State of the Cosmetic Dentistry Industry - AACD

65371_7AACDCosmeticDentistry2019_State_of_the_Industry_for_web.pdf

State of the Cosmetic

Dentistry Industry

2019 Survey Report

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Table of Contents

About This Study .............................................................................................................................................................. 4

Respondent Demographics .............................................................................................................................................. 5

AACD MembeƌǀƐ͘ŽŶͲĞŵďĞƌ .................................................................................................................................. 5

Dentists Dominated ..................................................................................................................................................... 5

A Question of Age ........................................................................................................................................................ 6

Community of Practice ................................................................................................................................................. 6

Practice Profile ................................................................................................................................................................. 7

Staying Power How many years have you been in practice? ......................................................................................... 7

Practice Location In what type of community is your practice located? ........................................................................ 7

Head Count What is the total number of employees working at your practice? ............................................................ 8

Going It Alone What best describes your practice? ....................................................................................................... 8

Scope of Practice In the past year, which of the following procedures has your practice completed? ............................ 9

Specialties Which of the following procedures/treatments do you complete in your practice? ...................................... 9

Location or Expertise? How far, on average, do patients travel to get to your practice?..............................................10

AACD Labs Is your primary laboratory technician a member?.........................................................................................10

In-Office Technology Does your practice use a chairside CAD/CAM system? ................................................................11

Use of Digital Smile Design and 3-D Printing ................................................................................................................11

Materials ........................................................................................................................................................................12

What Materials Do Dentists Prefer? ............................................................................................................................12

What would you put in your mouth for anterior composites? ......................................................................................12

Where Dentists Get Materials ....................................................................................................................................13

Dollars and Sense ............................................................................................................................................................14

Big Spenders In the last year, how much did your average patient spend on cosmetic dentistry services? ....................14

Marketing Does your practice employ a dedicated marketing person or an outside firm? ..........................................155

Frequency and Revenues for Top Cosmetic Procedures.................................................................................................155

On average, how many veneers do patients receive at once? ....................................................................................155

ŚĂƚ͛ƐŽƉƵůĂƌ͍Please report the approximate number of (each of the following) procedures your practice (including

all associates) performed in the last year. ..................................................................................................................166

ŚĂƚ͛ƐƌŽĨŝƚĂďůĞ͍What is the average cost of a (each of the following) procedure in your practice?........................166

Who Patients Choose What is the average number of procedures by member type? .................................................177

And What They Are Willing to Pay What is the average cost per procedures by member type? ..................................177

Show Me the Money Please indicate the total revenues for all dentistry procedures (both cosmetic and non-cosmetic)

that your practice performed in the previous year? ...................................................................................................188

Market Trends ................................................................................................................................................................19

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Competition and partners Who is your competition for tooth whitening? ....................................................................19

What aligner companies are you working with? ..........................................................................................................19

What do you see coming in the next five years for dental practices in terms of new technology, materials, or smile

trends? ......................................................................................................................................................................200

What might disrupt the dental industry in terms of changes in standards or the competitive environment in the next

five years? .................................................................................................................................................................200

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About This Study

This singleͲmode survey (email driving to an online instrument) of dental practices was conducted by the

American Academy of Cosmetic Dentistry (AACD) and Acuitim Marketing Research and Consultancy to

better understand the dynamics of the cosmetic dentistry market and determine the size and impactͶ

in terms of procedures and revenuesͶand the patient makeup of this market. Previous benchmarking surveys were conducted in 2004, 2007, 2011, 2013, 2015, and 2017 by Levin

Group, Inc., Readex Research, Acuitim Market Research, and AACD respectively. Data for the 2019 study

was collected between January 13 and January 27, 2020. A total of 878 responses were tabulated, with

fewer respondents completing the latter portion of the survey. The net number of respondents is noted

on each exhibit.

The invitation to participate was primarily offered via email to the AACD membership at large, but also

distributed to nonͲAACD member dental professionals via social media and dental media partners to

provide an outsideͲin view of nonͲmember dental practices that derive income from cosmetic procedures. Cooperation with this survey was much higher than previous years, but the increase in number of surveys is not balanced by member type. Compared to 2017: General member surveys increased from 211 to 424. Non-member surveys increased from 79 to 387. Accredited member surveys decreased from 73 to 67. The lack of increase among Accredited members is likely because all accredited members received invitations in previous years, so there was no increase in distribution.

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Respondent Demographics

AACD ǤǦ

Nearly half of respondents (44%) were non-members which compares to 22% in 2017.

Dentists Dominated

Almost all respondents were dentists (97%), with lab technicians (2%) comprising most of the rest of the

sample. 0% 10% 20% 30%
40%
50%
60%
70%
General MemberAccredited MemberAccredited FellowNon-Member 48%
6%2% 44%
58%
15% 6% 22%

Percentage of Respondents

20192017

0% 10% 20% 30%
40%
50%
60%
70%
80%
90%
100%

DentistLaboratory

Technician

Dental

Hygienist

Dental

Assistant

Office

Administrator

97%

2%0%0%0%

95%

4%0%1%1%

Percentage of Respondents

20192017

878and363responding

878 and 363 responding

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A Question of Age

There are fewer respondents over age 55 (27%) compared to 2017 (41%).

Community of Practice

Most respondents (86%) identified themselves as either general dentists or cosmetic dentists. Half of

accredited members are cosmetic dentists (55%) compared to only 20% of non-members. This is

consistent with previous studies and the lower percentage of cosmetic dentists in the total sample is a

result of the increased sample response among non-members. 0% 10% 20% 30%
40%
50%

20-3536-4546-5556 or over

27%27%

19%

27%25%

18%16%

41%

Percentage of Respondents

20192017

878and363responding

0% 10% 20% 30%
40%
50%
60%
70%
24%
62%
7%

2%2%0%2%

32%
60%
5%

0%0%1%3%

Percentage of Respondents

20192017

878and355responding

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Practice Profile

Staying Power

How many years have you been in practice?

The reduction in practices of 20 or more years is largely related to the increase in sample size among

non-members. While the percentage dropped among General members (from 46% to 36%), there was little change for Accredited members and non-members.

Practice Location

In what type of community is your practice located? Practices continue to migrate to more urban environments. The percentage of practices in urban

locations increased by six percentage points since 2017 and a total of 21 percentage points in the last

thirteen years. Between 2017 and 2019, urban settings increased five percentage points among General

members (from 37% to 42%), while the percentages of both Accredited members and non-members

were unchanged. The increase in the numbers of urban practices also contributed to this shift, as this

group had the most urban practices (51%). 0% 10% 20% 30%
40%
50%
60%

Fewer than 5

years

5-9 years10-15 years16-20 yearsMore than 20

years

17%13%

19% 11% 40%
19%

10%10%10%

52%

Percentage of Respondents

20192017

878and362responding

0% 10% 20% 30%
40%
50%
60%

UrbanSuburbanSmall TownRural

46%
34%
17% 3%

40%38%

17% 4%

Percentage of Respondents

20192017

878and359responding

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Head Count

What is the total number of employees working at your practice? There was a slight increase in larger practices with ten or more employees (35% compared to 31% in

2017) and a corresponding decrease in practices with 7 to 9 employees. This slight increase is consistent

in almost every group with the exception of Accredited members and respondents describing themselves as cosmetic dentists.

Going It Alone

What best describes your practice?

There are fewer solo practitioners and more respondents in group practices compared to 2017. This shift is apparent among General members (+7% in groups, -5% solo) and non-members (+5% in groups, -

2% solo), while most Accredited members are solo practitioners (63%). The decline in solo practitioners

was mostly among those age 36 to 55 (52%, down from 64%) The increase in sample size among non-

members also contributed to the overall shift as they have the lowest percentage of solo practitioners

(44%) and the highest percentage in group practices (41%). 0% 10% 20% 30%
40%

1-23-45-67-910-1415 or more

9%

17%19%

21%

18%17%

9%

17%18%

25%

15%16%

Percentage of Respondents

20192017

878and362responding

0% 10% 20% 30%
40%
50%
60%
70%

Solo practitionerGroupCorporateUniversity

50%
38%
6%6% 55%
32%
7%6%

Percentage of Respondents

20192017

878and352responding

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Scope of Practice

In the past year, which of the following procedures has your practice completed? Almost all practices complete crown and bridge work. However, only about half offer orthodontics or

aligners. Non-members remain the least likely to do aligners, though they are catching up (44%, up from

29% in 2017). More practices perform direct bonding procedures (anterior, 93% and posterior, 87%)

compared to 2017. Slight declines in veneers, implants, and inlays/onlays are based on the increase of

non-members in the sample. Non-members are less likely to complete these procedures compared to members, but the percentages increased among members.

Procedure 2019 2017

Crown and bridge work 97% 98%

Direct bonding: Anterior 93% 89%

Bleaching or whitening 88% 89%

Direct bonding: Posterior 87% 83%

Removable prosthetics 83% 80%

Veneers 81% 84%

Implants 77% 81%

Inlays or onlays 62% 67%

Other cosmetic dental procedures 56% 64%

Invisilign or other tray aligners 56% 52%

Orthodontics 41% 44%

Specialties

Which of the following procedures/treatments do you complete in your practice? Almost all respondents perform crowns, bonding, bridges, whitening, veneers, and dentures. Non- members remain less likely than members to do implants (64% to 73%) or recontouring (60% to 74%). However, both of these specialties increased for non-members by about 10 percentage points compared to 2017.

Procedure 2019 2017

Crowns 96% 94%

Bonding 90% 91%

Bridges 90% 93%

Bleaching or whitening 89% 89%

Veneers 87% 92%

Dentures 85% 84%

Implants 69% 75%

Recontouring 68% 74%

Implant-supported dentures 64% 68%

Invisilign or other tray aligners 56% 54%

Short-term ortho 39% 42%

Microabrasion 39% 40%

Periodontal plastic surgery 28% 37%

Long-term ortho 24% 30%

878 and 361 responding

878 and 358 responding

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Location or Expertise?

How far, on average, do patients travel to get to your practice? Fewer (60%) respondents say that their patients travel an average of 10 miles or less to get to the

practice. This decline is mostly among suburban practices where the percentage of patients who travel

10 miles or less is down from 76% in 2017 to 66% in 2019.

AACD Labs

Is your primary laboratory technician a member?

Most Accredited members identify their primary lab technician as an AACD member (67%). Fewer general members (20%) and very few non-members (5%) say their tech is an AACD member with most

ƐĂLJŝŶŐƚŚĞLJĚŽŶ͛ƚŬŶŽǁ;ϱϭйŽĨŶŽŶ-members and 40% of general members).

0% 10% 20% 30%
40%
50%
60%
70%

0-10 miles11-24 miles25-50 miles50-100 miles100 miles or

more 60%
25%
10% 3%3% 65%
26%
7%

1%1%Percentage of Respondents

20192017

878and358responding

0% 10% 20% 30%
40%
50%

An AACD

member

An AACD

Accredited

member

An AACD

Accredited

Fellow

Not an AACD

Member

Uncertain

8%6% 3%

41%42%

13%10%

2% 42%
33%

Percentage of Respondents

20192017

878and360responding

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In-Office Technology

Does your practice use a chairside CAD/CAM system?

Use of a chairside CAD/CAM is similar to usage levels seen in 2017. All membership types increased by

one or two points, with members (39%) higher than non-members (25%). Larger practices with 10 or more employees remain the most likely to use a CAD/CAM system (45%), but with no increase compared to 2017 (50%).

Use of Digital Smile Design and 3-D Printing

In questions added in 2019, respondents were asked if their practice uses digital smile design and 3-D

printing. One-third (34%) of practices use digital smile design with two in ten (18%) using 3-D printing.

Members are twice likely to use digital smile design (38%) as non-members (19%) but non-members are nearly as likely to use 3-D printing (17% compared to 21% for members). Corporate practices are

somewhat more likely to use both (37% and 26%, respectively), with 37% of solo practitioners also using

digital smile design. 0% 10% 20% 30%
40%
50%
60%
70%
Yes, currently useNo, but considering purchasingNo, not interested

32%33%34%34%32%34%

Percentage of Respondents

20192017

878and348responding

0% 20% 40%
60%
80%
100%

Practice uses digital smile

design

Practice uses 3-D printing

34%
19%

Percentage of Respondents

878responding (2019only)

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Materials

What Materials Do Dentists Prefer?

What would you put in your mouth for anterior restorations?

In a question added in 2019, respondents asked what material they would use in their mouth specifically

for anterior restorations. Lithium Disilicate is clearly the preferred material (90%), with fewer dentists

selecting Zirconia specifically for anterior restorations (28%) and almost none selecting gold (2%). Non-

members are much more likely to select Zirconia (37%) compared to AACD members (22%). 0% 20% 40%
60%
80%
100%
28%
90%
23%
7%2%

Percentage of Respondents

774responding (2019only)

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Where Dentists Get Materials

In a question added in 2019, respondents asked where they are getting materials. Most dentists use U.S.

distributors for materials 84%. Amazon is used by 8%, with some using Chinese distributors (5%) but almost as many using either European (3%) or Canadian (2%) distributors. Non-members use Chinese distributors (10%) far more than members (1%).

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13% 19% 21%
22%
15% 10% 9% 10% 35%
14% 15% 16%

0%10%20%30%40%

Less than $500

$500-$1,000 $1,000-$2,500 $2,500 - $5,000 $5,000 - $10,000 more than $10,000

Percentage of Respondents

2019
2017
774
responding: and 291

Dollars and Sense

Big Spenders

In the last year, how much did your average patient spend on cosmetic dentistry services?

2017 Average $5,477

2019 Average $4,336

2019 by Member Type

General Member $4,645

Accredited Member $7,169

Non-Member $3,482

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Marketing

Does your practice employ a dedicated marketing person or an outside firm? Accredited members (49%) are the most likely, followed by General members (41%). Non-members are less likely to employ a marketing specialist (25%). Practices with dedicated marketing average $1,318,000 in total revenues compared to $893,000 among firms that do not. Frequency and Revenues for Top Cosmetic Procedures On average, how many veneers do patients receive at once? Respondents are asked how many veneers are done at once. In 2017, nearly 80% said they averaged

three or fewer veneers at once. In 2019 this has reversed, with almost 75% saying they do either 4+ or

the entire smile zone. Accredited members (31%) are the most likely to say they do the entire smile

zone. Meanwhile, university practices (46%), dentists under 35 years old (34%) and non-members (31%)

often say they do 1 to 2. 0% 20% 40%
60%
80%
100%
YesNo 35%
65%

Percentage of Respondents

519responding (2019only)

0% 20% 40%
60%
80%
100%

1 to 234 or morethe entire smile zone

23%
2% 59%

16%18%

61%
3% 19%

Percentage of Respondents

20192017

519and191responding

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ǯǫ

Please report the approximate number of (each of the following) procedures your practice (including all associates) performed in the last year.

Respondents reported many more direct bonding procedures (average of 968) than in 2017 (578). This is

consistent across all member types. There were less dramatic increases in implant procedures,

inlays/onlays and crown or bridge work, but fewer veneers were reported. There was little change in

bleaching or whitening procedures, suggesting that marketing for OTC/DIY options increased the total

market without dramatically shrinking the in-office market.

ǯǫ

What is the average cost of a (each of the following) procedure in your practice?

The average cost of most procedures is similar to 2017 in most cases. Non-members average prices are

lower than members for all procedures. 0 200
400
600
800
1000
59
451
968

1121009861

418
578

8179114

Average Number of Procedures

20192017

(Base sizes vary by procedure) 0 250
500
750
1,000 1,250 1,500 1,750 2,000 2,250 2,500 $393 $1,188 $300 $2,257 $905 $1,156 $353 $1,246 $356 $2,299 $1,048 $1,313

Average Cost per Procedure

20192017

(Base sizes vary by procedure)

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Who Patients Choose

What is the average number of procedures by member type? Compared to 2017, Accredited members reported more direct bonding procedures. General members had large increases for most procedures. Non-members also had increases in many procedures, but

showed little or no increase in veneers as well as crown and bridge work, two areas where their

practices remain behind member practices.

And What They Are Willing to Pay

What is the average cost per procedures by member type? Accredited members report the highest cost per procedure for all procedure types. General members report higher cost per procedure than non-members for all procedure types 0 200
400
600
800
1000
1200
60
529
1,033

12410110257

577
885

775410559

322
903

10610891Average number of procedures

General memberAccredited MemberNon-Member

$0 $250 $500 $750 $1,000 $1,250 $1,500 $1,750 $2,000 $2,250 $2,500 $2,750 $3,000 $404 $1,235 $325 $2,390 $1,010 $1,248 $594 $1,646 $475 $2,639 $1,280 $1,601 $332 $1,024 $227 $1,985 $671 $921

Average Cost per Procedure

General memberAccredited MemberNon-Member

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30%
15% 14% 13% 8% 8% 12% 24%
19% 15% 11% 11% 10% 11%

0%10%20%30%

Less than $500,000

$500,000-$749,999 $750,000-$999,999 $1.0 - $1.24 million $1.25 - $1.49 million $1.5 - $1.99 million

More than $2.0 million

Percentage of Respondents

2019
2017
774
responding: and 294

Show Me the Money

Please indicate the total revenues for all dentistry procedures (both cosmetic and non- cosmetic) that your practice performed in the previous year? Compares to 2017, member averages are essentially unchanged, with General members up by $22,000.

2017 Average $1,081,000

2019 Average $1,055,000

2019 by Member Type

General Member $1,188,000

Accredited Member $1,593,000

Non-Member $809,000

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Market Trends

Competition and partners

Who is your competition for tooth whitening?

In a question added in 2019, respondents were asked who they consider competition for tooth whitening. Nearly two-thirds consider OTC options as competition. This includes more members (72%)

than non-members (55%). It is notable that compared tŽϮϬϭϳ͕ŵĞŵďĞƌ͛ƐƉƌĂĐƚŝĐĞƐĂƌĞĐŚĂƌŐŝŶŐŵƵĐŚ

more for whitening while completing nearly as many procedures. This suggests marketing for OTC/DIY options has grown the market, allowing dentists to differentiate their service as premium.

What aligner companies are you working with?

In a question added in 2019, respondents were asked what aligner companies they work with. Most practices that perform alignment use Invisalign (80%). Clear Correct (24%) is also used with other competitors used by 5% or less. Non-members (73%) and small town or rural dentists (69%) are less likely to use Invisalign, with both using Clear Correct slightly more than the overall average. 0% 20% 40%
60%
80%
100%
65%
53%
24%
3% 18% 4%

Percentage of Respondents

782responding (2019only)

0% 20% 40%
60%
80%

100%80%

24%

5%2%1%1%

Percentage of Respondents

491 responding (2019only)

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What do you see coming in the next five years for dental practices in terms of new technology, materials, or smile trends? In a question added in 2019, respondents were asked what industry changes they expect. About one- third (32%) expect a trend toward more digital or CAD/CAM. More 3-D Printing or milling (24%) and increased use of scanners (16%) are also expected. Incremental improvements in materials (12%) and smile design (11%) are also expected.

Procedure 2019

More Digital & CAD/CAM 32%

3D Printing/milling 24%

More scanners 16%

New/Better Materials 12%

Better Smile design 11%

More/Better Tech 3%

Genetic engineering/Stem cell 3%

Artificial Intelligence Diagnosis 3%

Laser 3%

Video consulting online 3%

What might disrupt the dental industry in terms of changes in standards or the competitive environment in the next five years? In a question added in 2019, respondents were asked what disruptions the industry might face in the

next five years. Many respondents (34%) are concerned about growth of corporate dentistry, which was

mentioned more by members (39%) than non-members (25%). OTC and DIY products also concern some dentists (13%). Government and Insurance regulation (9%), Insurance trends (9%) or lower reimbursement (6%) are also common concerns. Some fear reduced qualifications (6%), poor work (4%),

ůĞƐƐƉĞƌƐŽŶĂůĐĂƌĞ;ϯйͿĂƐǁĞůůĂƐĂŶŝŶĐƌĞĂƐŝŶŐĚŝǀŝĚĞďĞƚǁĞĞŶƋƵĂůŝƚLJǁŽƌŬĂŶĚ͞ĐŚĞĂƉ͟ƐŽůƵƚŝŽŶƐ͘

Procedure 2019

More corporate 34%

DIY / OTC 13%

More Gov't/Ins regulation 9%

Insurance trends 9%

Lower insurance reimbursement 6%

Reduced qualifications 6%

Economy 6%

Tech/Robotics/AI 4%

Poor work 4%

Online consultations 3%

Less personal care 3%

Divide between high quality vs. cheap 3%

380 responding

316 responding

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