We're good? Perfect. Hello, everyone. Good afternoon. This is Rachel Vatnsdal with the Life Science Tools and Diagnostics team here at J.P. Morgan. Today, we're gonna have Envista's presentation. As is typical with most of these breakout sessions that you've been in, it'll be 20 minutes of a presentation and then roughly 20 minutes of Q&A. So with that, I will invite Amir and Stephen up to the podium.
Thanks for having us here. This is over four years since we have been independent as an independently publicly traded company. Wanted to give you a quick status update of our transformation, where we are, and what to expect moving forward. You are familiar with that, I'm not gonna read it. Simply put, that we are keeping the 2023 guidance that we had provided before, that's intact. We are working through it. It's been a challenging year. A lot happened during 2023. We have been able to manage through it. But when we look at it, the macro environment continues to remain really volatile and across the board. You got the geography aspect of it, interest rate, as well as resource.
When you talk to DSOs, one of the biggest problem that they have is recruiting, maintaining, and getting resources in order to be able to expand in different geographies. And then the macro issues around the geopolitical continues to be a forefront. You had the Ukraine to begin with, now in Israel, we have a company in outside Tel Aviv that has been impacted by it, but we are trying to manage through it, and a lot of that is kind of thing that we cannot plan for it, respond to it. We're trying to put our energy around what we can control. In the past four years, we have completely changed our portfolio through a series of exit, acquisition.
We have put ourselves in a really different place, and we expect to expand margin as we go forward and expect to see growth accelerated over time. That's a promise we made when we came out of Danaher, that this independent company is gonna be a lot faster, a lot quicker in getting margin expansion, growth trajectory to be built and focused on a specialty. In the past four years, we have been able to prove that, and we continue to make progress toward that journey. We're about $2.5-$2.6 billion company, over 13,000 employees, about half of them in manufacturing, distribution. About 50% of our business is in North America. But for those of you who may not know our history, only four years ago, about 55% of our business used to be equipment and consumable.
Today, that number is less than 40%. 60% of our business is sold directly, is ortho as well as implant. Over 80% of our business is now consumables, is things that people use on an ongoing basis, and even on our equipment business, we have a really different mix than what we had only 4 years ago. We have completely transformed our mix over time. We report in 2 different segments, equipment and consumable, and a specialty business. Basically, implant, ortho, and a specialty which is sold directly, and equipment and consumable, which is sold indirectly. About 60% of our business is implant and ortho, and the other 40% is divided between categories such as imaging, restorative, endodontic, as well as infection prevention. Emerging market continues to play an important role in our growth.
Despite some of the challenges that we have seen in the past couple of years, we're committed to it. We have significant presence in different geographies, such as China and others, and we're gonna continue to see that over years. I wanted to talk a little bit about who we are, what we stand for. We see ourselves as a primary partner for clinician in order to improve people's lives. We come out of Danaher. We have that heritage of a continuous improvement, but we adjusted those values to reality of a dental market by putting customers in the center of what we do every day. Focus on patient, focus on the dentist. Innovation that matters and make a difference.
When normally people think about innovation, they think about product innovation, but we think about business innovation, how we are providing support and help to DSOs to be more productive. How do we think about long-term impact of what people do in dentistry in order to improve quality of life of a patient? Respect, diversity, and coming to work, being your authentic self. We have been able to make significant progress in changing the management structure. Out of the top 150 that run this company, about a third of them now are female, and we have been able to improve and grow our talent over the last four years. Continuous improvement is close to our heart and what we do every day.
Continuously look at what we can do to improve margin, to improve growth, to build a better company that we can be proud of, and leadership and accountability, making sure that we have a feeling of ownership for what we do at the local level. These values is what has really created differentiation for us and what is in the heart of the company that we have built in the past four years. We call them CIRCLE, and it is the acronym that starts from customer centricity, innovation, respect, continuous improvement, and leadership. We recognize people who really demonstrate that and make sure every year we have nomination, and we communicate that continuously. Let me talk about a little bit about the dental market. About $350 billion spent worldwide, and the growth, think about it as GDP plus.
The macro trend behind this continues to be that this is an industry that has legs over it for decades to come. I'll talk about it a little bit more as we get to various segment. Over 2 million dentists worldwide, and if you look at it, the best way to describe that penetration and access to dental care is through the number of dentists per capita. Places like Switzerland and Germany, you got 85 dentists per 100,000. You go further down in China, India, you, what you will see is only 6%-7% of people that have access to basic dental care. 65% American, they have access to it, doesn't necessarily mean they use it. Some of the key element why dental hasn't transformed is because of cost. Cost continues to be a major issue. Skill set.
It takes about 10 years for somebody to start practicing the basics of dentistry, pain, time to healing. There's opportunity for innovation in all of those areas. Last but not least, about $75 billion spent, suppliers in-lab and in-office, and there are plenty of players and some really good players in here making a huge difference. But the number of acquisition, the number of IPOs, the number of investment has accelerated greatly since 2019. You see this business not as necessarily as recession-proof, but recession-resilient. What we saw in 2018, what we saw in 2020 after COVID, is a really good indication this is an industry that can test over time, can prove the test of time, and can stay on its own. Goes through volatility to some degree, but over long run, has plenty of potential.
What is happening in the industry, a little bit of bifurcation. Bifurcation of specialties, people who do ortho, endo, and implant, and a whole lot of DSOs, that they are getting large number of people coming to this network. Not all DSOs are the same, but in United States, out of 150,000 offices, 200,000 dentists, about 20% of them are now owned by DSOs. The other thing that we see in the United States specifically, and beginning to replicate in other places, is group practices. four or five people coming together, creating something really different around digitization, customer self-service, providing better service to customers, and differentiating themselves over time. Why are we so excited about this market? It's because more and more there are evidence of oral health and overall health. You know that it has significant impact in diabetes.
Chewing your food, being able to really fully enjoy the quality of life is something that everybody deserves to have. A lot of undertreatment and many different variation of the treatment, and there are some procedures that is really difficult to postpone. If you don't go to an ortho treatment before age of 13 and 14, you're gonna have a whole lot of problem over time. So preventative becomes an important part of this equation. Pain management has always been at center of dentistry, aesthetic and pain management. And if you think in the long run, you would be able to do a lot of preventative through your DNA analysis, looking at your heritage, take a look at the kind of habits that you have and see what you need to do in order to really get yourself in a better place.
Last but not least, insurance coverage has had up and down in what they cover, what they do not cover, but there are a variety of different form or shape. Financial treatment is coming in place to be able to give people the ability to get that dental care that they want. This industry is underpenetrated, and the reason that it's underpenetrated, because it's not well understood, and it's not well communicated. It's not front and center. It should become a standard care. Everybody deserves to have it, and by democratizing this, you have an opportunity to really make a difference in the whole quality of life of people. Let me talk about two segment, why we are so excited about this specialty business. About 5 billion people, they have some level of malocclusion, that they can get better smile.
They can be able to get, you know, present themselves, have confidence if they have that ortho treatment. If you look at the number of cases that start every year, about 500 million people, they can really take advantage of it. They can go through a standard treatment, but at any point in time, over 20 million people have an ortho case start. To the best of our ability, we think that's about 23-24 million per year, and about two-thirds of them still are bracket and wire. So when you think about the clear aligner and possibility around clear aligner, only 8 million cases, and there are a lot more to be done in this space.
We're really proud of what we have done in here, and a lot of others really have become this clear aligner and dentistry in this space has become really more of a standard care. A lot more people talking about it. You see it in a lot more advertisement, and the variety of different form or shape, they're educating people the importance of this, and this is gonna have a positive impact, the industry as a whole, and for us specifically. The same thing on implant. Half of people, they have missing tooth. Half of people, four billion people, in this country, 45 million people, they're not able to chew their food. They're having problems, a lot of people over the age of 65. So this is an opportunity to really make a difference in here.
You take a look at how many people are actually getting implant. Every year, all implant companies combined, they sell over 20 million units of titanium screws. That's less than 5% penetration of people who can really use implant and change their life. There are 100 million 3-unit bridges are placed every year. The average life of a 3-unit bridge is five to seven years. You gotta come back and do it again. Insurance play in a role, but to a large degree, ability to teach people to use implant as a standard care is such an important factor in here. Implant is one of the most profitable procedures that anybody can do.
In order to really make it a standard of care, you gotta do a lot more training, you gotta do a lot more education, and you gotta simplify it so people are not afraid of doing it going forward. You look at these two segments, you look at what the next 10, 20, 30 years, there's plenty of opportunity to really digitize them, to change the standard care, to be a major player in order to improve the quality of life of people. We participate... You remember that $75 billion that we talked about? About $25 billion of it is our core focus area. And if you look at it, in each one of those segment, about $11 billion of it is treatment planning for missing tooth, from the time that you go to a diagnostic, to planning, to placement, as well as your provisiona. $11 billion.
We're the number two player in that space. Nobel has been around for 35 years. Yeah, looking back a little bit, we wanna acknowledge the heritage of Nobel, but there is plenty of opportunity for us to continue to make a difference in this space. We also have other value players, such as Implant Direct, as well as ABT, part of that portfolio of a billion-dollar business. In the orthodontics business, as I mentioned, about $6 billion. We're the number one, number two, depending on what segment you look at it on. Bracket and wire business, that business is flat to low single-digit growth. We have been taking share and been growing. In clear aligners, we're the fastest-growing clear aligner on the ortho side with the Spark and continue to make progress in there. Imaging, 2D, 3D, IOS, we're a new entry into the IOS segment.
We're the largest imaging provider worldwide, and with IOS now, we have an opportunity to really make a difference with software, putting all of that together. On an $8 billion consumable, we're No. 2, No. 3, depending on the category, and we have been—Some of our brands have been around for 130 years. We're the combination of over about 30 companies that was formed in dental inside Danaher from 2004 to about 2015, and we have been in this transformation and migration since then, and since becoming an independent company. What we wanna do in this space, we wanna digitize the industry by partnering with professionals. And the main reason behind it is inefficiencies that exist in the system.
Self-service, ability to really diagnose, use AI, put it in the cloud, do a better job on the planning so dentists can spend a lot more time with the patient to develop personalized plan, because there is an opportunity to truly democratize this industry. That's our model. That's what we wanna do in the decade to come. We have done a good job to get ourselves here. There's plenty more to do. In each segment, we think about customers, customer at the center of what we do. If you look at it on our diagnostic piece, we get over 1,500 customer interactions per day. We have an opportunity with IoT to actually dive into a lot of systems and see what is taking place. We guarantee a 60-day return policy. We look at our install base, we got a 165,000 install base.
10% of all the dental offices worldwide, they have one of our diagnostic products. We have 55,000 installed base of sensors, DEXIS, in the United States. One out of every three offices in the U.S. has one of our products, and that software, DEXIS, is uniform and unified in the standard of care. We are going through a digital transformation in order to build the infrastructure, AI, FDA-approved capability, to not only capture images, but to provide input to a dentist, so they can do a better job simulating, communicating, executing the plan that they wanna do. Really proud of what we have done. We have some heavy lifting to do, shifting some of our portfolio, and addition of the Carestream IOS has really completed our diagnostic portfolio. In implants, as I mentioned, we're the number two player in here.
We have about 1,300 people on the ground providing support and teaching people how to place implant, showing them what a full arch capability look like. And we have over 65% net promoter score in, in that area, All-on-4 center of expertise, about 500 of them now throughout the world, that you can go in there and rest assured that you can get the best full arch treatment that you can deserve. And then when it comes to really training and education, this is the most important thing that we can do to help people to place more implant. Last year, over 1,200 events. 30,000 people. And on innovation, Nobel is built based on creativity, innovation, new surfaces, new biomaterial, and one as a next generation of things.
And we have a lot more work to do in here, but 1.5 million patients every year take our implants, and we have implants in people's mouths that have been there for 35 years now. On ortho, there is a significant transformation over time. We have over 500 people on the ground. They're teaching, building a network. We've got an incredible training and education. The reason the Spark is successful is not only because of a product, because of this network. 3,000 events, 50,000 people have gone through the training, 101, 201, 301, and 401 over time, geography by geography, hands-on training by individual. And we continue to innovate around the bracket and wire, as well as on our clear aligners, in order to really improve the quality of the treatment over time.
By far, we are the first and the last standing company in the bracket and wire area that continues to innovate in here, because the standard of the care outside the United States requires bracket and wire. Case one treatment, compliance needs that treatment. And lastly, on consumables, we have an array of products around restorative, endodontic, Metrex, and Orascoptic. Metrex is a standard. You will see it in almost every office. CaviWipes is well known. That color that you see is what is known in every dental office, and Kerr has been around for almost 130 years. Well known from a chemistry integration and Orascoptic. People who actually use it, they see the difference in how they can treat and see and improve the patient care over time. I want to talk about what makes us different. We have gone to attractive segment, change our portfolio.
We're trying to create connected solution and continue to use M&A and partnership, use our value system and EBS in order to create market leadership, in order to create accelerate growth, in order to create compounded return over time. We're at the beginning of journey. We have a lot more to do as we go forward, but if you look at the 2024, what are our priorities? If you recall, when we started, we said we're gonna triple the size of our Spark business in three years. We did that in two years. We have made a commitment to double the size of that in the next three years. Clear aligner, continue to expand it in ortho segment, improve the margin, make sure that we accelerate our implant growth over time. 50% of our business is outside US, and it is at proxies or above proxies.
We need to turn around our North America through training, education, through support to customer experience. And, last but not least, this is our heritage. This is what we know. How do we improve our G&A? How do we take cost out of the system? We think we can take another $30 million cost out, and we'll see the full benefit of it at 2025. We do these things, that long-term commitment, long-term plan that we have communicated stays intact. I've had a hard time and challenging time in 2023. We have made progress. We think there is a lot more for us to do because this is an awesome industry. It's attractive. People need it. We're making a difference.
We're beginning to build a proven track record around margin acceleration, around growth, around M&A, and we're gonna be able to build a differentiated opportunity and product categories and a company that is focused on growth, accelerated margin, and use that as an outcome to improve patient life, help our employees and customers, and create value. Thank you so much.
Perfect. Thank you for that presentation.
Of course.
First up, I wanted to dig into Q4 and some of the trends throughout the year. You'd expected that core growth was gonna decline low single digits in Q4 and down slightly for the year, while adjusted EBITDA margins were expected to land in that range of 18%-19%. Can you walk us through how Q4 has really trended relative to your expectations?
So obviously, we're not in a position to really talk about the Q4 or 2023 or talk about the guidance in 2024. But as I mentioned at the beginning, we think the guidance that we have provided stays intact. It's been a challenging Q4 for a variety of reasons, cybersecurity and many other things, but we have been able to manage through it and, while doing that, building capabilities that we need in order to really deliver that long-term view as we go forward.
Mm-hmm. That's helpful. I wanted to follow up on that Henry Schein cybersecurity incident. So can you kind of walk us through... You flagged during your 3Q earnings that you weren't really assuming a worst-case scenario, but we saw that kind of persist throughout the quarter. So having seen some of the recent updates, can you update us on both your U.S. and OUS sales trended in the quarter relative to your expectations in light of those cybersecurity and the impact there?
So, Henry Schein is a great partner. We've got a great relationship with them, very transparent. We work with them very closely. This is my year nine in this industry, and I've always had a really good partnership with Stanley and his team. So the number one challenge for us is visibility. We have had very limited visibility on what is taking place from a stocking perspective. So if you take a look at it, they have consumable, and they stock 6, 8, 10 weeks, and we had visibility to the SKU level of how much inventory they have, what's the sellout look like, what's the selling, and we lost that visibility through Q4. We know customers are able to get the product, but we haven't been able to see exactly what is taking place on the ground.
Equipment side, most of that is not being stocked. They get an order from customers, they place that order to us, we ship it, and they install it. For the first couple of months, we were not getting any orders because of all the issues, back envelope, writing a spreadsheet. As we went through Q4, by December, it got better, but it's still. We are lacking visibility of what is taking place. We know from a sellout data that if you look at the proxies, we feel good about that because we feel like we are at proxy or better. But when you look at the selling, what's going on in inventory, and then that's a little bit has been a little bit choppy.
Mm-hmm.
On the case of inventory management, we normally take a look at the entire year, and we think that's gonna sort itself out as we go through 2024.
Got it. That's helpful. And then I appreciate you're not giving us formal 2024 guidance until the next earnings call, but I do have to ask a few framework questions. So you noted that you do expect to have core growth in 2024 and adjusted EBITDA margin expansion. But can you walk us through, now that you've had some additional time, some of the trends that you just highlighted on lack of visibility, how should we think about the framework, even just for market growth for next year?
So, you all have seen a lot of research and data that's coming in, ADA services, patient traffic has kind of stabilized, 85%-95% pre-COVID, and that's a really good thing to see. We have tremendous insight into what is taking place on the DSO level. DSOs, they can take a look at daily number of patient, average spending, and also, because of our position on the premium segment, we have a really great visibility on scheduling. What's going on? I can go to any office, orthodontist office or a surgeon, they can show you the schedule for the next four weeks, six weeks, eight weeks. So let me talk about the DSOs. ASP, which is my average spending per patient, has been lower than it has been before, and the reason for it is purely on high-end.
Ortho treatment, implant, All-on-4, hasn't, hasn't recovered. It hasn't come back. Patients are there, average spending is down. When you go to the specialty business, what they have done in order to make sure that they're using their asset in the most effective format, they have reduced their hours.
They have less hours in office, but they're completely booked, but in a smaller format. High-end, you know, a full arch restoration, that's $25,000-$30,000, and it is. It just doesn't happen to you overnight. It is a process, so you can wait another two or three months. You can wait, and that's what we are seeing in here. Patient volume, steady. The spending on the high end continue to be muted. And then on the equipment side, majority of the equipment are bought through expansion, either replacement, expansion of services, opening in new offices. And not only the interest rate has played a role, but also resources. You know, dental hygienists, front office things, has slowed down this expansion of the DSOs, which were the fastest segment of the market. So that hasn't changed radically. That's what we're seeing in the market.
We're expecting that becomes more of a norm as we go through the year. We would see a better performance going forward, but there is no radical movement down or up as far as we can tell.
Got it. That's helpful. And then last question on 2024, how should we just think about margins from a jumping off standpoint, given how, you know, dynamic it's been?
So we are well known for margin expansion, but what we have done, we have been always focused on building a balanced portfolio that requires some investment in order for us to be able to see the return of that over time. For a period of... Since 2017, we got into the Spark Clear Aligner business in 2017. We have been in investment mode and continued to build capacity, resources, training, and education, and that category by itself continues to be below fleet average, but it is improving. Every quarter is improving. We expect that category to be at fleet average by 2025. So that's one piece. The other part, we talk about Nobel, those priorities and walking through those priorities. Nobel is a high-margin business.
If you see at proxies or above it, that's gonna have a direct impact in our margin. Last but not least, what we can control, which is continue to take costs out, EBS at work around procurement, about footprint, about, you know, kaizen on the floor in order to get more productivity.
Combination of those three things, we said by 2026, we'd be at 22.5%. We think doing these three in 2024 and shifting the portfolio will get us there in the long run.
Okay, that's helpful. Then I wanted to follow up on some of your comments around Spark. So you unveiled the new target of doubling Spark revenues by 2026. I wanted to talk about how are you thinking about, you know, investing thoughtfully in that Spark business, and how should we think about the growth trajectory there?
Yeah, so maybe a little bit of a math would be helpful. So let's say 8 million cases are done every year. One-third, one-third, one-third. One-third of these are done through direct to consumer. Despite of some of the challenges that you hear, this is still a very viable segment. A hybrid model, direct to consumers, you see it in Germany, other places. That's not our target. One-third of them are done by GPs, that go to office, you got other pieces. That's where it's really impacted by macro. So you can, you can wait. One-third of cases are done with orthodontists. There are eight or nine thousand orthodontists in United States, and to the best of our ability, 25-30 thousand that we can think worldwide. That has been our focus. It's the focus of our Ormco, it's the focus of Spark. We're way under-penetrated in that category.
Just take a look at it. We've got about 21-22% bracket and wire business. We have been around for 35 years. Less than half of our own Damon customers today, they use Spark. So there's plenty of opportunity there, and then there's a significant opportunity on other segment, orthodontists, that they use aligners, but it's not purely Align customers. And having this bracket, and wire, and aligner side by side give you a competitive advantage. That's one part of it. The other part, 70% of our business is outside the United States. So it gives us advantage through the network that we have to really build that up and expand it, geography by geography. So spending. We have built tremendous amount of capacity, infrastructure. We just opened a new factory in Czech Republic.
The rest of it is all about feet on the street, training and education, social media, training people, and bringing them up to speed. After you bring them up to speed, six or seven cases per month is an active doctor. So existing, they're gonna continue to use, and we're gonna continue to add into it. That's why we think getting to $400 million over the next two or three years is very doable. That's not a cap. We think we can do more as we go forward.
Perfect. And then I want to follow up on Spark, just about the margin trajectory there. So you've talked about how, you know, margins are lighter on Spark right now, just given where volumes are at. So what type of volume growth do we really need to see before Spark can hit corporate average on the margin line?
Yeah, so, just give you a little bit of a feel. We went from zero to 100,000 cases in three years. We went 400,000 cases to 500,000. So we treated the 500,000th patient in December, and it took us less than four months. So improve the margin, volume helps, but it's not purely based on volume. What drives that margin is when we were building this capacity, we put a lot of resources around it. So productivity gain, automation, transportation, and logistics. Having from Europe, ship to Europe versus China or Mexico makes a huge difference. And last, but not least, when we introduce somebody to Spark, we give them an introductory fee. After they ramp up, prices change over time.
So combination of all these three, productivity, automation, logistics, prices, plus the volume, will give us that margin that we are after by 2025 being a fleet average. By the way, we have seen gross margin improvement almost every quarter.
Perfect. That's helpful. Maybe shifting over to implants. Implants were an area of weakness in 3Q, as you saw low single-digit declines. You called out pockets of weakness in North America, partially offset by at or above-market performance-
Right
... in most other geographies. Can you kind of give us a better sense of what specifically drove that 3Q weakness in North America? And then any of the remediation so far and how that's trended.
Perfect. So 4.4 million implants are placed in North America. 200,000 dentists, 10,000 of them, they place 70% of them. 50%, 5,000, they're oral surgeons, and they have a network that refers implants to them, and they place it. That referral network has been bought by DSOs. They keep buying them, and when they buy them, they keep that implant in-house and don't refer them. That's number one. Two, the other 5,000 are super GPs. They don't have referral. They come to office, you do hygiene, you do drill and fill, and you place implant. The training education that these people need is very different than these people have been doing 25, 30 years. That's the second part of it. Labs have been playing an important role in this category.
So we did exactly the same thing in Europe in 2019, and we saw a return to growth in there. 14 quarters in a row, we have been growing. We have taken 300 basis points share in Europe since 2019. We are replicating that model in U.S., bringing the decision-making down, building a network of young, energetic, diverse speakers, providing support at the local level, providing support, you know, lunch and learn, study clubs, rather than doing it at the U.S. level, bringing it to Portland, Oregon, San Francisco, rebuilding this network, working with the lab, rebuilding that back up. Nobel is an awesome brand. Has tremendous amount of followership. Product is really good. We just got to get this go-to market refined. We have put some people on the ground. We're beginning to see the momentum of it.
Every quarter, we're gonna improve that as we go forward.
Perfect. That's helpful. Then I wanted to discuss your long-term targets quickly. You mentioned during your last earnings call that you're reevaluating some of the long-term market targets, just given the macro backdrop. Do you have any updated thoughts on those long-term market drivers, or should we expect an update when you host your next Analyst Day, typically next month?
Yeah. So we are gonna have our Q4 earnings. Obviously, that gives us an opportunity to talk about 2024, February 16, Analyst Day. We will communicate that. But let me leave you with a couple of thoughts in here. Doubling the Spark business over the next three years, at 200-300 basis points of growth per year, plus the margin. Getting Nobel and implant to be a proxy make a huge difference, both on growth, 40% of our business is implant, 20% of our business in North America. Getting out the proxy with the high margin make a difference. Sizing, resizing our G&A improves our EBITDA margin significantly.
Doing those three things in 2024, delivering on it as we have done in the past, I think gives us a leg up and puts us on track to be able to deliver in 2026. We'll talk about it in more detail, but at least gives you a little bit of a feel where the big opportunities are in 2024.
Perfect. That's really helpful. And then I wanted to ask on capital deployments. You guys have done a mix of organic growth, inorganic growth. So how should we think about some of the product investments internally, and how are you balancing that with inorganic growth, and how should we think about that heading into 2024?
Look, we're always looking at the ways to best deploy capital for the benefit of shareholders. So it's always gonna be a mix of continuing to invest organically in Spark and implants and these critical businesses, also our AI technologies and the diagnostics business, innovation across the portfolio. That's always gonna be a critical part. We're also. We do see opportunities to invest inorganically, given interest rates, given where valuations expectations are, we're gonna be very disciplined in our inorganic investment. We see opportunities, but we wanna be thoughtful about how we do that. So we're gonna look at different options about how to create more value for shareholders, but we're gonna be balanced. And again, our focus, as Amir said, is always we wanna be the right balance between accelerating the growth and improving our margins long term.
Perfect. That's helpful. Just as a follow-up, when we think about M&A opportunities for Envista, what types of assets would you like to go after? You know, what opportunities are there out there, and what size as well?
You know, you know, we have shifted our portfolio. The first couple of years, we wanted to get our exposure to market radically change.
Mm-hmm.
We walked away from a $150 million business in 2020, 2021. We sold $400 million treatment unit instrument. We bought Carestream, Osteogenics, Matricel. When we think about portfolio, the biggest opportunity is this end-to-end implant placement. I can give you a term, 60 minutes implant. You walk in, IOS, CBCT, you understand what you got to do, you plan it, you use AI, guided surgery, you place it, use biomaterial, then send it to a 3D printer, and you have a provision within an hour, $2,500. When we look at that, we say, "Okay, what do we have? What are we missing?" We need to have more value implant in different geographies. We need to have biomaterial. We need to continue to invest in software and capabilities. And last but not least, there is opportunity on the prosthetic side.
For every dollar of implant, there is 20-25 cents of biomaterial. For every dollar of implant, there is 20-25 cents of prosthetic. Having that, you can not only simplify it, but get a bigger share of that investment. That $11 billion, only $5 billion of it is titanium screw. The other $6 billion, all these other pieces that goes with it. That's a great opportunity for us to deploy capital.
Perfect. Awesome. With that, unfortunately, we are out of time. Thank you so much for joining us today-
Thank you so much.
Thank you to everyone in the room.