All right. Good morning, everyone. Welcome to Envista Summit, where we're hosting our first Investor Day as a public company. We're very excited to have you here. We're gonna have a great day. We have a good program. Before we start, I do need to do the obligatory forward-looking statements. During this presentation, we'll make forward-looking statements within the meaning of the federal securities laws. These forward-looking statements are subject to a number of risks and uncertainties as detailed in our SEC filings, and we do not assume any obligations to update any forward-looking statements made in this presentation. With that, just a quick overview of the agenda. We're gonna start off with Amir's gonna give you a little bit of an overview of Envista and our long-term strategy.
We'll then spend time on talking through orthodontic solutions, our implant-based tooth restoration business, our imaging and diagnostic solutions. Then we'll follow up with our long-term plan, and then ultimately we'll do a Q&A at the end. After the Q&A, we will also do a little tour where we'll tour our Envista technology village. We're really looking forward to a great day. Thank you very much for your time, and with that, I'm gonna hand over to Amir Aghdaei.
Thanks, Steven. It was the intention to select April Fool's Day to get you here. It's been 30 months since we formed the new company. Our intention is to give you a view of what has happened in the past 30 months as a publicly traded company, and paint a picture of what the next five years is going to look like. Let me start by framing the day. This is an awesome industry. This is my year seven in dental. The more I learn about it, the more excited I am about the possibilities of transforming this industry, about making a difference in people's lives, in making practitioners, dentists, a lot more productive in what they do, and really give access, oral care access to masses.
You will see that throughout the day through what we present, that our primary focus is improving people's quality of life. The thing that we do would have an impact in that transition and transformation. We're a company coming from the Danaher heritage that has a proven track record of execution. We are operationally capable, strategically differentiated, and the past two years has been an indication of what we can accomplish together when we put to set our mind around it. Now is the time for us to tell you what we intend to do as we go forward. We have a significant opportunity. A lot of you been with us since pre-IPO, during IPO, we talked, and we told you that we're gonna build a company that it is growing faster, have higher margin.
We have access to capital, so we can do a lot more M&A. Now we have an opportunity to really accelerate that growth. Accelerating that growth means higher margin, means ability to really create value for patient, for doctors, for our employees, and create value for our shareholders. That's the theme of today. You're gonna hear that in variety of form or shape. We're gonna give you details around it, and hopefully you would get a feel for the kind of company that we have built and we are about to build. Our intention is to build a legacy in here, build a company that proves the test of time as we go forward. Most of you are familiar with who we are. About a $2.5 billion company, diverse in variety of different geographies.
We work for brands that have been around for over 100 years. We have close to about 14,000 employees. We have over 1,600 patents. We are headquartered in Southern California in Brea, and we are in more than 140 different countries. We have over 3,400 sales people. Over 60% of our business is now direct. Over 85% of what we sell is considered to be consumable, that you use on a day-to-day basis. We have shifted this portfolio significantly in the past 30 months. This company exists because of this culture that we are building. As I mentioned, we brought a lot of good heritage from Danaher, but we have adjusted that to these five pillars. The pillars stand for customer centricity. We're focused on serving the customer, giving them the best customer experience. We're focused on innovation that matters.
Not only product, but business model, the services, what we build in order to make doctors more productive, the work that they do more predictable. We wanna be a reflection of the communities that we deal with. We're building a diverse, inclusive environment that gives people opportunity to see their career in here, to be their authentic themselves. We have started that journey. We are making progress. A lot more to be done in that area. Continuous improvement is what is at our core. It's in our DNA. Whatever we have decided to do, we have done a decent job in getting it done, and there is a lot more to be done in that area around continuous improvement, leadership, accountability, empowerment. We have shifted our approach, so 200 of our leaders now have total control of what they do on a day-to-day basis.
This set of principles allows us to empower people, to make decision faster, to get things a lot quicker. It is becoming a model and the way we recruit people, we develop people, we promote them as we go forward. This is what make a difference. As a kind of company that is gonna make a difference for years to come. These set of values, there's cultural differences. I consider this to be our report card. In 2019, we took a business that was flat, mid-single digit EBITDA, at about a 3x leverage, and produced about $260 million cash. In 2021, we built a business we forecasted it's gonna be a low single-digit, about 15% at the time of IPO, and we'll have about a 3x leverage. This is what we have accomplished.
If you look at it in 2021 versus if you take the COVID piece out, we have now built a business that is mid-single digit, over 450 basis points of margin improvement. We made a commitment that we would do about 50-75 basis points of margin improvement every year. In a two-year time period, we moved the needle significantly, and we have been able to improve our cash position. We are financially strong. We have access to capital. We have the firepower that is needed for us to add M&A as another lever to make us stronger as we go forward. Step one, we consider that as foundation building. We consider that as a starting point. A lot more to be done, but fundamental shifts that have taken to build in this business are not one-time events.
It is a change in the direction of this company as we go forward. Another way of looking at this transformation is over a 10-year time period from 2004 to about 2015, we had bought 28 companies. Majority of that business had a flat to declining portfolio. We were losing share. We were in a mid-10, mid-teens EBITDA. We had, you know, less than 50% of our business was direct, and we started making this transformation over time. We started that, Howard, myself in 2016, 2017. We started making a series of shifts and changes. Spending money in R&D, consolidating our ops, expanding our presence in China. But we still have significant number of brands. We have commercial execution challenges. We had not done any M&A for almost five years.
In a two-year time period, we start shifting this business to be more direct, more customer intimate. We made a commitment that we're gonna take about $100 million structural cost out. We were able to accomplish that by doing $125 million. These are the costs that is not going to come back. In reality, we took over $300 million cost out, but part of that was due to pandemic shutdown and other elements. 125 is something that we were able to do and is sustained with that business. We've fundamentally shifted the margin profile of this business going forward. We transformed the portfolio. In 2020, proactively, we exited about 5% of the business. That business wasn't growing. It had negative impact in our margin. We decided that it didn't have competitive advantage.
It didn't pull together the rest of our business. In 2021, we divested about $400 million of the business. Really good business, but it didn't fit into what we wanna do strategically going forward. We really changed the dynamic of the business going forward. However, we continue to have some challenges. The challenges around pandemic, the challenge around not having an intraoral scanner as part of the portfolio, not only as a standalone product, but as part of the bundle that we can offer to really create a digital and a digitally integrated workflow. We were underinvested and under-indexed in some of the key growth areas, such as value implant, regeneration, prosthetics, and some of the software and AI-related stuff. That brings us to where we are today. Mid-single-digit plus opportunity to continue improve margin over 20%.
Over 60% of our business is direct. This portfolio of a technology and a specialty growing a lot faster, higher margin. Changes of dynamic. You're gonna see more and more direct, more and more customer intimate going forward. We gotta accelerate our implant business. Spark reached a $100 million run rate a year ahead of the plan, but there is significant opportunity for us to make a difference. This combination of a treatment puts us in a really competitive advantage. Bracket and wire, the Ormco legacy, plus having a clear aligner that it stand on its own, gives us a competitive advantage, differentiates us in the market. Digital leadership. It is going to be standard work within the next three to five years that every imaging product that you sell needs to have cloud AI capabilities.
Otherwise, you basically are taking a picture that it stands on its own without any story attached to it. We're making significant investment in this space, and you're gonna see some of that today. We have a five to 10 year horizon to create this integration. To build a story from the time that you walk into a dentist office to the time that you get complete treatment going forward. There are some challenges. What you're hearing about in Ukraine and Russia, some zero COVID policies in China. To us, these are specific events that we will deal with. Does not deter us, does not change our trajectory. We have a long-term plan and may have an impact in a month or a quarter, but that has no impact in what we are building for decades to come. We also have this balance of growth versus margin.
There is significant opportunity for us to continue to make investment in commercial execution and innovation. We're trying to balance that versus margin expansion. What you will see in the outer years, we're gonna build a business that not only is truly differentiated, but financially performing a lot better than what the market norms are. We're gonna paint that picture for you as we go forward. We have a simple recipe. That recipe talks about the continuous improvement, improving the cost structure. We're gonna continue to reduce G&A through footprint consolidation, through continuous efficiency that we have become accustomed to and we know how to do. We're gonna continue to improve growth margin. That's what we are about.
We're about lean, we're about kaizen, we're about taking costs and waste out of the system, put that money back in growth, continue to invest in R&D, commercial activities, sales and marketing, accelerate growth, accelerate margin, take that financial outcome, that balance sheet, put it to work through acquisition to build a business that has this domino effect. A strong EPS growth year after year for years to come. We now have the foundation built for us to be able to put this recipe to work. The pieces of portfolio working together and individually performing to make this model a reality for us as we go forward. We talk about a $125 million cost takeout. Paint a picture for you of where did it come from. We had over 190 offices around the world.
We have about 40 now, and we're not done yet. If you think about it is not only square footage, it's IT, it's security, it's compliance, it's [RUA] , it's transportation and logistics. All of that has costs associated with it. We're taking that cost out. We had over 40 manufacturing sites, 44 to be exact. We are at 20 now, and we think we can drive that even further. Build mega sites that is a true example of what EBS can do. Lean, on-time delivery, highest quality, highest margin. We're at the position now that we can deliver product in U.S. and Europe within 24 hours through mega centers that we have built, distribution centers that we have built. In the middle of COVID, we built a distribution center in Venlo, in the Netherlands. In the middle of COVID, we built a factory in Mexicali.
In nine months, we built a factory that has increased our capacity significantly in meeting the demand for clear aligners. We shifted up not only our portfolio, but our resources. We took about a 15% headcount reduction on non-ortho business, and we added 60% additional headcount to our ortho in an 18-month time period. Eric is gonna walk you through that. That journey is just getting started. There is a lot to be said about the transformation that we have done. You're gonna see the result and outcome of that for years to come. These are fundamental shifts in the business, hard work that our team have been able to do, and they're proud of what we have been able to accomplish and where we are today. I wanna talk a little bit about the market.
When we take a step back, this market is about a $350 billion spend. Growth is about a mid-single digit. There are some fundamental trends and numbers that are mind-boggling. That's why we're so excited about this industry. 4 billion people today that have missing tooth. 5 billion people that have malocclusion. Aging population. Aesthetics that is becoming extremely important. Improving access to care, and a lot of under-treatment. Also, inconsistency in treatment. You go on the clinician side, over 2 million around the world, and a good way to look at it is dentists per capita to see where you are under-penetrated. The Chinese government has made a decision to double the number of dentists in the next 10 years. They're building an infrastructure to make that real. You're beginning to see a change in the dynamic of how dental care is provided.
From a GP focus to more of a specialist, to DSOs, to group practices, to specialty group, the shift is taking place in front of us. If anything, in the past two years, that transformation has accelerated. Dentistry has been perceived as a growth industry, as an opportunity to invest. If anything, back in March and April of 2020, everybody thought that nobody would ever go to a dentist. By end of 2020, you saw a significant investment coming in play, adding operatory, opening new site. DSOs continued to buy and build de novos, and that trend is not going to stop. About five minutes from here, 1,200 people are gathering together, talking about the future of a DSO organization. They're all excited about the possibilities in here.
There is a chance to accelerate that growth, not only in United States, in Canada, in Europe, in China, by over 20%. The dynamic of treating patient, providing access is radically changing in this industry. We see that rapid growth as an opportunity to really improve access to people that they need it the most. Efficiency becomes a really important factor in here. Because of labor shortage, because of the cost increasing, now is the time to start thinking about, "How do I take waste out of system?" 7% of offices' spending is used to just invoice it, getting paid. One out of every seven crown, bridges that come back from lab doesn't fit. You have to go back and redo it again. There is a significant opportunity for improvement, for workflow efficiency. Digitization is real. It's here.
However, it's brought tremendous amount of complexity to the system. Then you go to the supplier side. About a $75 billion dollar, everybody who's participating in here, in office, in labs, there is an opportunity for people to start expanding and building and growing in here. What is interesting, and you all know this a lot better than I do, five years ago, if you wanted to invest in dental, you had very limited choices. Five IPOs has taken place since 2019. Over 100 deals, large deals, has taken place since 2019. Investment is coming into this space. It is more of an annuity business. It's a recession resilient. It gives you an opportunity to invest, to see the outcome of it for years to come, and it's bifurcating.
The specialty businesses, where the growth is, where the opportunity is, where it's under-penetrated, and then you got equipment hygiene that is under tremendous amount of price pressure, and the cost is becoming extremely important in here. A picture of an industry in transformation. This creates opportunities for those that they have that EBS continuous improvement mentality. Creates opportunity for those who see innovation as a way to accelerate that transformation. We participate in about a $25 billion of this market. We have shifted our portfolio, so we are exposed to higher growth segment of this market. You have seen this slide over and over in the past. The only part of this that I wanna talk about is that $11 billion. We're shifting our view on the implant. It is not only a titanium screw, it is tooth replacement.
An implant is a method to do that. It's from the time that you walk in, do the diagnostics, do the planning, AI-related activities, do the surgery, regenerative, prosthetic, 3D printing, lab capabilities, all integrated together. That's a $11 billion market. We're number two in here, and we have every intention of positioning ourselves to be the number one player in that space. Spark and clear aligner $4 billion market, growing over 20%. We're a new entrant in here. We're the fastest-growing clear aligner. We're gonna paint a picture for you why we think that we have room for growth significantly as we go forward. What's going on in this industry? Go back only a few years ago, very analog. A lot of administrative work. Do the impression material, build the stone models. Inefficient.
You have to have 15, 20 years of skills before you can do anything. Bring it today, the digital dentistry is here. You got technology in offices. You got 3D. You got, you know, printing, 3D printing. You have IOS in offices. Everybody's buying it. You're seeing the outcome of it. The problem with it is it doesn't work together. It's really complicated. A dentist is not an IT expert. They're spending a lot of time moving files from one place to another. This lack of integration provides significant opportunities. It's complex. It's confusing. I have to tell you this, you can go to any dental office and you see. It's not about the brand, it's about the workflow. See, in every office, regardless of if it is a DSO or individual offices, there is a different workflow, and none of them are consistent.
Even with two dentists working in the same office, you see a different approach. You don't see consistency. When there is no standard work, you can't scale it up. You can't get efficiency coming out of it. What's tomorrow? The picture of tomorrow is an integrated cloud-based. It's a history available to you. It's AI-driven. It's simulation that gives you opportunity to see things before you actually do it. It's augmented reality. These things are not just blue sky. It exists today. We are experimenting with it. We're showing it. We're demonstrating as we go forward. It's better treatment. It's a consistent treatment. It's better efficiency. It's more predictable outcome. If there is one thing I want you to take away from today's discussion, it's these three words. We intend to digitize this industry. We intend to personalize it. We intend to democratize it.
We think we have the capabilities to do that with our partners around the world. What does that look like? What does digitization look like? A single source of truth where you can get all the patient file in variety of form or shape. You capture it, you visualize it, you see it in one place. It gives you opportunity to see all of that in one place to make the best possible decision so you can plan, so you can execute. What does personalization look like? You ask any dentist, what do they wanna do? They wanna spend time with the patient. They don't wanna spend time dealing with taking notes, dealing with the equipment, trying to figure out, "How do I design things?" They wanna spend time with the patient.
That gives them an opportunity, this personalization, to build treatments that it is digitally driven, to have consistency around treatment planning. It gives them confidence to describe to the patient what the possibilities look like, and it gives the patient confidence that I can see it. I can see how long it's gonna take. I can see how it's gonna look like. If you do that, you can democratize this industry. You can provide access. You can do more procedures. You can be more predictable. This notion of digitization, personalization, and democratization is a foundation for us for the next decade. We are gearing up to make that work. We start with what we call a single source of truth, open architecture, open system that allow you to pull 2D, 3D, IOS sensor, capture the videos, capture pictures in one place, a unified acquisition database.
Some place that you can see them, touch it, feel it, and know that it's real. You don't have to go from one system to the next. You can start doing your execution and planning. You can personalize it. You have that augmented reality. You have that AI-driven capabilities that give you recommendation about the identifying issues and also telling you the best course of action. You can plan it. You can plan implant, prosthetic, ortho treatment, and after that, you can democratize it, have a history of what the patient has gone through, treatment, personal support, capabilities that we can build. Organizations such as four and others gives us the capability to really expand that in a worldwide basis. We can streamline the process. Now is the time to make that work, and we have the capability to make that real.
DSOs are making a tremendous amount of difference in this market. Not long ago, there were only about 15% of the market. They are 20%-25% of the market. In the U.S., it's not unforeseeable that they will be about 50% of this market. The traditional network is changing. The referral network that oral surgeon and orthodontist got is disappearing. There is a different model taking shape in here. We're positioned to be the best partner for our DSOs. You have seen that in a variety of form or shape in the past several years. We got ahead of these things. We built capabilities around it. We're partnering with them. We're in it in the long run, building technical capabilities, unifying their offices, building training and education, building supportive staff in every place, managing the headquarters while managing people on the ground.
It's a different model that is taking shape right in front of our eyes, and we are adjusting our sales organization, our software capabilities to meet the requirement of this space. The story of China is yet to unfold. 1.3 billion people, less than 10% of those people, they have access to basic dental care. There is a lot more to be done in here. We have been growing over 15% in the past several years. Yes, there is a bump in the road. Yes, they closed Shanghai for a week. They're gonna open it. We have been dealing with that for two years now. That trajectory, that trend is not going to change. There is significant opportunity for growth over time in here, and we have been able to really change the dynamic of our business.
More specialty, more capability, more direct, more training, build training and education, R&D, manufacturing on the ground, and create a differentiated portfolio that is not under attack from a pricing, from commoditization point of view. A company exists because of a culture and because of its commitment to the environment, to social responsibilities, as well as the governance. We had our first ESG done. We're really proud of getting that done in our second year on existence. Quality and access, product that we put out there for years. When I talk to the Nobel customers, what they tell me continuously, "20 years after I have placed an implant, I still can depend on it. I still can find parts. It's a product that I can depend on.
When I charge somebody $25,000 for a full arch replacement, I do not want that implant to become an issue." People and community, we have created an Envista Smile Project, a foundation to help those that they needed the most. For every dollar that our employee contribute, we match it. We have done that in Ukraine. We're doing it around the world. We're sending our people to help people that they have the need. We're environmentally conscientious. We're getting more and more aware of what we need to do to do our part. We're building an ethical company, a company that can last the test of time, a company that can stand proud, and make sure that those standards remain wherever you are around the world. This is a great industry. We're well-positioned, and there is a lot more to be done in here.
With that, let me introduce Eric Conley, the Senior Vice President of our Ortho business, to talk about our ortho capabilities. Eric?
Thank you, Amir. Hi. It's great to see everyone, especially in person. We're all getting tired of seeing everybody in the Zoom screen. It's good to get people together, and thanks for coming out to see us. Again, my name is Eric Conley. I run our digital ortho business. I also run our Envista Business System office for Envista. I'm here to talk to you about our ortho business, which we're extremely excited about. Three things that I would like for you to take away with you today. One, ortho is a great market segment with long-term growth drivers, a large TAM, and Envista is uniquely positioned to compete in this space. Second, we have a full suite of products for orthodontists, so we're fully serving those practices. That gives us an advantage and allows us to sustain long-term growth in the double digits.
Lastly, EBS or the Envista Business System gives us the tools to drive long-term, sustainable, and profitable growth, working through scaling up quickly and putting the right processes in place. Our ortho business at Envista. Last year, we finished with over $500 million of revenue and grew over 30%. Our product portfolio is broad. We have Ormco Damon system, which are wire bracket components, so orthodontists can place braces onto patients. We have a Spark clear aligner solution, which can treat patients from young to old. We also have an orthodontics lab business, AOA, which has a large suite of products, including things like retention for patients. A lot of key brands, a lot of key capabilities, and if you look at patient volume all over the world, we're the number two player.
We're already coming into this with a great position to grow from. If you look at our geographic diversity across the world, 70% of our revenue is outside of North America. That highlights the capabilities of our sales team all over the world. This market is a fantastic market, and we sell to the orthodontic professionals in this space. We support their practices, and they in turn go and market to patients locally. That gives us the ability as we bring on new doctors, that creates a recurring revenue stream. Effectively, they become an annuity for us. This is consistent with our historical practice of supporting those practices, making the orthodontists great, and then they continue to build the business for us into the future and for them. The clear aligner market is a $4 billion space growing over 20%.
That's where Spark plays. The bracket and wire space is growing low single digits from $2 billion, and we're excited about the long-term growth drivers, not just in aligners, we're also excited in both segments as well. Wires and brackets is a strong growth market. Why is orthodontics gonna grow in the long term? There are 5 billion people in the world today who suffer from a malocclusion. Out of that population, half a billion, over half a billion people have both the means to get treatment and can afford treatment. That gives us a huge market to move into. There are 20 million case starts every year, and that is growing high single digits. The reasons these are growing, it's not just about the size and the opportunity of the market, but this market is becoming more accessible to patients. Costs are coming down.
It's more accessible. There's more orthodontists who can do treatments in different parts of the world. That will continue to drive the ability for doctors to do patient care in orthodontics. Patients are becoming more aware of the benefits of orthodontic treatment. If you look at the wires and brackets portion of this segment, most of the cases are done with wires and brackets, with braces. 15 million cases this past year, and that is growing. There's some important drivers behind that growth that you've got to keep in mind. One is the case complexity. When a patient comes in, the doctor with wires and brackets can perform a treatment plan with any complexity of cases, whether it's simple or very complex. There's no choice to be made. They can do anything. Second is affordability.
The cases are cheaper for doctors to purchase, so they're more profitable for the doctors. In a lot of cases, that profitability means a lot for the practice, and in some cases, doctors actually will pass along some of those savings to the patients to make it more accessible for them as well. There are certain markets in the world where aligners just aren't available and you're not able to use them. Wires and brackets, if there is orthodontics available in a geographic market, wires and brackets is always there. Lastly is compliance, right? Here in the U.S., and a lot of places, orthodontic treatment can be expensive. If you're a parent and you're gonna put your child in orthodontics, you can't take braces out, right? So they will be in there the whole time, and you'll get uninterrupted treatment through the entire process.
Clear aligners were 5 million case starts, and that's growing very rapidly. The interesting thing about clear aligners is it's brought in adults to the space to get orthodontic treatment. It's fundamentally changed the size and the opportunity for orthodontics. If you're an adult, whether you're getting your first orthodontic treatment you've had in your life, or like me, you had orthodontics, you had braces as a teenager, you stopped wearing your retainer, you need orthodontics again, it's a big opportunity, right? That's driving a lot of this. In addition to that, for doctors, the workflow that digital orthodontics and clear aligners brings is a unique workflow. It's a different workflow. As doctors adjust to that, they have more control over their scheduling, and so they like to have that as part of their practice.
These two things together, 20 million case starts, we see that growing high single digits long into the future. If you look at Envista's journey, we've invested heavily in the orthodontic space, and those investments are paying off. If you go back to the pre-IPO period, Ormco was a credible leading wires and brackets business with great sales execution and capabilities all over the world. We weren't participating in a fast-growing clear aligner space. Post-IPO, we pulled together a team of experts in clear aligners, and we invested aggressively to make Spark a reality. In doing so, we built up the sales team even more and taught them that they can sell both wires and brackets and aligners. It's the same customer, right?
We're bringing that capability and giving them the ability to cross-sell across those things with a full portfolio of solutions. We also built up our manufacturing and treatment plan capabilities, scaling that rapidly. As Amir mentioned before, we built a 94,000 sq ft Spark facility in less than nine months, shipping product, which is really incredible how we're able to do this. The key there for us is how we use the Envista Business System Office. It gives us the tools to scale that rapidly and do so in a very responsible way, so we're building for the long term. If you look into the future, Spark will continue to grow very rapidly. Spark will grow three times from 2021 to 2024. As we build, we're always adding capacity.
We're thinking ahead of what's needed for the future, building that manufacturing capacity, that treatment planning capacity to be prepared to meet the demand at any given time. We wanna be the choice for an orthodontist practice for all the tools that they need. We're investing heavily, not just in Spark, but we're also investing in Ormco and launching new product to make sure that the wires and brackets portion of the market, we're in a position to take tremendous share there as well. We will continue to outpace the market in both of these segments, and we're excited about the future. If I think about it, how are we really different? What makes us unique? First, we have over 500 specialist salespeople all over the world selling the complete solution. When you look at a practice and how do you support a practice?
Remember, our focus is on making sure orthodontic practices have the tools, have the training. We make them great, and then they will in turn reward us. We've got people embedded in these practices who understand orthodontics all over the world. In addition to that, we put a real focus on clinical training, education. We wanna make these practices great practices. We wanna make sure they can maximize the use of our solutions and deliver for their patients. Just in the last year, we held over 3,000 education events all over the world, training over 50,000 clinicians. That continues to be a focus. It continues to grow. Of course, we back that up with the innovation.
We're innovating rapidly in Spark, and we're also innovating on the wires and brackets side with the launch of Damon Ultima to really give them the best tools, train them on the tools, and support them along the way. When I think about innovation, I think about what problem are we trying to solve for both the orthodontist and for their patients. If you're an orthodontist, what do you want? At the end of the day, you want a great smile, an aligned palate, aligned teeth, not only to have a beautiful smile, but also to eliminate potential health problems that come along with misaligned teeth, headaches, bone recession, all kinds of things that could lead to bad outcomes down the road. We focus our products on making sure that they can precisely move the teeth and do that efficiently.
The other challenge is they want to get to the end of the treatment quickly, right? The doctor wants to do it to free up chair time, so they can move on to the next patient. Of course, the patient wants to get out of treatment and get through it as fast as they possibly can as well. We focus our innovation in these two areas. When you look at Spark, we have very high-performing plastics that move the teeth consistently through to a very precise position. We do that with more surface area covering the teeth. We do that with a consistent force retention throughout the treatment plan. We also give doctors a choice of plastics, and that's a very unique thing for us. They can choose a plastic based on what's needed at each stage of the treatment plan to optimize the results.
We're also imaging experts here at Envista, and we not only incorporate from the doctors the topical 3D scans or IOS scans of the teeth and gum line, we've also introduced the capability for them to use CBCT or use X-rays to see the roots and the bone density around the teeth. Because when you move teeth, you're not just moving the tops, right? You're moving the roots, and you want those roots, just like the teeth, to be in the correct position at the end. Without that visibility as part of the treatment plan, you're not able to do that. We bring that in as well. Damon is a very similar problem we're solving there. The new Ultima bracket system provides for very precise tooth positioning and movements throughout the treatment.
The wire that we have and the way the bracket engages the wire means that all the teeth are moving at the same time to get to the end more quickly. The other problem we're trying to solve for orthodontists is about productivity in their practices. Orthodontists are under pressure more and more to drive productivity. With the consolidation of practices into DSOs or orthodontic DSOs, that pressure is there to drive growth, more growth, more profitability all the time, and they've got to bring in new patients. They've got to be as productive as possible to do that. We focus our innovation here as well to help them solve that problem. If you look at the workflow that a doctor has with clear aligners in an individual case treatment, it always starts with the patient exam.
They look at the malocclusions, and then they take the 3D scans of the teeth and gum line with IOS scanners, and then increasingly using X-rays, CBCT, to see the roots, to see the bone structure underneath. All of that data comes together to build the treatment plan, and we allow the doctors complete flexibility to use their internal setups, what they have. We don't force them into certain X-ray technologies, into certain IOS technologies. The equipment that the office is trained on, the doctor's trained on, what they have, we let them use that, and we adapt to that. Once all that data is sent to us through the cloud, we work with the doctor through our software to devise a customized treatment plan for each patient.
As the doctors work with us to build this treatment plan, we give them complete flexibility on how they treat that individual patient. Every patient is different. It's all unique. We give them a maximum amount of choices to optimize the treatment plan through. We don't limit the movements they can make in the teeth. We allow them to use different tools like the multiple plastics. We also have doctors who are doing combo treatments, so they start the patient in braces to get maximum expression in the beginning, and then they finish with aligners.
It allows an adult, for example, to shorten their treatment time by getting a lot of movement in the beginning, and then they finish in aligners, which is just more aesthetically pleasing. Once that treatment plan is created, doctor approves it, the case goes into manufacturing. A handful of days later, the practice and the patient has the aligners. From then on, the patient's going through their treatment, getting regular checkups with the orthodontist to make sure they are on track. These are visits, office visits, that the patient has to make, that they don't wanna do, the doctor has to make. It's pure cost at that point. We want to limit what has to happen in that phase as well. The higher-performing plastics, the better treatment planning shortens the timeframe of that treatment.
We have doctors who are cutting time significantly from what they had before, and the amount of time it takes to get to that final position. As they eliminate appointments, that frees up chair time for new patients. In addition, we are believers in teledentistry, and we're partnering with companies that have these technologies out there to integrate that in. What that does is it takes an actual in-office visit and converts that to a virtual visit, which increases profitability and chair time availability significantly for the doctor. You see, the innovation really is about solving all of these problems, so we can partner with these practices and orthodontists in the long term. Spark just continues to accelerate rapidly.
The reason why we can grow as fast as we can grow is because we're building this on the back of the Ormco brand. Ormco is a credible brand, highly trusted in the space, with decades of science, understanding of orthodontics, and so we are not just a new brand coming in. They know we know what we're talking about. They know we're gonna be here for the long term and understand the space well. Also, we have access. The 500+ salespeople all over the world, the customer support people all over the world. When we enter a new market, we are there geographically, we are there and able to go and talk to every single orthodontist. We are in those practices already. Those salespeople are trusted by that orthodontist. It allows us to move customers over to Damon and also to Spark.
EBS gives us the tools to scale all of this. As we build rapid demand, we build excitement around Spark. We can scale up, we can scale up quickly and do so thinking about the long term, building the process, building the organization, so we can have long-term growth, profitable growth for a long time to come. I mentioned earlier 3x growth from 2021 to 2024, and we're building the foundation for long-term strong double-digit growth out into the future. As you think about the building blocks, especially around Spark, right? We're doing this in three different ways, driving this growth. One is we focus on bringing new doctors in, converting them over to Spark, right? And that starts that annuity stream. That starts that recurring revenue as you bring doctors on, and we build upon that.
Second, our existing doctors, they just increase their share. They increased in their markets, and that drives more business to Spark as well. Third, we're entering new geographies. As we go through the regulatory process in different places, we enter those markets. The team is in place already to make sure we're successful. All the three of those things help drive us in a fundamentally fast way, in a unique way. As you go home this weekend, the three things I want to leave you with is this is a great market. It's a great market. It's gonna be there for the long term. There's great long-term growth drivers behind it, and we are uniquely positioned with a complete portfolio to play in this space.
Second, that complete portfolio and the ability to partner with practices in a very unique way will help us sustain that long-term double-digit growth. Third, EBS means that we can build this, we could scale rapidly, and we could do it in a responsible way. We don't have to be concerned about, can we sustain the growth? Can we do the things that we need to do? Our teams know how to do this, and we've got the tools to help them. Thank you, all. I think we've got a 15-minute break, so please come back at 10 after the hour. Thanks, everyone.
In implants, almost all of it is coming from our premium businesses. As Amir mentioned in the beginning here, we've redefined the marketplace and the size of the market. We're now including prosthetics, which we think is about a $6 billion market. That includes standardized abutments, CAD/CAM abutments, all the crowns and bridges, et cetera, that goes on top of an implant. We have the traditional implant business, which is the titanium screw business, the fixtures and the components that goes together with the implant. $4 billion business, mid-single plus digit growth. The biologics and the regenerative business, biomaterials, about a billion dollar business, double-digit growth. It would include bone grafts, membranes, growth factors, and other things that help promote bone generation and growth.
In our business, there is a premium segment that is defined by four companies, Nobel Biocare being one of them. The value business has Implant Direct and ABT in them, and probably 200 other implant companies in the value segment. Typically, that's a geographically spread business with local heroes in different parts of the world. On the biomaterial business and the regenerative Nobel is one of the players, and there's a handful of other players that are in this space together. We have three types of customers, implant specialists or implant placing specialists, general practitioners, and laboratories. They tend to buy a little bit of different out of our portfolio. Our oral surgeons and implant specialists typically buy a lot of implants from us. Many of them also buy our biomaterials as they go hand in hand with the procedure.
Our general dentists, they are typically restoring implants, but many of them are now also starting to place implants and do the whole generation from start to finish. They tend to buy from all of these three categories that we offer. Laboratories typically buy from our prosthetics portfolio, and they will continue to do so. Eric mentioned this, and we have the same phenomena here. It's a phenomenally under-penetrated market. We believe there's 4 billion people that have a missing tooth in the world. Half of them have access to care, but only 5% of them actually seek treatment. This is a huge opportunity in itself. About 200 million people every year would go and seek treatment for a missing tooth. What is really even more surprising, that less than 10% actually end up with an implant.
There's a couple of barriers and a couple of obstacles that divert them from an implant treatment. One is the awareness of implant being one of the treatments that could be undertaken. The other one is the doctors that are not trained to place implants. The third one is fear. A lot of people think of fear as the patient having fear, which is true, but the doctors also have fear. If you weren't properly trained, you haven't seen it before, you're probably not gonna be comfortable recommending that. There's also a notion that it's a more invasive and more painful procedure maybe than the alternatives that are available. Then there's a cost component to this as well. We're all patients at some point in our life, and we're all an implant candidate.
You think about this, the most common way to solve the problem of one missing tooth is to put a three-unit bridge in there. You have two healthy teeth, and then you have a gap in between. The three-unit bridge solution takes the doctor to actually take your two healthy teeth, reduce them back, and grind them down so you can fit a bridge on there that has three teeth on them. That solution will last between five to seven to 10 years. It's a little bit cheaper than getting an implant, but you gotta redo it later in life, and the next time you do it, you're gonna have to grind your two healthy teeth a little bit more. You might end up having three teeth that you need to resolve. That's the three-unit bridge solution.
That's the most common way to solve that problem. There's a better way to do it, we believe, which is putting one implant there, preserve the two healthy teeth next to it, and restore this through an implant and the prosthetics, and if you need also, bone regeneration. I think there's a huge opportunity for everybody to drive education here, to drive awareness about different ways of solving this problem, and it's a great opportunity to grow this part of the business and this part of the market from less than 10% to a much higher number. Let's talk a little bit about our transition. Before the IPO, we were essentially a flat business. We were spending a lot of money on R&D, building a portfolio of new products and innovation coming through.
We spent time and effort on restructuring the business to drive a different margin profile and reduce our cost. Amir talked a lot about how we're driving the hunt for waste everywhere we did. There was a lot of the focus that we did prior to the IPO. We had a number of challenges at the same time. We weren't executing very well commercially. We were struggling with competing brands between our premium and our value implant businesses that actually competed against each other in the marketplace. Our offering on the value implant side was not particularly strong, and we were very under-indexed in the fast-growing biomaterials and regen business. During the transformation and the resetting phase here, which would be to 2019 till last year, we've gradually improved performance every quarter. The last six quarters, we have accelerated our growth, and that continues.
We have done that by focusing on our commercial execution and really get a much leaner machine going around focusing on customers, making sure that we have proper segmentation, and leveraging the EBS tools to drive discipline and execution into that part of our business. At the same time, the investments in R&D has started to pay off, and we've launched products that we've invested in for a number of years, our surfaces technology being one of them with Xeal and TiUltra. We also recently have launched N1 in Europe and just a few months ago here in the U.S. with a clearance from the FDA. We've also cleaned up and streamlined the value portfolio in the implants and made sure that we don't compete with each other anymore.
That's a segmentation and a structure that we've, you know, taken care of over this last few years. At the same time, we're doubling down on the workflow and the investment in DTX and navigated surgery and other digital technologies to promote the workflow from the beginning to the end. That will pay off, and you'll hear more about that from JC. We still have challenges. We are under-indexed, we are underrepresented in, and we don't have scale in our value implant business. We're still under-indexed in our regenerative business, and we see that we have gaps in our digital portfolio that we should rapidly close so that we can provide an even better and comprehensive workflow going forward.
We're at the mid-single-digit growth rate at this point, and we can see a sustainable way to maintain that and also accelerate that in the future. If you look into 2022 and beyond, we're gonna be a high-single-digit growth business. We see share gains happening as well, leveraging in digital workflow and the workflow around the entire spectrum as well, and doubling down on that will help us drive and grow that. We're continually challenged on the value implant sales situation, and we have great opportunities to continue to do supplemental things on our digital workflow. What makes us different? It's four things. First, the commercial execution. We have 1,300 highly skilled and highly trained individuals around the world that are promoting and helping our clinicians be successful clinically and with their business every day.
We're continuing to expand and grow that. We have just recently nominated and appointed and certified centers of excellence for All-on-4. This is a procedure that's been around for over 20 years. We have over 300 centers in the U.S. alone that are experts in treating edentulous patients and really changing their lives. We're also working very hard to improve the customer experience. When you deal with us as a company, we want you to have an outstanding experience. We measure that with Net Promoter Score, which is currently 65, and we've been increasing this by making sure that we deliver product on time with the highest quality, and we're making also sure that all of the different touchpoints you have with our business is removing all the waste in the system.
It should be easy to pay, it should be easy to understand your invoices, it should be easy to return product, it should be easy to whatever it is that you need to do, and we're relentlessly doing this month after month, week after week, quarter after quarter. Just like Eric talked about training and education, we train and educate a lot of people. If you go back to the market opportunity, that's one of the things that to unlock, to really make sure more clinicians are able to place implants, remove their barrier of fear, and making sure that they have the skills to place implants successfully. We ran over 1,200 events last year and trained over 30,000 clinicians. Some of them were new to implants, so they learned how to place it for the first time.
Others are going from a new level to maybe learning how to do All-on-4s or upskill themselves into be able to do more indications and treatments with patients. Innovation is a huge part of our heritage. That's what we've been doing for the last 40 years as a company. The All-on-4 treatment concept, which is two decades old now, continues to be evolved and developed to treat more complex cases and more indications. The new surfaces allows us to also have a much higher and better treatment outcome compared to what we've seen in the past, and it's now available on all of our implants across the board. Of course, our N1 system that is a biologically driven innovation to really help promote in five different dimension a much better way to place and maintain implants for success.
Then lastly, and perhaps what really touches my heart the most, is that over 1.5 million patients that we had a hand in, we had a small part of treating last year, changing their lives, changing their trajectory, making them smile again. This is a purpose of ours, this is purpose-driven, that gives me a lot of pleasure, and it's a privilege to actually be able to impact another person's life like we are. You've seen this slide before. This is about the really digital workflow, and I think we're at the beginning of a trend and an emerging of a lot of technologies that would enable us to do things in the future that we couldn't dream of doing only five years ago.
If you think about the starting point of treatment on the diagnostic capture, I was part of the transformation from an analog world to a digital world, and that was profound. We had another shift in this technology from 2D imaging to 3D imaging that was profound. We're seeing how each of the image modalities continues to get better sensors, better definition, and combination of different image modalities from 2D to 3D to surface scanning to facial scanning and positioning allows us to combine those datasets and really drive a totally different diagnostic ability and capability.
If you think about some of the things that also JC will mention on how we can apply algorithms and AI to help aid a clinician to identify things in the diagnostic part of the treatment to make sure that you're doing the right treatment protocol or you're selecting the most successful one, maybe even help aid what that might look like in the future. Having one source of truth, like Amir said. If you walk out to a clinic today and ask them how many software systems they have, ask them how many places they store data to have a complete medical or dental record of their patients, the answer is not one, it's a lot, and it's hard to keep track of.
Our mission is to make it easy to collect all of this information, to have one source of truth, and that's what we're doing with DTX. We're continuing to rapidly move into more and more aids for the clinician, help you sort what's in there so you can find what you're looking for, help you identify things in the diagnostic panoramic images and other images so that you can get to a conclusion much faster, document it well, and make sure that you're consistent time after time after time. Once you've established that, you have a great opportunity to then go in and design the treatment plan and design the customized ways in which you're gonna treat this patient. Perhaps present more than one alternative, preferably not the three-unit bridge, but maybe an implant solution. If you think about that, you do that in DTX too.
You can plan your entire implant case there. It turns out that the placement of the implant is very critical for the long-term sustainability and the long-term success of the implant. In DTX, you can get help to create a guide or send it immediately to a navigated solution that don't require any printouts, but it's more of a guidance system, navigation system. These two technologies are significantly helping clinicians to place the implant exactly in the right place. If your ridge is really wide, you have a lot of space to place the implant, and it can go in more than one place. If you ask any of the clinicians that are here today, there are complicated cases with narrow ridges.m
You don't have a lot of room for error, and this is where you really make a difference when you guide or navigate these, place them at the right place. Now, I've placed the implant. It's time for the prosthetics. Systems now can help you design these in the software. You can put a lot of help into aiding that, making that planning process a lot more efficient, and the possibilities to do this incredibly well in the future is just around the corner, I believe. When you think about the All-on-4 treatment concept, and this is a patient here that has that. You walk into an office, like I went to a live surgery a few weeks ago. The patient, a 49-year-old female without any teeth in one of her arches, came into the office at 8:00 A.M.
The doctor started to perform the implant surgery and placed a number of implants for an All-on-4 treatment. At 2:00 P.M., the patient walked out of that office with a whole set of teeth and a new arch, and she was crying. I told the doctor, "Why did you hurt her so bad?" It turned out she cried of joy because that was the first time in over 10 years that she'd been able to be proud of her smile. You think about our digital workflow and how we can really help that and help doctors and clinicians get to that result more efficiently and faster. That's exactly what this workflow will help them do. This is on the prosthetic side.
All of this is underpinned and helped by the biological and regenerative business to make sure that you have great placement and great bone for that to happen. This young woman here is not the 49-year-old I was talking about, but she also had a really life-changing experience, as you can see the before and after. It's a privilege for us to have a hand in this and to be able to help professionals and clinicians all over the world accomplish this great success with patients. Our growth is driven by innovation. It's our heritage. Our surfaces are there to promote faster healing, and they've been incredible. We use them also to manage soft tissue, which is really unusual, and it's an unusual approach for an implant company to do.
We've had an incredible uptick here, so over 30% of implants that we ship now have the new surfaces. Remember, we launched this in America a year ago, so this has been very quickly. Our N1 system, again, is geared towards a biological concept, making sure that we have faster osseointegration and have faster healing so that we can shorten the time to teeth. Again, going back to the patient, they're fearful that it could be painful to do an implant treatment. The treatment protocol and the drilling protocol of N1 is different. You only need two drills, one pilot and then another drill, and that drill doesn't produce any sound. It's a very low-speed, slow way to create an osteotomy, so the comfort for the patient is incredible.
If they've ever had an implant before, they don't even think the implant is placed when the doctor's already done. I'm very proud of that innovation, and I think that's gonna have long runway for decades to come. It's a paradigm shift. Just in summary, we love this business. We love this market. It's significantly under-penetrated. There's a lot of opportunity for us to grow in here, and we're incredibly well-positioned across the entire implant workflow. Thank you very much. With this, we're gonna switch gears. I'd like to welcome JC Kyrillos, our Senior Vice President for Diagnostics and Digital Solutions.
That was awesome. Well done. Well, I'm really humbled by these great explanations by Patrik and Eric and Amir. Let me bring it home with imaging and diagnostic solutions. The first step in almost every dental procedure starts with imaging, and certainly with high-value procedures, that's definitely the case. We're gonna talk about three things here. First, that our strategy is pretty simple. We try to get easy-to-use devices and easy-to-use software to help clinicians with their confidence to drive cases. By doing that, they can also help patients understand the case and accept the case. Simple to use devices and software ultimately driving patient acceptance. If we do that, I should say when we do that, because we're already doing it. When we do that, we drive more procedures like the ones you just heard about.
2021 was a good year for us. We made a number of difficult decisions over the 2.5 years, and a lot of them came in for us and still are. Let's talk a little bit about some of the equipment. What's inside this $450 million in sales, $425 million in sales. We start with 2D intraoral sensors. Intraoral, inside the mouth, and phosphor plates that do the same, and then a number of extraoral products, and you're gonna see some of these when we take our tour later on today. Extraoral, outside the mouth, 2D panoramic, 2D cephalometric, which is a profile shot of the head, and then 3D CT or CBCT. We also sell the X-Guide product from X-Nav Technologies.
I see our partner, Ed Marangola here in the audience. Thanks for coming, Ed. An awesome product. That's the navigated and guided surgery tool that Patrik spoke about. We wrap that up with the DTX software. You heard a bit about that. I'm gonna speak about it further, but basically software that helps all of those imaging modalities come together and also empowered further with our AI tools. A recap on how big this market is. It's an essential part of dentistry. It's a great market, and we have the best-in-class products in that market. If you go to a dentist office, and you see our tools there, our brands there, you know right away that's an office that cares about quality, that cares about patient outcomes.
Now, our products, most of where we sell today is in that first piece, that $2 billion, which is low single digits growth. We've had a gap in our portfolio for a while now on the IOS side. We're excited about adding that to the portfolio, adding even more growth to the portfolio as it is. These products are applicable to all the different types of dentists, so general dentists, the different specialists that we talked about, orthodontists, oral surgeons. They're very, very relevant for DSOs. The standardization that our tools, the ease of use that our tools bring very, very relevant for those organizations, help them grow. We're proud of the fact that we reversed a trend of several years of negative growth on a pre-IPO basis. As I mentioned, 2021 was a good year for us.
got into mid-single-digit growth compared to pre-pandemic. How did we do that? Well, the first thing we did is during the pandemic, we said, "Let's take a look at all our costs from scratch. Let's go into zero-based budgeting, zero-based staffing. Let's not think about what we used to need. Let's just say, 'What do we need now to do?'" And we looked at every part of it around the world and every function. We're proud to have been a substantial contributor to the $125 million that Amir mentioned earlier. We also did a major set of portfolio shifts, both on the product and on the geography. We exited over 40 products that were either low margin or low growth or both. We exited over 50 countries that were either low margin or low growth or both.
Really focused on the places where we can win, where we've got a differentiated advantage, and that's working out for us, and I think it'll continue to be the case. We also had, over the course of the last six, seven-ish quarters, like everyone, lots of supply chain challenges. Every supply chain challenge has got its own unique drama. Using our Envista Business System tools, our EBS tools, we've been pretty successful in mitigating those. We've, for the most part, been able to ship. Now, no one knows what tomorrow brings, and there's undoubtedly gonna be more problems that come. We've got a sense of confidence with that capability that we're in a good position to deal with those as they come up, and I'm very proud of the team that's managed that huge attention to detail and commitment on that.
Let's talk about on a go-forward basis for 2022. Those changes we made, those good decisions we made, combined with the installed base that we have, and the new products that we're bringing to the table, the AI solutions that I'm gonna speak about in more detail, and the high relevance for standardization and assistance to the big DSO growth that you see make us super optimistic about the future. This is an essential part that is synergistic with the other two businesses that we talked about, and I'm personally really psyched about our products. The other thing we did and really tuned up in addition to cost and portfolio adjustment is we went back from scratch and looked at the customer experience. We said, "Listen, we have the best-in-class products. We have an excellent quality and an excellent quality system.
Why don't we talk to people about... We talk to people routinely, 1,500 a day. "Why don't we let them have a chance to try our products?" We introduced a 60-day money back guarantee, no hassles, for any reason or no reason at all. To our knowledge, this was virtually unique in the dental industry. When you think about some of those more expensive price points, six figures for an extraoral device, you know, it's a big decision who you're gonna go with. If you get a chance to try one for 60 days, and you can still give it back, that's a potential big incentive to do that. No kidding, all of our products in North America and Europe, you can try them, you can give them back.
You know, we also use that offering as a way to contact our installed base, as you can see the numbers there are extensive, and describe that to them. If you've got, you know, one of our devices in your office, I often use the analogy with the team, if you have one of our appliances in your kitchen, why not have more? Why not take a look at the rest of our offerings? As I mentioned before, another one of those offerings is the excellent navigated surgery from the X-Nav company. We try in all of these to drive simplicity, drive ease of use. Let me talk a little bit more about some of the software that we wrap around that.
Driving, as I said at the very beginning, confidence for clinicians so that they in turn can instill knowledge and confidence with the patients. The DTX Studio, you basically have about seven different imaging modalities that can come to place in an office. I mentioned several of them already. Intraoral scanner, another one. A simple camera inside the mouth, intraoral camera or an external camera. You have the potential for four or five or seven different softwares to look at all of those images. You can imagine the challenge in doing that and keeping that straight inside your mind. You know, the size of the tooth itself, a simple composite, it might be larger on one image than on another. This software has the ability to take all of those.
First of all, you tap on one tooth, all the images associated with that tooth in any modality come together all at once. We have AI fusion technologies, which can take two different kinds of 3D, the CT 3D, which is looking inside your body, and the IOS 3D, which is a topographical, three-dimensional image, and fuse those together in an automated way. By having these kinds of technologies, the easy-to-use devices and easy-to-use software, gives us the opportunity to teach clinicians and drive expertise and confidence in doing it. After we had run our 60-day guarantee for a while, we introduced another 60 concept, 60 images within 60 days. What does that mean? Well, dentistry is unusual in the field of medicine in that the clinician is usually their own radiologist. Dentists are usually their own radiologist.
If you get a new tool that's expensive and difficult to use, and also if you take a 3D, some dentists worry about liability. "I've taken a new kind of image. Have I understood and diagnosed everything that that teaches me?" It helps to have an expert, a formal dental radiologist, to give me a second opinion as I get trained up on it. Offering those 60 images within 60 days, and we do that through a third party, an excellent company called BeamReaders, that offers that service for it. That helps us to give the dentist that opportunity to digitize, then allows them to talk to the patient, personalize it, and more and more dentists can do that, more cases, more acceptance, democratize.
In addition to the facility of having those software, those images together, we have those energized and further impacted in a positive way by artificial intelligence. Now you hear a lot about artificial intelligence in our society in all aspects, right? You know, hardly a day or even an hour goes by where we don't either interact with it or read about it in some way. You should know that this is a company that has very deep and very long understanding in AI. Our first FDA software as a medical device was cleared in 2017. We've had several clearances since then, but most recent was just last week. Just a week ago today, we had our last one, which was for the mandibular nerve automatic tracing.
That's another example where a clinician who's not used to doing an implant may have a concern because they can injure that mandibular nerve, causing potential paralysis, permanent paralysis for the patient. We understand how to do that. We understand how to interact with FDA and get the 510(k)s approved. These tools on AI are also excellent for the DSO community, and we announced last year a partnership with Pacific Dental Services. They're a partner with us in developing additional future AIs. What's that interaction about? Well, they have access to, you know, virtually unlimited images. Obviously, we need images to understand that and train the next AI. They can give us advice about human factors and clinical relevance that helps them with their workflow. As a large user, they're a great testimonial site for us.
I mentioned the gap on intraoral scanners. This is an area that we've studied for years, and we've looked at the whole spectrum of small to large players, premium to lower price point. I feel that we are very, very informed on this subject. We're thrilled with the acquisition of the Carestream IOS scanner line of products. These are excellent products, the 3600, 3700, 3800 cordless. And they satisfy a range of price points and a range of needs in terms of clinical application. Importantly, this is a great addition to our portfolio, not only 'cause it rounds out the solution, but also doesn't hurt that it's above our fleet average in both margin and in growth profile.
Taking this product and putting it into the Envista Business System, putting it into our imaging installed base, putting into the over 3,000 commercial people around the world, is an opportunity for us to drive that even further. We are a great owner of this kind of a product to further drive it. Also our supply chain knowledge, also our quality management systems, all of those we think are gonna accrue to some great value creation and huge growth for this product. Many of you are aware that we divested our treatment unit and instrument business at the end of last year to Planmeca. With that went the KaVo name. We announced very recently that we're changing the KaVo imaging name to DEXIS. Now DEXIS was already on some of our products, a great brand known for premium images, known for easy-to-use software.
We're now gonna move that DEXIS name over to the rest of our imaging products, and that will include our new IOS products once that closes. Summary, the first step is imaging. Our strategy is to make easy-to-use devices, easy-to-use software that drives that clinical confidence and ultimately patient acceptance. More cases presented, more cases accepted. When we do that, it's an opportunity to sell more of our implant-based tooth replacements and our orthodontic products, both on the wire and bracket and also on the aligner side. Thanks a lot.
The depth of capabilities and the scale that we are building. We wanna close this by telling you what the long-term potential of this business look like. We're in some of the most attractive segments of this market, ortho, implant, diagnostics, relationship with DSOs, high growth margin. The segment exposure has radically changed in the past two to 2.5 years. We're thinking about the next five or 10 years. What does this digital workflow look like? We've got a large imaging set of capabilities that gives us the install base to be able to integrate, improve productivity and drive usage. Usage of implant, of ortho treatment.
We got a strong workflow solution with continued improvement culture behind it, and then the capital structure that we have, the M&A capabilities that we have, allows us to continue to make investment in implants, specific regions, variety of different software tools, adding to our digital portfolio, continue to do AI development, and put some resources and investment in some of the emerging technologies. Early investment in areas that gives us an opportunity to experiment. Take the market, take the exposure, multiply that by the company that we are building. That culture that we talked about, the culture of customer centricity, the focus on the patient, the focus on productivity, innovation, diversity, continuous improvement culture. The leadership that we are instilling in the market. An EBS-driven model that is here to last and continue to improve over time. The outcome of that would be market leadership.
We are positioning ourselves to be the winner of this market for decades to come by accelerating growth, by improving margin, and we are gonna build a model that has a compounded return, a domino effect that continues to build on it as we go forward. As we start building this equation, you're gonna see us moving from a mid-single-digit plus to high single digit growth. Our intention is every year to continue to improve the growth profile of this company organically. Our intention is to continue to build the margin structure. Howard and I have made a commitment on a 50-75 basis point of improvement year after year after year. You're gonna see that evolving over time. We think that there is no limit, there is no ceiling in building this momentum of growth and margin.
We are committing to double-digit earnings per share growth as we move forward, and this acceleration is going to take shape and take momentum. Bumps in the road, as we have seen in the past several weeks, long-term horizon. That's what we are communicating. That's what we're committing. We have a proven track record of execution, strategically differentiated, building the company that will prove and stand the test of time. We wanna build a $4 billion enterprise with the exposure to the market that has about a 4%-5%. Divestiture that we did last year, the exits that we did in 2020 has moved our exposure to 150 basis points better. We're in a 4%-5% growth market now.
The commercial execution capabilities that you have seen, as painful as it was to make those changes, has allowed us to outpace the market. six quarters of growth on implant. Our Ormco business, our bracket and wire, taking share quarter after quarter. Innovation playing an important role here. Opening a new dimension, going from zero to 100,000 cases from 2018, reaching a $100 million run rate on Spark. N1 is adding another dimension to good performing business that's going forward. Then you have the power of capital structure, the firepower to put acquisition and M&A as another lever. A $4 billion enterprise, double-digit earnings. That's the business that we are building that is gonna impact the life of patients, those that they need it the most.
It's gonna partner with people that they see potential in this industry for years to come. This is an incredible market. We're excited about it. We're excited about the possibilities. We are differentiated. We are strategically differentiated. We can demonstrate that. We have a proven track record. We come from that culture of continuous improvement. We have an opportunity to create significant value for patients, for dentists, for our own employees. We wanna build a company that they wanna come to work, be proud of what they do every day, to have a hand, to go home, tell their families, their neighbors that I made a difference in the world. We wanna create value for our shareholders to see that doing the right thing, doing the good things pays off in the long run.
We're gonna open it up for an opportunity to have a little bit of exchange with you. Let me invite the rest of my team in here on stage. Thank you, sir. You have to bring your own chair. Thank you. We have Steven. I think we have people online, and we have microphone in here. Steven, we got a question right up front.
You got Jeff, and you got Michael.
Hello?
Yeah, you can go.
Thank you. Good morning, guys. Thank you for all the overview here. Amir, you mentioned, you know, the long-range plan. I guess I'm sure we'll have questions come back to, and not to focus too much on the short run or the near term. You mentioned Russia and Ukraine, China lockdown, currency has not been working in anybody's favor here recently, things like that. Just wondering if you can help us. You know, we know there's another round of price increase going in May the one. Should we think of that as incremental to the last time you guided? Or with those other things I brought up initially, is that just to kinda help offset there? Just really in the context of your guide, how do we think about 2022 with everything that's changed in the last couple months?
Yeah. Jeff, let me go ahead and take that one. I think you're right. There is a lot going on these days, certainly even in the last week. With regards to China, we see that as, you know, continued par for the course. We don't think that that's gonna be long-term in nature. We think that it's a short blip. As we've seen since Q1 of 2020, you know, things get shut down, things open up, the business returns. We think the same way about this situation. A little bit unique in the timing of it, and then, obviously, we have a warehouse that's in the province of Pudong, and so that's been impacted this last week.
Again, we've been in communications with the management team there on a consistent basis, even as recently as this morning. We think that once they open up, they have a couple national holidays next Monday and Tuesday. Once they open up, that business will return. We'll get the product shipped, and we'll be in good shape there. Russia's a little bit different. As we provided the guidance, at that point, all the geopolitical things that are going on there, I think are unique, and have recently occurred. We have, you know, about 4% of our business. We said $100 million of our revenue is based in Russia. You know, we've gotten primarily through the first quarter.
Getting products in relationship to all these sanctions and all the logistics companies that have fundamentally pulled out has made it a bit more challenging. We'll provide an update as it relates to guidance with the Q1 earnings.
On the pricing.
Yeah.
Go.
I mean, as it relates to the pricing component, I mean, you know, we look at each of our businesses to monitor both their growth as well as their margins to maximize both of those. We're gonna continue to look at pricing and periodically adjust throughout the year. At no point do we say that we're one and done as it relates to pricing. We'll continue to look at that, look at opportunities to increase on the pricing. Of course, it's tied somewhat to inflation as well. We wanna make sure that we're doing the appropriate countermeasuring.
Two follow-ups. Just one, you're not making any comment about 2022 guidance at this point. Not reiterating, not commenting, not anything. Is that correct?
Yeah. We're gonna provide an update with our Q1 earnings as it relates to that.
Okay. On the pricing side, you know, it's easy to talk to some of maybe the dealer reps that we all talk to or go out and figure out what's going on maybe on the consumable side and that. What are you doing pricing-wise on maybe implants, on core ortho? Are there opportunities there as well? Maybe, Amir, if you could even talk about the longer term pricing outlook for those areas where I think you tend to have a little bit better pricing power, but just any thoughts there. Thank you.
Yeah. I mean, again, Jeff, we look at each of, you know, the operating companies. We'll look at their pricing strategy, looking at their growth and making sure that they're managing to drive maximized growth, but also to ensure that we have the profitability. When we look about pricing, we will see what our competitive position is. We believe that in many instances, we've had opportunities to do some increases. You know, if you think about it historically, pricing had been a challenge. We see this as an opportunity for us to go ahead and put in some of that pricing. We started that in 2021, particularly in the second half of 2021, and we'll continue to do that here in 2022 as well.
One more maybe comment around pricing and the way we think of things. I know that, we measure it, year-over-year same SKU sales, but the way we think of things is also with all the heavy emphasis that we put in innovation, we see that as an opportunity for us to upscale into newer product as well. If you think about implant, one of the areas that you mentioned, getting people from the NobelActive product, the TiUnite to the TiUltra, yeah, they're different SKU numbers, but we sell those at a premium pricing. Those are. That's another way to think about some of this as well.
Yep. Michael.
Perfect. Thanks so much for all the details so far. I guess it's probably a good transition talking about premium-priced implants. The high-end premium implant market's been one that's, I would say, volatile, clearly one competitor that's doing quite well. I know N1 seems like it, for all your sakes, took longer than you probably wanted to get in the U.S. I remember you demoing it back at New York Dental in 2019. Now that it's here, how do you think about your position and your ability to continue to build back towards that high single digit growth rate that you targeted in premium implants, given the competitive environment and the fact that your competitors aren't necessarily sitting still?
Go ahead.
First of all, the premium implant space, we have some formidable and very good competitors in there. The new surfaces in Xeal and TiUltra that has been in the U.S. market for a year and in Europe for a little bit more than two years, we've been able to gain price on those, as Howard was mentioning. So far, the revenue stream that we're getting from N1 is not a significant growth driver for us, so that's further upside opportunity. We're using the Spark model when we're launching N1, which we I think we've covered a little bit, but we take a small group of doctors and train them and follow them, and then we train another group.
Great. Thanks. Erin Wright, Morgan Stanley. On Carestream, how quickly can you integrate and start to see more material cross-selling contributions from that? And thinking about other emerging technologies out there, what's of interest to you? Are you interested in 3D printing? Are you interested in other technologies? What can really bolster your offering and portfolio and maybe fill some gaps there? Thanks.
Take the Carestream, and I answer the second part of the question.
Yeah. I didn't understand. You said integrate, and then I couldn't quite copy what you were saying on Carestream.
Just cross-selling opportunity, integration with the broader portfolio.
Broader. Sure.
How quickly
Well, we're gonna start on that immediately. We're gonna close in the second quarter. We're already doing extensive planning, both internally and in some part with the Carestream organization. We want for both organizations' customers for this to be as seamless as possible. For us, we're gonna plug it into our network, into our channels and our opcos, on the Nobel and Ormco and other side. We'll start with that immediately. We'll also start development with the DTX group on integration of that product.
Erin, when you think about emerging technologies, it normally starts with the patient journey. What is taking place in a dentist office, a day in the life of a dentist? You see where they spend their energy, their time, where are the bottlenecks, what problems are they trying to solve. We deployed about 50 people in a three months time period, interviewed about 1,000 dentists, DSOs, individuals. We rank and stack from number one impediment waste in the system to number 100. We started looking at where can we make a serious difference in taking cost waste out of the system. The number one priority revolves around patient file.
How do you manage that patient file without moving it from one place to another in unified format that you can take it from diagnostics, AI helping you do planning, execution, post-treatment, to lab, on-site same-day crown, night guard printing, guided surgery, all these elements? It is centered around that patient file. You hold that as a core, and you start looking at what other activities around that. We have always said that we subscribe to open architecture. We're willing to work, partner with many companies in order to make that workflow a lot more effective. In this room, there are two of our closest partner that we have been working with building this API, this relationship with them, so we can offer a complete solution. The new world is a different world. It is not a closed system.
It's an open architecture that you cooperate with the focus on the patient, the focus on the dentist. We have seen in some areas, and we have done that in some of the CAD/CAM technologies, in some of the design capabilities. We have placed investment, early investment, and experimented with that, right? To see what the outcome look like for us to be able to execute that. There are plenty of opportunities around material, around case acceptance, around 3D printing. We're exploring all of that. We're finding people that they are innovative and culturally complementary to us in order to be able to build a better world together.
Hi. Thanks so much. Elizabeth Anderson from Evercore. Two questions. One, could you talk through sort of the impact in the short term on the margin line of some of the short-term dynamics in terms of the Russia business and potentially in China too. Over the longer term, can you talk more specifically about the value implants and sort of that contribution to the high single digit growth algorithm you were talking about in terms of the implant business? Thanks.
You wanna take the margin.
Sure, sure.
I'll answer the value implant.
Elizabeth, we do have a reasonable infrastructure based in Russia. As that business, you know, and is very dynamic and fluid, we know that we're in that business for the long term. You know, I happen to know the president of Russia during Danaher, during the previous disruption period, and we know that that business will return. One of the things that we did do, you know, very quickly, same day essentially, was looking the ruble impact and the devaluation, and we raised prices. I mean, to your question, Jeff, around not the 3% or 4% or 5%, but we raised it north of 30%.
That, you know, limits some of the exposure as it relates to the FX impact there as well, and we'll continue to look at that. Russia's part of our long-term strategy continues to be. It's been part of that emerging markets that has contributed nicely to our growth overall, and we're in it for the long haul. I mean, as Amir's indicated, we're not building a business for this year, next year, or the one after that, but we're building one for many years to come. We think that Russia will still be a part of that strategy.
Elizabeth, I was fortunate enough. It's interesting now you look back and say, "Well, that worked out really nicely." I was Danaher president of Russia in 2013, 2014, early part of 2015. When the Crimea annexation took place, we had attrition. Retention in Russia was a serious problem in 2012 and 2013. By 2015, we had one of the best retention policies. Our engagement survey in Russia went up by 20% over a two-year time period. What did we do? We exactly as Howard talked about, we immediately changed our practices, pegged prices to euro and dollar. We started looking at the inventory situation, make sure that we're not fueling a black market, secondary market.
We partnered with a lot of American companies in Russia, tried to figure out what was the best practices, tried to do that. We spent tremendous amount of time educating our people, communicating, instilling the Danaher business model at the time. That three, 2.5 years of experience really came handy in the past six or eight weeks. We got to work immediately. The management team that is on the ground, it's the same management team that was back there. We have about 300 people. We have a R&D organization in there. We understand the dynamic of what is taking place, but we are focused on helping people having better quality of life. That's our mission, and we follow American guidance on a med tech, whatever the standards are.
I wanna come back to the value implant, if I may take a step forward and say, why do the people buy a value implant versus a premium? There are oral surgeons sitting in this room that they have 30 years of experience. You charge $25,000-$30,000 for a full arch All-on-4. The price of that implant compared to what you do is very minimal. But do you want your reputation to be impacted on a lifetime solution that you put out there? I mentioned that before. I reinforce it. Parts for Nobel implant. 20 years later, you're able to go and receive those and get that started.
If this is the first time that you are entering that market, this is the first implant that you're placing, and you wanna experiment with it, the value implant plays a really important role to teach you, to get you started, get you going. Majority of places that we see there is a dual approach. You take the oral surgeon, the best in class out of the equation, go to DSOs, general practitioners, total solution providers, referral network. It gives you an opportunity to test, experiment, and get variety of different solutions out there. We need to be present throughout this whole continuum. We need to give people options, but at the same time, we gotta make sure those values as a standard that we described is prevalent and present regardless of what product we put out there.
We're in a really great position with Implant Direct in North America and continue to make progress. We are really under-index in a $2.25 billion market that is growing mid to high single digit. We have a very small position. The only way to solve that problem is through inorganic activities. We took the first step in filling the portfolio gap on IOS. Now we have a methodology and a process, standard work, continue to repeat that as we go forward. We've gotta demonstrate that acquiring is an important part of this equation. We're gonna demonstrate and show that integration of IOS inside Envista has a much better performance. Not only as a standalone product, but as an integrated solution. Next step in that journey, biomaterial, value implant, AI-related digital capabilities, 3D printing. We're gonna continue to do that for the next 5-10 years.
Thank you. Nathan Roth from Goldman Sachs. Two questions. Maybe the first on margins. You know, Amir and Howard, you kind of laid out the path to 22.5% margins or higher. You know, it seems like with the level of revenue growth and the amount coming from those higher margin categories that you expect, you should, you know, in theory, I think, be able to do, you know, comfortably, you know, that 50 basis points plus, if not something well higher. You know, can you talk to me about maybe, you know, how you think about balancing, you know, investing for growth versus dropping some through to the bottom line, and how that might change over that kind of five year horizon that you gave?
Sure. Thanks for the question, Nate. I think you’re exactly right. You hit the operative word. It’s about balancing and making sure that we’re measuring, not just maximizing pure growth at the cost of margins, but also making sure that we’re investing appropriately. If you think about our Spark business that Eric described today, clearly, we’re pleased with the performance. It’s ahead of schedule. Every indicator shows that we wanna continue to invest and ramp up in that business. We’ll continue to do that. Does that cost us a little bit because the margins right now for that business are below our fleet average? The answer is yes.
Do we anticipate that we'll continue to put productivity, efficiency gains that we've seen quarter-over-quarter in that business and get us above fleet average at some point? The answer is yes, long term. We'll do that. Think about the Carestream acquisition. Eyes wide open. We know that it's a carve-out. We're gonna go ahead and bring that in. There'll be some investments that will be needed, whether it be in R&D, quality, you know, the infrastructure setup associated with that. We wanna make sure that we stay very balanced. What we've committed to is getting to that, you know, mid single digit plus and taking it to the high single digit growth, and then committing to 250 basis points of margin expansion over the next, you know, several years.
If I recall, I mean, you know, and I think Amir showed this in the report card a little bit this morning as well, we committed to 50-75 basis points when we went public. We were at mid-teens. We're sitting at, you know, 20% this year. The idea here is that, you know, we wanna make commitments that we can deliver on and be prudent in that regard as well.
Makes sense. Thank you. Amir, going back to the time of the IPO, one of the other growth drivers was high growth, you know, emerging markets. Could you maybe talk a little bit more about where you see the most attractive opportunities? You know, it sounds like you're committed to Russia. China's obviously a large opportunity like you highlighted. But could you maybe just kind of go through that landscape and talk to us about where you see the biggest potential for growth?
Yeah. Thanks, Nate. About 25% of our business today is in emerging markets. The growth actually has accelerated. It's going double-digit, the whole combination. You saw China. China is about 10% of our business. The other 15% has come out of COVID a lot stronger. What we did in the past two years, you saw that transformation in Russia that we became a lot more specialty-focused. We did exactly the same thing in emerging market. JC talked about 50 countries exiting. A lot of that was in emerging market. We saw ourselves being subscale under tremendous amount of price pressure, commodity-based product that really wasn't differentiated.
We started shifting our business in emerging markets to be specialty-focused, differentiated, with the ability to really be visibly differentiated through training and education, feet on the ground, ability to really build a great registration, quality assurance, the RA/QA capabilities, warehousing capabilities that we can deliver things very quickly. Let me go back to our original hypothesis. The top 20 metropolitan cities in the world is where the majority of all the opportunities are going to be in the long run. It's no surprise that young, educated, looking for opportunities, that's where they gravitate to, and that's where we wanna be. We wanna build our infrastructure. In fact, in some of these geographies, we have decided that we are gonna go direct.
We just made a series of announcements over past three months that we're building infrastructure in these major metropolitan cities to be able to scale up over time. Emerging market is going to be an important part of the growth equation for us in the long run, but we also wanna make sure that we are differentiated. We're not competing just on price and just be present. You know, this is a little bit of a history of, 28 different companies bringing it together and building something new. The answer resides somewhere in the middle.
You don't have to centralize everything, but you need to get the best of the capabilities that we have and try to leverage it. That's the journey that we are on. We're committed to emerging market. We're gonna continue to build capabilities in order to make that a difference. When we talk about democratization, a big part of that resides in this emerging market. Eric is registering Spark in every one of those geographies quarter after quarter, and we can make a difference in that. Thank you, Nate.
Hi, Justin Lin from William Blair. Just a quick question on N1. Can you talk through the use cases a little bit more? For example, can you use it in full arch cases currently? You know, what are the current size options available for N1?
N1 originally was developed to hit five different biological aspects and improve the performance of the system and the faster integration. We didn't particularly develop it to do full arch solutions with All-on-4. We have excellent products today that are already doing that. However, there's nothing that would prevent probably N1 to be used for All-on-4s. As a matter of fact, some customers are already doing so, but we would never originally intending that to be the focus. N1's target group and target focus is really where it matters on soft tissue management and really protecting the implant as such. The surfaces with Xeal and TiUltra comes in to protect that. The drill protocol and the preparation of the osteotomy is another aspect where it provides a totally different starting point for future osseointegration and healing.
We've also developed a new connection that is tighter and has a lot less micro motion in it, which is also a good thing for the future stability of the implant.
Got it. Thank you. That's very helpful. The second question is just about your CapEx needs going forward. Maybe help us with a breakdown of that, if you could. How much, you know, for example, is going towards growing Spark, you know, threefold in the next three years, versus your digital workflow transformation and growing the implants business?
This is around CapEx. Was that the question, Justin?
Yes.
Okay. Yeah, got it. Yeah, you know, JC kind of hit on this in his presentation as well. I mean, during the pandemic we've always done it, but more intensely, I think, during the pandemic about looking at ROI specific to all of our investments. As a result, I mean, we made some decisions that were tougher decisions around some of the equipment business and then directed some of that. We call that DRA into some other areas. Likewise, even on the headcount, we reduced headcount by, you know, 15% elsewhere, but grew headcount in the Ormco business by over 50%. Take that mentality and also apply it to our capital expenditure policies. That's the way we think of it as well.
We mentioned earlier that we're gonna get three times the business in 2021 by 2024 in Spark. That's gonna require some CapEx. We built a facility in Mexicali, as Amir talked about. We're gonna continue to build that out in a meaningful way to make sure that we meet customer demand. We'll do that with every bit of our business. As we think about Carestream and the acquisition and what might be involved as it relates to equipment there. We'll continue to protect our Ormco bracket and wire business. Amir and I were just on a call approving some things last night around some of the CapEx associated with some of the MIM products and the like.
You know, we think that CapEx will continue to be a relevant component of our investment. And you know, some of that will come by way of equipment. We'll continue to look at consolidating, as Amir said, even in our manufacturing facilities. While we've made some substantial progress, we'll continue to do that as well. We'll see some of that as being an offset, too.
We're gonna take a couple questions from online. This one is from Jonathan Block. Can you provide some of your long-term thoughts about Spark and bringing that into general practitioners channels? Is that needed to triple the business? As a follow-up, how dependent is implant high single digit plus on N1 rollout and success, or could N1 be accretive to the high single digit plus goal?
We start with the Spark and general practitioners, and then we come back to N1. Please.
Sure. We are primarily focused on the orthodontist space, and we're not exclusive there. If GPs wanna come into the practice, and you've seen announcements with Vitaldent, PDS, we're open to that. Our innovation focus, our marketing and sales focus is on the orthodontist. To reach the growth goals we've got over the next three years, that's enough. I mean, we can really focus on the orthodontist, build that up, and we've got a lot of share that we can gain there.
Just to repeat the question about N1 so I got it right, Melissa.
Is the expansion, the plan, what does that look like? What have you seen so far in Europe, and what's the rollout plan look like then?
Yeah. The rollout plan is mimicking what we did with Spark. It's very methodical, small groups, one after the other. We are seeing great success with our current surfaces, and they will help us drive the growth targets we have. Today, N1 is a nominal contribution to our growth, and over time, that will continue to grow and drive further growth opportunities for us.
Yeah. I think what we've committed to is that over the next few years, between Spark and N1, that will drive 200-300 basis points of growth. We're excited about both those products.
A question from Rachel Vatnsdal. Just the EBITDA margins are expected to go from over 20% this year to over 22.5% in 2026. How should we think about margin contribution from cost savings versus growth from higher margin products like clear aligners and intraoral scanners?
You need to answer it. I'll tell you what the question is. Margin contribution.
Yeah.
of a product versus the cost.
Yeah. Yeah. I got it. Yeah, we talked about 250 basis points of expansion minimum over the next five years. We feel confident about that. Clearly, as the question implies, I mean, you know, we're growing faster in our more profitable business, and so that's clearly gonna have some tailwind associated with that. We will continue as part of, you know, a tenet, a fundamental tenet of EBS is around productivity gains. That's what we look at every day, is to improve those things.
Even in the context of this inflation, I mean, one of the first things that we look to countermeasure some of that is look for productivity gains within our own manufacturing processes to go ahead and improve that and mitigate some of those impacts. That will contribute a substantial amount as well as part of that 250 basis points of margin expansion. Really, it's gonna be driven by the growth and the more profitable, you know, the more profitable profile that we have going forward as well.
Apologies. We have a little bit of a hard time hearing the questions.
There's a lot of reverb.
Yeah.
Yeah.
Please.
Hi. Thanks so much. Matt Miksic from Credit Suisse. One question on sort of the guidance commentary that you talked about, impact of Russia, and then I have one follow-up. I think you'd mentioned a couple of times that you know you have this exposure to Russia, you're taking action to sort of mitigate that impact. Something you know will come out of that in terms of a guidance update. Can you talk about anything else in the quarter or in recent trends that we can expect to hear about that either can offset that or you know things that are perhaps going better than you expected since the beginning of the year? I had one follow-up.
Go ahead. Yeah. I think as it relates to Russia, what we said was, given all the sanctions that are there and getting products into the country has been the challenge. We continue to remain open for business. We're working through the inventory that we have in country today. That gets us through much of the quarter. I think as we look forward, we're looking at opportunities as to how do we get additional product into that country. That's the current challenge that persists today. We'll continue to look at that. The business outside of Russia as it relates to developed markets and such, I mean, continue to perform well.
Even with the latest, you know, late December, early January Omicron, I think that North America has worked its way through it and continues to improve throughout the quarter as well.
Okay. Thanks so much. On digital dentistry, this is something I think you've highlighted and others have highlighted, this sort of fragmentation of platforms in the doctor's office and the opportunity to get after that. If you could talk maybe just a little bit about what the sort of key catalysts or sort of you know drivers for Envista to be the leader of that and how much of that is you know real opportunities to unlock productivity that you can get to quickly, and how much of that comes with change in behavior that perhaps take a little bit longer.
Go ahead.
Yeah, sure. Happy to take that. I mean, in part, you answered the question. You know, it's a combination of both. I think that as we've rolled out both new equipment and new aspects of the DTX software, the potential for people to embrace it goes up. We've also spent a lot more time training our own teams and our own partners on what those value propositions are. Like many things in dentistry, it takes time for people to change what they learned in medical school. A lot of these things, you know, weren't even thought of two, three years ago, never mind, you know, 20 years ago, if you've been practicing and had a successful living doing it.
You know, the more we educate on it, and in many ways, you know, this meeting is about educating people, taking clinicians who are very successfully using it, and basically telling the story that now that I've broken through the other side to use it well, and my staff is trained and they can use it well, I'll never go back. We hear that phrase over and over again. Driving that, you know, this summit is a commitment to having educational activities. We have many other educational parts. We've gotten better over the course of the pandemic at delivering virtual content of the same.
Question from Jason Bednar online. Regarding the gaps that exist on the implant side, are there things that you could do internally, or do you have to go outside the walls of Envista to fill those gaps? For those implant areas that you need to fill via M&A, is there an elegant way to do this in a single transaction, or will these need to come together through a series of transactions?
I'm sorry.
Yeah, it's a lot of reverb in here.
I can... I didn't even...
Yeah. I couldn't understand.
Let me try again.
I couldn't understand the question.
Can you hear me now? Can you hear?
All right.
The gaps that exist on the implant side, are there things that you could do internally, or do you have to go outside the walls of Envista to fill those gaps?
I got it.
To the extent that you need to do M&A, can you do it with one transaction or will need to be multiple transactions to fill the gaps on the implant side of the business?
I got it.
Mm-hmm.
Why don't you take the organic activities?
Yeah.
I answer the inorganic part.
So, in each of our different product portfolios, we're constantly looking at closing gaps in the portfolio to make it a better system and more comprehensive way for our clinicians to treat patients. That's an ongoing organic activity inside of all of our implant companies. I think the M&A portion of that, maybe Amir, you can take.
So there are a set of capabilities that we can do internally. As Patrik said there, we have put tremendous amount of R&D into the program. We are also doing a whole lot of collaboration in various places. Let's take, for example, the biomaterial. These are the kind of capabilities, building a clean room, material science. It's not something that we have inside. It's not something that we are developing.
The best way to do that is to find the best-in-class solution in different geographies and come to an agreement. It doesn't necessarily have to be everything around M&A. We can come to a partnership agreement. We can get product rebranded, OEM and other method. Our approach is shifting toward everything in-house or a complete acquisition. You could do a lot of work around early investment, seed money, partnership. Both companies are seeing the benefit of it. A good example of it is the relationship that we built with Medit and 3Shape. We compete with them in some places, we cooperate with them. That is the new model that is going to exist in this industry, and we are championing that. We did that in those two areas, and we're gonna explore all options. Not all founders want to be bought.
Not all founders want to be part of a big companies. We're trying to adjust our approach based on the realities on the ground. Again, I'll go back to that single principle of patient and dentist. As long as we can meet those requirement, we are open for business. We're willing to do what it takes to make that happen. We do have the firepower now and the credibility to be able to deploy capital and do things very rapidly. Having those optionalities, having that in our hand, gives us option to close the gap and get ahead of it a lot faster than what we had done before. I wanna touch on one more thing. Incredible company, Danaher. Beautiful performance. Doing a $50 million acquisition inside Danaher was not necessarily moving the needle.
Inside a $2.5 billion-$3 billion company, a $100 million acquisition is really meaningful. That's what we intend to do continuously going forward. Things that make a difference in what we offer has impact across our portfolio, but make us stronger on an ongoing basis.
Great. Do we have any other questions in the room? Sure. Absolutely.
Sorry, just one follow-up. Amir, on the double digit LRP for orthodontics, you know, if we look at clear aligners, penetration has been moving up maybe a point or two a year in the teen category for the last several years. Seems like we're kind of at an inflection point, although that's always tough to call. You know, if everybody's aggressive Spark and SureSmile and Invisalign numbers are gonna come true over the next few years or prove somewhat accurate, that penetration rate's gonna have to accelerate. We're gonna have to pick up three points a share, then four points a share, then five. Within your LRP, I guess my question is, in the core base braces business, you know, the last couple years, we haven't been at that big inflection for clear aligners, so you've been able to nicely offset a little bit of pressure maybe on volume.
Right.
With the price mix. A few years from now, my gut is that the volume component has to accelerate to the downside a little bit. Is there enough price mix to keep that part of your business still growing? Not next year, not in the next one or two years-
Right.
Three or four years out. Again, in the LRP, to get to double digits, are you assuming braces are flat, they're up, they're down? Just how to think about that. Thanks.
That's a really good view of this, Jeff. We have seen that, by the way. We are seeing exactly what you touched on. The number of case starts is kind of flat. It's really not radically changing. What is happening is the mix is radically changing to high growth market, to emerging market. Less in the United States, less preteens in the United States, a lot more outside U.S. Let me just give you a simple answer. Average treatment on a clear aligner today is $4,000-$5,000, in some places, up to about $6,000. About 20% of that goes to manufacturers, 20%-25%. With the amount of time and energy that you spend to do that. Now, compare that with the bracket and wire.
You pay 1/4, 1/5 to the manufacturers. Getting a sub-$1,000 treatment in India, in Brazil, in China, is a lot more affordable than a $5,000 treatment. With average labor rate, with all the things that is taking place, being able to do that and give that quality to adult, to preteens in those geographies. The numbers are shifting, the mix is shifting, becoming a lot more in high growth market in other places. There is one more things. There are 750 clinicians in here. They've been here since Wednesday. Now they're gonna be here until Saturday afternoon. I've been walking around talking. We are not asking people.
They're telling us that if the bundled solution from the same company, if you give me Damon Ultima, if you give me Spark, I can make that treatment a lot faster, a lot quicker. Do it six months, nine months, and then go to a Spark. You say, "Well, they have it today." Yes, but there are two different system, two different pricing. They have to charge it twice. So now you're giving options to people. You're giving options to people to have opportunity to make difference. Having those in our portfolio, exactly as Howard said, it gives us optionality to change the margin structure and pricing. The numbers are flat to go down, no question about it. We are compensating for it by going to emerging market, by doing this optimum of a mixed treatment, by opening the door in one place and expanding it in other places.
At the same time, people are exiting that market. We all know that. This gives us an opportunity to enter. It's been interesting. Eric talked about Ormco gives us an opportunity to go sell a Spark. The opposite of that is also true, that we are able to enter in places with a Spark and now start teaching Damon. Now start teaching bracket and wire and use that combination. Laws of numbers are not changing. That's absolutely true. How you deal with that, what your approach is on a pricing on a combination will compensate for it as we go forward. We're committed to the bracket and wire. We're not exiting that market. It is a high margin, 35 years of, you know, presence in that area, and it gives us a base of differentiation compared to everybody else. Thank you.
Thanks. I think that'll be our last question. For everyone on the virtual event, thank you very much for joining. We're gonna adjourn to a break, and then for people here, we will do a tour. We really appreciate you joining us on our first Investor Day as a public company. The replay of this as well as the presentation will be posted on our website a little bit later today. We really appreciate your time, and thank you. For people in the room, we'll take a 15-minute break, and then we'll regroup for a tour. Thank you very much.