All right. Good morning, everybody. I'm Jim Gustafson, Vice President of Investor Relations here with Envista, and it's my pleasure to welcome you to our 2025 Capital Markets Day. Thank you all for your interest in our company. I'd like to remind you that the presentation that you see today will be available for download on the Events and Presentations section of our IR website at investors.envistaco.com, and it is available right now if you want to download it. Additionally, this event is being webcast live in the same Events and Presentations section of our IR website, and will be available for replay later today after the event is concluded. Today, you'll have the opportunity to hear from four members of Envista's leadership team.
Paul Keel, our CEO, will lead off the agenda with a discussion of the dental products industry and our plan to create value over the next few years. This will be followed by presentations from the leaders of our two largest business units. Stefan Nilsson, President of Nobel Biocare, will discuss our dental implant business, and Veronica Acurio will go over our plans in orthodontics. And then Eric Hammes, our Chief Financial Officer, will follow with details on our multi-year financial outlook, and Paul will close with some summary remarks. Then, after a brief break to set up for Q&A, those of you in the room will have the opportunity to ask questions of members of our leadership team. So in our presentation today, we will make forward-looking statements within the meaning of federal securities laws. These statements are subject to a number of risks and uncertainties.
For more information on these risks, please refer to our SEC filings, including our most recently filed 10-K. Additionally, we will reference some non-GAAP financial metrics. Reconciliation of these non-GAAP measures to our most comparable GAAP measures are included in the appendix of this presentation, which, as I mentioned, is available for download on our website. And with that, I'd like to turn the stage over to our CEO, Paul Keel.
Isn't it customary to clap? Thanks, everybody. Good to see everyone. Appreciate you joining us. As many of you know, I'm coming up now on my first full year with Envista, and the other presenters this morning, Stefan, Veronica, and Eric, joined me a few months after I came on board. Now, we all decided to come back to this industry, having spent most of our careers in and around dental, and we chose to do it at a very particular point in time and to this specific company. And we did that, of course, because we believe in the opportunity. And you see a summary of the opportunity we see in front of us on this slide: the three tenets of what we think of as a value creation thesis. Now, the first part of the thesis, of course, is around the market.
Dental is a structurally attractive market. If you add up all the pieces of it, it's roughly a $400 billion category, and it has consistently grown in sort of a 3%-5% range. Now, prior to COVID, it had been very, very stable. The dental market had, prior to COVID, only contracted once in the preceding 75 years. There was a brief single-digit contraction following the global financial crisis. But then, as we've seen in a number of other categories, COVID materially disrupted that. We had a record dip in 2020 when none of us could go see a dentist, and then we had an even larger rebound in 2021 when all of us went back, and that then caused this below-trend growth over the last couple of years while the market has digested that turbulence.
Now, nothing has fundamentally changed in the underlying structure of dental, so we expect it to return to that same 3%-5% range over time, so that's the first piece of why we think there's a good opportunity here. The second is specific to Envista and our position within the market. Envista and our predecessor companies have been serving the global dental community now for more than 100 years, and across this time, we have had a long and successful track record of introducing some category-defining new products. I'll show you more about this here in a moment. Our portfolio has been carefully curated over time to focus on what we think are the most attractive parts of the dental market.
In addition to being well-balanced by a sector perspective, our portfolio also has strong global reach, and we have deep capabilities in commercial outreach, clinical, regulatory new products, manufacturing, etc. Also important for as far as this company has come across our century-plus history, we have a very strong continuous improvement culture, which drives us to make tomorrow even better than today. So that's the second half of the thesis we'll talk about this morning. Now, with a structurally attractive market and a well-positioned company, the opportunity for value is clearly there, which brings us on to the third part: turning that potential into performance. Now, we believe that Envista currently has the right people, plan, and capabilities to convert this potential into improved performance, and we recognize that that has not always been the case with Envista over the past couple of years.
We had a capital markets event about this time of the year in 2022. Many of you will remember it. And at that time, we put forth guidance that we felt was appropriate at the time, coming off that record post-COVID surge that I just mentioned. But just as nothing has changed in the underlying fundamentals of dental over the past two to three years, nothing had changed during COVID leading up to that surge. And now, with the benefit of hindsight, of course, that 2022 medium-term guidance has proved to be overly enthusiastic. More to the point, we undertook a series of short-term actions to try to deliver against those targets, which had further damaging downstream effects. So the change in management last year also allowed the company to reset our targets, reset our plan, and that brings us here today.
We're now squarely aligned on a set of key priorities. They cluster around three groups: growth, operations, and people. And I'm going to walk through the broader frame in my comments, and then we'll let Stefan, Veronica, and Eric fill in the details. Okay. Before I get to the plan itself, recognizing that some of the fundamentals, the market, and for the most part, our positioning have been stable for a while, you're probably asking yourselves, "Well, what is changing and what isn't?" So let's begin with the top half of the ledger and what is not changing. Our portfolio was first assembled when we were part of Danaher. So that company pivoted from industrial to healthcare in the early 2000s. And at that time, Danaher focused on dental as a particularly attractive part of the healthcare landscape.
A decade or so later, Danaher pivoted again to life sciences, and that is when we spun out in 2019 as a separate independent publicly traded company. Now, our portfolio has been intentionally curated and honed over the last 25 years, and that has served us well. That focus on the most attractive parts of dental will not change moving forward. We're also continuing to focus on our four fundamental strengths that contribute to our competitive advantage. Those are innovation, a strong portfolio, global reach, and that continuous improvement focus that I mentioned earlier. Still more, we remain committed to the core belief that while a good market and a capable company are certainly necessary for value creation, they're not fully sufficient. Ultimately, performance drives value, and it's that part of the equation where we're most intensely focused right now.
And that brings us to the lower half of the ledger. What is changing? Now, again, we recognize that Envista is not currently performing in line with its vast potential. So the changes that we're making are mostly focused on bringing the two in better alignment. That all begins, of course, with leadership, and you're going to get a chance to meet the full team here today. You're going to see a lot of familiar faces. The core group of our leadership team is the same. These are the folks who got us to where we are today, but you'll also see a few new faces, in particular, the four of us who are presenting this morning. As I mentioned, our plan is focused in three areas: growth, operations, and people. So you won't be surprised to see a focus on things like commercial execution, capital efficiency, and talent development.
It's more the disciplined execution of these priorities that is changing. Another change which you heard about on our Q1 call was an expanded approach to capital allocation. We announced a $250 million share buyback program. That's a new arrow in our quiver for Envista, and Eric will say much more about this when he presents. And finally, we aim to direct all of this activity towards building a stronger, more consistent track record of delivering against our commitments. We reset our 2024 guidance shortly after I joined in the middle of last year and delivered against those commitments in Q3 and Q4. We then introduced our 2025 guidance last month on the Q4 call. You'll get your first chance to see how we're doing in that regard here in a couple of weeks. And then today, we'll introduce our medium-term financial targets.
I'll flash them during my presentation, and then, of course, Eric will talk us through those details. Okay. Having laid out the three components of our plan, let's walk through each of them, beginning with the market. So as everyone in this room knows, dental is a structurally attractive industry. Across the full landscape, from patients to clinicians to suppliers, it's about a $400 billion annual spend, one of the larger healthcare categories, which comes as no surprise since everyone on the planet is a potential patient. Further to that point, every one of us tends to demand more dental care as our age, our income, and our particular needs change as we go through life. So importantly, dental growth is not limited by demand. As you see on the left side of this chart, almost two-thirds of the world's population currently suffers from a malocclusion or misaligned teeth.
Almost half of us are missing one or more teeth. In a regulated industry like ours, supply is the more common constraint to growth: the number of licensed clinicians and, in our case, the number of registered products that are on the market to serve this demand. Now, to illustrate the point, Veronica, when she presents, will walk us through the situation in ortho. Roughly 600 million people in the world have the financial wherewithal and the clinical need to undergo orthodontic treatment, but fewer than 5% of those actually get treated. That's because there's only 60,000 orthodontists in the world. A similar unmet demand exists in implants, and Stefan will talk about this. There's about 200 million people a year who seek treatment and fewer than 10% who currently receive it, again, because there's not currently enough clinicians to place the implants. This persistent shortage of supply is one of the reasons why you see such consistent growth in our market. There are 2 million dentists in total around the world serving 8 billion people, and there's roughly a dozen of us global suppliers who serve the clinicians. So from a market perspective, there's plenty of opportunity. Okay. There's a number of additional secular reasons that contribute to dental consistently growing over time. You see some of those here, working from the right side of the chart back across to the left. It's well understood that populations are aging around the world to the degree where we are literally outliving the biological life of our teeth. By the age of 60, the average person in this room will be missing at least one tooth, and an unlucky 20% of us will be missing all 32. You might want to write that down.
Rising living standards, of course, help expand demand both for aesthetic reasons but also for well-established connections between dental health and overall health and well-being. And similar to many healthcare sectors, digitization in dental is rapidly improving both the efficacy to patients but also the efficiency to clinicians. Technologies like 3D imaging, digital treatment planning, custom orthodontics all lead to a much better experience for us as patients and for our customers as providers. Importantly, these are not transitory effects. These are structural, long-term, foundational trends that support the long-term growth of this industry that you see here on this chart. So I mentioned that the industry over time typically grows 3%-5%. You can pick any five, 10, 15-year period you want. You will get a similar CAGR. You see that in the blue bars on the left.
Not true, though, if you pick the five-year period around COVID. Those are the orange bars in the middle. Again, you see illustrated that trend that I mentioned previously: a record dip in 2020, an even larger rebound in 2021, essentially two to three years of demand pushed into an 18-month period, and then with the benefit of hindsight, a below-trend growth over the past couple of years while the industry has been digesting this disruption. Now, nothing has changed structurally in the market. It didn't change in the period leading up to the big spike, and it hasn't changed in the last two or three years as we worked through it. So there's general consensus that the market will come back, but there's also a fair bit of debate, particularly right now, around the timing of when that recovery will happen. So two additional macro factors deserve mention.
The first is consumer confidence. Another one of the benefits of the dental market relative to the rest of healthcare is that it tends to have lower regulatory risk and lower dependence on reimbursement. But of course, the flip side of that is that dental has a higher proportion of out-of-pocket spend by patients. So consumer confidence plays an important role. Consumer confidence has been slowly migrating up from the depths of 2022, but it's still 10 or 15 points below where it was pre-COVID. So as confidence grows, the market will come with it. The second is interest rates. Now, dental again tends to be less capital-intense than other healthcare categories, particularly on the hospital side. But there are certain parts of our industry that get financed. New clinic builds are an example. Some diagnostic equipment and very high-ticket procedures like a full -arch restoration often will get financed.
So as interest rates continue to moderate, that will be supportive to the recovery. Now, while dental in total is a very nice industry, we are focused on a very specific part of it where the margins tend to be higher and growth tends to be even faster. Those are the four segments you see here on the left. Now, there's a couple of reasons why we like these four segments. The first is that there is a continuum of care that exists in dental. Pretty much every procedure has the same three steps. There's an upfront diagnostic step where the patient's needs are assessed. There's an interim middle step where the case is planned, a treatment planning step. And then, of course, there's the third step, the therapeutic stage where you actually treat the patient. Now, it's difficult to serve our customers across that full continuum of care.
But for the providers who can do it, there are clear clinical, operational, and financial benefits. And Envista is one of a very small handful of providers who do this on a global scale. A second reason we like these particular categories is that the specialty sectors often go direct to our customers, meaning that there isn't a distribution layer in between that typically leads to higher margins and faster growth. And as Stefan and Veronica will share with you, we're a leader in both of the two largest specialty categories, implants and orthodontics. Now, a third reason that we focus on these is while consumables and diagnostics as sectors do tend to grow less quickly than the specialty sectors, you need to serve them if you want to be part of that continuum of care.
Again, it's very hard to do that, especially on a global scale, but if you can, it's a big competitive advantage. And again, we're one of the few who can do that. Okay. We've now walked through the first element of that value thesis I talked about, why dental is such a good market. Let's now go to the second half, why Envista is so well positioned to access this opportunity. Now, for those of you in the room who are newer to our story, Envista is a global dental company, and we go to market through two reporting segments: specialty products and technologies on the top left, and then our E&C business on the lower right. About two-thirds of our business is specialty, and about a third is equipment and consumables.
We have a top two or three position in almost every category in which we compete, and some of our brands, like Nobel, Kerr, or Ormco, have nearly 100% recognition amongst those specialty groups that we serve. We operate in over 130 countries. About half our revenues in the lower right come from the U.S., which is the world's largest dental market, and the balance is equally split between Europe and developing markets. We have about 1,800 patents to our name, and as I'll come on to in a moment, many of the most important innovations in dental over time have an Envista brand attached to them. Our company is powered by what we call our four fundamental strengths. You see them here: innovation, a balanced portfolio, global reach, and a continuous improvement mindset. I'm going to give you a chart on each of these to go into more detail.
Let's begin with innovation. So I mentioned that we have a rich history of developing innovative, customer-centric new products. These are more than just words on a page. Nobel Biocare literally invented dental implants. Stefan will say more about this. Ormco, our orthodontics business, did the same for fixed-wire appliances, for what you and I call braces. They also invented passive self-ligation and custom orthodontics. DEXIS, our diagnostic business, did the same for panoramic X-rays and for seated CBCT. If you were to compile a list of the most important advancements in dentistry over time, our fingerprints would be all over it. Going on to portfolio, I mentioned that it's well balanced by sector. It's also well balanced geographically and in terms of go-to-market model, direct versus through distribution. That leads to a couple of important competitive advantages.
First, it leads to a lot of economies of scale and scope in the different areas that form the basis of competition in dentistry, things like new product introduction, operational efficiency, clinical education, etc. In the same way, our individual businesses can access the broader, strong balance sheet of total Envista. It would be very difficult for each of the businesses to do that on their own. In the same way, we're able to build scale in the specific countries where we compete, even if that local market wouldn't be big enough for a local competitor to do the same. We can leverage our world-class functional expertise in the same way in regulatory, clinical, etc., which allows us to attract top talent and get the best local partners. We go to market as a unified global team. We're able to think globally but still able to act locally.
Finally, and most importantly, this balanced portfolio works for our customers. Now, some of our customers are large multi-site, multidisciplinary players like a DSO or a university or a government system. We're unique in the dental world, having that full portfolio, but a lot of our customers focus on one particular specialty area, and we also have best-in-class solutions for those folks. Let's turn to global reach. Envista products can be found in an astonishing 90% of every dental clinic on the planet. We hold tens of thousands of product registrations across 20,000 different products. We have incredible worldwide breadth and depth, and it's taken us decades to build this.
In addition to our unmatched regulatory and clinical assets, we have one of the largest sales and marketing forces in our business, over 2,400 leaders strong, and we have a supply chain that covers 20 different plants on most of the major dental markets. Now, important for today's dialogue around tariffs, Envista has long architected our supply chains with a local-for-local mindset, meaning wherever possible, we source raw materials in the same country or region where we manufacture them, and then we serve our customers from those same sites. All of our big businesses, implants, ortho, diagnostics, and consumables, have factories on two or more continents, and that allows us to better navigate the different forms of supply chain interruption, whether it's a physical good interruption or a currency fluctuation, or yes, helps us better mitigate tariffs. We'll see if we get any questions on tariffs here in the Q&A.
Let's go to the third fundamental strength or the fourth fundamental strength, sorry, that being continuous improvement. This is embodied in the Envista Business System. As I mentioned earlier, we grew up inside Danaher, and they're a much-vaunted Danaher Business System. We took DBS and customized it for the needs of our stakeholders. EBS is very much and truly the way we work at Envista. It's central to how we improve performance, how we develop our people, and how we advance our culture. As you can see on the chart on the left, we use EBS to drive productivity in both COGS and G&A, and then we also use EBS to direct the reinvestment of those gains back into the growth levers: new product development, commercial effectiveness, etc.
I spent more than 20 years of my career in other strong continuous improvement cultures, GE and 3M in particular, so I know firsthand the foundational importance of continuous improvement to building sustained long-term value. So after I joined Envista last spring, we redoubled our focus on EBS. Let me give you a couple of examples. We aligned all priorities across our whole enterprise. I'll show you that list here in a moment. And now we're operationalizing those priorities through shared boulders, through employee objectives, and through daily management boards. You'll see a real-life example for implants and ortho. We have put in place EBS leaders for every business and every function, and we're now conducting what are called CEO, CFO, and president Kaizens to get the organization focused on the very highest priorities across our company. Again, you're going to see specific examples of this shortly. Okay.
Having gone through the attractiveness of the industry, why we are so well positioned to succeed in it, let's now get to the plan on how we're going to do that. Everything begins, of course, with our powerful purpose of partnering with dental professionals to improve patient lives. This is an important purpose because it aligns us so well with our customers and allows all of us to move together, move forward together. The second chevron over, as I mentioned, Envista has built a very broad global portfolio. My 12,000 colleagues around the world reside in more than 130 countries and more than 100 different locations that are set up proximate to our customers.
But wherever you go in the world of Envista, everyone is united by those same values you see in the center of the chart: customer centricity, innovation, respect, continuous improvement, and leadership are what we call our CIRCLe values. Every professional employee in Envista is measured annually both on the what, what some folks would call a contribution score, but also the how, the CIRCLe values in how we deliver these results. We then operationalize the purpose and the values through the three priorities you see here: growth, operations, and people. We're going to have a bit more on that in the coming slides. And then all of this is quantified in the commitments that we make to all of you. So last month, we introduced our 2025 guidance: core growth of 1-3%, EBITDA margins of 14%, and EPS of $0.95-$1.05.
Today, we introduce new medium-term guidance: core growth of 2-4%, which we then convert at a higher rate into EBITDA growth of 4-7%. Some work on tax and other things that Eric will talk about allows us to turn that into 7-10% EPS growth, and we convert all of that into cash at a 100% rate. Okay. Let's go through the priorities again around those three categories that I mentioned. In terms of growth, we are laser-focused on our customers, leveraging that great global reach I mentioned to serve either individual clinicians in a particular practice area or those multidisciplinary practices like a DSO or government system. We're focused on commercial execution, in particular in our two biggest businesses, Nobel and Ormco. You'll get chapter and verse of that here shortly.
As noted, we keep innovation and portfolio management very visible in our company and keep it well-resourced. With respect to operations in the orange, our attention centers on two particular areas: productivity and capital efficiency. With respect to the first, we have opportunities to improve our efficiency in both COGS and in G&A. In support of COGS, we have an organized series of Kaizens to drive both factory productivity as well as price capture. In terms of G&A, we announced a restructuring last month that is expected to generate $20 million of gross savings across the medium term. Capital efficiency is similarly important, and we benchmark well against our peers. Our CapEx typically falls below 3% of sales, and our working capital turns are typically above 5. Free cash flow was up 35% last year, in large part because of our focus on these activities.
And our people make all of this progress possible. We have focused efforts underway to advance leadership development, to improve our colleague engagement, etc. I'm going to introduce the senior team here in just a moment, and then those of you who are joining us for lunch will have an additional opportunity to engage with all of us. All of these priorities are enabled by Envista's business system, and all of them are rooted in our core CIRCLe values. Okay. Let's spend just a bit of time on each of those three priority areas: growth, operations, and people, and then I'll wrap things up. Let's begin here with growth. In a high gross margin business like ours, of course, the surest path to sustained value creation is top-line acceleration. We have a very organized, intentional approach to do that.
You can see it described by these four different spheres where we focus. Our biggest focus, consistent with what I said earlier, is just accessing the available growth in our core markets. Despite our very large and strong positions in our core segments, we're still a very small piece of that $400 billion opportunity. The second sphere is around new product innovation. I showed you an example of our very rich history in that regard. Stefan and Veronica will give you a sneak peek into what we're currently working on. Third, we have a very specific focus group of adjacencies that we're penetrating. And then on top of our focus on core organic growth, we supplement that with a creative M&A. You have an example on the right for each of those. Slide 20 here gives you some data behind our focus on operations.
Three very common measures of operational effectiveness are safety, on-time delivery, and working capital turns. Each of them is particularly important to a different stakeholder group. Recordable incident rate or safety measures how you treat your most important asset. Across all manufacturing environments, whether in healthcare, industrial, transportation, etc., an RIR averages around 1.6 accidents for every 200,000 hours worked. Now, an RIR of 0.6 would put you in the top quartile of all manufacturers around the world. As you can see, we typically hover around 0.4. Very safe environments. Any accident is one too many, but 0.4 is a world-class RIR level. Secondly, on-time delivery measures how well you treat your customers. As you can see, our OTD consistently hovers in the high 90s. That's particularly important in direct businesses like our specialty categories, but also allows us to build very strong partnerships with our distribution partners.
And working capital turns on the far right, of course, measures how well you use your operating assets. Now, for a diversified global supply chain like ours, working capital turns anywhere north of four would be a good number. As you can see, we're consistently above five, and we bumped up against six last year. So it clearly demonstrates the operating strength of this company. Which brings us to our most important priority: our people. We have a full leadership team today with us, as I mentioned. I'm going to quickly introduce each. They're sitting in the back of the room. They will wave but not make any comments. Team. And again, those of you who are joining us for lunch can quiz them. So let's begin on the right side of the page with our business leaders. Stefan, you'll hear from shortly. He leads Nobel.
Veronica, you'll also hear from, leads ortho. Drew leads consumables and Challenger implants. Robert Befidi, on the right, leads diagnostics, and Filippo leads our Developing Markets group as well as Japan and Australia. On the left side of our round table are our functional leaders. Eric, of course, is our CFO. Claudia, Mark, and Suraj lead regulatory, legal, and HR. Mischa is our captain of our business development team, and Andrew is our CIO. He keeps our data in and the bad guys out, so that's our team, and we're lucky to have such an accomplished, capable group of leaders guiding our company. Okay. I'm going to wrap things up then, similar to how I opened, by summarizing the compelling opportunity that we see in front of us. All of us are fortunate to work in an industry with consistent structural growth.
It's an industry poised to return to its long-term average of 3%-5% after digesting that post-COVID surge that I mentioned. I'm fortunate to work for Envista, a company so well positioned to take advantage of this great market. We boast a 100-plus year history of innovation, an enviable portfolio, a well-balanced group of businesses, both geographically and through go-to-market model, and unmatched global reach. We shared with you our plan today to turn all this potential into improved performance. We have a clear set of priorities that guides our attention and our resourcing. There's a tight correlation between resourcing and performance. And then, of course, we have a clear understanding that improved performance will drive sustained value creation. It's as simple and it's as hard as that.
So with that as an overview, let me now invite Stefan to come up and show you how we operationalize that in our implants business. Stefan? Well done, man. Thank you.
So good morning, everyone. I'm very thrilled to be here today. It's a big day for me, first time in New York exchange, and also very thrilled to have joined Envista in July last year. I'm heading the Nobel Biocare and the implant business. And Nobel, being from Sweden, given Nobel Biocare's roots in Sweden, it's an honor to be leading this business. It's a legendary organization, and it means a lot to me. I come from the customer side. Before, I worked for Colosseum Dental Group. It's the largest DSO in Europe. And I think as a customer. So what interests me with Nobel Biocare was it's not just about the history and all the patents and the clinical and scientific, but it's also about its leadership to always continuously improve innovation.
I'm hopeful that my unique customer perspective will prove helpful as we embark on this journey with Nobel Biocare to accelerate growth, profitable growth. Additionally, I led various businesses and companies around the globe. Notably, I established Nespresso in Latin America. Beyond the passion for emerging markets, this experience taught me the importance of premium experience and a brand in establishing and protecting premium product positioning, which is notably very highly relevant for Nobel Biocare. I should also mention that I'm an engineer. I work globally to optimize manufactories and logistics centers. And as an operator, driving operational excellence is in my DNA. I'm very excited to have these opportunities for Nobel Biocare ahead. Beyond the history, its brand, portfolio, I have nothing short of being very impressed by the talent and commitment and expertise of the team of Nobel Biocare.
There are unique assets, all of them, that represent a very strong competitive advantage. With this intro, I jump into our plan. The global dental market offers an attractive $12 billion opportunity, experiencing mid-single-digit growth. Its long-term growth potential is driven by several factors, including a substantial underpenetration of implant treatments for missing teeth, as Paul mentioned before. Envista has a very strong position in its premium segment with Nobel Biocare, also exposure in the fast-growing Challenger segment, sometimes called the value segment, with Implant Direct and Alpha-Bio Tec, combined industry-leading digital solutions and global reach. We heard about that, with advanced clinical education capabilities worldwide. This provides us an excellent opportunity to play and win in this market. We have a clear strategy and operational plan to achieve profitable growth. This growth is driven in three pillars. The first one, commercial execution, a sharp focus on continuous improvement.
We heard about EBS, enhancing sales processes and customer engagement. Number two is to strengthen our respective brand presences and reputation, and number three is to sustain investment in innovation. Further, EBS provides us with a mindset and toolkit to drive operational excellence and allow us to drive profitability and reinvest growth initiatives like innovation. Finally, and most importantly, we are drawing on a unique, incredible, talented, and committed team across our implant businesses. I'm humbled to have joined this organization. It's an incredible experience and expertise in the field of dental implants, but also prosthetics and regeneratives. To unleash this power now with these teams, we are establishing an empowering culture, a focused organization with clear priorities and accountabilities, and we foster a positive and collaborative and high-performance working environment. With this, let's take a look at the implant market.
The dental implant market represents a highly attractive opportunity, valued at a total of $12 billion, and it's growing at a mid-single-digit rate. $4 billion is the implants or the fixtures, which serves as an artificial root to provide a stable foundation for the dental prostheses. This $4 billion dollar segment is divided into Premium, $2 billion, and Challenger, $2 billion, and represents in total around 30 million implants yearly. The other component is the $2 billion standardized components. This includes the abutments. These are basically connectors that attach on the implant so you can put basically the teeth on top of it. There are digital scan bodies and soft tissue healing components, and these components collectively represent a $2 billion dollar growing at a mid-single-digit. The biggest piece is actually $5 billion, which is the dental customized prosthetics.
This is the visible part, and this is growing at a low single-digit rate, primarily served by the dental laboratories. And last but not least is a $1 billion market in regeneratives. This is a rapidly growing biomaterials and regeneratives, and this aids tissue and bone regeneration and the healing process. This is currently valued at $1 billion and growing at a mid-single-digit rate. Despite the recent macroeconomics and geopolitical challenges leading to softer demand and recent market decelerations that Paul also talked about, there is a long-term market growth potential that remains very attractive. This potential is driven by secular trends and key market growth drivers. An aging global population is associated with an increased prevalence of missing teeth. However, there is a substantial and underpenetrated dental implant market to treat these missing teeth.
We estimate that less than 1% of patients with missing teeth are treated with dental implants. Approximately 4 billion people suffer from failing or missing teeth. Various barriers prevent individuals from obtaining implant-based tooth replacements. It's a lack of awareness about this treatment option. It's a limited access to dental healthcare services, often due to affordability issues. But even among the more than 200 million individuals who seek this treatment annually, implants may not be offered because the doctors are either unaware or unable to perform implant therapy. Patients may reject these treatments due to fear or lack of trust or misunderstanding of the implant process. Dental implants are the standard of care for tooth replacement. Envista is an active partner in supporting dental clinicians to address and lower these barriers. Our goal is to help patients receive the treatment they need and deserve.
We in Envista are very well positioned in both premium and Challenger segment. Coming to premium and Challenger, as mentioned, implant brands are typically segmented into premium with a higher price point and Challenger or value at a lower price point. This presents a unique opportunity for a small group of implant manufacturers to implement a tiered multi-pricing strategy supported by clear differences in value propositions. The premium segment is expected to grow at a mid-single-digit. It comprises a small, stable group of three core players, where Nobel Biocare is one. It represents the founding group of the implant industry.
Given the heritage these companies have, the strong inimitable brands, and reputations built over decades, this position continues to be justified by continuous innovation and development, specialized solutions for specific clinical cases, deep scientific capabilities among these companies, and decades of experience, follow-up, and clinical evidence supported on the products over time. They also have usually global reach and scale, both commercially but also in clinical education. And additionally, the premium implant brands often enable implant-placing doctors to tailor the treatment fees to the affordability of their patients, hence expanding the pool of patients they can offer their services for. The Challenger segment is expected to grow at a high single-digit, largely driven by bringing new patients and clinicians into the market rather than shifting demand from the premium to the Challenger segment.
The Challenger brands are typically characterized by the versatile product functionality, a lot around the focus on practical innovation, simplicity, and often local heroes, positioning with local strong support and clinical education. The premium segment has demonstrated resilience over the past decades and continues to show potential for mid-single-digit growth. Talking about Nobel, Nobel Biocare is a direct legacy of Professor P.-I. Brånemark. He is known as the founding father for dental implants. In 1952, he was a young clinician and did a lot of research and found the groundbreaking titanium integration into bone. This is laying the foundation for dental implants. He placed his first dental implant into a human, his first patient, in 1965, leading to the industrialization of dental implants through the company that became Nobelpharma first and which is today Nobel Biocare.
Over the past 60 years, Nobel Biocare has pioneered key products, clinical protocols, solutions in modern implant dentistry, notably innovations that include the world's most famous Brånemark, Replace, Parallel, and Active implant systems. They also, Nobel Biocare, invented the first zygoma implant, which is a cheekbone implant. These were all the patients that don't have enough bone to put an implant in the upper jaw, introducing anodized surfaces, the TiUnite and TiUltra, and the invention of All-on-4, the full -arch that Paul mentioned as well, which is a first-class treatment where they invented a multi-unit abutment to enable this concept. Also, the first-in-class angulated screw channel abutment, which is an opening possibility for outstanding prosthetic aesthetic results. So Nobel Biocare products, its concepts, have advanced implantology for decades. Today, Nobel Biocare continues to innovate and push the boundaries for dental implantology and is widely recognized as a leader in premium.
Continuing, Nobel Biocare portfolio is unique. It offers differentiated solutions across all aspects of dental implantology. It is known as best-in-class implant threads, designed for specific use cases, from simple to common to rare and complex. For instance, the NobelActive implant system is renowned for its unrivaled ability to provide primary stability for immediate loading. Also, the unique anodized surfaces that accelerate osseointegration and improve soft tissue healing. A broad range of surgical protocols and concepts include guided surgery, dynamic navigation with X-Guide, which is a digital placement system, the new drilling protocols that improve osseointegration, and a market-leading portfolio of biomaterials and regeneratives. This is unmatched customized prosthetic solution with NobelProcera, which is individualized CAD/CAM solutions. So the NobelProcera cutting-edge solution for precision and aesthetics is something also that was invented under the umbrella of Nobel.
A distinctive edge of Nobel Biocare's premium brand is positioning its unparalleled body of real-world clinical evidence supporting our products and solutions over time. Over this time, 30 million Nobel Biocare implants have been placed globally, which makes us one of the leading implant brands. Nobel Biocare solutions are the most studied in the industry, providing robust body evidence that clinicians can rely on when choosing the best implant solutions for their patients. A few highlights: 4,500 publications in peer-reviewed journals include Nobel Biocare products, most in the world. Eight out of 10 cited publications in the last 25 years feature Nobel Biocare products. Nobel Biocare has the highest number of implants from any premium player included in published clinical studies. So Nobel Biocare industry-leading follow-up periods demonstrate long-term favorable clinical outcomes. We have a 20-year follow-up of our TiUnite surface that demonstrates a 95% survival rate.
We have a 5-year follow-up study on our TiUltra and the NobelActive with a 97% survival rate. We expect more publications in 2025, and we will continue to solidify Nobel Biocare's position as the most reliable implant manufacturer in the world. Concluding this, unlike many of our competitors, Nobel Biocare can substantiate its claims on the long-term clinical outcomes of our products. This is crucial as clinicians express the desire and need to trust and rely on medical devices they use to treat their patients. Moving over, Envista has a strong foundation to grow in the Challenger segment with Implant Direct and Alpha-Bio Tec brands. Implant Direct has a key commercial presence in North America, and Alpha-Bio Tec has a strong position in Europe, in Asia, and also including China. Given the rapid growth of this segment, these outstanding brands present a great opportunity to expand our reach.
Our Challenger brands excel in advancing implantology and make it more accessible to an extended range of clinicians. Over 10 key new product introductions since 2023 in this segment. Development of guided surgery protocols that require fewer drills, reducing the burden of consistent implant placement. These strengths are recognized by a growing number of clinicians, with more than 50,000 clinicians relying on Implant Direct and Alpha-Bio Tec to help treat their patients today. Both Implant Direct and Alpha-Bio Tec feature strong capabilities in areas critical to success in the Challenger segment. For instance, with Implant Direct, we have the Simply Iconic system, with a single prosthetic platform. We call it Simple Platform. It provides simplicity and flexibility in the prosthetic restoration while minimizing inventory needs for dental practices, or DirectGuide, a streamlined guided surgery solution.
For Alpha-Bio Tec, we have the MultiNeO system, which is a differentiated hydrophilic surface, we call it NiNA, which fastens treatment of broad range of patients. A highly performant lineup of digital prosthetic solutions enabling clinicians and dental laboratories to deliver prosthetics in a highly productive and digital manner. In summary, we are very confident in our ability to compete and grow also in the Challenger segment. Enabling implantology is the end-to-end digital treatment workflow. Digitization has revolutionized dentistry, and dental implant workflows are no exceptions. It helps clinicians to feel confident about the clinical outcome. It improves the quality and consistency. The benefits of digitization are manifold. It streamlines end-to-end implant workflows. It drives productivity and better capacity utilization. It improves cost efficiency of care in the clinics, enhancing the predictability and repeatability of implant care, so it improves consistent quality.
It enhances also established lower barriers to adopt dental implant care and potentially drives market expansion. Envista is unique in positioning to this accelerated digitization of implantology, thanks to our industry-leading solutions across complete implantology pathways. Beyond our portfolio of implant products and consumables, Envista offers a range of software equipment essential for digital implantology, and that consists of DEXIS CBCT, the DEXIS IOS, DTX Studio, which is a surgical treatment planning software. We also have an attractive range of photogrammetry devices, ICam, FastMap. We have the X-Guide, which is a dynamic navigation, and also for printing with SprintRay. Envista provides a true turnkey solution for clinicians who wish to fully adopt digital implantology. Key to this are the extensive teams of digital specialists. We help our customers to go from theory to fully implement digital workflows in their daily clinical routines. Go a little bit deeper in DTX Studio.
This highlights digital solutions with an AI-powered studio clinic software built with clear objectives. It enhances diagnostics and supports doctors in seeing more to treat more, streamlines and increases the accuracy of surgical planning and delivery, and provides an optimal platform for clinicians to engage and communicate with patients, driving patient case acceptance. Today, DTX Studio offers the most advanced AI automations and functionalities. Delivering on these objectives is very important. The highlights include an open platform allowing doctors to work with a single software regardless of the imaging equipment used. It has an AI automation image analysis, including AI-assisted X-ray diagnostics. It has an AI automation for key steps in the implant surgical planning process, including the mandibular nerve detection, merging of CBCT images with the scans, virtual tooth extraction, and virtual crown generation for prosthetically driven planning, and automated surgical guide designs.
We are very proud to have this technology in-house, and the customer feedback has been excellent. This next slide is to talk about the global reach. A crucial element of our value proposition is to deliver clinical training and education across the globe. Training and education are vital. This supports our customers in continuously improving their dental implant services, whether by optimizing clinical results or building clinicians' confidence to treat more complex cases, streamlining workflows to drive productivity and cost effectiveness, building strong relationships and exchanges with our customers, serving as a source of insights to drive further innovation, and onboarding new implant places to grow global treatment capacity and expand the market. Last year, we trained over 70,000 clinicians globally in more than 3,500 events.
For this year, we have several activities lined up, like the Nobel Biocare Global Symposium in May, where we expect more than 1,500 global participants. We have the Implant Direct Full -Arch Guided Surgery courses. We have the Osteogenic s Soft Tissue Symposium. We have the FOR Summit in China. We have the Zurich and also New York Digital Days, and many, many more events coming up. Moving to the priorities following the framework of EBS, as Paul talked about. So we benefit from our strategic and competitive advantage across our implant businesses by defining clear operational priorities along three Envista pillars: growth, operations, and people. Last year, we invested an incremental $25 million to accelerate growth in our implant business, with a particular focus on Nobel Biocare in North America. This investment went into three areas: commercial execution, clinical education, and new product innovation. The foundation work is done.
The results confirmed our approach. We intend to draw on this and continue this execution. The first pillar was in commercial, excelling in sales force effectiveness, customer segmentation, target-focused sales execution. We have a big focus on new customer acquisitions and retention of the top customers by every sales territory manager. We deploy EBS tools to sustain execution and track results, standard work, and daily management, and we adopt a trial-and-error approach. The second piece is around branding, where we revitalize our heritage branding of Nobel as a pioneer in implantology and leader in innovation. And the third piece is about product innovation. We sustain investment in differentiation innovation, including digital dental solutions, accelerate new product development, and demonstrate clinical differentiation by generating sound clinical evidence, strengthen collaboration and partnership with scientific and academic institutions, including FOR. The second pillar is around operations. EBS is a key competitive advantage.
We systematically use EBS to continuously improve our operational performance. This includes driving efficiency gains and productivity along our full value chain. The third pillar is about our people. I'm very privileged to work with an incredible, talented, committed, and experienced group of people. It is a personal objective to establish a high empowering environment where each individual and team has a clear set of three priorities and have full accountability to deliver over time. This transformation has started, and I'm confident it will be a key driver for success going forward. As mentioned, 2024 was a transformational year for our commercial execution, and we came back to growth again in Q4 2024 after eight consecutive quarters of decline. Drawing on incremental investments, we have implemented several changes to growth, with a particular focus in North America.
We rapidly ensured coverage of open territories by hiring qualified sales representatives and changing others. Moreover, we expanded our capacity of digital sales specialists. These highly skilled professionals are crucial to our strategy of digitalization implantology. Beyond selling digital solutions, our digital specialists act as experts and consultants, supporting customers in implementing efficient digital workflows for their implantology services. Lastly, we intensified our marketing and training and education activities. Two marketing campaigns have been initiated and will continue to deploy. One is around the Nobel Biocare digital workflow solutions, showing here the Digital All-on-4 campaign, and the second one is around the Nobel Biocare heritage campaign, as mentioned before. This is to strengthen our premium brand, raising awareness of Nobel Biocare pioneering heritage. Beyond these investments, we doubled down on optimizing execution. We have enhanced sales force effectiveness through EBS, including daily management and standard work.
For instance, we implemented systematic standardized accounting planning in our CRM system, standardized dashboards with leading KPIs to track our performance, and daily weekly sales huddles to drive execution. Furthermore, we deployed the trial-and-error mode, as mentioned before. For instance, we tried a particular sales concept in North America in the first half of 2024, but then we decided to change course and reallocate these resources to more clinical-facing digital specialists, where the returns were much better. We continue to track the impact and return on marketing activities, making improvements as needed. EBS is a key advantage for us. I am an engineer coming from operating factories globally. Continuous improvement exists. I'm adapting to EBS. We went to the floor in November in one of our factories here in the U.S. The top leadership across Envista, and you heard it from Paul, is very, very committed to operational excellence.
In our large-scale Kaizen that we did in November, we were a multi-cross-functional team of all levels for one week together on the floor, where we measured, observed, discussed, and found incremental possibilities to improve. The result speaks for itself. We had a more than 50% increase in CNC productivity in our U.S. plant and a more than 60% increase in staff productivity. So really, kudos to our cross-functional Kaizen team. It's a very good example that we now continue in different plants within not only Nobel but other OpCos in Envista. Ultimately, such initiatives are key to free up funds to reinvest in growth, and innovation needs to meet one of these following criteria when we invest in growth. One is the end-to-end solution, enhanced clinically proven workflow. The other one is to improve simplicity and patient outcome. And the third one is to be medical and science-driven.
The funds that we get from EBS go into those three objectives. This is an example of what we are doing in 2024, and there are project names for the future, but there's the right number of projects ongoing as we speak. Innovation is essential to remain competitive and differentiated, and it's ultimately a prerequisite for long-term growth. For Nobel Biocare, in particular, differentiating innovation is at the core of our premium positioning. For our challenger brands, innovation is critical to nimbly navigate a dynamic market. We continue to invest in innovation and intend to maintain a high pace of new innovations through Nobel and our challenger brands. In 2024, we launched several new projects, and we plan even more for 2025 across Nobel Biocare, Alpha-Bio, and Implant Direct, spanning all segments of the implant market.
We have a robust pipeline for innovation and NPI, which makes us confident in our ability to sustain growth. Core to our innovation, how we prioritize development projects, is EBS. We follow up proven, integrated processes for identifying, prioritizing, and execution innovation projects. The key principles are voice of customer and scientific and clinical foundation. I spoke about FOR. A prominent example is our partnership with FOR, the Foundation for Oral Rehabilitation. FOR is a foundation governed by an independent board of trustees with a mission statement that we completely align with. It's about improving oral healthcare treatment quality through scientific credibility, evidence-based education, ethical practices in surgical, aesthetic, and reconstructive dentistry. FOR provides education to more than 70,000 dental healthcare professionals across the globe yearly. We are very honored to support this organization, and we are looking forward to a couple of events with them.
One is the FOR Symposium in May here in Las Vegas, in the U.S., and the other one is the FOR Summit in Greater China in July. To wrap up, dental implants are a very attractive market for Envista. Envista is very well positioned both in premium and challenger segment. And thirdly, we have a clear plan, a clear strategy of driving profitable growth in both segments. Thank you so much. I now hand over to Veronica, who leads orthodontics in Envista.
Thank you, Stefan. Well, well, well. Good morning to everyone. Great to be with all of you today here. I am excited to have joined Envista last summer and very excited to be leading this business. I have a wealth of experience in the healthcare industry and particularly in the dental industry. And also, I have led multiple medical surgical businesses with deep, strong understanding.
Oops, I am doing this and I haven't said hello here, and with deep understanding of the importance of strong clinical evidence, and that is a super important capability not only for dental but also in particular for the orthodontic industry. I spent much of my career in commercial, operational, and business leadership roles in 3M, leading a wide range of geographies around the world. During the time that I had spent, I supervised large teams that executed multiple successful new product introductions, and I was also fortunate to take charge of a core business, of many core businesses with mature product lines that needed to be transformed, and I was able to turn them around, redefining innovation paths, adding new service models, building detailed capabilities, and focusing on clinical evidence to deliver better outcomes.
I am privileged to be here to share with you what we are doing to extend our leadership position in OrthoCare, a business that has both a lot of potential for accelerated growth and also has great opportunities for further transformation. The market in which we play is very attractive. Orthodontics is a large $7 billion global category, growing in the mid-single digits, with a long runway for future growth due to the very large number of unserved patients globally. Ormco has the best platform to address all the needs of patients and clinicians. We have a strong presence in both fixed appliances, traditionally named brackets and wires, and in clear aligners, a category that offers a lot of growth potential as well. We are the leaders in the self-ligating market, which is a treatment modality that is utilized in brackets and wires, with mid-single digit growth.
Spark, one of the best and fast-growing products on the market, is a product that we developed through internal R&D and successfully launched five years ago. These strong products are supported by impressive clinical training and leading digital treatment planning platforms. We aim to continue this promise of growth and profitability path in the next three to five years, and we have demonstrated capabilities. We have a clear plan and the right team to deliver on innovation to support growth and continued operations over the next years. Data shows that while there are almost five billion people that have malocclusions and could benefit from orthodontic treatments, the addressable market opportunity is more than 600 million that need orthodontic treatments and have the capability of being treated.
Despite that large addressable market, fewer than 25 million people actually receive orthodontic treatments on an annual basis, so roughly 3.5% of the total addressable market. There are multiple reasons why such a small portion receives treatments, and mainly the concerns are about personal appearance during treatment, concerns about the long timeframe required for a treatment, and concerns about cost, especially for what would be considered minor or relapse cases. Of the 21 million cases that are started annually, about 75% are currently still done with brackets and wires and 25% done with aligners. At Ormco, we focus on specialists, the orthodontists who treat the vast majority of cases today. While some of the general dentists have started orthodontic care over the last two decades, three out of four orthodontic cases are still treated by orthodontists, who are the professionals with the most training and experience in moving teeth.
The introduction of clear aligners was a significant transformation and breakthrough in this industry over 25 years ago and has significantly expanded the interest in orthodontic care from adults, a previously underserved population who are looking for an aesthetic and more comfortable orthodontic modality that meets their lifestyle needs. While the growth in aligner treatments has been hugely transformational, even today, most teens are still treated by traditional brackets and wires. Mainly the reason is because most of the teens are more prone to have non-compliant behavior. I am assuming that most of you that have children can understand what I'm talking about. It's important to say that this continues to be a very important treatment mechanism for children. Within brackets and wires, there are two different modalities in brackets and wires: traditional twin brackets and self-ligating systems like our Damon franchise.
Self-ligating systems are the fastest-growing modality within brackets and wires as they provide a faster course with greater comfort. Similarly, with aligners, there is a range of aligners that can cover and design to treat advanced as well as more simple cases. In recent years, both brackets and wires and aligners have expanded the utilization of digital treatment planning data. Aligner productions are fully supported by digital planning and customization of individualized trays, and the accumulation of data associated with this type of treatment will continue to expand and plan better clinical outcomes. In brackets and wires, the use of digital solutions is growing, helping drive custom treatments for patients, but the use of digital planning and production for brackets and wires is still in its infancy, and it's likely to become a driver for future transformation.
At Ormco, we have positioned ourselves to be the leader in digital orthodontics. There are five main trends that are driving growth in orthodontic treatments. Number one, the increased awareness and prevalence and consequences of malocclusion. Malocclusions have implications beyond just aesthetics of having a nice smile. They can also impact the quality of sleep with narrower airways or impact on the overall oral health that can lead into gum and surrounding bone diseases. Advancements and widespread adoption of technology have also helped doctors show what an expected treatment outcome could look digitally. This can improve the acceptance rate. Today, in the United States, out of 100 patients who are looking for an orthodontic treatment and have a consultation with clinicians, only 67% of those patients end up having a treatment.
Through the use of treatment planning technologies, a patient can see and project their image of him or herself, and this will help increase the patient's acceptance rate. The growing desire for more aesthetically appealing smiles, as you probably all know, since the pandemic, the new work environment and video calls proliferated, and adults noticed more of their smile. Many adults were frequently reminded of the need for orthodontic treatments, and when combined with the availability of less noticeable aligner treatments, this is continuing to drive an increase of adults looking for care in this type of clinical application. An increased willingness to spend on aesthetic treatments is also a very important trend that will continue to drive growth here, with both out-of-pocket as well as a reimbursement being done by payers.
Last, the growing middle class in emerging markets in countries like China, Brazil, and India is greatly increasing the number of people who have access to orthodontic treatments, and having a bigger presence in these markets is a big focus of the near and midterm for us at Ormco. All of these trends will likely persist and will drive long-term growth in orthodontics. At Envista, and particularly within Ormco, we have a well-defined business model to win in this category. Our customer-first mentality, supported by our service and support teams in every region of the world, as well as the more than 500 commercial resources that we have globally, are detailing and complete treatment options for our customers. Training and education with our extensive network of KOLs and key experts that we work with closely in delivering the science behind treatment options.
Last year, with our key experts, we provided more than 3,000 educational events and reached more than 50,000 clinicians globally. Innovation, our R&D and product management, keeps on innovating in both treatment modalities, brackets and wires, as well as aligners, and we're also innovating to have both treatment modalities be digitalized, designed, and on the same digital treatment platform. Ormco is unique. Ormco is unique, and we are the only orthodontic product company with a scaled leading presence in both aligners and brackets and wires. Damon Ultima and Spark both have leading positions in their segments. That comes from the continuous improvement our R&D and product team have kept pushing, acting upon the input from orthodontists. We know the clinicians well, and we understand their pain points, which we are working hard to solve on a daily basis.
We have a global commercial and operations scale with presence in more than 120 markets directly or through distribution, and we plan to continue to invest in coverage to drive future growth. Our Spark aligner treatments are used in more than 50 countries globally, supported by regional manufacturing operations across three continents: Asia, America, and Europe. In addition, we have a proven record of achieving continuous improvement supported by our EBS systems. When it comes to product innovation, we take our inspiration from orthodontic experts we serve. Ormco has been a leader in the introduction of game-changing new products and therapies introductions. Our legacy of innovation goes back over the last 65 years, and we have been providing disruptive treatment modalities across the depth of our portfolio and, in recent years, increasing the adoption of digitalized orthodontic care.
In the '60s and '70s, we innovated brackets and braces, creating the essentials for starting an orthodontic treatment. In the '80s and '90s, we introduced the first straight wire appliances, which allowed teeth placement in the desired position, and then started the era of multiple and self-ligation appliances, enabling therapies that have proven clinical superiority versus other modalities, and it is the segment among brackets and wires that grows faster. In the early 2000s, we were the pioneers in custom treatments, expanding our focus on more aesthetic treatments with clear ceramic braces as well as lingual treatment options. In the last five years, we mobilized our teams to create a compelling clear aligner offering, leading to the introduction of Spark while maintaining our focus on brackets and wires segments through the introduction of Damon Ultima, which has perfected the teeth movement strength and speed.
Most recently, we just launched Ormco Digital Bonding, which is enormously improving the bracket placement and reducing the number of appointments required to close a case. We believe we are the experts in orthodontics with an unmatched record of innovation. For the last 20 years, there was only one primary offering in the clear aligner space. One of the main patents expired, and the market witnesses a proliferation of suppliers trying to compete in this fast-growing category. There are several very good competitors in the clear aligner markets, and our product Spark, a product that Ormco developed entirely organically, has emerged as one of the best and prime offerings in this space due to five key differentiations.
The advanced material science that we utilize with two material strengths and with clinical evidence driving the desired outcomes of movements of teeth, our excellent patient experience driven by the clarity of our stain-resistant materials and proven comfort to wear for the desired treatment time, both helping improve patient compliance as well. Our operations across three continents, which allows us to be closer to our customers and improve our efficiency and adaptability to meet geographical needs. The excellence in education teams and service that we have around the world, which are actively driving our portfolio, and last, the flexibility of treatment planning to meet patient needs with an aligner portfolio that covers both simple and complex cases, but with more exciting developments to come in the future, such as combining in a single case brackets and wires and aligners.
With what I believe is the most and the best complete orthodontic offering for patients and clinicians, Ormco is well-positioned to continue to drive innovation and growth over the next several years. To ensure this happens, my team and I are focused on growth, operational excellence, and people. In growth, our objective is to continue to grow Spark and accelerate Spark with investment of additional coverage as well as the introduction of new products while we continue to improve our customer experience, grow our leading position in brackets and wires, bringing brackets and wires into the digital world, and become the digital orthodontic leader. In our operational excellence, getting Spark to the right level of profitability, enabling us to accelerate innovation investments with this great franchise as we deliver on price growth supported by increased value creation for our customers.
The focus on our people as the center of everything we do. We will continue to build and develop our teams to drive a highly engaged organization. Our first priority is to continue driving Spark growth. Last year was a big milestone for us. We surpassed 800,000 cases since the introduction of Spark, and we have an amazing track record of success, and we have demonstrated our clinical and commercial capabilities. Ormco is a partner committed to orthodontic specialists, and we are confident that we can fulfill our fulfillment of a full value proposition. We are looking to build on the success and to continue to grow and gain share among patients receiving treatments with aligners. And our focus is going to be on expanding and intensifying our commercial execution, continuing to expand customer reach in key markets like Europe and North America.
And we will also intensify our investments in education as we continue to expand our partnership also with DSOs. Our amazing portfolio of new products with more in the pipeline. We have lately introduced Spark On -Demand, Spark Retainers, and we are close to launch our mandibular advancement to treat Class II cases. Our expansion into many high-potential geographies is also a priority for us, and we are looking to expand into geographies where we currently are not present or also accelerate penetration in those geographies where we have a lot of opportunity for further penetration. The second priority is to drive Spark to profitability supported by the great efforts we do with our operations team and leveraging our EBS to drive continuous improvement.
Over the last six quarters, we have reduced the cost per aligners by nearly 30% and included a nearly 10% sequential reduction in Q4 of 2024 alone. This is the result of the work our teams do to leverage our Envista Business Systems for continuous improvement, and with major production facilities in three continents, each of our facilities uses the same processes, the same software, the same equipment, and the same process flow. We have the ability to serve any country from any of these plants, and we have a pilot facility near our California headquarters staffed with talented engineers where we identify improvement opportunities. We pilot them. We perfect them before they are rolled out across our production facilities around the world. This allows us to drive continuous improvement. Furthermore, we are able to benchmark the performance of each of our production teams to get further insights for improvement.
We have an ambitious goal to continue this momentum in the next years and to continue to drive cost and service improvements with Spark. We have many areas that we want to focus on our future improvements, and we are pursuing to improve profitability with our scope covering the continual automation of our manufacturing sites while expanding work in case design automation, portfolio structure adjustments, and optimization of our global footprint to continue the increase in aligners output. Innovation will also continue to be a priority for us in the next years, and one of the most exciting opportunities we have in our efforts to continue to disrupt the orthodontic treatment is leveraging our digital platform to create more customized treatment solutions for clinicians and patients. Our digital platform was initially created for planning treatments with Spark aligners.
Now it is able to be used not just for aligners, but also to plan brackets and wires. Last year, we introduced our first Ormco Digital Bonding with Damon Ultima, and within our plans, we plan to extend this platform to more brackets to meet customer needs. This single platform supporting aligners and brackets and wires, which we are working to introduce in 2025, will provide the possibility of bringing new treatment options where customers can treat the same case with a mix of modalities, part aligners and part brackets and wires. And as I mentioned earlier, we're planning to introduce that in 2025. Our goal is to be the first to provide treatment options for all of the cases that exist around the world, the 21 million cases, and in that way, to provide the best treatment for each patient based on their needs.
This is what's so powerful about our portfolio. With leading offerings both in brackets and wires and aligners supported by our leading digital platform, we can help clinicians straighten teeth, but in the best way that is the best option for clinicians and what is the best option for patients. We are not limited to offering just one treatment modality that may not be right for all patients, and in the future, we see the opportunity to improve care by blending these two into one, so to close, I am excited about the opportunity we have. As I mentioned earlier, the orthodontic market is large and has a large unaddressed population around the world. Ormco has the best platform to address the needs of patients and clinicians. With Damon, we are the leaders in brackets and wires.
With Spark, we have one of the best and fastest-growing aligner offerings in the market, and this is supported by training and our leading digital treatment platform. We have demonstrated capabilities. We have a clear plan and the right team to continue to deliver on innovation, growth, and continued operations improvements over the next several years. With that, this is what I wanted to share with you, and let me now hand it over to our Chief Financial Officer, Eric Hammes.
Excellent. How did you start that off, Veronica? Really, honestly, Veronica, thank you. It's great to see how Ormco can extend its brand and, of course, its long track record of innovation into the orthodontic market with its global reach. And let me just give a nod to both you and Stefan. You did a fantastic job of setting the stage here and presenting a great and inspiring view of implants and orthodontics both. So I'd like to just start by thanking all of our investors, everybody in the room here, and of course, everybody online for your interest in Envista, for your support of our company, and of course, for your time today. We greatly appreciate all of your help over the last many years.
Paul, Stefan, and Veronica, I think all each covered very well the strategic and operational aspects of our plan. I'll now take us a bit deeper into the financial elements of all of this. Beyond our recently issued 2025 guidance, over the medium term, we expect Envista to deliver annual core growth of 2%-4%, Adjusted EBITDA growth of 4%-7%, earnings per share growth of 7%-10%, and free cash flow conversion of approximately 100%. Our overarching objective when we look sort of across all of these measures is consistent and sustained shareholder value creation, which comes from the interconnectedness of basically working a balance of all four of these. Any sustained shareholder value creation we fundamentally believe begins with core growth.
As you heard earlier from most of my colleagues, we have a number of meaningful initiatives underway to accelerate our core growth over the next few years. Our legacy of innovation, balanced portfolio, global reach, and continuous improvement will all ultimately help us to additionally drive Adjusted EBITDA growth of 4%-7%. The work that we're doing in tax, coupled with our recently announced share repurchase program, will also provide us even more leverage through earnings per share growth. Our goal is to deliver 7%-10% annually, and our capital-efficient model with generally low CapEx and strong working capital turns enables us to convert all of this into free cash flow. Combined, we see this as a compelling economic framework. Let's go a little bit deeper into each of these four metrics. Beginning with core growth, a couple of points to consider off the bat.
First off, Envista reported core growth of down 150 basis points in 2024. With the impact of the Spark deferral change that we've talked about many times, as well as our decision to better realign the dealer inventory channel, our core growth was closer to roughly plus 1% positive last year. So that's our starting point as we consider looking outwards. Through the levers that were covered earlier, we think we've got good line of sight to accelerating further into that 2%-4% range in the medium term. Let me just talk about a couple of them, recapping what Stefan, Veronica, and Paul mentioned. First off, I would say our most immediate opportunity lies in better accessing the growth available to us in the secularly attractive core markets that we play in.
For example, we've now posted five straight years of share gains in Spark, and we continue to outgrow the market as you just heard from Veronica. We have a strong market position in both developed and developing markets, and each of these offers significant upside, and Envista is also distinctively well-suited to serve growth in the DSO segment. These are customers who value our portfolio breadth, our operational excellence, and our clinical capabilities that are all hallmarks of Envista. Second, as Veronica and Stefan also described, new product innovation has long been the lifeblood of our company and remains so today. We invest approximately $100 million each year in R&D, and you heard from Paul earlier that we grew that amount by about 5% last year in 2024.
That was an intentional move for us to accelerate and amplify getting off that one point of growth, ultimately being able to get into this 2%-4% medium-term outlook that we're providing. Third, we'll continue to build on our strong market-leading positions to extend into attractive adjacencies. For example, we built on our number one position in brackets and wires over the past many years to quickly build out a number two position in clear aligners. We're extending our number one position in X-ray imaging to ultimately penetrate better into intraoral scanning. And we're extending our number two position in premium implants to build a growing presence in regenerative materials. You saw that as a mid-single-digit growth segment presented by Stefan.
On top of the organic growth drivers, we have a proven track record of using a creative M&A to supplement our primary focus, which again is on core growth. Our Envista growth plan parallels what we're seeing in the broader markets. The global dental market grew low single digits last year. We expect that with our 2025 guidance to improve moderately as we go through the year, and eventually, we'd like to see an acceleration back up to that long-term market average of approximately 3%-5%. Just as we'll continue to build on our momentum of core growth year on year, we expect the same from the underlying dental market. Turning for a moment to Adjusted EBITDA growth, we expect to generate annual growth between 4%-7%.
We previously guided to EBITDA margin, which of course is closely related to EBITDA growth, and we'll continue to track margin rate each quarter and annually as we go forward. EBITDA dollar growth, however, we see as more consistent and directly linked to cash flow generation versus margin, so that's the reason for the subtle shift in our guidance today. A number of factors underpin EBITDA growth. I'll underline just three of them today in the interest of time that will help us to drive our plan of growth as well as margin expansion. Cost of goods sold, Spark productivity, and then I'll wrap it up with G&A productivity. With respect to cost of goods sold, we've had a long tenured focus on manufacturing effectiveness. You saw that from Paul. You also heard a great example of it from Stefan today within implants.
The operational KPIs that were shared, on-time delivery, working capital, and safety, these are all good proof points of our ability to translate EPS into continuous improvement. Stefan mentioned in the implant space, we're increasing labor and equipment productivity in one of our highest throughput factories globally, also in the United States. We've got dozens of other efforts along the way. You may have heard a couple of quarters ago, Paul talk about the big kickoff that we had with our CEO Kaizen. That's basically fueling our pipeline and our ability to ultimately drive cost of goods sold. You all know of our commitment to getting Spark back to profitability in 2025. We've communicated in the very near term that we have the near-term milestone, but also only as a first stop. Our playbooks focused on improvements in three areas, all underscored by Veronica.
The first is around design process efficiency. That's the steps of treatment planning to align our design. The second area is in cost per aligner reduction. That's efficiency within the four walls of our factory and more broadly our supply chain. And then the last is around supply chain scale. That's leveraging our large, capable global supply chain for the volume growth and meeting the business objectives that Veronica mentioned. EBS is a backbone to all of these gains. G&A is the third growth lever deserving a little bit of attention today. You heard from Paul earlier that we took action and had some streamlining of our transactional and back-office processes that will work to yield roughly $20 million in annual growth savings across the medium term. And we've got a number of additional efforts underway around that space.
In our investor conversations, several of you outlined the opportunity for Envista to place more focus on earnings per share. As such, we added earnings per share to both our annual guidance as well as our medium-term outlook. I'll comment on three factors that will help us to turn 4%-7% Adjusted EBITDA growth into 7%-10% earnings per share growth. The first we discussed on our Q4 earnings call, we noted that we currently have quite a high effective tax rate. This is in particular due to our global intercompany loan structure. Streamlining this process is going to help us to reduce our annual tax expense. And while not a trivial effort, we have a focused project underway to reduce the tax rate, which will help elevate our EPS, and ultimately it will help us to improve free cash flow dollar generation.
Second, our board recently authorized a share repurchase program of up to $250 million. Capital return had not previously been part of Envista's capital allocation playbook. This was another area that many of you highlighted as important to all of you as investors and shareholders. It also happens to be an area where Paul and I have previous experience, and then third, we also see additional opportunities for interest expense optimization. For example, we recently implemented a global cash pooling structure that enables us greater flexibility to move our funds that helps us to better access our cash, and it also helps us to ultimately optimize interest income. The last of the four medium-term financial metrics is free cash flow conversion. This is yet another area of demonstrated strength for Envista. We generated over $600 million in free cash flow in the last three years at a high conversion rate.
We'll aim for approximately 100% conversion going forward. As mentioned earlier, we have an efficient global supply chain that's both in how we serve customers, but also in terms of our annual CapEx consumption. We'll continue to invest in opportunities to drive growth and cost, as well as geographic expansion, and these strong ROI investments will continue to generate strong free cash flow conversion, as well as dollar generation. Like our fixed overhead structure, our working capital is similarly cash efficient. Envista's working capital turns have consistently been above five times, which is best within our industry. Capital structure is another strength for Envista. We have over $1 billion in cash today, and on our Q4 call, we noted that we recently repatriated over $300 million of international cash. That was at a low tax cost.
That helped us to further increase our financial flexibility, and it also helped us with flexibility relative to capital deployment. The $1 billion in cash is balanced roughly by $300 million of net debt. This was supported by the $300 million of cash that we generated in 2024, ultimately for a net debt to EBITDA ratio of around one times. We recognize that the strong financial framework of Envista would support greater leverage, but in the current environment, we think that low leverage continues to be an advantage, primarily for the stability or stabilizing the ability given a macroeconomic uncertainty, as well as responding nimbly to any new or emerging opportunities that we might have. In the medium term, our financial framework that we're providing today, we consider not to be dependent on a material change in the macroeconomy, or for that matter, the fundamentals of the dental market.
Said differently, delivery of these targets is largely within our control. That said, there are naturally factors that could accelerate or decelerate Envista's performance. Let me touch on a couple of these. As you see today, most of our leadership team has been in and around dental for decades. Across that time, the market has proven to be a reliable 3%-5% grower, and while COVID naturally disrupted that for a short period of time against a long-term pattern, nothing has structurally changed in our dental markets. It's a fundamental belief of ours. We expect it to eventually return to that same GDP plus growth rate over time. If we get there sooner, we anticipate that will accelerate our progress, but if a more protracted recovery should exist, that has a dampening effect on our ability to grow core growth. Continuous improvement is also one of Envista's fundamental strengths.
We're already a stronger company today than when I joined six months ago. Our recent wins are fueling us every day, and as our momentum continues to build, our improvement trajectory should steepen along with that, but we've learned that when we focus on, or lose focus, if you will, on the shortlist of priorities, that can be challenging, which is why we're focusing so heavily on revitalizing the execution of EBS, ultimately our best lever to control what we can control. We also understand that we can't control the macroeconomic environment. Fortunately, dental is a regulated market. It's supported by secular long-term growth drivers, and it's also proving to be more stable than the economy at large.
In the same way, our solutions are mostly regulated Class I and II devices in the United States, not subject to the same regulatory and reimbursement risks of the other MedTech sectors. The flip side of this is that it does tend to be more responsive to consumer-specific signals like confidence in the economy or, of course, interest rates. In the end, again, our aim is to control what we can control and to deliver the highest level of performance possible. To wrap up, Envista's position to win. We're confident in our plan and also that our financial model allows us flexibility to do more. As we deliver, we'll deploy capital in line with the priorities that we've previously communicated. First off, investing organically in the business to accelerate core growth while also leveraging CapEx investment for a more efficient supply chain.
Secondly, identifying and executing on a creative M&A. That's aimed specifically at helping to differentiate our portfolio and to deepen our geographic reach. Then last, but certainly important, returning cash to shareholders. Thanks again for your interest and your investment in Envista, of course, for being with us in New York today, and for those that are joining us online. With that, I'll hand it back to Paul for a couple of closing comments.
All right, thank you, Eric, and thanks everybody for coming out. Hopefully, you leave today with a better understanding of the opportunity we see in front of us and also greater confidence in our ability to execute against it. I am just going to put a bow on things by recapping the three main takeaways again for today. Beginning with the dental market, you've heard many times that we believe in the structural attractiveness of it. And as it migrates back into its long-term rate of 3%-5%, those who are best positioned will benefit the most, which brings me to point number two. Hopefully, you saw today that Envista's capabilities are exceptional. Powered by our fundamental strengths of portfolio, innovation, continuous improvement, and global reach, our potential is vast. And so that brings us to point number three, converting that potential into performance.
Outlined in the new medium-term financial targets that we issued today, you can see that the outcome of all this is quite compelling. So that wraps up our prepared comments for today. Why don't we take a quick break while we set the stage for Q&A? Refresh your coffee. There's probably a few croissants left, and we'll get together here. Why don't we call it five after the hour? We're tracking right to our schedule. Thanks, everyone, and cash flow swing for us. We have very high confidence in our ability to continue driving down that cost of goods sold curve. We showed you six quarters, I think, on today's chart, and we have a full pipeline of additional manufacturing improvements that are all being tested in the Pomona pilot factory that Veronica mentioned. So we think all of this will come together. Resurgence of growth.
So just all that to say that you can use the 4%-7% as an average year, normal year against our 2%-4% growth. But we do think that we've got a little more tailwind early in the period, maybe a little bit less late in the period. And then I would just kind of take you back to something that I mentioned in the prepared remarks, which is the more that we can prove to ourselves that the revitalization of our EBS model is going to generate incremental benefits in factory productivity, cost of goods sold. Stefan had a great example of that. That's just going to build on more confidence for us to deliver that number or over-deliver that number. All right, Veronica, you got three Spark questions. First, your confidence in continued cost of goods sold reduction.
The second part was room to grow in the ortho channel, and third is your longer-term thoughts on expanding into GPs.
Okay.
Did I get that right?
I only heard two. Yeah, yeah. Okay. I only heard two, but that's okay. Let me start for the first two that I remember in my mind. The first one I think you asked, John, was about what is the penetration in a way that we have with the brackets and wires customers and with our overall aligner business. My answer would be we still have a lot of opportunity for growth within our current customer base of brackets and wires. As you probably heard during my presentation, we still have a lot of countries where we sell brackets and wires, where we do not sell aligners.
In those countries where we do sell aligners and brackets, I think more than half of the customers are still open to further penetration. Lots of opportunity for us to grow with our current customer base and also geographically expanding into markets in which we do not sell today aligners. Second question was the GP. Definitely, as I showed in my presentation, aligners provided the opportunity for GPs to practice orthodontics, and that has been a fast-growing segment. Our focus.
Is your longer-term thoughts on expanding into GPs?
Okay.
Did I get that right?
I only heard two. Yeah, yeah. Okay. I only heard two, but that's okay. Let me start for the first two that I remember in my mind.
The first one I think you asked, John, was about what is the penetration in a way that we have with the brackets and wires customers and with our overall aligner business.
Magnitude of dilution you'd be willing to take relative to the 7%-10%. And then my second question is just on implants, kind of what's assumed in the guide regarding kind of implants' return to market growth. Can you do that over the medium term? If so, do you need to make any incremental investments over what you've already done? Thanks so much.
Okay. So we did the 2%-4%. We did the 4%-7%. We're doing the 7%-10%. Jeff, you're probably going to ask about the 100% cash flow conversion if somebody starts thinking about that. Accretive M&A.
So, I mean, listen, Envista has done a lot of M&A across our career. The portfolio was assembled through M&A. Eric and I have done a fair amount of M&A across our careers. When we say accretive, the ideal accretive is that it is accretive to your growth rate. It grows faster than you. It's accretive to your margins. It has higher margins than yours. And it's accretive to your multiple. You buy things that trade below where you trade. Those are great deals. They're hard to find. You then decide on which of these you're willing to bend to get a strategically attractive deal. In my training across the tens of billions of dollars of deals I've done, there's no such thing as strategic value. If it doesn't fit in the economic model, it doesn't exist.
You have to have a tangible reason to think that that business will generate faster growth or higher margins inside of us than it does stand alone. And so we will have Eric and I and the others up here will have a very disciplined approach to M&A. But two of the benefits we have is, one, a highly cash-generative business. We generate more cash than we can consume, which leaves surplus cash for M&A or for capital return. And the second is, for better or worse, we got a lot of scars on our back having done good and less good deals. So I think we have some experience in this regard. Anything more to add to that?
Yeah. I would just say, I mean, you're trying to make, I think, the direct connection to our medium-term 7%-10% EPS guide, right? EPS outlook.
So I would say, admittedly, think about our four financial metrics, primarily the first three, as being organic. And at the end, when I talked about sort of our capital structure, Paul just mentioned it, $1 billion in cash, a good net debt to EBITDA, the ability to lever more if we should need to lever more. If we can find that attractive, call it hitting on two metrics, both accretive and core growth, accretive to margin, accretive to EPS dollars, that can help us deliver above and beyond our medium-term financial objectives. So I think that's really the right way to think about M&A. We've got the flexibility to deliver however we need, should it be any of the elements of our sort of three priorities of our capital allocation playbook. Jeff.
Wasn't there an implant question?
Yeah. Just implants returning to growth. If you need to make any additional investments there, what's assumed in guidance? Thanks.
Stefan, go ahead and take that.
Yeah. Sure. First of all, I spoke about commercial, brand, and innovation. So from a commercial perspective with EBS, we are becoming much more competitive in commercial. We have all territories now, especially in North America, but also in Europe and strong in emerging markets, just coming back from China and Australia. So we will be very competitive there going forward, even more. Secondly, the brand. I think, unfortunately, it's a huge potential. But unfortunately, when I visit universities, a young clinician doesn't know the story of Brånemark nor Nobel. They just think we are in another implant company. And we are definitely not just another implant company. So we can build on that one. And thirdly, EBS will help us ourselves.
We don't need any money from anyone else to free funds in order to invest in innovation. Innovation takes usually a couple, three years before you have something groundbreaking. Having that said, we have a lot in the drawers. So that's what we're going through now. That's why you see quite a lot of numbers or a number of projects up on the slide where we think we can actually, some of the innovations are secret for some people already because we didn't do a great job to market it. So I'm confident that we will come back to market growth in the coming years. Yeah.
Thank you. Sorry.
Yeah. Jeff.
Yeah. Okay. Sorry. Jeff Johnson from Baird. So Paul, I'm actually going to stay on EPS as opposed to only free cash flow.
Just on that 7-10, Eric, I guess the other point I was hoping you could clarify. It sounds like you're saying accretive M&A or any kind of M&A would be kind of upside or however we want to think relative to the LRP. Are buybacks kind of neutral to offset stock comp? And then when I think about your tax rate at 35%, if I would step that down over, let's say, a three- to four-year period, somewhere in there, it's about three- to four points of EPS growth per year. So one, is your 4-7 EBITDA going to 7-10% EPS really a function of just getting that tax rate from 35% to 25%? Is that the incremental few points per year? Number one. Number two, does that play out as tax rate stays 35% for the next few years?
EPS growth is near the lower end of that. And then we get a big inflection kind of year two or three or four when you get some of the tax rate stuff figured out, and EPS growth in one year pops to 15% or something. And then I have one follow-up. That's
Okay, so let me hit first on share repurchase. So yeah. So just as a reminder to everybody in the group and on the line here, so $250 million authorization. I don't remember if we said it on the Q4 call or we said it post-Q4 call. But our intention, our first priority with share repurchase is to offset dilution. For Envista, that's call it $20 million-$30 million per year, right? That's sort of our first priority with our share repurchase. It's the no-brainer.
That's what we'll be in the market making sure that we execute to shortly after capital markets day, call it in the second quarter. From there, it'll be based on where our stock price is at. It'll be based on how we see the value of our stock. In a period like right now, a little bit tough to judge based on the overall market, but we see our stock as still an attractive stock price. But importantly, maintaining, if you will, each quarter as we go through that plan and look at kind of the sum total of the 250, what our other capital allocation priorities might be. I mentioned in the prepared remarks, we want to maintain flexibility.
So the way to think about it, I think just for modeling purposes, is offset dilution, $20-$30 million each year, and then step into the share buyback repurchase over time. But it'll be up and down. You'll see it at the end of each quarter based on the value of our stock and how we see sort of the total capital allocation of our plan. On tax rate, so tax rates, honestly, it's kind of difficult to put the core of your question in a medium-term guide, right? So what we talked about in Q4 was $30 million in 2024 that we had as a tax expense related to this intercompany loan structure and sort of the correlation to the cap on U.S. interest expense. The reality is that when we resolve that, we're probably going to resolve that.
And let's just say, hopefully, it's going to be a reduction in our tax expense in kind of one shot. I wouldn't consider that really to be in a normal EPS 7%-10% year, right? Maybe it happens over a couple of years if it just.
Of our sources of supply to give you guys confidence that relative to many of our peers, we're better positioned to respond to the shifting tariff landscape. So Spark is a good example. We have Spark Manufacturing in the US, in Mexico, in Czech Republic, and in China. In all cases, as Veronica said, the manufacturing design is shared. The equipment is the same. And incrementally important, the product registrations specify multiple sources of supply. So we can service effectively all countries from any of the three main sources of supply. The US site is principally pilot operations.
That's point number two. We don't know any more than you, of course, what's going to come out on a tweet tomorrow morning. But we have a team in place who's very focused on this. It brings me to point number three. This team here, our leadership team, gets together every Friday morning at 8:00 A.M. We have a dedicated team focused on response to the shifting supply chain environment. At any given time, we know if this happens, if that happens, what's the biggest exposure to us. Through EBS, we think we're well positioned to move the steering wheel of the car and expect the wheels to turn. The best you can do, in my experience, is to set yourselves up that you have an infrastructure that allows you to respond and then an operating cadence where you really do respond.
So that's our approach to tariffs here in the near term. Longer-term footprint design, it's a balance always of two things. It's always a balance between cost and customer service. So if you want the lowest cost, typically, you put the most volume through one site, and you try to put it in the lowest cost center that you can. That was in vogue for most of the world through the early 2000s. Everybody moved their supply chains to Southeast Asia. And there was pretty uniform cost of goods sold improvement across manufacturers. And then we all found out that was a bad strategy when the first Trump administration introduced tariffs. And people realized having huge dependency on China exclusively was a problem. And then we really learned the lesson during COVID. And so now everyone is re-onshoring their supply chains.
I wasn't in Envista when the wise people set up the supply chain, but they mostly ignored all that. They said that we're as interested in competing over quarter centuries as we are over fiscal quarters. Today, we're a benefactor of that. The ability to respond that I just walked through is because we're in a lot of places. Do we have an opportunity for additional factory productivity? Hopefully, you heard quite clearly from us today that that is a priority for us. We are currently consolidating footprint. We're moving on the consumable side, shutting down one site, moving it into another. We'll continue to do that, trying to strike that right balance between factory productivity and responsiveness to shifts in the supply situation. Really, most importantly, being able to serve customers directly. You don't get 95-plus% OTD consistently without having a pretty strong supply chain.
Okay. Steve and then Vik.
Yeah. Yeah. Steven Valiquette from Mizuho. So I also have a question on the medium-term guidance here. Really kind of more maybe a clarification. I guess if you look at street consensus right now for EBITDA growth, let's say in like 2026 and 2027, it's kind of in that 10%-12% range. If you look at EPS growth, it's kind of in the 13%-20% range. So really, I guess the question is, is the message today that we should be fairly rigid in modeling those medium-term years sort of in line with the medium-term guidance today? Or is there enough inertia, maybe low-hanging fruit near-term, that you can maybe outperform those medium-term metrics in the first couple of years of that medium term, if that makes sense? Thanks.
Yeah. I think the answer goes back to this one.
It doesn't sound like it's on. I'm going to move it back, but yeah. Mic on? Okay. How about that? Still not yet. All right, we'll just go for it without the mic. The mic doesn't work, so I think the answer is sort of in line with a couple of questions ago, right? When I talked about the 4%-7% Adjusted EBITDA growth and to a degree, the 7%-10% growth, I do think that we have more tailwinds, not substantial, but more tailwinds in the early period. We still have the unwind of our Spark revenue deferral. We have a little bit of carryover in our G&A actions that we took in the first quarter of this year, the carryover into 2026.
And the trend on Spark profitability is likely to be leaning a little bit more towards Adjusted EBITDA growth or a generator of Adjusted EBITDA growth more in the near term versus the long term. So if you want to kind of shade or take that as a reason why 2026 could be a little better than the average of the medium-term guide, I would say that would be reasonable. And then this group can better answer how our tax rate and the $30 million tax expense from the intercompany loan and the U.S. interest cap is sitting in the analyst consensus out there. We can't really predict when that's going to happen. It's a project we're working on. It's probably not going to be a 2028 thing. Hopefully, it's more near term, but it's certainly not going to be in 2025. So hopefully, that helps.
I mean, I think what it says is all of it leans a little bit more towards the early year being better possibly than the latter years. But we're also sitting here, obviously, with not perfect certainty as to how the world evolves.
Vik Chopra, Wells Fargo. Thanks for hosting the day. So Paul, one for you. Appreciate the comments on M&A. And clearly, you have financial flexibility at this point. But where do you see portfolio gaps and are there areas you're more likely to be active in? And then I had a follow-up, please.
Yeah. I'd say three things, Vik. So first is the current portfolio has been shaped and honed for about 25 years by folks who are pretty good at this. First, inside Danaher, and then our own team knows the dental landscape as well as anyone on the planet.
So we're pleased and comfortable with the core portfolio that we have. We don't have any intention right now to make a significant shift in it. That'd be point number one. Point number two is these are dynamic markets. And so if you don't pay attention every day to where your customers and your competitors are doing, you wake up one day and that well-focused portfolio is no longer centered over the bullseye. So in the same way that we like the core portfolio, we're constantly honing it. We gave a couple of examples of regenerative deals that we've done over the past two years that are a perfect example. And we'll continue to do that moving forward. The key focus for us, hopefully, it came through in our comments, is we think the way to generate consistent long-term sustained value creation is to steadily increase your cash flow.
High-margin businesses like ours in structurally good markets generate more cash than they consume. That gives you a lot of capital allocation flexibility. That's what we're trying to do here.
Okay. Helpful. Thank you. And then my follow-up question is for Stefan. On one of the slides, you highlighted a number of recent and upcoming launches in implants. There's quite a bit there. I'm just curious which ones you're most excited about over the near term. Thanks.
Yeah. I mean, we have actually launched quite a few already this last, let's say, 18 months. And one is after 15 years, we have a new zygoma just coming out. I actually participated in a surgery of a zygoma implant the other day. And this is really showing the science of Nobel. We have already with the former zygoma implant a 97% survival rate. So we're attacking the 3%. Why?
Because this is an implant that is placed in the cheekbone. So you don't really want to have bacteria or anything happening close to the eye, etc. So with a new surface and small modifications of this implant, we're attacking to make sure we get even a better survival rate. So that's out now since late last year in the markets. Simplicity, and it's important as we grow and more GPs as well start to use implants, is to have a simplicity and a predictable outcome. So we have a big project going on that we call One Platform. And that is to simplify to have the same screwdriver, if I simplify it, to all the different implant systems. And that makes it much easier. You have less inventory of things in the clinics. That's a big one. Another one is around science again.
We have learned, everyone has learned over the last decade that you should place your implant subcrestal, about 2 millimeters, then you have less bone loss. The thing is, sometimes you have to take away too much bone, which you shouldn't from the patients in order to put the abutment. But if you change the emergence profile, so the project is called Emergence Profile, you change actually the piece, the component you put on the implant, so you make it so you can take away less bone. And that's better for the patient than for the healing process, so we are adapting that on all our implant systems, and that should be launched by beginning of 2026. So that's a big one. A lot of clinicians with science-driven, they will move. We believe they will move to us by this example. Bigger ones are things I cannot talk about.
But we are looking to have some blockbusters in the next two to three years. And those are projects that are initiated right now with the funds that we can free up through EBS in operations and also within the commercial area. So.
Thank you.
Yeah.
Thanks. Jason Bednar from Piper. Wanted to press a little bit first with the first question just on the 3-5% market growth and almost look at a contrast of where we were pre-COVID versus today. I mean, pre-COVID, you had coverage expansion from ACA. Aligner market was growing faster. You had things like DSOs that were smaller and had less buying power. You fast forward to today, coverage can't really expand further. It might even go the opposite direction depending on what tweets we see. You have the Aligner market that's slowing. DSO is much bigger, have more buying power.
And you've also got things like value implants, low-priced equipment that's creating a little bit of some mixed pressure. So as I look at kind of contrasting today versus pre-COVID, what's going to fill that void that some of these pressures today are creating to get back to that 3 to 5?
Yeah. Let me give you three ways to come at it. One, I'll give you just the statistical reality of it because we have good data on these different trends. The second is the specific shifts that you've talked about, DSO and clear aligners, etc. And then let's talk about the near term, what's pressuring the market right now. So statistically, the numbers are pretty clear. We have 75 years of data after World War II. And you only have two where the dental market contracted.
As I mentioned, a very brief single-digit contraction after the global financial crisis and then the hopefully once-in-a-century impact from COVID. So the statistics of the 3%-5% are very, very strong. And you can get a p-value as low as you'd like on that. The second, though, is the forces that you talk about. Most of the ones that you mentioned, the introduction of clear aligners, the growth of DSOs. You didn't mention VBP in China, but that's another one. Most of those are market accelerants. They are not market decelerants. And so all of those things would give you confidence that you'll get back to the 3%-5% even faster because they all bring in more patients into the category. One of the very clear characteristics of dental is this insufficiency of supply relative to the vast potential.
Anything that brings more clinicians into these specialty areas, anything that brings more patients into the clinician's office accelerates growth for dental. Now, third, I think many of us are surprised that the market hasn't digested that post-COVID kind of turbulence quicker. Certainly, when I was coming back into dental and I was thinking about this opportunity, I'll be honest, I thought by the end of 2024, it would have worked through that bolus of demand that went in in 2021 and 2022. It was essentially two to three years of demand in an 18-year period. I thought it would take two to three years to work through and we'd be back. The primary reasons why I think it's slower, the two macro effects I talked about, consumer confidence being a little bit softer, interest rates being a little bit higher.
And then right now, there's just macro uncertainty across the board, certainly not specific to dental, but all of that stuff impacts those two forces. All of that makes consumers a little more nervous. All of that makes it less clear if interest rates are going to normalize quicker. So I think that's where we're at.
Okay. Fair enough. That's helpful. Follow-up question, a little bit of a follow-up off of Vik's question. And Stef and Drew, feel free to respond here. But thinking back to that implant innovation pipeline slide, it was littered with Nobel. There's a lot of Nobel innovations in there. So it seems like there's a lot coming that we should all be looking for.
But I guess what struck me was that it was very Nobel-heavy when the market is clearly shifting and you acknowledge that value challenger or whatever you want to call it is growing faster. So I guess, why is Nobel the right ROI when you're spending on implants? Why not have a more balanced or even more tilted approach? I'm sure Drew would love that. But I'll let you guys respond on that.
But this will be good. We'll see you two guys can make your case for increased R&D spending.
Yeah. Maybe it's not fair because I present it. But I'm sure Drew has more than we show. That's first of all I would like to mention.
I think premium why the focus and so much on science and clinical evidence and etc. It drives a lot of fundamental innovations in the premium brands that are then quickly nimble follow-up by the challenger segment to local heroes and so on and so forth. So maybe I would say we have a tendency to maybe invest more in innovation in premium than challenger, but they are very quick and very nimble to make it maybe simplicity and predictable for outcomes. But I hand over to Drew. I know you do a lot.
Sure. Thanks for the opportunity. I'd point to slide formatting as a primary explanation. It was a pretty full slide. If we had a couple of slides space, I think you would have seen many more associated with Implant Direct and Alpha-Bio Tec. We're pretty proud of a design philosophy that we embrace.
Practical innovation is what we call it. And you would have seen some of those launches that we've rolled out over the last couple of years that Stefan profiled specific to Implant Direct and Alpha-Bio Tec. And there's a lot more of that in the pipeline. I think that's not fully represented on that slide.
All right. Hi. It's Erin Wright, Morgan Stanley. I have two questions. So one on China, one on implants. I'll ask them both upfront. So on China, over the weekend, there was draft guidance introduced to regulate dental pricing from a services perspective, specifically with a focus on orthodontics. I guess it may be too early to comment. Maybe there's offsets with VBP in terms of volume. Maybe that comes at the expense of pricing at the services level.
But if you could comment on just more broadly, also just the China market, your overall exposure as well as in market dynamics that you're seeing. And then second question would just be on implants. It's a more near-term question. It's just we went through those eight quarters of declines. It flipped to positive. In the most recent quarter, how much of that was underlying market dynamics versus you trying to, I guess, regaining a little bit of that share and how you're just feeling about kind of in markets right now, particularly on the implant side. Thanks.
All right. Filippo, you're the closest to VBP, so maybe you can answer that. And then you guys did a nice job tag teaming that last one. We'll have you do it on market growth as well.
Very good. Yeah. Thank you for the question about China.
So just a couple of thoughts. We have a great position in China with our presence there. This was a position that was not built overnight, but over 20 years. We have a phenomenal team, great talent across different levels of the organization, and we have a really meaningful relationship with customers, whether they are in public, private, DSO. We understand their business under multiple lens, right? Whether it's implant, orthodontic, consumable technology. Paul mentioned earlier about implant VBP being a market expander. The first round of implant VBP was a couple of years ago in 2023. We have seen demand significantly increase, higher awareness at the patient level around implant treatment. I've been fortunate to be in China over the last few years, almost once every quarter. You can totally see, talking to a clinician, patients are going and asking for an implant treatment.
That's a phenomenal indicator for the potential growth. Price is also coming down, obviously making that procedure affordable. What is happening in Ortho? I think we're going through a similar process, though the process is likely to be split in two. There's a current initiative that you mentioned was made public by the Chinese government over the weekend, and that is specifically regarding service treatment fees. Orthodontics is included. The goal of the Chinese government is to make those fees more affordable, so highly likely, we will see over the next three to six months the cost of service treatment. So this is the labor component to decline. Hopefully, we will see, as we have seen in implant, sort of like that will have a positive impact in adoption demand for orthodontic treatment. As I mentioned, that's specifically for service treatment. We are expecting some sort of VBP regarding supplies.
There's no official announcement where we are expecting some development towards the end of the year. Again, we are very well positioned to capture that growth in case that will obviously pan out. China, for the most part, is still a very underserved, under-penetrated market.
Okay. Implant market. Why don't you let Drew kick us off, and then Stefan can clean up.
Sure. Two thoughts as we think about implant growth on the challenger side. If we were to contrast the product portfolio in our challenger implant businesses now versus a few years ago, we have a lot of confidence that we have the right portfolio now across surgical tooling, implants, prosthetic components, the full workflow to go and compete and to grow.
And I think we look to some of the improvement in that business over the last four quarters, six quarters without meaningful market tailwind as kind of substantiation that we can go out there and do that.
Yeah. I'm confident because especially looking at North America, the commercial pillar. So we were simply not present all over in all the territories. We had open positions of product specialists. So those are filled. We have doubled down on the training education, the EBS, the standard work, daily management. We have particular focus on how to hunt new clients and protect our top five clients. So we have specific target for each territorial manager. And I cannot guess in percentage, but that's the majority of the improvements we see. And we will, of course, maintain that. Second pillar is now our brand.
Everyone my age, 50 plus, that has many of them even met Professor Brånemark. When we start to talk about our brand and pioneering, this is not only about them acknowledging a very good system. They have such respect or had such respect for Professor Brånemark and the whole process. They actually made them who they are. So that really resonates. What we don't know yet, but what we hope is that the young clinicians will take an interest in this. What is this? Because they don't really know who Professor Brånemark was. What is the DNA of Nobel? So I see an uptick there. And come back to innovation. We need to be the leader in innovation. And that's what we now refocus on to do even ore.
I think definitely that this is not just the market coming back because we don't see it coming back that strong yet. It's us getting the game together again, definitely.
Allen, this is probably our last set of questions here. Allen Lutz Bank of America. I wanted to follow up on Erin's question around implants, Stefan. So you mentioned really three areas that's driving some of the incremental growth you're seeing, addressing underserved territories, more clinical education, and then new launches. As you think about attribution for the fourth quarter, is there any way to decompose exactly what was driving that return to growth in the fourth quarter? And then as you look to 2025, is any of that changing versus what you saw in fourth quarter versus the relative contributions there in 2025? Thanks.
During the year of 2024, we filled the territories.
We put in the targets for hunting new clients and protecting the top five. That was really the big shift, so to speak, to get a focus on. And then another thing that I haven't mentioned around the branding and the heritage is that this really resonates also with the team. Team are very proud to work for Nobel. So you get engagement and focus also from the team, not only from the 50-plus clinicians who has a relationship with Nobel. So that definitely is a big, big impact for the fourth quarter. There's no reason why we should not maintain that focus going forward. And as we expand with the branding and innovation, we should see an uplift. That's what I expect from that work.
Great. Thank you.
And then one clarifying question, Eric, around the $30 million tax benefit, should we think about that 7%-10% excluding that $30 million, or is that layered into that 7%-10%?
Yeah. I would think about it as excluding, right, in any given year. So if we are able to do some work on the structure of our intercompany loans and eliminate it, of course, it's going to be helpful for us to deliver in the 7%-10% range. But it's certainly much bigger as an attribute than that 7%-10% range. So think about the EPS range we gave as I wouldn't say excluding. I think that's a little bit heavy. But that's an annual guidance. That's a normal tax rate and sort of a normal set of business circumstances from growth down to Adjusted EBITDA, down to EPS.
And we'll keep you up to date as we go along.
Thank you.
Okay. I think Brandon's got a question. We got extra time if you want to grab it. As long as it's an easy question, Brandon.
Hey, it's Brandon Vazquez from William Blair. Thanks for squeezing me in here. I wanted to ask on maybe not the easiest or softball to end us on here. But as we look at the guidance, as we've seen with other dental peers, when you throw these or put together these targets, throw is an inappropriate way to say that you guys have put a lot of work into it. But macro will be important, right? And we've seen a lot of ups and downs. Even in the last two months alone, we've seen consumer confidence take a step down. We've had companies talk about worsening consumer.
So I hate to be the guy asking on what are the trends you're seeing today, but it will matter, I think, for the foundation of these long-term targets you guys are putting out there. So can you give us a little bit of what you're seeing through the month of February, even as consumer confidence seems to be taking a step backwards, jobs seems to be getting worse a little bit this morning as well? Thank you.
Yeah. Let me give a couple of thoughts, and then we'll let Eric get the last word. So with respect to the targets, I mean, this was good. The questions that you guys asked helped us position how we're thinking about the targets. This is what we think our company can deliver over time.
We think we can accelerate into that 2%-4% range from kind of the 1% today. If the market recovers faster, as Eric mentioned, that would be an accelerator. We'd get into that range quicker. We see the opportunity for improved productivity in both our cost of goods sold line and our SG&A lines. And that's why we think we can convert the 2%-4% into even higher 4%-7% EBITDA, implying you should expect margin expansion. We're fortunate to have a strong balance sheet, and we have some one-offs like this tax thing that allow us to convert that 4%-7% into even more EPS growth. So think of the targets as what is this model capable of delivering, maybe more so than the specific year-over-year expectations. I think that's what maybe your questions helped surface.
Second, with respect to what are we currently seeing in the market, I would say continued improvement relative to what we talked about on the Q4 call. We'll, of course, report Q1 here in the couple of weeks. So I don't want to say too much specifically about the first two months. But we're continuing to gain momentum. All of the work that we're doing that we talked about this morning is playing out. So we're building more and more momentum. We expect the market to continue improving. And we think we're at the beginning of a pretty nice period for Envista specifically, but we think dental more broadly. Last thing I'd say, and then I'll turn it over to Eric, is yes, the dental community has a history of putting out very exciting medium-term targets.
And everyone feels great for a couple of weeks until you get to that first quarter. That has two issues, and we have lived it. And we're trying to avoid that mistake. The first issue, of course, is you disappoint your investors. You don't do what you said. But more importantly, it causes you to take near-term actions that you otherwise wouldn't, chasing that quarter, that then have longer-term downstream negative impacts. And that makes it really hard to build long-term shareholder value. So we're just trying to avoid all that, trying to put out reasonable targets, give you guys confidence that we can deliver against them, build a track record, keep building momentum, and get this wonderful machine in the center of this great industry moving better over time. That's what we're trying to do.
Good. Okay. Hard to follow that up.
So I would just say two things, Brandon, maybe three. So number one, the easiest question could have been, how do you guys think Luka Dončić is going to play for the Lakers or something on that level? So we can work on the easiest question thing. Two points on the core question. So relative to the short term, we get our business intelligence from two places. We get a lot of it from you all, right? All the surveys that are put out to general practitioners, specialists. And I would just say on the back of what Paul said, we continue to see the dental market, not unlike the way that you're all reporting. It's soft but stable. That's, I think, our best term. It's probably the industry's best term, maybe with a little bit of uptick, but you have to kind of squint to see it.
Depending on which month you look at it, it's sort of bumping along. So nothing more dramatic that we get from the outside in intel. And then I would just say our inside-out intelligence, which is how are we performing in first quarter? We're performing in line with how we thought we would perform when we issued the full 2025 year guide. And we're performing generally in line with what we said on the Q4 earnings call, which is that Q4 could be a little bit of a soft quarter, maybe slightly down. It's sort of steady as we go relative to that, notwithstanding some of the improving trends that Stefan talked about as one example.
Okay. Looks like you guys are out of bullets. Or maybe you're just hungry. Why don't we put a cap on there, cap on it there? Thanks again for coming out.
We're trying to be very interactive with all of you. Hopefully, we're easy to get a hold of, put an email, a call into Jim. And we're very excited to continue the dialogue. Thanks, everybody.