.

Howard: And what, you said the implant market was growing 3 to 4% globally.  What do you see the Clear Aligner  market growing?

Marco: You know, if you look at clear-aligners, there is one dominating force in this segment, and we all know the company.  It’s actually Align, Align has a market share of over 70%.  And, so looking at their numbers gives you a very good indication about the growth of the segment itself.  Align has grown during the first six months its business by 30%.  

I think that they are looking at the clear-aligner market.  It’s a little bit like the dental implant market twenty years ago.  The penetration rate overall, when it comes to orthodontic treatments is still very, very low.  If you look at the US, for example, it is the highest penetrated market when it comes to orthodontic cases you have potentially 200 million Americans eligible for one one-type or a v-alignment type or a traditional braces and bracket types of ortho treatment.  Roughly 200 million.  And the number of ortho cases in the US on an annual basis is four million.  So, you have a penetration rate of 2%.  And then if you look at how many of these four millions are actually treated with clear-aligners, we are talking here a penetration rate of roughly 20%.  So, there are roughly five hundred thousand cases in the US treated on an annual basis with clear-aligners.  So, I think the potential is tremendous, its very, very big, to actually bring, first of all, the penetration rate, overall, when it comes to orthodontic treatment rates up, then more and more of the cases, which, up to now have been treated with traditional braces and brackets, are in the future potential cases for clear-aligners.

Howard: Well you are making all the news in America.  Because you just made a very big acquisition.  You bought the number 2 largest company in clear-aligners.  You just bought ClearCorrect.  Do you remember buying that?  

Marco: Slightly, yeah, yeah.  It was a couple of days ago so it’s still very fresh to my memory.  But you know, it is actually interesting what you mentioned, ClearCorrect number 2 company in the industry?   ClearCorrect generated last year 32 million US Dollars of revenue.  This is actually 2%global share.  And its number 2 or number 3, you know if it’s number 2 or number 3 you can debate, but there is really one company which is really dominating this segment, it is Align.  Ok, Align is, and we all know that they are generating more than 1 billion US Dollars of revenue on an annual basis.  

Howard: 1 billion?

Marco: I think really it could be close to 1.2

Howard: 1.2, and what percent of market share does Align have?

Marco: Today, we can say the market is roughly 1.5 billion.  You know, they are 70% of the market.  

Howard: So, a big part of Align technology was the purchase of iTero for the digital scanner.  You also bought a company not far from here, Dental Wings in Montréal as a lab scanner and intraoral scanner.  Is that kind of Dental Wings your version of iTero?

Marco: Yeah, its opposites, it’s an alternative.  But as you know, there are several intraoral scanners in the market.  You know, the most integral scanner, intraoral scanner is the Cerec Scanner from Sirona.  You have an opposite there, you have iTero, which Align bought, I think 5 or 6 years ago.  You have Dental Wings, you have 3Shape, which is actually the number 2 company when it comes to intraoral scanners, I would say worldwide, behind Sirona.  So, these days, you have a couple of options.  We believe that with Dental Wings we have a very strong partner, so this is actually our powerhouse when it comes to development of CADCAM, not only the equipment, but also the corresponding software.  We are actually very happy to have them on board.  But, having said that, you also have a distribution partnership with 3Shape.  So, we also distribute the 3Shape intraoral scanners.  Not yet in the US.  We distribute them in Europe, but during the first quarter of 2017 we will also start to distribute, through the Straumann network, the Trios 3 intraoral scanner of 3Shape.  

Howard: I think 3Shape just signed a distribution with Patterson Dental Company.

Marco: Yesterday it was about, I hear that that Patterson is also having several intraoral scanners in their portfolio.  Going forward they signed the agreement with 3Shape a couple of weeks ago, and they just announced yesterday that they also entered into an agreement with Align to actually distribute their ITero scanners going forward.

Howard: So, I am going to go back to implants.  So, first of all, what are your plans for ClearCorrect.  Do you have any big plans for that now that it is backed by a large company like Straumanns?

Marco: Well what is also important to kind of notice is that the large majority of clear-aligner cases are made in the US.  So, roughly 2 out of 3 cases, these days, are made in the US.  So, it not only, in a way, one dominating company in this segment, it is also one dominating country, and that is the US.  Align is now expanding into China, for example, where they put up a treatment centre, so we believe, that what we can help Clear Correct with is to take that business international.  We are entertaining a direct to dentist and lab salesforce of roughly 1500 throughout the globe and we believe that we will be in a position to generate leads, to actually bring the Clear Correct portfolio in front of our customers and through that, to actually generate also business outside of the US.

Howard: Straumann also has a porcelain implant.  The Straumann PURE.  How is that going?  When they first came out, I thought it was aesthetic, but everybody that I talk to that placed them, their patients think they have metal allergies.  Did Straumann come out with a porcelain implant more for the humans that their allergies are from metal or is it more cosmetic or what was your thinking in a porcelain implant?

Marco: There are three factors which potentially speak to place a porcelain or ceramic implant instead of a titanium implant.  One is obviously the aesthetic aspect, because obviously, in case you have gum recession what is shimmering through is not the grey titanium implant its, then in that case an implant which looks like natural bone in a way.  The second point is, and I think that is very interesting, especially mid-long term, BC based on pre-clinical studies and some versed results of clinical studies that soft tissue integration works better with ceramic implants compared to titanium implants.  And then obviously the third factor, as you pointed out, there are actually people that don’t want to have any metal in their body and then obviously ceramic implants are an alternative to titanium implants.

Howard: Yeah, a lot of Americans believe that.  We believe you can’t have metal in your body.  You have to work back from that, I mean if they just believe it.  You’re very big in the mergers and acquisitions.  I noticed you bought some of the biggest implant companies around the world other than Straumann.  Like you bought the large implant company in Brazil, Neodent.  How many different implant companies have you bought so far?

Marco: If you look at our portfolio of implant brands, we have obviously the Straumann brand, which is our premium brand, our global premium brand.  Then we have two international brands.  One is Neodent, as you pointed out, the market leader in Brazil, which is besides the US, the second largest market when it comes to dental implants.  And the third brand we have in our portfolio is the German brand by the name of Medentika.  So, these two brands, these two non-premium brands, we actually launch internationally, we actually take them outside of their home markets, so outside of Brazil for Neodent and outside of Germany for Medentika, and then we have a couple of other brands which are more local regional brands like last November we acquired the number 3 in the Indian market.  A company by the name of Equinox.  An Indian manufacturer of dental implant brands and we also have a shareholding in a French implant company by the name of Anthogyr and Anthogyr is actually our non-premium brand in the Chinese and the Russian markets.  And on top of that we have two joint ventures.  We have one joint venture for Turkey and the surrounding markets and that implant has the brandname of Sinadent, and we are in the process of developing, together with one of the largest micromotor companies in the world, an injection moulded ceramic implant.  So, this is the portfolio of implants that we have.  

Howard: Do you have more mergers and acquisitions on the way?  You look like you are not going to stop.

Marco: Yeah, I think we have now, you know, after the latest acquisitions with ClearCorrect and also Dental Wings and we also entered the 3D printing field as you may know, through partial acquisition of a company by the name of Rapid Shape.  We have now, I would say, a lot of opportunities created through M&A and for us, the key priority now, the focus over the next couple of years is to actually make sure we take these businesses and we increase our market share in the corresponding, relevant markets.  But that doesn’t rule out, you know, if opportunities arise that we will not look at this or that or that we stay away from opportunities.

Howard: Do you think, you know, with the dental markets are reducing a block and now it is going into 3D printing, how significant do you think 3D printing will go moving forward.  I mean, you mostly see it in Straumann surgical guides.  Do you think 3D printing will start doing your clear-aligners for ClearCorrect, or do you prefer doing restorations?  What is your prediction for the 3D printing market?

Marco: As you pointed out today, you know, it is mainly models, its reader guides, its bite plates.  Obviously ClearCorrect is using 3D printers because to manufacture aligners, clear-aligners, you first have to 3D print the model then you can actually manufacture the aligner.  3D printing aligners, I don’t think that we will see this over the next two to three years but down the road, yes.  It is actually not a question of printing technology, it is a question of the  material.  And I also believe that, you know, three to four years down the road we will see crowns and bridges 3D printed.  Also, there, it is not a question about the printing technology, it’s more a question about the materials.  So, I personally believe that a lot of the problems which are currently still milled, being it, you know, chairside or inlab or some centralized milling samples, in three to four years from now these products will be 3D printed.

Howard: How many dental implant manufacturers do you think there are on the globe today?

Marco: Roughly 500.

Howard: So, a lot of people that listen to these podcasts are Millennials.  They seem to be more likely to be born after 1980, whereas the people on Dental Town are more likely to be old and fat and bald, like me.  Baby boomers.  A lot of these Millennials come out of dental school and they are listening to you right now and saying I just came out of dental school and we didn’t even learn how to place implants.  What would you say to someone who had just graduated from dental school and she’s looking out there and there are hundreds and hundreds of implant companies, and how does she pick an implant company and how does she learn how to place implants and how does she go from “I just graduated” to “I have never placed an implant”.  “How do I learn how to place an implant?”  What would you tell her?  Why should she choose Straumann instead of … how many companies do you think there are?

Marco: Roughly 500

Howard: Five hundred.  So how does she pick between 500 implant companies and what advice would you give her to learn how to place an implant?  Because dental school didn’t teach her how to place one.

Marco: You know, one great opportunity to actually really get the opportunity to place implants is obviously through post-graduate programmes, but obviously there, you know, the number of people who can enjoy such a programme is rather limited.  Another opportunity which is actually coming up more and more with dental service organisations is they hire younger dentists, they train these dentists, and then once they trained they open them up to open their own practice.  But it’s an excellent training drive.  There is, for example, one company not in the US, in Spain.  The name of the company is iDental, they employ 750 dentists in 26 clinics in Spain.  And they have a very good, very well-structured training and education programme for young dentists.  They come in, they first watch but already after a year they place dental implants, in the second year they come to the more complicated phases.  In year three, they even actually are kind of monitoring what the first-year dentists are doing.  So, this is a great opportunity to get, you know, experience with implants, because you know that, as well as I do, very often a dentist starts his implants, places 2 or 3 and then forgets again about it.  You need to be, you know, in the game.  You need to place, I would say, at least 20 to 30 implants on a yearly basis to really stay tuned in.  

Now, in terms of the brand, I would obviously like you all to use the Straumann brand but that is actually also a good opportunity to actually talk about Straumann.  There are other very good implant systems out there.  So, I am not advocating that Straumann is the only good and suited implant system out there.  But, I would say, if you actually look at the really tangible benefits what you get out of using Straumann, for example, compared to a non-premium, no name brand you get, first of all, peace of mind, which I think especially if you are a young dentist, you know, you open up a new practice, you want to make sure that the products you work with they really hold up.  You don’t want to have complications in your practice already during the first couple of years.  So, you want to work together with somebody you can really trust to have the corresponding clinical studies, who also has the field support which is also important, you know.  Reps out in the field who actually provides the training and education courses, because you are not yet a surgeon who has placed thousands of implants.  Really brings you up to the next level.  A business partner for you.  And we at Straumann, we can actually offer that.  I don’t say we are the only ones, there are also other companies that do that, but as a young dentist, you know, new in my practice, I would work with a company who has this reputation.  Just because I want to make sure my practice grows nicely, and maybe after I place 2000 or 3000 implants then I can actually say, you know, I know exactly, this indication, I don’t need to go with the Rolls Royce, I can also go with a non-premium brand and I actually potentially use the premium brand for the more difficult, more challenging situations.  

Howard: Well there is already thousands of cases posted on Dentaltown of what implant is this and five years later the chief implant company is out of business or gone.  And it seems like that most of the oral surgeons and periodontists that I know in the United States say they are afraid of the one million attorneys and they will use implant systems and if one of these cases fail and go to court, they have tons of research from an implant company to keep them out of court. And there are 500 other dental companies and you’re in the very top market, so there is a big reason why you are one of the top.  Well you definitely in the top, let’s say 2, 3, 5, in almost any country.

Marco: So, we are globally, clearly the number 1 company.  We sold last year more than three million implants.  The total amount worldwide is roughly sixty million implants, so more or less, 1 out of 5 implants is coming from the Straumann Group, so either Neodent, or Straumann or Medentika.

Howard: So, you are number 1 then.

Marco: We are number 1 globally.

Howard: Wow, but you are only number 7 on the most influential man in dentistry.

Marco: But that’s not bad, I am the only American in the top 20.  So, I think I am actually quite proud of that ranking.  

Howard: You also bought Botiss, for bone grafting regenerative.  Will you talk about Botiss?

Marco: Yes, Botiss we are actually in the process of registering the Botiss trade  in the US.  I guess we will be ready to start promoting the Botiss products from the second half of 20XX onward.  We already have an interesting Botiss product in the US market.  

Maybe some of you have heard about the bone ring, the bone ring technique.  This product doesn’t need registration because it’s a customised product.  That’s already available.  The other products of the Botiss range, you know, the excella grafts, the synthetic bone grafting materials, the membranes, etc., they will be available from Q3, 2018, almost

Howard: I notice that with the bone ring graft, that there is three different dentists claiming they invented that and I notice there are a few that invented all on 4.  There is a man in Cambodia that says he invented it, but then there is a German and a Swiss too.  So, did you ever figure out which one really invented it?

Marco: To be honest, I don’t really care.  The product works, we have the distribution rights, let’s have somebody else fighting our good.  Who really is the inventor, I don’t really care, to be honest.  

Howard: I did an entire podcast with a man from Cambodia and he just wanted to tell me what he wanted for the entire hour.  But, I want to ask if there are any questions from the audience.  Somebody has to have a question for this amazing man.

Audience: I just have a little bit more of a corporate type of question I guess.  First of all, I would like to give a shout out to my Straumann friend over here, Brandon McKinly.

Marco: Eh, Brandon, whoo hoo

Howard: He’s worked for you for 5 years and he has never even met you.  

Audience: If you haven’t met him, you are going to meet him like right now.  

Howard: Just say Hi.

Marco: Eh Brandon, great to get to know you.

Audience: Can you just give me a little idea about the velocity of all these mergers and acquisitions.  Like how do we see, or how can we picture Straumann in the future, in the sense that since you are buying all these different facets all under the dental umbrella.  Is it gonna be that Straumann is going to be the provider of all things dental or is it that you are just trying to get yourself into different markets.  Can you look out a few years and give us an idea of how you guys see that kind of coming to grips.

Marco: Very good question.  You know, if you go back to the end of 2012 and you look at the product portfolio that we had at hand.  At that time, we were a premium, parallel load, dental implant company.  What we had in our portfolio were tissue level, bone level, parallel load premium implants.  Ok.  With that portfolio, we were actually able at that point of time to address a market of roughly 1 billion US Dollars.  We then decided, during the course of 2014, we want to be a total solution provider for tooth replacement for dentists and for labs.  

So, in this case a dentist wants to actually look dutifully and also wants to actually manufacture or produce some of the products in his own dental practice he gets today from Straumann, not only the intraoral scanner but he also gets to buy materials, the implants, the prosthetic parts, the chairside mill and the corresponding blocks to put in the chairside mill to actually do an inlay, overlay or a graft.  So, we have the whole workflow and all the products actually a dentist needs today to replace a tooth, we have available today.  And the same we have available for the labs.  We have labs cameras, we have inlay milling machines, we have pre-mills, we have discs, we have blocks.  So, this has been our ambition back in 2014 and I can say now, looking now at the product portfolio we have at hand today, we are able to cover a market of roughly 8 billion US Dollars.  So, we increased the addressable market for Straumann as a company from 1 to 8.  So, by a factor of 8.  This is also the reason that we have clearly been able to outperform competition in the last couple of years.  By growing in the space, which is growing between 3 and 4%, we have been able to grow last year by 30%, and the first six months of this year by 14%.  So, we want to be more adventurous in providing dental implants.  We want to provide holistic treatment concept for more holistic solutions to dentists and to labs.  

Howard: And that is strictly, right now as we see it, it would be strictly implant workflow.

Marco: It was, implants now obviously since the acquisition of ClearCorrect, we are also playing in other markets, however, having said that, we believe that this is in a way complementary, because in many many cases, and you guys know that even better than I do, in many cases you first of all have to move the teeth into the right position before you can actually do the implant treatment.  So, it’s complimentary to what we have been doing in the past.  

Audience: Thank you very much

Marco: Thank you

Howard: Any other questions.  We have a second-generation dentist coming down.  

Audience: My question is kind of furthering on that with regards to the acquisition of ClearCorrect, as I see it is a holistic approach and creating that space.  You have just released in Canada and it’s coming up in the US industry 2.9 mm (33:16 unclear).  How did you come to that decision when you are realistically not being marketed as (33:24 unclear) spaces for smaller cases. Just wondering with the internal connection how that (33:33 implant )

Marco: When we are talking about the 2.9 mmm implant, we only offer that in Rock solid so, our strong material.  This has been the gap in our product portfolio.  We estimate that roughly 8 to 9%of all potential cases, you need a small diameter implant.  We also know that the small diameter implant, the problem in the past has been breakages because they are single, and eventually they break more often.  We have now with Rock Solid, we have actually overcome this to a degree, because the Rock Solid material obviously has higher tensile strength than any other material.  So, the idea was that STI was actually to offer a solution to a roughly 8 to 9 percent of all the cases where before, you know, our customer base was not able to use the Straumann products.  That was actually the intention.  

Audience: With regards to (34:38 unclear) with ClearCorrect and facilitate space opening, they kind of compete in the same markets, is that correct?

Marco: Yes, just as I pointed out before, you know, in many cases, especially, you know, when you talk about cases in the anterior reaches or the aesthetic area, moving two teeth first, to actually create space and then place the implant, that’s what this is all about.  Do we see that as complimentary products and complimentary offerings?  In a way you are right, you know, in a way we are competing with ClearCorrect against the STI, but, you know, in the more broad picture, we believe this is actually a very, very good and complimentary add on to what we already have when it comes to our product portfolio.

Audience: Where do you see the digital workflow.  We always think right now that we are the best that we can be but then a new product comes out with a new merger.  Where do you see the workflow in 5 years?

Marco: I guess some of you are actually working digitally in your practices, or at the universities.  You know, today we are still far away from really  being able to provide seamlessly integrated digital workflows.  You know, and I am talking here open systems. So, if you have, I don’t know, maybe an iTero scanner and you have a Cerec Mill, it’s a hassle.  Ok.  And if you even then have a have a 3D printer, it’s for a dentist in the practice, many dentists they don’t want to get involved into digital workflows because they don’t want to become software engineers.  They want to, you know, fix problems in the patient’s mouth.  So, I think the first thing we have to do, as your industry partners, is to make sure we will provide you with seamlessly integrated digital workflows.  So that you don’t have to worry about can I upload this STL file on Basel data, is it compatible, is it working.  But really to provide you with closely integrated digital workflows.  So, I think this has to be the first priority of us as your industry partners.  And then down the road, you know, we talked about 3D printing. I think, you know, that this will actually change the world.  I think that we will see more and more products which are actually today either provided by a lab, or manufactured chairside, or provided by centralised centres like Straumann.  Many of these products will be replaced by 3D printing, and you can actually do it chairside in your own practice.

Audience: One final one,  and I may not get an answer but what is your per unit manufacturing cost on the  (37:34 unclear)?

Marco:  You obviously have different implant systems eh?  Our manufacturing side in Curitiba Brazil is probably the most effective site worldwide and also from a cost per implant point of view is extremely efficient.  Then you look at the Straumann production in Switzerland.  Now Switzerland is a high cost country, you know, and we put a lot of emphasis on quality assurance on each and every single small production state.  So, the manufacturing of a Straumann branded implant is much more costly, it’s much more expensive than manufacturing a Neodent implant.  So, this is what I can tell you.  I think you can appreciate that I don’t share publicly the numbers of what the production costs of an implant are.  

Howard: Now his dad is an orthodontist, and he is going to ask the final question.  He is an orthodontist, he is going to ask about ClearCorrect.  

Audience: No, I don’t use ClearCorrect.

Howard: Well you’ve got to ask him a question about it, you have a Clear Aligner question.

Audience: No I don’t.

Howard: Are there any other orthodontists in the room?  You are the only one, are you the only orthodontist?  

Audience: No, there’s a guy at the back..

Howard: Who else is an orthodontist? Come on baldy, get down here

Audience:  I am very loyal to Invisalign.  

Howard: So, I just want to thank you so much, this was amazing.  It’s so neat, the technology, that you are in Switzerland, I am from Phoenix and we are here in the capital of Canada asking questions.  Technology is very very exciting and I know you are the busiest man in dentistry and the fact that you took time to talk to us today was amazing.  Thank you so much for your time.

Marco: Thank you for your time, for having me.  I feel a real pleasure to be with you guys.  Thanks a lot and good afternoon Ottawa.  It was a pleasure, thank you guys.

Howard: When you come to America, don’t forget to ride the Matterhorn.

Marco: Thank you guys.

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