ATLAS DENTAL European Markets /// Structures, Challenges and Scenarios - GFDI
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ATLAS DENTAL
European Markets /// Structures, Challenges and Scenarios
www.gfdi.de | A study from REBMANN RESEARCH with strategy ideas for the European dental industry.
PUBLISHERS‘ FOREWORD (GFDI/VDDI)
The European dental market is in a state of flux, and complex environment are confronted by a readers, encouraging reflection and stimulating
but despite the different framework conditions range of variables when taking strategic deci- discussion. It is designed to promote dialogue in
prevailing in individual EU member states, sions for which more accurate information on the industry and, where possible, sensitise read-
common challenges and developments are dis- the market and its development is needed. ers to questions that affect market players and
cernible. In a complex and heavily regulated illustrate approaches in the search for solutions.
market, these impact equally on dental service When illustrating findings, particular impor-
providers and dental laboratories, manufactur- tance was placed on the depiction of informa- The study in no respect represents action or
ers of dental technology and dealers. tion for specific countries in a comprehensive strategy recommendations for participants in
and, yet, striking manner that grasps the read- the dental sector. None of the propositions put
The engines behind current developments in er’s attention. Differences within or between forward in it represent the official positions of
terms of what is on offer are demand factors European countries can be easily compre the publishers.
(e.g. demographic trends), regulatory require- hended, thanks to cartographic illustrations
ments within the common EU internal market, and so-called structural profiles.
digitisation and advances in medical technolo-
gy which are increasingly based on cross-cutting The purpose of the ATLAS DENTAL study is to
technologies. Consequently, any market players highlight trends and tendencies on the basis of
positioning themselves in an extremely dynamic contemporary dental market activity, informing
GOALS OF ATLAS DENTAL
1. Sector overview & reference work
Our first GFDI study, the “Schedule for the European Dental Market”, a series of propositions regarding probable tendencies, and we would
marked IDS 2013 by collecting information relating to FIDE countries, like to replicate this again with a contemporary overview of the sector.
illustrating the latest events on the European dental market and making
2. Clear, compact depictions
The issues selected and the manner in which they are elaborated upon DENTAL. Individual countries are depicted in green or red, depending
mean that this work far surpasses our 2013 study in many respects. on whether an average value is exceeded or not. National and interna-
It aims to help the reader identify items of relevance at, so to speak, a tional differences are immediately identifiable. A uniform evaluation
glance. The selection is accompanied by cartographic representations, grid enables direct international comparisons.
with national or European maps being used to create a true ATLAS
3. Offering a basic analysis of the European situation
Drawing on a multitude of features which influence the dental market system and dental supply and demand structures is also illustrated for
in a particular country, a comparative analysis is then conducted for these countries.
ten selected countries. In addition, information relating to the health
2 /// 3
CONTENTS
International perspective������������������������������������������������������������������������������������������������������������������Page 6 DEVELOPING SCENARIOS
Germany�����������������������������������������������������������������������������������������������������������������������������������������������������Page 12
Tomorrow’s patients������������������������������������������������������������������������������������������������������������������������ Page 68
Belgium������������������������������������������������������������������������������������������������������������������������������������������������������Page 16
Tomorrow’s dental practice����������������������������������������������������������������������������������������������������������Page 70
France���������������������������������������������������������������������������������������������������������������������������������������������������������Page 18
Tomorrow’s dental laboratories�������������������������������������������������������������������������������������������������Page 72
Italy��������������������������������������������������������������������������������������������������������������������������������������������������������������Page 20
Tomorrow’s manufacturers and trade������������������������������������������������������������������������������������Page 74
Netherlands��������������������������������������������������������������������������������������������������������������������������������������������Page 22
Austria�������������������������������������������������������������������������������������������������������������������������������������������������������Page 24
Switzerland���������������������������������������������������������������������������������������������������������������������������������������������Page 26
Spain�����������������������������������������������������������������������������������������������������������������������������������������������������������Page 28
#IDSCOLOGNE
Czech Republic�������������������������������������������������������������������������������������������������������������������������������������Page 30
IDS as part of the marketing mix and showcase of tomorrow������������������������������Page 78
United Kingdom������������������������������������������������������������������������������������������������������������������������������������Page 32
Sources��������������������������������������������������������������������������������������������������������������������������������������������������� Page 80
Legal notice�������������������������������������������������������������������������������������������������������������������������������������������Page 83
MASTERING CHALLENGES
Demographic change������������������������������������������������������������������������������������������������������������������������Page 36
The digital patient������������������������������������������������������������������������������������������������������������������������������Page 40 Perspectives of this study:
Technological developments��������������������������������������������������������������������������������������������������������Page 46 Demand structures
Market consolidation������������������������������������������������������������������������������������������������������������������������Page 50 Dentists/Practices
Globalisation������������������������������������������������������������������������������������������������������������������������������������������Page 54
Outsourcing��������������������������������������������������������������������������������������������������������������������������������������������Page 58 Dental laboratories
Regulatory requirements���������������������������������������������������������������������������������������������������������������Page 60 Manufacturer/Trade
Infrastructure
4. Dental sector profiles
ATLAS DENTAL illustrates differences between countries through the contribute to a rapid appreciation of conditions in different countries.
aid of structural profiles that analyse relevant features, both in terms Dental technology is an important and independent component of gen-
of supply and demand. This examination is complemented through eral medical engineering. The similarity of these sectors also means that
the addition of recognised indices which compare countries in terms we frequently make references to general medical technology.
of competitiveness, innovativeness and digitisation. Structural profiles
5. Identifying potential and risks
One significant goal of a work of this nature is to sensitise readers to be exploited in the different countries (and, in part, in their different
significant issues associated with the dental care available to Europe’s regions) is illustrated and measures presented to obviate future risks.
citizens. Simplified depictions also help “amateurs” form a picture of
what is certainly a complex market situation. The potential which can
6. Current market developments in the dental sector
This study illustrates contemporary market developments from the per- of the respective country are also described at various points. Texts and
spective of dentists/practices, dental labs and manufacturers/dealers. graphic depictions are marked in colour to reflect different perspectives.
Furthermore, demand structures and information on the infrastructure
European Markets /// Structures, Challenges and Scenarios /// ATLAS DENTAL /// INTRODUCTION
ANALYSING STRUCTURES
INTERNATIONAL
PERSPECTIVE
Around € 80 billion is spent on dental treat- the Federation of the European Dental Indus- The utilisation rate is of particular interest
ment in the European Union. Given that there try, represents the interests of over 550 dental from the point of view of demand behaviour
are 512.7 million EU citizens (as of 2018), this manufacturers organised in nine national as- for dental services. It indicates what propor-
is equivalent to about € 156 per capita, and this sociations. tion of the population has contact at least once
figure continues to rise. The eurozone alone with a dentist within a year. Fig. 1 illustrates
was home to around 341.5 million people in A Europe-wide consideration of selected de- that high utilisation stretches like a green belt
2018. Public expenditure for dental treatment mand and supply indicators is conducted ini- from the Nordic countries over the United
was between 3 and 8 % of respective national tially in the first chapter. This data is prepared Kingdom and through Central Europe. The
health spending in individual European states. for a few selected countries, with double the Czech Republic, Slovakia and Austria form
Demographic, economic and political factors number of pages dedicated to illustrating the the eastern boundary lines of this green belt.
ensure that the demand for dental services German dental market, due to its importance. The utilisation rate in Southern and Western
continues to rise. Health systems are being Significant challenges in the sector are pres- Europe is considerably lower, and even Swit-
expanded, access to dental care improved, ent in the second chapter. The third chapter zerland only manages to reach the EU average.
the population‘s disposable income is rising demonstrates how the target group under con- Ireland exhibits a strikingly high utilisation
(again), the baby boomer generation is getting sideration here (consumers, dentists/practices, rate.
older and providing for people in need of care dental labs and manufacturers/dealers) can
is becoming a major challenge. face these challenges in future. Where these values are available in even great-
er detail, they are an indication of significant
Patients in a majority of the countries exam- There is an increasing focus on working with potential which is not only restricted to the
ined need to cover a higher proportion of costs intelligent data in dental practices and dental dental practice (e. g. in different age groups,
for dental services (particularly in the area of laboratories, but in particular in the produc- between women and men and between differ-
prosthetics) through private means (supple- tion of and trade with dental products. The ent regions). Utilisation rates for different den-
mentary dental insurance or out-of-pocket) range of products and services on offer should tal services such as screening examinations/
than for other outpatient or inpatient health be customised to reflect the preferences of cus- prophylaxis, fillings, X-ray services, endodon-
care. The tendency in most countries in recent tomers in as complete a manner as possible: tic treatment and dental prosthetics are availa-
years has been for this proportion to rise. ble for a few countries.
■A
wareness of the demand behaviour of
The ATLAS DENTAL makes no claims with patients in a region (e. g. with regard to age, The demand and supply situations for dental
regard to completeness, as the data situation in gender). services should match each other
a vast market such as Europe and an area as ex- ■O ne‘s own patient file or the customer
tensive as dental health is far too varied. There management system is the most important Regional analyses of this kind regularly show
are around 340,000 practising dentists1 work- source for one‘s own supply strategies. This that significant differences still exist between
ing in approximately 230,000 practices in the information interacts with external data in demand and remuneration. Knowledge of
EU area alone. Approximately 210,000 dental an ideal case. age-specific characteristics among one‘s own
technicians are employed in around 40,000 ■ Th
e demand and supply situations for dental patients or, also, of the demographic structure
dental laboratories throughout Europe.3 Aside services should match each other. of the region help one to adapt more effectively
from this, approx. 25,000 medical engineering ■F urther specialisation strategies first require to special needs. The lock and key principle is
companies with about 650,000 employees are an analysis of potential. also a guarantee for success here, because mar-
to be found in Europe. Half of these companies ■K nowledge of demographic data is impor- ket players can only be successful if the prod-
– with around 210,000 employees – are located tant, as this impacts on both the demand ucts or services supplied to the dental practice
in Germany. After the USA & China, Germany and supply structure. or the dealer who supplies the dental practice
is the third largest producer of medical tech- ■ Th
e secondary health market offers oppor- also reflect the uniquely specific demand in the
nology in the world. The United Kingdom, tunities for growth, but it requires a detailed vicinity.
Italy, Switzerland, Spain and, also, France are knowledge of the market.
further major producing countries.2 FIDE,
6 /// 7
Fig. 1 /// Utilisation of dental services
GRÖNLAND
ICELAND
SWEDEN
≥ 91 %
70.5 %
81 – 90 %
FINLAND
56.9 %
75 – 80 %
RUSSIA
NORWAY
66 – 74 %
77.9 %
57 – 65 % ESTONIA
EU average 50.1 %
60.1 %
48 – 56 %
LATVIA
48.3 %
39 – 47 %
LITHUANIA
DENMARK 46.5 %
< 39 %
80.2 % RUSSIA
IRELAND BELARUS
Not evaluated 92.6 %
UNITED
KINGDOM
74.0 % POLAND UKRAINE
NETHERLANDS 52.7 %
78.8 %
BELGIUM
59.7 % GERMANY
81.9 % CZECH REPUBLIC
75.6 %
SLOVAKIA MOLDOVA
74.8 %
AUSTRIA HUNGARY
71.6 % 46.0% ROMANIA
SWITZERLAND 15.0 %
FRANCE 63.0 %
54.9 % SLOVENIA CROATIA
59.0 % 54.6 %
BOSNIA AND SERBIA
ITALY
HERZEGOVINA BULGARIA
45.8 %
44.5 %
KOSOVO
MONTENEGRO MACEDONIA
PORTUGAL SPAIN ALBANIA TURKEY
48.7 % 46.2 %
GREECE
47.4 %
ALGERIA
MALTA
TUNISIA
MOROCCO
Source: Eurostat, ZWP online4 /// Graphic: REBMANN RESEARCH /// As of: 2018
European Markets /// Structures, Challenges and Scenarios /// ATLAS DENTAL /// ANALYSING STRUCTURES
Further specialisation strategies first re- population group, depending on the country poor oral hygiene. A further not insignificant
quire an analysis of potential involved. Caries are the main reason for the to- factor is tobacco consumption. With regard
tal loss of teeth among senior citizens. Between to paediatric dental hygiene, 14 % of children
Practice owners, dental laboratories, the dental 5 and 51 % of the 65 to 74 age group are affect- worldwide exhibit a lack of mineralisation of
industry and dental trade must be prepared to ed by this, depending on the region. The main enamel (MIH). Tooth substance is lost in 5 %
face the demographic development and the as- cause of caries and dental erosion is diet. Sugar of children, and they suffer from toothache as
sociate increase in chronic multiple illnesses, consumption in particular encourages caries a result.
including appropriate care people in need of bacteria and the formation of acids that at-
care and the elderly. This means that, through tack tooth enamel. Over 50 % of the European Socio-economic factors also heavily influence
greater mobility and networking with other population suffers from a periodontal disease, the prevalence of dental diseases. According
service providers, that the dentist too can also with 10 % of these individuals suffering from to the WHO, underprivileged, disadvantaged
differentiate him or herself more markedly a severe form. In the case of the 60 to 65-year- population groups who, generally speaking,
today. In addition, greater consideration of old population group, the proportion affected find it difficult to access dental care are dis-
diseases which are associated with oral health is as high as 70 to 85 %. The main factor con- proportionately affected. Preventive measures
could also close loophole in basic care. tributing to the development of periodontal are decisive when it comes to improving oral
diseases which can also lead to tooth loss is health. Consequently, the WHO recommends
Financing of dental services is heavily influ-
enced by political/regulatory requirements. Fig. 2 /// Dentists per 1,000 inhabitants
Two system variants are important when it
≥ 1.00
comes to public health care in European coun-
tries: the Beveridge model and the Bismarck 0.90 – 0.99
model: Beveridge systems are state systems, 0.80 – 0.89
with a health care network of doctors’ prac-
0.70 – 0.79
tices and hospitals financed through taxes EU average
0.74
to which all inhabitants have access. Systems 0.60 – 0.69
SWEDEN
of this nature are to be found in the United 0.50 – 0.59 0.77
Kingdom, the Scandinavian countries, Italy FINLAND
0.40 – 0.49
and Spain. Bismarck systems are social health No data
insurance models financed through the so- < 0.39
NORWAY
No data
cial security contributions of insured persons Not evaluated
ESTONIA
and their employers. There are three variants 0.95
of this system: standard regional or central LATVIA
0.73
insurance (France, Poland, Czech Republic), DENMARK
0.73 LITHUANIA
company/occupational and compulsory re- 0.99
gional insurance (Belgium, Austria), systems IRELAND
No data UNITED
with a free choice of insurer and competition
KINGDOM POLAND
between insurance providers (Germany, Neth- 0.52 NETHERLANDS No data
erlands, Switzerland). 0.39
BELGIUM GERMANY CZECH REPUBLIC
0.74 0.87 SLOVAKIA
0.75 No data
Oral health
AUSTRIA HUNGARY
FRANCE SWITZERLAND 0.57 0.62 ROMANIA
0.64 0.51 SLOVENIA 0.83
According to the WHO, there is a high preva-
0.69
lence of dental diseases in European countries. CROATIA BULGARIA
The main conditions affecting dental health 0.81 1.14
are caries, dental (acid) erosion and periodon- ITALY
SPAIN 0.82
tal diseases. Between 20 and 90 % of 6-year-old PORTUGAL 0.75
children suffer from caries while, on average, No data GREECE
No data
between 0.4 and 3.5 (depending on the coun-
try) of the remaining teeth are damaged in
the case of 12-year-olds.5 In the case of adults
aged 35 to 40, almost 100 % suffer from caries.
Between 10 and 20 teeth are affected in this
Source: Eurostat, ADDE/ FIDE8 /// Graphic: REBMANN RESEARCH /// As of: 2018
8 /// 9
a drastic reduction in sugar consumption, ac- density of dentist in these countries (namely (30 %) among dentists mean that, far from the
companied by legislative measures such as the France, Switzerland, Austria and Hungary) low dentist density improving here in future, it
introduction of taxes on beverages and food- is, if anything, average to low. With 0.39 den- is more likely to worsen in the wake of Brexit.
stuffs containing sugar or the introduction tists per 1,000 inhabitants, the Netherlands The number of foreign dentists practising in
of mandatory labelling for the sugar content are the only “red blemish” on the European the United Kingdom how are leaving has al-
of products. Fluoride also plays a key role map (at least in terms of the countries exam- ready intensified.
in reducing levels of caries. In order to reach ined) and, consequently, the worst performer
the entire population, the WHO recommends in the comparison of countries. This shortage In principle, per capita expenditure for dental
fluoridation of drinking water, salt or milk and of practising dentists can be traced back to treatment (Fig. 3) divides Europe into three
use of toothpaste containing fluoride.6 the high training figures in the 1980s and the zones. The western zone encompasses the
subsequent closure of some dental faculties. In United Kingdom and France with average
Dentists the United Kingdom, significantly more den- to slightly below average per capita expendi-
tists are registered than are actually practising ture. The central “green” zone indicates high
Fig. 2 indicates that north and south of Eu- (registered dentists: 41,705; actually practising: per capita expenditure in Sweden, Denmark,
rope, which is well supplied in dental terms, 34,760). A growing problem with regard to re- Germany, Austria and Switzerland. The east-
are divided by a yellow and orange belt. The cruitment and sharp fluctuations of personnel ern zone reflects the extremely low per capita
expenditure in countries such as Finland, Es-
Fig. 3 /// Per capita expenditure for dental services in € tonia, Latvia, Lithuania, Poland, Slovakia, Slo-
venia, Hungary and Greece.
≥ 400
300 – 399 In the majority of European countries (with
250 – 299
only a few exceptions, such as the United
Kingdom or Spain, etc.) the provision of den-
200 – 249
tal services is currently (still) characterised by
150 –199 conventional sole practices. 24 % of all dentist
SWEDEN
100 – 149
EU average
156 283.31 in the United Kingdom and 25 % in Spain are
FINLAND organised in chains (see Fig. 30, p. 51). The
50 – 99
93.25 number of practising dentists in Europe has
< 49
NORWAY only risen marginally in recent years. Spain in
No data
Not evaluated
ESTONIA
particular has experienced a significant rise in
88.92 the number of practising dentists (for the peri-
LATVIA od 2010 – 2015: + 23 %). On the other hand, the
47.21
DENMARK number of dentists practising in Denmark and
284.32 LITHUANIA
38.75 Lithuania is declining.
IRELAND
122.42 UNITED
KINGDOM POLAND
129.83 NETHERLANDS 31.88
192.74
BELGIUM GERMANY CZECH REPUBLIC
153.23 330.86 SLOVAKIA
68.77 49.97
AUSTRIA HUNGARY
FRANCE SWITZERLAND 213.44 50.52 ROMANIA
163.35 439.3 SLOVENIA No data
52.35
CROATIA BULGARIA
No data No data
ITALY
SPAIN 179.88
PORTUGAL 164.6
No data GREECE
62.89
Source: OECD, REBMANN RESEARCH, Eurostat7 /// Graphic: REBMANN RESEARCH /// As of: 2018
European Markets /// Structures, Challenges and Scenarios /// ATLAS DENTAL /// ANALYSING STRUCTURES
Dental laboratories worldwide volume of more than USD 4.5 bil- A growth in dental tourism (especially in
lion in 2016, and it is expected to grow to USD the Asia-Pacific region)
The remuneration of dental prostheses in Den- 8.4 billion by 2025. The reasons for this are a
mark, Germany, the Netherlands, Switzerland reflection of the situation in the overall dental With regard to concentration processes, the
and Hungary was examined in greater detail market: implant market has also become an example
in a comparison of countries by the Institute for mergers and acquisitions to position itself
of German Dentists (IDZ, Cologne). Overall An ageing population on markets worldwide. Simultaneously, indi-
prices for prosthetic services (dental fee plus A trend towards group, multi-unit and vidual medium-sized enterprises remain very
material and laboratory costs) in Germany are corporate dental practices competitive.
in the middle range and roughly comparable Technological advances in areas such as
with Denmark and the Netherlands. However, CAD/CAM systems, intraoral imaging, At 22 %, the proportion of manufacturers
if material and laboratory costs are considered digital radiography, caries diagnosis and supplying dentists or laboratories directly is
on their own, these are the second highest in computer aided implantology. highest in Germany.11 In many other Euro-
Germany, directly after Switzerland. With lab- An increasing demand for particularly pean countries, especially the Netherlands,
oratory costs accounting for 61.3 %, Germa- sophisticated aesthetic cosmetic dental Switzerland and the Czech Republic, sales are
ny is around 10 % higher than the average of treatments conducted almost exclusively through dealers.
50.7 % for the countries examined.9
Fig. 4 /// Inhabitants per km²
≥ 400
Manufacturers/Trade
300 – 399
About 95 % of all medtech companies, in- 250 – 299
cluding those involved in dental medtech, are
200 – 249
organised as small and medium-sized enter-
prises (SMEs). They are highly innovative and 150 –199
SWEDEN
strong exporters. These companies generally 100 – 149 24.4
employ fewer than 250 people. The most im- EU average FINLAND
30 – 99 117.5
portant dental market is North America, fol- 18.1
lowed by Europe. Emerging Asian economies < 30
NORWAY
16.9
such as India, China, South Korea, Malaysia, Not evaluated
ESTONIA
Thailand and Singapore should offer a growing 30.3
market due to their rising per capita income. LETTLAND
31.0
Germany has by far the largest trading volume DENMARK
136.4 LITHUANIA
in Europe. The German market is regarded as 45.8
the world‘s leading market in the dental sec- IRELAND
69.3 UNITED
tor. Manufacturers expect sales to increase
KINGDOM POLAND
for 2018, especially in the area of materials. In 270.5 NETHERLANDS 123.6
the export business, manufacturers recorded 498.2
BELGIUM GERMANY CZECH REPUBLIC
an increase in sales, particularly in the target 372.1 233.1 SLOVAKIA
136.8 111.5
regions of Western Europe and the Far East.10
AUSTRIA HUNGARY
FRANCE SWITZERLAND 105.9 ROMANIA
105.5 210.1 SLOVENIA 84.1
According to a forecast of the US market re-
102.5
search institute Renub Research, the global CROATIA BULGARIA
dental market (dental diagnostics and dental 74.6 64.8
surgical equipment) will grow by more than ITALY
SPAIN 203.6
USD 10 billion by the year 2022. Global sales of PORTUGAL 92.5
113.5 GREECE
dental equipment amounted to USD 12.8 bil- 69.3
lion in 2016. This is expected to grow further
to USD 17.8 billion by 2022.
Particularly healthy growth is also predicted
for the implant market. This market reached a
Source: Eurostat13 /// Graphic: REBMANN RESEARCH /// As of: 2018
10 /// 11Currently, increasingly protectionist tenden- Massive effects on trade are also feared in the dental care is provided on a widespread basis.
cies in world trade, an imminent Brexit and event of a hard Brexit. The map shows green values for the densely
trade conflicts, especially between the USA populated United Kingdom and some coun-
and China, are a cause of worry. China‘s eco- tries in Central Europe. The further one moves
nomic growth in the third quarter of 2018 has Infrastructure/young dentists away from the centre of Europe, the larger the
already fallen to its lowest level since 2009 (at area of countries such as Sweden and Finland,
only + 6.5 % when compared to the same pe- This study illustrates some indices that en- France and Spain, Romania, Bulgaria and
riod the previous year). As a few US special deavour to portray the infrastructural frame- Greece become and, generally speaking, the
duties on imports from China have only been work conditions of a country. These include more difficult it is to provide care, especially
in force since September 2018, their impact is the DESI Index which measures the level of far away from major cities.
expected to be considerably greater in 2019. digitisation of European countries. In addi-
According to the Federation of German Indus- tion, the GC Index reflecting competitiveness Figure 5 shows the number of dental gradu-
tries (BDI), these conflicts have not yet affect- is shown, as is the GI Index for innovativeness. ates per 100,000 inhabitants. Very high levels
ed German exports. However, the BDI sees an Figure 4 illustrates the population per km2 as of up-and-coming talent (depicted in green)
urgent need for political action to avoid future a key infrastructural feature. The larger an can be found in, for example, Romania. Many
negative consequences for international trade. area is, the more difficult it is to ensure that countries have significant entry barriers such
as the numerus clausus or high tuition fees.
Fig. 5 /// Dental graduates per 100,000 inhabitants Some Eastern European countries, such as
Hungary, Bulgaria and, above all, Romania
≥ 7.0
are producing astonishing numbers of gradu-
4.0 – 6.9 ates in dentistry. Spain and Portugal are also
3.5 – 3.9
currently educating an above-average number
of dentists. In Western Europe, where demo-
3.0 – 3.4
graphics seemingly have the strongest impact
2.5 – 2.9 on the future, levels of up-and-coming talent
2.0 – 2.4
EU average
2.74 2.33 are rather average (Germany) to critical (Ita-
FINLAND ly, Netherlands). Today‘s prospective dentist is
1.4 – 1.9
2.01 likely to be more internationally oriented and
< 1.3
NORWAY location-independent.
No data
Not evaluated
ESTONIA
1.9
LATVIA
3.26
DENMARK
No data
IRELAND
1.65 UNITED
KINGDOM POLAND
1.80 NETHERLANDS No data
1.34
BELGIUM GERMANY CZECH REPUBLIC
2.23 2.91 SLOVAKIA
2.97 No data
AUSTRIA HUNGARY
FRANCE SWITZERLAND 1.53 ROMANIA
1.79 1.53 SLOVENIA 10.46
3.34
CROATIA BULGARIA
No data 3.5
ITALY
SPAIN 1.32
PORTUGAL 3.71
6.5 GREECE
No data
Source: Eurostat, ADDE/ FIDE12 /// Graphic: REBMANN RESEARCH /// As of: 2018
European Markets /// Structures, Challenges and Scenarios /// ATLAS DENTAL /// ANALYSING STRUCTURES1,000 inhabitants15
No. dentists per
Schleswig-Holstein
2,383
GERMANY
Mecklenburg-Vorpommern
Hamburg 1,423 ≥ 1.00
Bremen 2,033
547 Lower Saxony Berlin 0.90 – 0.99
Germany is Europe‘s “Dentalland”, achieving 4,286
6,639
peak values both in terms of consumers and Brandenburg 0.80 – 0.89
Saxony-Anhalt 1,967
suppliers. At 82 %, utilisation of dental services North Rhine-Westphalia 1,919
is among the highest in Europe, since statutory 14,631 0.70 – 0.79
Saxony
and private health insurance funds cover about Thuringia 3,905
Hesse 2,025 0.60 – 0.69
70 % of dental services. The population density 5,569
of its almost 83 million inhabitants fluctuates Region/Federal state/etc.
Rhineland-Palatinate 0.50 – 0.59
strongly on a regional level. Around 75 % of the 3,045 No. practising dentists
population lives in in towns and cities. Ger- 0.40 – 0.49
man health expenditure totalled € 374.2 billion Saarland Bavaria
674 11,787
in 2017. Its share of GDP has risen steadily in Baden-Württemberg < 0.39
recent years to a current (2017) level of 11.3 %. 9,093
The healthcare market is therefore growing Not evaluated
significantly faster (2017: + 5 %) than the econ-
Graphic: REBMANN RESEARCH
omy as a whole (2017: + 2.2 %).14 Around 7.4 %
(€ 27.4 billion) of health expenditure can be
attributed to dental practices. In terms of per
capita dental spending, Germany scores in the the demographic situation in Germany, which involved in care) is responsible for organising
upper middle range across Europe at € 331, but has one of the highest median ages (46 years) care. Health insurance contributions (which
is still a third below the Swiss average. Provid- in Europe, nevertheless raises many questions are split and borne equally by employees and
er structures are correspondingly pronounced for the future. This applies in particular to the employers) are paid into the health fund,
in Germany. When compared to the rest of financing of an increasing demand for dental from which insurers are allocated their funds
Europe, there is an above-average provision in services and dental innovations. According to through a risk structure compensation scheme
almost all states in Germany, with the figure a study conducted by the Institute of German adjusted to take morbidity into consideration.
on a federal level being 0.87 dentists/1000 in- Dentists (IDZ), an increase in employment of Insured persons can freely select their doctors
habitants. City-states such as Berlin (1.21) and around 20 % is expected in the area of dental (and dentists). Private households are the most
Hamburg (1.13) are “dentist metropolises”, but care by 2030. This means approximately 65,000 important payers for dental care under the SHI
are still surpassed by, for example, the Czech additional dental health and dental technology system, with an average of 29.8 % of dental
capital Prague. Only Saarland, with a figure professionals and around 11,000 additional re- costs being paid privately (supplementary den-
of 0.68, still exhibits a value slightly below the tailers of oral health products. Growth effects tal insurance or out-of-pocket). Germany is,
European average. However, more in-depth should be generated primarily through the by European standards, the country with the
Atlas maps indicate that there are also many privately financed, so-called “second health highest share of public funding. Associations
regions in Germany with dental care problems. market”. for panel doctors (and dentists) are responsi-
Despite this, the supply of young dental profes- ble for ensuring outpatient care. Around 15.4
sionals remains intact, as demonstrated by the Demand structures million people (16.6 % of those with statutory
slightly above-average quota of dental gradu- health insurance) had supplementary dental
ates. In cross-European comparison, the den- In terms of caries experience, periodontitis insurance at the end of 2016 (a quadrupling of
sity of dental technicians also reaches a peak and complete edentulism, Germany achieves the figure since 2000). Statutory health insur-
value in Germany, with a dental technician for top marks in oral health in an international ance provides full coverage
almost every dentist. At € 7.5 billion, costs for comparison. Public social insurance exists
dental prostheses are very high, and the lab- which is mandatory up to an upper income ■ for prophylactic measures in the case of
oratory density is also above average with 0.2 limit (Bismarck model). The dual system of children and adolescents,
dental laboratories per 1,000 inhabitants. Most private (PHI) and statutory health insurance ■ for two prophylactic examinations per year,
manufacturers offer their products through (SHI) is unique in Europe. Approx. 10.5 % of ■ for necessary conservative and surgical
specialist dental dealers, but around a quarter the population is privately insured. SHI cur- treatments (including in the home environ-
also does business through direct sales. In the rently consists of about 109 individual funds. ment and nursing homes if necessary) and
dental trade, the ratio of dentists to each den- The state specifies the framework conditions, ■ necessary orthodontic treatments for adoles-
tal dealer (435:1) is above average. However, while local self-administration (everybody cents up to 18 years of age.15
12 /// 13In the case of costs for dental prostheses, the The average age of dentists involved in dental (ZFA) is a prerequisite for admission to stud-
own contribution rate is 50 % or higher (de- care has increased steadily in recent years, ies.
pending on the form of care selected). The reaching 48.6 at the end of 2016, with female
fixed allowance increases by 20 – 30 % in the dentists on average younger (45.5) than their The number of people working in dental prac-
case of regular visits to a dentist.15 male counterparts (51.1).15 tices has increased over the past decade by
around 53,000 to 365,000 (2017). However,
In 2017, 3,819 orthodontists, 3,175 oral sur- despite an absolute increase in jobs, services
Dentists/Practices geons and 1,733 oral and maxillofacial sur- offered in dental surgeries have been steadily
geons were active in dental medicine.15 There declining since 2011 as a proportion of total
Of roughly 72,000 practising dentists, around are also many practices specialising in one health expenditure.
61,900 were working in panel dental care for area, or groups of practices offering services
outpatients in 2017, with about 11,200 of these that focus on one or more specialities. A total of 69,075 dental operations were per-
employed as dentists. The density of dentists formed in German hospitals in 2017. Most
throughout Germany has increased consider- In contrast to some other European coun- of the procedures involved tooth extractions
ably since the year 2000. The number of dental tries, the job of dental hygienist is not an in- (25,620 cases), followed by tooth removal
students in the winter term from 2017/2018 dependent profession in Germany, but a career through osteotomy (23,893 cases). In third
was 15,151, of which about 64 % were female. In advancement for qualified dental assistants place was gingival modelling (gingiva plasty:
contrast to the number of dentists, the number (ZFA). Dental hygienists in Germany work 11,533 cases) following extensive periodontal
of dental practices has been steadily declining under the supervision of a dentist. The focus treatment or implantations.17
since 2010. Dental care continues to be largely of dental hygienists is oral prophylaxis as part
provided by individual practices (82 %), and of the pre- and follow-up treatment of perio- (Public) expenditure for dentures only in-
small practice structures also dominate in the dontal disease. A bachelor‘s degree in dental creased in five years by 5.8 % (+ € 179 million).
case of group practices (87 % of group practices hygiene also exists since summer 2014, where a By contrast, all other dental services clearly in-
have two owners).16 completed apprenticeship as a dental assistant creased in the double-digit range. The largest
Fig. 6 /// Structural profile – Germany
80,000 90 Mio. 30 13 48 85 30 Mrd. 500 100 1.0 4.5 4 0.25 1 5 100 23 600 600 75 90 70
82,850,000
22.0 %
€ 27.41 bil.
81.9 %
0.94
0,87
82.80
46.0
0.2
4.06
435.92
58.39
27.6 %
€ 330.86
0.74
2.91
72
3.41
55.62
2,74
55,5
50.85
43.1 60.1 72.9
11
€ 39,389
0.46
25,6 270.08
233.10
0.09
34
30.0 %
1.69
156 1,74
30,000
171
1.70 %
2,11
30.0 %
10.000 0 22 -2 38 35 0 0 20 0.2 0.5 1 0 0 1 0 0 0 0 30 55 30
GDP per inhabitant
Population
Population share 60+
Population development
(growth) up to 2030
Median age of population
Utilisation of dental services
Market volume of dental practices
Per capita expenditure
for dental services
Share of private costs for
services in dental practices
Dental graduates per
Number of dentists
Dentists per practice
Dental laboratories per
Dental technicians per dentist
Dental technicians per dental lab
Goods procured by dentists
per dental trader
Inhabitants per km²
Degree of digitisation (DESI Index)
Competitiveness (GC Index)
Innovativeness (GI Index)
Dentists per 1,000 inhabitants
100,000 inhabitants
1,000 inhabitants
via the internet
Share of direct sales
XXX Ø EU XXX Ø 10 countries (study)
Highest utilisation of Lowest private contribution Greatest dental lab and Highest quota of dental Very high competitiveness
dental services to dental services dental technician density manufacturers with direct sales and innovativeness
Source: Eurostat, OECD, European Commission, ADDE/FIDE, World Economic Forum, Cornell University, INSEAD, WIPO and others /// Graphic: REBMANN RESEARCH /// As of: 2018
European Markets /// Structures, Challenges and Scenarios /// ATLAS DENTAL /// ANALYSING STRUCTURESFig. 7 /// Endodontic specialists Fig. 8 /// Dental practices with labs
249 329
Hesse: 7,040 inhabitants per dentist Brandenburg: 21,959 inhabitants per dentist
84 28
63 14
42 0
21 -14
0 -28
-33 -43
Percentage deviation from average
Percentage deviation from average
This map illustrated the density of den- This map illustrates the density
tists in Hesse (Germany) specialising in of dental practices in Brandenburg
endodontics. Green areas are regions in (Germany) with their own lab.
which there are still good opportuni- The fewer own labs calculated per
ties for specialising from a competitive inhabitant, the less the competition,
point of view. hence the green colouration.
Source: www.ATLAS-MEDICUS.de /// As of: 2018 Source: www.ATLAS-MEDICUS.de /// As of: 2018
area of spending, namely conservative surgical treatment, also grew the consisted of 7,211 commercial dental laboratories, to which 11,290 prac-
strongest in absolute terms (+ € 1,469 million or + 22.6 %). With regard tice laboratories with and without dental technicians can be added.18
to absolute spending, this is followed by the “Other” category which,
in percentage terms, increased most dramatically (+ € 144 million and 70.1 %, or 5,056 labs are among the small laboratories classified in the
+ 41.7 %, respectively). The field of orthodontics grew by € 125 million, turnover tax bracket under € 500,000. Their share of overall turnover
or 12.8 %. Spending on periodontal treatment increased by € 67 mil- was 26.0 % in 2016. “Medium-sized laboratories” include 29.4 % (2,117)
lion (+ 17.3 %), while turnover from individual prophylaxis (IP) grew by of laboratories which are in the turnover tax class between € 500,000 and
€ 63 million (+ 13.3 %). Overall, this review illustrates that the dental € 5 million. Only 0.53 %, or 38 laboratories achieve a turnover exceeding
service spectrum is shifting due to improving oral health and increasing € 5 million. However, these laboratories have a total market share of
health awareness. The need for dental prostheses is increasingly shifting 21.4 %. The largest proportion of commercial laboratories (72 %, or 5,195
into advanced age.16 laboratories) generates turnover of between € 100,000 and € 1 million.
Operational figures have been steadily declining since 2012, with small
businesses in particular being affected by this development. Of a total
Dental laboratories of around 64,700 dental technicians, around 49,500 were working as
employees in 2017. Over 85 % of dental technicians work in commercial
The German dental laboratory market is highly fragmented, with dental laboratories.20
around 19,500 commercial dental laboratories and laboratories in prac-
tices active. Approximately 32 % of all dental practices have their own Total expenditure on dental prostheses in 2016 was € 7.51 billion. This
laboratory (55 % of them with dental technicians). Spending per mem- related to services provided by both commercial dental laboratories and
ber of the statutory health insurance was € 249.81 in 2016 for treatment practice laboratories.21 The turnover of commercial dental laboratories
by dentists, including dental prostheses, and € 190.75 for treatment subject to VAT was around € 5 billion in 2017. Turnover development
without dentures.16 in recent years was continually below GDP, with the turnover increase
in 2017 being 1 % when compared to the previous year. The volume of
When one only considers those businesses subject to VAT and disre- services is declining and, despite annual increases in remuneration,
gards micro-enterprises, the German dental laboratory market in 2016 spending for dental prostheses has hardly grown in recent years. The
14 /// 15reason for the decline in the volume of ser- 30 % (see also p. 55).23 More than half of dental Overall, the German medtech market contin-
vices is primarily explained by the increased prostheses manufactured abroad are produced ues to develop very positively. The domestic
oral health of the population. The demand in China, with Turkey and the Philippines be- market recorded an increase in sales of 4.2 % in
for dental services is shifting more and more ing further important countries of origin.24 2018 compared to the same period for the pre-
towards restorative dentistry/prevention and The increasing demand for high-quality, indi- vious year. Medtech exports to EU countries in
(due to the growing importance of aesthetics) vidual products and, also, the growth in CAD/ the first half of 2018 only slightly exceeded pre-
higher value care through which laboratories CAM parts produced very cheaply and quickly vious year‘s level (+ 0.8 %). However, the situa-
can compensate somewhat for the decrease in practices, dental laboratories and manufac- tion with regard to profitability remains tense
in volume. On the other hand, baby boom- turing centres put the importance of foreign due to falling prices and increased costs. In ad-
ers maturing into “best agers” and increasing prostheses into perspective.25 dition to economic reasons and the impending
cooperation with nursing facilities combined Brexit, this development is chiefly attributable
with better billing options for the dental care to increasing regulatory requirements (main-
of nursing home residents are having a positive Manufacturers/Trade ly due to the new European Medical Device
effect on future prosthetic needs. These devel- Regulation [MDR]). Nevertheless, investments
opments are tempering the decline in the vol- After the USA and China, Germany is the in German production locations grew and re-
ume of dental prostheses which, nevertheless, third-largest producer of medical technology search spending also tended to increase. Ger-
will continue in future. The frequency of pros- in the world. Heavily characterised by small man medtech enterprises currently invest on
thetic care and restorations decreased by 9 % and medium-sized enterprises (approx. 11,000 average 9 % of their turnover in R&D.26, 28 The
in the period from 2006 to 2016, while single micro-enterprises < 20 employees and around German medtech industry is regarded as high-
crowns (+ 10.8 %), bridges (+ 8 %) and telescop- 1,300 companies > 20 employees), the medtech ly innovative with short product development
ic prostheses (+ 18 %) increased significantly.16 industry provides around 200,000 jobs. About cycles. The annual turnover of the entire Ger-
9 % of turnover is invested in research and de- man medical technology sector was around
As well as being evidence of increased oral velopment each year.26 € 30 billion in 2017.26
health, this also indicates a clear tendency
away from removable to fixed prostheses. Con- The German market is regarded as the world‘s In its Survey 2018, the Association of Dental
versely, the volume of services increased by leading market in the dental sector. German Dealers in Europe (ADDE) lists 165 dental
27.5 % in the area of orthodontics from 2006 dental companies are market leaders in nu- trade companies for Germany, of which 120
to 2016 and by as much as 86.5 % in the area merous areas. The 200 mostly medium-sized are so-called full-service providers whose mar-
of mandibular fracture/temporomandibular enterprises which are members of the Associa- ket share amounts to around 52 %. According
joint disease, presumably due to the increased tion of German Dental Manufacturers (VDDI) to the ADDE, dental products marketed exclu-
need for occlusal splints.16 represent 85 to 90 % of the German dental sively through distance selling (online, cata-
market. According to the VDDI, the range of logues, etc.) only account for a market share of
Very little reliable market data has been avail- services offered by the German dental indus- around 18 % in Germany.
able to date to indicate the degree to which try includes more than 60,000 products in
the stagnating volume might be offset by of- the areas of equipment, devices, instruments
fering higher-quality service. A study on the and materials covering the entire spectrum
cost of dental prostheses indicated that 59 % of dentistry, from diagnosis and prevention to
of patients pay over € 1,000 for prostheses, restoration/therapy. Solutions are also offered
with 19 % paying more than € 5,000.22 Many for the dental laboratory sector. VDDI mem-
people simply cannot afford their own con- bers alone provide work for 20,700 employ-
tribution towards dental prostheses. This was ees. The numbers employed by VDDI mem-
revealed in a household survey conducted by ber companies have risen by more than 22 %
the Federal Statistical Office in 2016. 44.3 % of since the year 2000. Typical characteristics of
respondents (48.4 % of those at risk of poverty) German dental companies are a high degree
decided against visiting a dentist for necessary of specialisation, high development costs, an
treatment due to financial reasons.19 Dental above-average patent quota and a high level of
prostheses from abroad exert additional com- vertical integration. VDDI member companies
petitive pressure on laboratories working in a achieved sales of around € 5.3 billion in 2017,
conventional manner. Exact data on the mar- with exports accounting for 62 %. Growth out-
ket share of foreign prostheses is not available, side Germany was 5.9 % higher in 2017 than
with estimates differing widely between 10 and domestically (+ 2.8 %).27
European Markets /// Structures, Challenges and Scenarios /// ATLAS DENTAL /// ANALYSING STRUCTURES1,000 inhabitants29
No. dentists per
BELGIUM East Flanders
Antwerp
1,175
Limburg
≥ 1.00
0.90 – 0.99
West Flanders 1,055 3,045
Belgium occupies a very central location in Eu- 811 Brussels - Capital Flemish Brabant
rope and, with 11.4 million inhabitants, 65 % Region 3,045 0.80 – 0.89
of whom live in towns and cities, is one of the 3,045
most densely populated countries (372 inhabi Walloon Brabant
Liège
0.70 – 0.79
3,045
tants/km2). In addition, a strongly technical Hennegau 3,045
infrastructure ensures that the country‘s im- 667 0.60 – 0.69
age appears above average in Europe in terms Namur
299 0.50 – 0.59
of innovation, digitisation and competitive-
ness. These factors are also the reasons why Region/Federal state/etc. 0.40 – 0.49
Belgium is forecasting relatively strong pop- No. practising dentists Luxembourg
ulation growth until 2030. Overall, therefore, 159
< 0.39
the country also offers first-class framework
conditions for the dental market. This contin- Not evaluated
ues to lead to a rather average existence in Bel-
Graphic: REBMANN RESEARCH
gium, with per capita expenditure of € 153 on
dental care being just below the average for the
countries examined here. The market volume
is € 1.75 billion. Utilisation of dental services both schemes since 2008. Private insurance Dentists/Practices
and the density of dentists both fairly accu- providers only account for a small share of the
rately reflect the average. What is noticeable is market. A national health insurance institute Belgium has some regions such as Brussels and
the relatively low private share of 48 % which administers the entire health system and dis- Flemish Brabant which enjoy a high level of
patients have to bear themselves for dental ser- tributes funding to health insurance providers. service. The density of dentists there is almost
vices. On the one hand, this makes the dental It also negotiates tariffs for a duration of two twice as high as in Hainaut or the province
market less susceptible to cyclical fluctuations years at a national level with representatives of of Namur. Due to the relatively small area, it
but, on the other, it also restricts the supply of doctors (and dentists). This “convention” must is assumed that even in less well-serviced re-
innovative forms of treatment, as these would be signed by the health minister. All individ- gions, a large part of the population can reach
place too great a burden on the state system. ual doctors are then obliged to agree to this. a dentist by bus or car within 15 minutes. The
Physicians are free to practice as “convention approximately 8,300 dentists in Belgium work
doctors” or to apply their own tariffs (which in around 4,050 practices. This means that, on
Demand structures are remunerated lower). Individual contracts average, there are 2.04 dentists to a practice,
cannot be concluded between insurance firms which overall is an above-average figure for the
In Belgium, 99 % of the population is in a com- and providers. Patients are free to choose their countries examined here. In the neighbouring
pulsory insurance system (Bismarckmodel). doctor, hospital and insurance. Netherlands, this figure is just 1.25 dentists per
This consists of six private health insurance practice. Numerous dentists restrict treatment
funds and one public health fund. Insurance Health expenditure in 2017 was € 43.8 billion, exclusively to private patients. Following a
contributions are income related, not risk re- with around 75 % of this being covered by five-year master‘s degree, general dentists then
lated. Two insurance schemes exist: taxes and social security. 3.1 % of all govern- complete their studies with a one-year intern-
ment spending on health care in Belgium is ship. Having acquired their masters, they can
■ Major risks: hospital care, obstetrics, spent on dentistry.30 Despite the relatively good specialise further as an orthodontist, implan-
elective surgery, dialysis, rehabilitation, dental care cover provided by the compulso- tologist or periodontist.31 Belgium also has
implantations and consultant care. ry insurance, utilisation of dental services is a problem when it comes to up-and-coming
■ Minor risks: medical consultations, only average at around 60 %. The more private talent, as the rate of dental graduation is sig-
dentist, minor surgery, home care, medical system in the neighbouring Neth- nificantly below average. Whereas a European
medication in the outpatient sector. erlands obviously offers more mobili sation comparison shows that 2.74 graduates are edu-
incentives, and utilisation there is around 20 cated for every 100,000 inhabitants, the figure
Self-employed persons previously only insured percentage points higher. in Belgium is only 2.23. Although the problem
for major risks are obliged to pay insurance for regarding young talent is not as great as in the
16 /// 17Netherlands, supply constraints, especially in medical technology import rate is 80 %. Clin-
the already underserved regions, could soon ic projects are opening up very good business
emerge, given the steadily growing population. opportunities.32
About one quarter of all dental instruments
Dental laboratories and X-ray appliances originates in Germany.33
Belgium has only half as many dental labora- The proportion purchased by dentists via the
tories per 1,000 inhabitants as the 10 countries internet is significantly below average in Bel-
which are the focus of this study. With 0.15 gium. In the neighbouring Netherlands, this
dental technicians per dentist, only one third trend is three times as pronounced. At only
of the average value is achieved. Additionally, 5 %, the share of manufacturers involved in
with 2.08 dental technicians, the dental labo- direct sales is also considerably below average
ratories are small to a below-average degree. in Belgium (see Fig. 9). The sale of dental con-
sumer goods and consumables clearly takes
place through dealers. Since there are relatively
Manufacturers/Trade many dental dealers and, by comparison, only
an average number of dentists, the number of
The Belgian medtech market is forecast to dentists per dental dealer, namely 202, is also
grow by 23 % in the period from 2016 to 2019 below the average of the 10 countries focused
to attain a volume of € 2.5 billion. Around 300 on here.
medical engineering companies are registered
in the beMedTech association (formerly Un-
amec), with 250 of these involved in sales and
only 40 enterprises producing themselves. The
Fig. 9 /// Structural profile – Belgium
80,000 90 mil. 30 13 48 85 30 bil. 500 100 1.0 4.5 4 0.25 1 5 100 23 600 600 75 90 70
60.78
0.74
0,74
372.10
72
7.25 %
76.60
3.41
2.74
55.5
49.85
50,85
59.1 %
43.1 60,6 72,9
11
€ 38,307
0.46
25,6 270,08
2.23
2.04
48.0 %
41.6
201.86
€ 153.23
0.09
24.5 %
34
152,55 1,74
30.700
2.08
171
2.08
5.0 %
20.0 %
0.05
11,413,058
0.15
Market volume of dental practices € 1.75 bil.
10,000 0 22 -2 38 35 0 0 20 0.2 0.5 1 0 0 1 0 0 0 0 30 55 30
GDP per inhabitant
Population
Population share 60+
Population development
Dental graduates per
Dental laboratories per
Degree of digitisation (DESI Index)
(growth) up to 2030
Median age of population
Utilisation of dental services
Per capita expenditure
for dental services
Share of private costs for
services in dental practices
Dentists per practice
Dental technicians per dentist
Dental technicians per dental lab
Goods procured by dentists
via the internet
Share of direct sales
Number of dentists
per dental trader
Inhabitants per km²
Competitiveness (GC Index)
Innovativeness (GI Index)
Dentists per 1,000 inhabitants
100,000 inhabitants
1,000 inhabitants
XXX Ø EU XXX Ø 10 countries (study)
Very good population Private contribution to Dental lab market below Relatively few dentists Very good
forecast until 2030 dental services < 50 % average small per dental dealer infrastructure indicators
Source: Eurostat, OECD, European Commission, ADDE/FIDE, World Economic Forum, Cornell University, INSEAD, WIPO and others /// Graphic: REBMANN RESEARCH /// As of: 2018
European Markets /// Structures, Challenges and Scenarios /// ATLAS DENTAL /// ANALYSING STRUCTURESYou can also read
