Straumann Holding AG

SIX:STMN

Earnings Call Transcript 2020-Q1

[Guillaume Daniellot, CEO & Member of Executive Management Board]

Good morning, everyone. Thank you. I very much hope that you, your families and your colleagues are well, and thank you for joining this conference call on Straumann's 2020 first quarter results. We'll be referring to the presentation slides that were published on our website this morning. And as usual, we kindly ask you to take careful note of the disclaimer on Slide 2 regarding forward-looking statements. As to summary, I will run through the highlights; and then Peter Hackel, our CFO, will review the business and regional performances. After that, I will give you an update on our recent achievements and our strategy regarding COVID-19. I'll conclude with some thoughts on the outlook, after which we will look forward to answering your questions. So beginning with Slide 5. We made a promising start to the year, continuing the solid growth trend of 2019. But this was severely disrupted by the outbreak of coronavirus in China and its spread through Asia, Europe and the Americas. Towards the end of the quarter, the majority of dental practices in most of our markets were either locked down or limited to emergency treatment only. Even in places where practices did remain open, patients stayed away in fear of infection. These circumstances brought the global market for implant and aesthetic dentistry almost to a standstill, and our sales dropped significantly. However, thanks to the good performance up to the middle of March, our first quarter revenue reached CHF 357 million, which, in term of organic terms, were just 1% off the comparative period in 2019. Revenues declined sharply in Asia Pacific and remained flat in EMEA, while both North and Latin America posted single-digit growth. Across the Straumann Group, we responded quickly to the emerging pandemic, ensuring the safety of our people and the continuity of our operations and key functions. We also took prompt measures to mitigate the financial impact by adapting costs and capacity in addition to securing liquidity. The shutdown restrictions have not diminished the passion and creativity of our people. Working from home, we have built and strengthened relationship with customers and creating new opportunities. We have also used the shutdown as an opportunity to train our staff. All of these initiatives will help our business to rebound when countries reopen and dental practices will get back to normal. Very importantly, we have not relaxed the momentum on key innovation projects and have pressed ahead with exciting projects in our R&D pipeline that will help drive future growth. We are fully confident that our underlying business fundamentals are intact. But in view of the continuing uncertainty, we are withdrawing the financial guidance we issued in February. And we will not be able to provide you with a new forecast for the time being, as you can understand, looking at the uncertainty of the current situation. Moving to Slide 6. Our regional results reflect the different phases of the pandemic. Asia Pacific, which has suffered the longest, reported a revenue decrease of more than 20%, in stark contrast to its dynamic growth in 2019. EMEA slipped from growth in the low teens to 0%, while North and Latin America dropped to the upper single-digit range. And now for the details, I will hand over to Peter.

[Peter Hackel, CFO & Member of Executive Management Board]

Thank you, Guillaume, and good morning, everybody. The outbreak of disease and subsequent lockdown in China had a substantial impact on our growth throughout Q1. Most European markets and North America were heavily affected in the second half of March. Excluding China from the results, growth February year-to-date would have been in line with the previous year. And even including China, we would have reached the double-digit growth rate for which we guided in February. Obviously, this fact does not embellish the numbers, but it does give us confidence in our ability to continue growing strongly under normal condition. As you can see on Slide 9, our reported 3-month revenue in 2019 amounted to CHF 372 million. We have to contend the Swiss FX headwinds that amounted to a negative impact of CHF 22 million. The acquisition impacts, mainly of Anthogyr, added almost CHF 12 million, bringing the adjusted revenue base in 2020 to CHF 362 million. As you can see, our 2 largest regions, EMEA and North America, together with LATAM, almost made up for the large decline in APAC. As mentioned, the strong Swiss franc weighed heavily on our reported revenue, and you can find more information on the impact in Slide 32. Looking at Slides 10 and 11, the regional performances in detail. Our largest region, Europe, the Middle East and Africa, posted good initial growth, driven by premium and value implant solutions. Clear aligner sales were initially promising, but the rollout program and sales in general were interrupted by the pandemic. Dental clinics remained partially open in Germany throughout the quarter but focused increasingly on essential treatment. While Italy, Spain and France were the first large markets to suffer, growth remained intact in Russia, Turkey and parts of the Middle East until late in March when the pandemic started to take its toll. As a result of these factors and currency headwind of almost 7 percentage points, regional revenue remained more or less flat at CHF 162 million, corresponding to 45% of the group total. North America contributed almost 1/3 of our total revenue, having delivered double-digit growth for all but the last 2 weeks, when Canada followed by the U.S. went into lockdown. The growth was driven by premium implants and Neodent, with additional lift from our digital business. In total, revenue increased 8% in organic terms or 5% in Swiss francs to CHF 116 million. The business disruption in China was in line with our expectations. Also, digital equipment sales were better than expected, thanks to the range of intraoral scanners we offer under the Straumann brand. In the meantime, both China and Korea have begun to emerge cautiously from the crisis, but consumer confidence is more reserved than before the crisis. Taiwan has hardly been affected, while Japanese customers purchased more than usual in anticipation of the shutdown, which came in April. Other countries in the region are also locked down. As a result of these various factors, our revenue in Asia Pacific declined 22% organically or 26% in Swiss francs to CHF 54 million. With an improvement in the economic environment, the year started well in Latin America. All countries delivered good performances in the first 2 months, driven by premium and value implants and lifted by sales of Straumann's competitively priced Virtuo Vivo intraoral scanner. However, with Brazil and the region in various stages of lockdown and with patients anxious about visiting clinics, sales were generally modest as the quarter ended. Organic growth reached 7%, but a strong negative currency impact resulted in Swiss franc terms by almost 20 percentage points, bringing regional revenue to CHF 26 million. Driven by increased demand for fully tapered and apically tapered implant, the group's largest franchise, Implants and Restorative, were strongly initially but declined over the full period due to the interruption in March. The value implant line, especially in Neodent, Medentika and Zinedent, grew throughout the quarter, while Anthogyr was constrained by the early lockdown in France, its home market. CADCAM prosthetic sales were positive throughout the quarter following the strong implant sales in the prior quarter. Demand for digital equipment was strong, driven by sales of intraoral scanners. ClearCorrect posted double-digit growth with additional lift from the recently acquired thermoplastic business. Projects to expand production in the U.S., Brazil and Germany are on track. And in spite of the challenging environment, sales of biomaterials remained stable thanks to the group's attractive bone regeneration portfolio. And with that, I'll hand back to Guillaume.

[Guillaume Daniellot, CEO & Member of Executive Management Board]

Thank you very much, Peter. With regards to our achievements and strategy, I would like to start by adding some details on the businesses. Peter referred to the strong pre-crisis demand for our innovative Straumann BLX implants, which continued to gain traction and consequently gained further share in the premium segment. BLX, together with the broad range of fully tapered implants offered by Neodent, Anthogyr and Medentika, positions us strongly in the area of immediacy. Our strategy to lead in immediacy is exemplified in the collaboration with -- we have with [ saltered ] implants to bring a new zygomatic implant solution to market. It combines proven implant design features with the advantages of our BLX and BLT prosthetic systems. In addition, it can be used with the Straumann CARES digital workflow to plan the implant position by computer. This increases flexibility and efficiency for clinics providing advanced implant procedures. In addition to increasing our access to maxillofacial surgeons, our new implant creates opportunities for treating compromised patients. Zygomatic implants have been used for several years to offer an immediate treatment option to people with insufficient bone in the posterior upper jaw, who would otherwise be unable to have an implant solution. As you can see in the illustration, they are much longer than conventional implants so they can be anchored in the cheekbone. Clinical evaluation of the new system is underway in 8 international centers, and we are working with various centers of excellence to increase education in this area. Another highlight in Q1 was the launch of NUVO, our new implant brand aimed at the lower value segment. We introduced it at CIOSP, the largest dental congress in Latin America, and are planning its international rollout to address the increasing need for affordability. Moving on to Slide 15. In our digital business, a substantial contribution to growth came from intraoral scanners, which will be the gateway to dental practices in the future. This is why we have been working hard to connect various scanners seamlessly with our digital workflow. It explains the urgency of restoring production at Dental Wings, which was disrupted by the fire last year. I am pleased to say that we have reestablished capacity, including production of our competitively priced Virtuo Vivo intraoral scanners. As you can see on Slide 16, our orthodontics business performed well, although its progression was interrupted by COVID-19 and a change in the marketing approach of certain customers. We are looking forward to continuing the international rollout of our ClearCorrect product portfolio. We are also excited about the new software we have in development as well as the new high-performance Zendura thermoplastic that we plan to have ready by the end of the year. With the next few slides, I would like to share our perspective of COVID-19 with you and to tell you about our initiatives to mitigate its impact and to create new opportunities. Slide 18 maps the progression of general restrictions triggered by the coronavirus together with its impact on dental practices and patients. Based on insights from our local team, we have plotted our key markets in the chart according to where they are in the chain of events. As the middle line indicates, we don't anticipate an immediate rebound in our market as soon as lockdown restrictions are lifted. The reason we see for this are as follows: elective procedures depend on disposable income, which may be reduced in the post COVID-19 economy. Secondly, patients need to feel confident that there is no risk infection before they go to the dentist, especially their treatment can be postponed. And thirdly, dentists will need to wear personal protection equipment and change it with each patient. They will also have to take additional hygiene measures, which can reduce the number of patients they can treat per day. And the main concern for us is the expected economic recession, which will lead to low consumer confidence and reduced disposable income. This, in turn, will cause people to certainly put off elective dental treatments. Although China, Korea and the initial countries in Europe are opening up, we are cautious about the form and extent of the recovery. Fortunately, with our broad geographical footprint, our ability to address all price levels and our strong balance sheet, we are equipped to prevail and come out strongly. Slide 19 provides more insight into the current phase of the pandemic. Of the largest markets, Italy, France and Spain are closed, while fewer than 20% of practices are currently open in the U.S. and Brazil. At the other end of the scale, 80% or more are open in Germany, China and Korea now. So that gives you a brief overview of the situation. Now let me tell you about some of the things we have been doing to come through it together with our customers. We have often told you in the past about the importance of our culture journey in driving growth and high performance. Our player-learner mindset and calm behaviors like being agile, focusing and supporting customers, creating opportunities in the marketplace, taking ownership and building trust are even more important in those difficult times. They have truly enabled us to respond quickly to the COVID-19 crisis and will help us to stay in control of our destiny. To weather the storm, we have been focusing on the past 2 months on the priorities listed in Slide 21. First, people safety. Secondly, business continuity. Then mitigate the financial impact. And finally, supporting customers and preparing for a strong rebound. With regards to people safety and preventing the spread of infection, our quarantine, social distancing, hygiene and other protective measures have been very affected. Thanks to this and the responsibility of our entire team, the number of confirmed cases in our global team since the outbreak has been extremely small and thankfully, no one has been serious. To ensure business continuity, we have adapted production capacity to meet demand and have encountered no supply issues. Our e-shop, customer services, sales team and internal functions are operating remotely and are all working very well. Straumann CADCAM services are running, and our warehouse teams are processing orders in time. We have been working hard to adapt our cost base also to current and near-term demand, ensuring that we retain our flexibility and maintain capabilities without compromising projects that will drive toward our success. In February, we implemented an immediate short-term cost reduction plan, putting travel, hiring, consultancy and nonclinical initiatives on hold. We also took measures to reduce personnel costs, including voluntary pay cuts by the Board and global leadership team. These details of this are presented in Slide 24. In addition, we began to implement global reductions in working hours and pay, applying for government support wherever possible. We have reduced CapEx until demand picks up, and we are evaluating further measures to adjust our cost structure based on mid- to long-term scenario planning. On Slide 25, you can see some of the innovative things that our staffs are doing to create opportunities in order to rebound strongly. The most significant of these are our 2 dedicated web portals offering valuable information on COVID-19, supporting customers as well as educating opportunities, virtual conferences, webinars and more, all free of charge. The aim is to enable dental professionals to learn about the latest techniques, treatment solutions, products while their practices are closed. So far, the portals have attracted more than 200,000 visits. One master class on immediacy with Straumann BLX drew 7,000 attendees. Being fully integrated in our digital platform, the portals have generated no fewer than 220,000 visits. And finally, Slide 26 shows how inspirational we can be. In response to the urgent need to sanitizing agents, our colleagues at Yller Biomateriais in Brazil started producing a hand sanitizer gel, which is named NeoGel. Yller specializes in resin for 3D printer. And before long, it has inspired a number of customers to use their equipment to print clips for attaching protective face shields. Across the world in Germany, manufacturing equipment for our clear aligner business was reprogrammed to produce protective face shields for the professionals. We offer this free of charge or at cost and encourage recipients to make donations to support COVID-19 relief. And that brings me to the Slide 27 and our thoughts on the outlook, which, of course, are barring unforeseen circumstances. Although China and South Korea are now open and initial markets in Europe are beginning to reopen, key countries elsewhere remain locked down. We, therefore, expect the impact seen towards the end of Q1 to continue in Q2. In view of the current uncertainties, we are withdrawing our guidance for full year revenue and earnings. As noted in our press release, the pandemic has triggered economic issues around the world, and we have to be prepared for a weaker macroeconomic environment with reduced consumer confidence and lower disposable income, factors that we believe we've lengthened the time to fully recover. With our broad geographical footprint, wide range of solutions covering all price levels and strong balance sheet, we are well positioned to address all customer preferences and needs through the crisis and beyond. Nonetheless, we still have to adapt as an organization to the new realities without compromising our ability to innovate, manufacture, supply and sell winning products and solutions with service excellence. The underlying business fundamentals of the Straumann Group remain intact. And we are confident that when the general economy and consumer confidence return to normal, we will emerge as an even stronger brand and partner of choice for our customers. And now I would like to open the question-and-answer session. [Operator Instructions] So Chorus Call, can we have the first question, please?

[Operator]

The first question from the phone comes from the line of Chris Gretler from Crédit Suisse.

[Christoph Gretler, Managing Director in Equity Research]

Guillaume, Peter, I hope you're doing fine as well. I have 2 questions. The first, with respect to the exit run rate at the end of Q1, could you indicate to some degree kind of how that level was relative to kind of a normalized plan? That would be very helpful so that we can get a base of where we can expect a recovery from it. And then the second is on the drop-through rate. Could you maybe give kind of an overall indication what level of drop-through we should expect from this lower sales relative to the original plan? For example, for the first half, I know obviously, the visibility is still very clouded. But maybe kind of an indication whether it should be kind of above 100%, for example, given additional cost or so. That would be very helpful for us.

[Peter Hackel, CFO & Member of Executive Management Board]

So let me address -- Peter speaking, Chris. Let me address your first question, the exit run rate of the first quarter. I mean if you look at the Chart 8, that listed certain indication there. You see the bar in relation -- the size of the bar in relation to the full year growth 2019, you see approximately what's the growth. And until mid-March, more or less, in most of the countries, we had a softer business in March, but it was still generating growth. So especially in the second half of March, most of the countries went into a lockdown around the globe, so you can see the negative impact here in March. That was mainly from a good half month. So that gives you a certain indication how April could look like. And as we said, COVID-19 has created a lot of insecurity, but the visibility going forward is very limited. So we are working with different scenarios in that respect.

[Christoph Gretler, Managing Director in Equity Research]

But you cannot give us kind of a first indication about April, maybe?

[Peter Hackel, CFO & Member of Executive Management Board]

Yes. If we take the growth rate here for March and if we -- basically, that was for a half month. If you extrapolate that for a full month, then you would see it's basically double the amount of March. So in April, as most of the countries in Europe, in North America and in various places also in Latin America were in a lockdown, the business in April was rather soft. And I would expect for the April alone a decline something like 70%, that order of magnitude.

[Christoph Gretler, Managing Director in Equity Research]

That's very helpful. And on the drop-through rates?

[Guillaume Daniellot, CEO & Member of Executive Management Board]

What do you mean, Chris, exactly by the drop-through rate? If you can express that.

[Christoph Gretler, Managing Director in Equity Research]

Yes. Basically, let's say, you expected kind of sales to grow 15% and now we are basically from 100% to 115%. And now we are basically at 100%. So the incremental 15%, kind of -- what kind of margin on this 15% should we assume? Basically, I mean your gross margin is really high. So I guess, it could be as much as -- pretty much 100% that will drop through your operating profit line. So that was my -- or I mean just to get a sense about, on the one hand, we have additional costs given all the measures now that have to be put in place. On the other hand, you have some savings. Maybe as you indicated, just to get a bit of a sense kind of on a net-net basis, how that kind of equals out.

[Peter Hackel, CFO & Member of Executive Management Board]

I mean Chris, that's a very tricky question, I think, because I assume you are referring to the full year drop rate at the end and not especially in April. I mean in March, we were able to cut all the incremental short-term costs such as travel, promotion activities and so on and so forth. And obviously, as most of the dental practices were locked down in April, we see a bigger positive impact in April from this reduction in top -- on top of that. We are in short-term work as some people have taken vacations. So currently, I would expect a bigger savings, especially in April. And in the future months, we will adapt the same so that we can generate also a little bit to the top line development in this month. But for the full year, we are able to generate a significant amount of savings, which is in -- at least in the high double-digit million amount.

[Christoph Gretler, Managing Director in Equity Research]

Okay. And then maybe just one last question, if I may. Could you maybe elaborate on the next triggers that you basically have in your scenario planning that would kind of result in some action?

[Guillaume Daniellot, CEO & Member of Executive Management Board]

The scenario planning is obviously based on trying to understand the rebound or the recovery of the different markets, and one of the trigger is obviously Asia Pacific and China, in particular. First, because China has been the first one into the crisis, then it gives a lot of indication on how we can get out of this crisis and especially how dental practices can create a new normal for treating patients with implant therapy. The second one is obviously the consumer confidence after the outbreak and how much the patients are going to come back to the practices and use a part of their disposable income for implant treatment. And while we don't think that we can 100% apply to the rest of the countries what's going to happen in China, at least it will be giving a very good indication on how we can rebound in Asia Pacific, which has been, for us, a very strong driver for our growth overall.

[Operator]

The next question comes from the line of Tom Jones from Berenberg.

[Thomas M. Jones, Analyst]

I have 2 kind of in a similar vein, really. Maybe one for Peter and one for Guillaume. Peter, I was just wondering what -- if you could give us some indication of what percentage of your labor cost you think you might be able to offset or have compensated through various government salary compensation schemes, furlough programs, et cetera, both as a percentage of your labor cost and a percentage of your total cost. That will be helpful for us to try and understand. And then the second is kind of a follow-on question to Chris' and a big picture one for Guillaume. I mean Straumann probably could have been accused in the past, in '08, '09, '11, '12, of being a bit slow to adapt its cost base. I'm not sure that's playing on your mind now. But equally, this is not a normal recession. This is not a sort of financially driven recession. This is something new. So I wonder if there's a risk that if you do adapt your cost base more aggressively in the short term, you don't get caught out by a rapid market recovery and end up having to rehire all those people at respectively higher cost. So I guess the question for you is, how are you thinking about balancing those 2 risks? The risk of going too early or against the risk of going too late. Just kind of some general thoughts as to how you're thinking about that balance would be useful, I think.

[Peter Hackel, CFO & Member of Executive Management Board]

So thank you for your questions, Tom. Let me address the first one in terms of savings or percentage charges in terms of personnel costs and other cost savings. I mean I want to say you have seen what kind of savings are we achieving on the personnel expense side. You have seen these, on the one hand, voluntary pay cuts, as listed in the Chart #24. In addition, some -- we have encouraged the people to take vacation, which comes on top of that. And in some of the countries where we are on short-term work, we also get respective government subsidy. Assuming that all these measures will stay in place for the full second quarter and especially on the short term, that that's my current planning assumption, but we don't know that. We could also probably lift that once business is coming back. But assuming that will stay in place for the full second quarter, then the positive impact we can achieve with these measures is a high million single-digit figure, which would be a good 10% to 15% of the personnel cost. And on top of that, if we take that to the total cost in the second quarter, that would be something like 5% of the total cost in the second quarter. But of course, that's a very dynamic situation going forward, and we will adapt that depending on the top line development.

[Guillaume Daniellot, CEO & Member of Executive Management Board]

Yes. Tom, thanks for the question. Guillaume. I think that's obviously a very important question that we have on our mind. I would see there is 2 dimension of it. It's you have the when, and you have also the how much and the magnitude of those kind of decision. First one on the when, that's what I was just saying. I think for us, it's very important that we are having the right timing in evaluating exactly the recovery in our key markets. And the key markets, especially for growth, has been Asia Pacific and North America. Then as you can imagine, we are following the situation with our local teams very, very carefully in order that we can have the best potential sense of how the recovery is going to look like. With -- how much would we be taking some measures to avoid being -- not being able to capture a faster recovery, one very important decision we took is first on the manufacturing side. Manufacturing side, we have done a lot of short working time, and we are planning short working time also moving forward in order to be able to adapt the manufacturing to the demand very quickly. And I think this is a very important point for us, not to be facing any back orders in case we were, for example, seeing a better situation than we could be planning at this moment in time. On the other side, it's much more a good opportunity also of having this crisis to reassess all our priorities in terms of development and making sure that we invest in all the critical innovations and projects for the future, be it the digital, the clear aligner, be it all our core business on the value and premium side, and still keeping what is going to make the difference tomorrow but maybe easing some of the nice to have that we were having in the period of double-digit growth. And I guess we are having a lot of commitment from our team to really look at that in detail and as our scenario planning, which are run and designed along those kind of guidelines that I just shared with you.

[Thomas M. Jones, Analyst]

This might sound like a slightly perverse question given it looks like revenues in parts of your business are currently down 70%, 80%. But is there any intention, scope, opportunity to actually increase investments in certain areas, whether that's in internal projects, hiring good quality people from perhaps from other companies? You've got an opportunity to poach some good people. Or perhaps on the M&A front, clearly, some companies are going to be struggling at the moment and looking for a way out of their current situation. Is there any opportunity to actually go the other way and find some places to put money that you might not otherwise have done?

[Guillaume Daniellot, CEO & Member of Executive Management Board]

That's a very good question, Tom. And actually, yes, we are doing this. We have been pleased to hire a couple of very good people that we think are going to help us also through the rebound about the specialty expertise that we were not having internally that are going to be very useful. We are looking at M&A opportunities in different segments to be able to either capture additional market shares or, again, adding some specific expertise of technology that we would not have. And this is really present in our rebound plan, and those are things that, yes, we are evaluating as we speak.

[Operator]

The next question comes from the line of Michael Jungling, Morgan Stanley.

[Michael Klaus Jungling, MD, Head of MedTech & Services and Analyst]

I have 2 questions. The first one is on earnings for the first half of 2020. If sales were down, let's say, minus 50% in Q2, would you be loss-making on an EBITA basis in the first half? Well, if you can't answer that, maybe you could highlight what sort of the sales breakeven number would be for a flat profit in the first half. And then question #2 is in relation to orthodontics. You commented that you saw some changes in the marketing approach of certain customers. Could you please explain what you experienced?

[Guillaume Daniellot, CEO & Member of Executive Management Board]

Yes, I will start for the second one, while Peter will give you some color on the first one, Michael. Yes, on the ClearCorrect side, what we have seen then during the second half of Q1 is that some large customers of ours have been, well, trying to reduce also their operational expenses and decided to be much less active in promotions and direct spend in advertising towards patients and health consumer, as this is something which is very, very dynamic in North America and especially in the U.S. We have seen a direct correlation in some of our key customers in between their direct promotional spend and their new cases generated, and this has impacted some of our growth within our overall ClearCorrect in the domestic market. Peter?

[Peter Hackel, CFO & Member of Executive Management Board]

So coming to your question concerning loss-making in the first half given the situation that you assume a sales decline of about 50% in the second quarter. As I said, we have different scenarios there. But if that would be our scenario, then I would not expect that we are loss-making on an operating level in -- for the first half year in that scenario.

[Michael Klaus Jungling, MD, Head of MedTech & Services and Analyst]

Okay. So if minus 50% does not cause loss-making, at what point does that happen? Is it -- I mean if April was down 70% and let's say we go down the route of May and June being a little bit better, would 60% or 65% in Q2 cause you to become loss-making?

[Peter Hackel, CFO & Member of Executive Management Board]

Well, Michael, I think that's a difficult question because, as I said, we will adapt our cost base also to the revenue development, and we are right now in a critical phase. I would see where Guillaume has alluded that some of the countries are easing their lockdown, we see some business coming back. So if that will be stronger than expected, then we could spend a bit more on the promotional activities to create opportunities and capture business. If that would be weaker than expected, we would spend a little bit less. But we see -- and there's also a question of how much short term we have. But on a full year basis then, we are able to significantly save costs in 2020. And I would expect we are, at least, able to save high double digit -- very high double-digit million figures for the full year this year.

[Guillaume Daniellot, CEO & Member of Executive Management Board]

And Michael, maybe to give some color also about how we see the trend on the net sales side for -- well, for the months to come. While Q2 is going to be strongly impacted because of the April results -- and obviously, May as well, looking at -- well, if the situation is not unlocking, we still see, well, China doing much better. Germany is getting back to already on our core business pre-COVID-19 implant volume. We are seeing and expecting also that North America will open state by state, and we see the announcement in Texas being already reopening now. Then we don't expect afterwards Q2 getting worse than what we have known in April, and that's why we believe some of the situation here is going to ease as Q2 is moving forward.

[Operator]

The next question comes from the line of Julien Dormois, Exane BNP Paribas.

[Julien Dormois, Research Analyst]

I would have also 2 questions. One relates and elaborates on your previous answers. But could you -- I think China is probably the country in which the market has reopened to a higher degree so far. Could you just comment on what kind of volume you see on the year-on-year basis? Are you still down 10%, 20%, 30% compared to the pre-COVID level? That would be interesting. And then the second question -- and I know you don't have a crystal ball and you're working on different scenarios, but some companies have already started to say that they would not expect the 2021 levels in volume terms to be at the same level than 2019. Is it -- what's your best guess at this point in time? Do you expect 2021 to be below 2019 levels at this stage?

[Guillaume Daniellot, CEO & Member of Executive Management Board]

Yes, yes, yes. Some additional input on China. Then China is also, I would like -- I would say, a bit like the U.S. It's a very wide country with a lot of different provinces. And what we see right now is that the business is coming back differently based on its geography. When you look at the provinces that were less impacted by the outbreak, Shanghai or Guangdong, we are already having a really, really nice run rate. Our DSOs in those areas are also very dynamic in getting the patient flow. And we are close to a pre-COVID 2019 level. Now you have provinces like Beijing and Hubei, obviously, where the outbreak started, where then first the unlock rules have been stricter. And we see that the run rate which is much more lower as it has been quite conservative in the way they have started to reopen dental practices. Then all in all, we are seeing China in April, and we can share that with you, that we see a little bit the trend. We believe it's going to be around 75% of last year level already in April. Then that's why the team in Asia Pacific and China is pretty confident that it's going to get better and better as Q2 is moving forward. When it comes to your 2021 question, as we are not able to give guidance on the base for 2020, then it's not the moment for us to give any idea of 2021 because it will depend on a lot of different factors based on not only the fact that the pandemic can come again if the unlocking rules are not followed strictly enough in some geographies, but also with that global recessions that we are seeing and the latest information being given by the U.S. with their GDP going down minus 4.8% in Q1. Then we are going to be following this North American number very carefully because this is -- this has been also a big base for growth for us in the past 4 years. Then 2021, it's difficult to say which level it will be. We believe it will be obviously much better than 2020. It should not be so difficult. Are we going already to reach 2019 level? There are some chance if everything goes well, but there are also a lot of factors that could prevent us to be there.

[Operator]

The next question comes from the line of Veronika Dubajova, Goldman Sachs.

[Veronika Dubajova, Equity Analyst]

Yes. I have 2, please. One, I was just hoping, Guillaume, you could elaborate a little bit on your comments around the European performance and just to give us a little bit more insight into what you're seeing in some of the large markets in April. You alluded to Germany maybe seeing some pretty decent recovery. If you can share some of those data points for some of the other European -- larger European markets, that would be helpful. And then just on kind of back to the P&L question. Can you help us understand, in particular, for the savings that you are looking at, which areas are you targeting? Where do you see the biggest opportunities and I guess how durable those savings would be? So if the business does return back to normal fairly quick, do you see those expenses coming back? Or is this something that you think offers you some opportunities on a more sort of sustainable basis to improve your profitability?

[Guillaume Daniellot, CEO & Member of Executive Management Board]

Yes, Veronika. Thanks for the question. When it comes to European performances, Germany has been, I would say, even surprisingly, doing very well through the crisis. They never closed fully their practices. They have been -- the dental practices have been seen part of the fight against the COVID-19 crisis and have been seen as health professionals in order to try to help a little bit the control of the pandemic. We see that now most of them are starting elective treatment again, then we are very confident to get back to a 2019 level as soon as April is over. Obviously, you have some [ lack in ] European countries which are in a very, very different state. The pandemic has hit very strongly Italy and Spain, as you know, and France as well. And U.K. is really in the middle of the storm right now. And in those countries, I think we have seen almost no activity because all dental practices have been closed. They have been seen as a vector of the pandemic progression. Then they will need to follow some strict rules to reopen. We see in some countries, especially like Spain, the possibility to reopen to do classic dentistry. But we think on this side, for us, this is going to be the part where the recovery will be slow, in markets like Spain, Italy and France.While in the U.K., we believe that the activity can resume quicker because they have that capability to do elective treatment. We're also addressing them directly to the patients and doing dental procedure promotion, which is not allowed in some of the Latin European countries. Last but not least, we see the Scandinavian countries being able also to come back to a decent level rather quickly. Sweden never closed all its practices. Then I think there is a -- as you have seen in the press, there have been some comments about was it a well-handled crisis or not. I think I will let everyone judge the situation. But when it comes to the economics, they are still active, and we are having still practices in Sweden that are doing activities. While it was not the case in Norway nor Finland, and Denmark has been also active, reopening right now, and we hope Denmark to be also active quite strongly during the month of May.

[Peter Hackel, CFO & Member of Executive Management Board]

Talking about the second part of the question, the cost savings, Veronika, it's important to say that we don't want to compromise on our ability and position to develop innovative products, to produce this product and also to launch this innovative product at the end. We have a successful winning portfolio that allows us to gain further market share once we are back to normal. So it's important that we don't want to compromise on these abilities at the end also for the patient benefit. So all the savings that we have taken is basically cutting incremental cost, be it on the promotion, marketing side, be it on the travel side, be it on the consultant side. We have not stopped our major R&D projects. We continue to invest in these projects and push these projects. But obviously, we have reviewed out the portfolio on the -- we have delayed one of the minor -- what we currently consider less relevant projects we have, we have postponed them. But given the fact that I have said we have cut and are still cutting these incremental costs, once we would see a bouncing back of the business, it's rather easily to increase our expense rate again in this area.

[Veronika Dubajova, Equity Analyst]

That's very helpful. And could you kindly qualify, just when you say the double-digit -- high double-digit million savings, is that versus the original budget or versus the spending levels that you had in 2019? I just wanted to make sure I get that right.

[Guillaume Daniellot, CEO & Member of Executive Management Board]

That would be at the 2019 level, Veronika.

[Operator]

The next question comes from the line of Daniel Jelovcan, Mirabaud.

[Daniel Jelovcan, Analyst]

Two questions also. The first, more a big picture. Can you quantify maybe, of your implant portfolio, how many treatments are really nonessential? Again, your best guess, I guess it's not so easy to assess that. And the second question is, in the United States, I mean I learned from other companies that it's also client heterogeneous over the country. For instance, in New York City, people are afraid to go to the street, so I can understand that there is probably 0 activity. But in others, regions like Texas or California, which are very wide, that business is still okay in general. And how is that for Straumann, let's say, in that area? Is there also no activity or there are other some dentists which are open?

[Guillaume Daniellot, CEO & Member of Executive Management Board]

To the question about -- especially on the dental implant side, I would say what is nonessential, I would say, well, it's either all of them or none of them. I will explain myself. It's still an elective procedure. Then in most of the case, then if you want to wait, you can wait for an implant treatment. If you have an infection, then what is very important is to treat the infection and remove the affected tooth and make sure that you are creating a good filling site for a future implant. Now all implant treatment, I would say, are essential for 2 reasons. The first one is that if you don't replace a hole in your mouth, then you will have all the rest around which is going to move. Because the occlusal teeth, that means the teeth which is, if you have a hole in your lower jaw, then the tooth in the upper jaw will not have any one to shoe on, and it will start to have the bone on the upper side, which is going to diminish. Then that's why we're always saying that you really never have to leave a tooth without being replaced because it will have some very significant impact midterm to your adjacent teeth or to your opposite tooth. And that's why we -- this implant treatment is now becoming a golden standard because this is the way to keep a very good oral health situation for the future. And having a good functional oral health is helping your overall body in order to have the right metabolism and the right nutrition, and so on and so forth. And in that sense, all implants are essentials, and that's why also treatment are continuing quickly after the different crisis, but it's how fast it's going to come back. But we believe that the business fundamentals of implants are still very strong and at every situation for an implant then will be covered, and there will be an implant placed. The only question is when this is going to happen at 100%. When it comes to the U.S., Daniel, I think the U.S., we have seen, yes, very strict rules being applied, and we have seen really 0 activity, whatever the state, because -- there have been a little activity in the Southern states because, well, there have been the ones less impacted by the crisis. But if you remove Texas or the northern states like Illinois or Michigan, then the rest in the middle of the U.S., who have very, very low populations and very low business, then that means that if you are impacting both coasts and Texas, as it has also followed the rules, then you have almost 0 activity in the U.S. And it has been very, very low in April. And then we are looking at how they will unlock states state-by-state in order to see the performance that we can create and generate within the U.S. Obviously, New York will be one of the slower states to come back, looking at the impact that the COVID-19 had in this particular city and this particular state.

[Daniel Jelovcan, Analyst]

Okay. So in other words, the U.S. is even -- was even weaker in April than Europe because in Europe, we have important markets like Germany partially open, correct?

[Guillaume Daniellot, CEO & Member of Executive Management Board]

Yes, even though it has been mainly Europe (sic) [ Germany ] and Sweden that were active in Europe, in U.S., it was, yes, very, very low activity in April, very low activity, lower than Europe. That's true.

[Operator]

Next question comes from the line of Maja Pataki from Kepler.

[Maja Pataki, Head of Med Tech Devices Sector]

Guillaume, I have a bit of trouble to consolidate some of the statements that you've made and that are also in the press release, and I hope that you can maybe help me understand. How am I supposed to read the words strong rebound and long -- lengthy recovery? And how does that go together? Is it -- are you expecting to see a strong rebound from the very low levels that we are here, but to see a lengthy recovery until we are at the 2019 levels or until we're seeing double-digit growth? It's just something that I find a bit difficult to consolidate. Second of all, for you, Peter, in the past couple of years, the focus has been very much on top line growth, and you've been very successful with that. How will -- or how could your thinking change if indeed we are going into this difficult time from an economic perspective, top line growth remains for a few years in the single digits? Are you going to then follow the same path on the margin progression, i.e., flattish to slightly positive margins -- or margin improvement? Or are you going to be more focused on delivering better margin improvement?

[Guillaume Daniellot, CEO & Member of Executive Management Board]

Yes. Thank you for the question, Maja. Yes. I will help you to reconcile those 2, let's say, prospectives. I agree that that's also a good question. When we are talking about lengthy recovery, we are talking about our environment. Then we are more of the belief that it will take some time for the industry and the overall market to get where it was, 18 months, maybe 24 months, in order that the overall market is going to have the same patient inflow, the same dynamics than the one it had before the COVID-19 crisis. That's why we are using the term lengthy recovery on this side. We are using rebound for us as an organization because, despite the fact that we could be in a flattish market, there is no reason for us not to gain significant share as we have done in the past. And this is why we are saying that we are really looking at preparing us for rebound in order to get back significantly some of the things we -- some of the net sales we have lost, not only by benefiting from some of the recovery of the market, but also gaining significant share from competitors that would get out weaker from that crisis. That's the way we are looking at a rebound for us and lengthy recovery for the environment. I hope it's...

[Peter Hackel, CFO & Member of Executive Management Board]

On the second question, Maja, a very visionary question, interesting question, and you can be sure we also had discussion on these. I think once we would really face a very pessimistic outlook with a strong recession, no top line growth, then obviously, we would need to think how we would react on that. And obviously, in such an environment, we would need to think more about our OpEx structure than what we are currently doing. I would not expect a year-over-year margin increase in that situation. Probably, we will be at a lower margin level that we are currently. But nevertheless, I think the fundamentals of our business, even after such a recession period, are intact. We have a very innovative portfolio. I'm convinced that we have -- with our portfolio and our sales organization, also and in such a scenario, once the recession will be over, we have abilities to gain market share. We will be very careful in compromising our position in that respect because I think in the not -- in such a scenario, not in the midterm, but in the long term, we have good opportunities to generate further growth again. But obviously, sales and margin would be both at the lower level in such a scenario.

[Guillaume Daniellot, CEO & Member of Executive Management Board]

And if I may just add, I think something -- first, as we have commented, most of the environment with the COVID-19 crisis, what we want to express still is that BLX is just at the beginning of its launch. And the immediacy segment is still only for us a complete new business segment. We have not launched in LATAM yet, not launched in APAC yet. We are just active in Europe, and we have started in North America for[Audio Gap] now. And BLX is a huge potential growth for us on the premium side. Value is also the same with our GM line, for Neodent and some very interesting projects that we are preparing at the moment to help it to develop its value proposition. We have obviously NUVO that we have just started, that COVID-19 will, I would say, delay a little bit its introduction in some markets because of the regulatory side that has to be done and that has been put on pause because of government being -- shutting down those activities for a moment, and without mentioning the Digital and ClearCorrect. Then our 4 areas of growth that we started with at the beginning of the year are still there and are still owning the same opportunity from market share gains. And we are pretty confident to have the opportunity to continue being a growth story, to be really honest with you.

[Maja Pataki, Head of Med Tech Devices Sector]

Sure. Peter, just to double check, you said like margins would be lower. I'm assuming you're referring to 2019 levels, right?

[Peter Hackel, CFO & Member of Executive Management Board]

I didn't understand the second part of your sentence, Maja. Apologies.

[Maja Pataki, Head of Med Tech Devices Sector]

So you just -- sorry. You just said in a recessionary environment, growth would obviously be lower, but also margins would be lower. And I guess you're referring to the March lower than 2019, not to what you're expecting to see in 2020.

[Peter Hackel, CFO & Member of Executive Management Board]

Yes, you are right, Maja, yes.

[Operator]

The next question comes from the line of David Adlington, JPMorgan.

[David James Adlington]

So 2 for me, just slightly different tack. So I just wanted to get your thoughts on dentist appetite for capital spending in the current environment and how we might be looking at over the next few quarters. And second, just picking up on the hygiene procedures that are going to be required between procedures, how much do you think that impacts the dentist capacity for procedures during an average day?

[Guillaume Daniellot, CEO & Member of Executive Management Board]

Yes. Thanks for the question. Interesting questions as well. I would say the appetite for dentists, for capital equipment, very often, we always say, in term -- after a crisis, then this is going significantly down because they would like to reduce, obviously, their purchasing. Now I believe that COVID-19 is also driving significantly this digital dentistry and being as less contact as possible or as less analog as possible. And we see intraoral scanner being still -- although less dynamic than it has been pre-COVID crisis, but still being an area for some investment by a significant number of practitioners because you don't put then your hand in the mouth of the patients. You don't have this gummy material with saliva. You just have to use intraoral scanner, which is much cleaner, and then drive a better protection for staff and dentists. Then we still see some dynamic in this segment. However, we believe that cost-effective solution will be prioritized by practices much more than the high premium, most expensive equipment. This is a perspective, still has to be verified, but that's the way we are seeing the capital equipment, especially from an intraoral scanner perspective.Secondly, when it comes to hygiene, we are actually monitoring this very carefully that we see and to support our customer to keep the same level of efficiency and productivity despite the different PPE that they will have to use for them and their staff. The first evaluation that we run in China with some of key customers is that they could potentially see, for example, between 15% to 18% less patients than they had before due to the reason of changing PPE in between each of them when you are doing surgical procedures.

[Operator]

The next question comes from the line of Kit Lee, Jefferies.

[Nyeok Lee, Equity Analyst]

I have 2, please. Just firstly, just a similar question to the CapEx budgets. What are your thoughts on ASP and also your product mix going forward? I guess are dentists more willing to take down to cheaper implants now if they were to do promotions to win that customers or get people to visit clinic again? Just any thoughts around that, that would be helpful. And then my second question is on the DSOs and the large customers. Just wondering, have you heard any sort of financial difficulties or other situations they are in now? And how do you think about potentially offering some solutions to them and some sort of changes in payment terms?

[Guillaume Daniellot, CEO & Member of Executive Management Board]

Yes. Well, when it comes to ASPs, I think this is where we, as an organization, are much better positioned than we have been in the past and with the past crisis of 2008 because we are offering all the different price points from an implant perspective. Then we don't expect our ASP for each product line to change much because we are then going to support customers wanting to have a more cost-effective treatment then to use a higher mix of less expensive treatments or less expensive implants than what they were used to do at the beginning. Then we are expecting the value implant to grow faster than the premium implant and that this trend would be accelerated by the crisis. Now to which extent, that is difficult to say at the moment because we have also seen that a lot of our growth is coming from expanding the boundaries of the implant treatment in some cases where they would not have supported implant treatment before. That means needing to use higher quality implants for this particular advanced cases. And we have seen also in the first quarter that premium was growing much less or was not growing, whereas value was growing much faster. We will see that impact on ASP, and we'll be able to evaluate more after the first half. When it comes to DSO, then DSO are exactly like other organizations. I would say the ones that entered the crisis with a weak financial situation are in significant difficulties right now. That we have heard about, not a lot of them, but some of them, in Spain, as an example. Otherwise, we see DSO also being backed up by strong PEs having the capability to survive the crisis, even though we can see some potential consolidation here as well with some of the weaker ones. But we still believe DSO will be a strong, growing customer group after the crisis, as it was before COVID-19.

[Operator]

The next question comes from the line of Oliver Metzger, Commerzbank.

[Oliver Metzger, Equity Analyst of Life Sciences]

My first one is how to think on catch-up effects. So you already commented that a certain degree of normalization in China takes place. Obviously, the demand for dental implants is there. So there are no -- this does not decrease just the way how you treat it. So when do you think that potentially some catch-up effects will compensate even for previous experienced losses? My second question is also on M&A, similar or in addition to the question which was asked. Over the last year, M&A was just a major part of your DNA, and you're still in a quite comfortable position with regards to cash and also cash generation. Over last years, you executed your strategy with a long-term horizon. And in that context, the discount segment was named quite often as the next big area for M&A. So I assume that the share of discount players going into financial troubles might potentially be higher than for the average dental implant market in the current crisis. So would you regard it as prudent even to be more aggressive in that field on such opportunities? And because also prices might be much attractive than a couple of months ago.

[Peter Hackel, CFO & Member of Executive Management Board]

Oliver, Peter speaking. Apologies, but I didn't really understand your first question about the cash out. What is the question, really?

[Oliver Metzger, Equity Analyst of Life Sciences]

Yes, it's -- at the end, there is currently a disruption in the market. And this -- the underlying demand for dental treatment is basically intact. So people postpone their dental implant procedure. But at the end, they still should do it. And I would assume that it should not only see a normalization of market, but also to a certain extent, some catch-up effect of the previously experienced losses. So do you -- when do you think these catch-up effects might take place?

[Peter Hackel, CFO & Member of Executive Management Board]

Obviously, as you have said, now in April, that sales are pretty much down. And obviously, I would also expect a certain delay or increase of our days sales outstanding in that respect. And obviously, we will have a different operating cash flow this year than in the previous year linked to all the financial topics we have been discussing. However, we have a very strong balance sheet. We were also, on the net debt perspective, been in positive. We have renewed or issued another bond to repay accidental 2 days the outstanding bond, and we have increased our credit line significantly. So even if we would not have any cash inflow, and that's just a hypothesis of the scenario now, we could -- from a liquidity base point of view, we could finance all the activities for quite some months. So I'm not sure if I have answered your question in that respect, to be honest.

[Oliver Metzger, Equity Analyst of Life Sciences]

I ask it more towards the overall casual effect of dental implant market itself, but I will -- I will leave it at that.

[Peter Hackel, CFO & Member of Executive Management Board]

Okay. Maybe we can take it [ off-line ]. I think what I have on the second part, is that it is also true for the second part. Obviously, in such a situation, there might be M&A opportunities. We don't know. We will see that. But based on our strong balance sheet on the credit lines and the liquidity that we have, we could also -- if that will be the case, we could also take these opportunities. On the other hand, we have a long-term strategy and all the M&A activities in the past we made on the long-term strategy and the long-term vision. And as I said before, we don't want to compromise on our long-term vision and our ability to launch and develop innovative products and expand our business. So there might be opportunity and we would have the means to do so, but we would also not deviate from our long-term strategy.

[Operator]

Next question comes from the line of Falko Friedrichs, Deutsche Bank.

[Falko Friedrichs, Research Analyst]

I also have 2, please. Firstly, could you talk about the effectiveness of virtual interactions between your sales force and dentists in this current environment? And then secondly, are equipment orders usually binding via contracts? Or can they be canceled currently? And do you tend to receive a down payment when these orders are placed?

[Guillaume Daniellot, CEO & Member of Executive Management Board]

Well, when it comes to the effectiveness of virtual contact with customers, actually, they are very effective because you can really get quality time with the doctor. Very often when our sales rep walk in the office, he has a very limited time because this is obviously during surgery time. Then being able to address a customer or a dentist or even the entire staff about an innovation, requiring them really to have a focus on what we are going to deliver as a message and being able to prepare to change some of their routine because of the new technology or the new procedures or the new approach to care, then this is not so easy. Here, thanks to the fact that the practice is on pause mode, then we are able to address not only the dentists, but also his entire staff, having them fully focused on the message and being able to plan introduction of future innovation. Then so far from what we have seen, we have been very pleased with those interactions. And we are planning to continue and capitalize on the experience for the future. Peter, do you want to address the second question?

[Peter Hackel, CFO & Member of Executive Management Board]

The second question was about down payment for digital equipment -- that's right. And there's no general rule for down payments. That depends from market to market, also a little bit according to the market characteristics in the different countries. In the first quarter, we have not seen any change in that respect, but we also need to be aware that we have tight links to our customers. So we have -- most customers, we know very well, and we also know the payment history of these customers. So that's also one of the reasons why we are not generally asking for down payments for digital equipment.

[Falko Friedrichs, Research Analyst]

Okay. And have you noticed any cancellations of existing orders so far?

[Guillaume Daniellot, CEO & Member of Executive Management Board]

No, we have not received any cancellation of orders so far.

[Operator]

Next question comes from the line of Markus Gola, MainFirst.

[Markus Gola, Vice President]

Yes, great. Just one question left from my side. The market leader, Align, reported a fairly strong recovery in China. So do you think that there could be generally a development where we see a faster recovery of clear aligners compared to dental implants given the less invasive nature of these procedures?

[Guillaume Daniellot, CEO & Member of Executive Management Board]

Yes. Thanks, Markus. Yes, we have seen also the activity being strong, it seems, from Align in China. Honestly, I don't see clear aligner having on the midterm the capacity to recover faster than implant. But what is clear is that, being a less invasive procedure, it's first easier to implement quickly than reopening surgical procedures where, if you look at how it has been -- how China has been unlocked or resuming activities, they have started with what I would call noninvasive procedure, and surgery has been allowed afterwards. And I think there have been kind of a 2-week delay into this based on some of the rules that have been defined. But we believe that the dynamic of clear aligner will be the same that the one we will know on the implant side, with a couple of weeks difference because of the different rules that we have known. But when the different practices will be ready, whether it's ClearCorrect or whether it's clear aligners or implant therapy, we'll see a lot of promotional activities and a lot of direct-to-patient activities to create inflow, which is going to be the same in both market segments.

[Operator]

Next question comes from the line of Lisa Clive, Bernstein.

[Elisabeth Decou Bedell Clive, Senior Analyst]

Just a few questions about the patient profile of the customers that are coming back. Can you just remind us of the average age of a dental implant recipient? And are there particular characteristics in the patients who have been coming back? Are they generally the younger patients, so in their 50s or 60s versus 70s and 80s? And also any observations from your sales force on whether it's mainly single tooth cases versus the more complex and expensive multi-tooth restorations?

[Guillaume Daniellot, CEO & Member of Executive Management Board]

I think it's a very interesting question, Lisa. We don't have answers on all of them. For your information, we see an average patient's age for implant therapy is going to be starting from 45 -- 45 to 65, I would say, average, then that's what we see, generally speaking. Now who are the patients that are coming back? First, then -- that I don't know. We can't say. We don't know -- we don't have seen any evaluation nor study on this, but we will evaluate what we see in China with a question we can ask from our customers. For the time being, the only feedback we received is that the people that have been -- whatever their age, the people that have had planned surgeries are just rescheduling them, but we don't see major cancellation. Then I don't feel that it's going to be a question of age because as you don't see any cancellation, it's going to be much more a question of time. But we are going to look into this because that might be interesting question for us to learn from.

[Elisabeth Decou Bedell Clive, Senior Analyst]

Great. And I was just thinking -- I was thinking about it, particularly in light of the fact that here in the U.K., the restrictions for elderly people sort of aged 70 and over may be significantly more prolonged. So yes, I mean the information you could share about it, that would be very helpful.

[Guillaume Daniellot, CEO & Member of Executive Management Board]

That's correct, actually. And we see in many European countries that there is still recommendation for elderly people, not to ease the lockdown. That might have an impact. But implant therapy is, in average, for a younger patient than above 70s. But we still have a lot of those patients in as well.

[Operator]

Next question comes from the line of Daniel Buchta, Vontobel.

[Daniel Buchta]

Two questions from my side, please. The first one, maybe a bit unusual as well. I mean do you have an idea about how the income distribution is of your end customers? Because I would assume implants and clear aligner treatments, they are rather expensive. And that's why I would assume that a good part of your patients at the end has rather high incomes. And if we see the situation on the labor markets in various countries, and especially U.S. here stands out with a huge increase in unemployment, I would assume that these are rather the people with lower incomes, working in service industry, hotels and things like that. So is that something that may help you a little bit coming out of the crisis, that a good part of your potential customers, so the a bit more wealthy ones, are the ones that still have their jobs and thus they have disposable incomes? Is that something you see? And how is your distribution? And then on the second part, on BLX. I mean in the past, you had talked quite openly about your expectations in terms of gaining market share. So you said like BLX -- BLT now, 35% or something you would expect as well after 4 years for BLX. Is this still valid? Or do you see it more difficult now to gain market share over the next, I would say, 6, maybe 12 months? Or are your plans here still unchanged?

[Guillaume Daniellot, CEO & Member of Executive Management Board]

Thank you, Daniel, for the question. When it comes to -- well, I would say, the resilience of implants business when it comes to crisis, we have seen in 2008 that the implant is considered as a standard of care now, then there is not only the highest income category that can afford the implant treatment. It has been really placed in all the different income categories. Then we are having an impact on the overall volume when it comes to the implant because of the crisis. And we don't believe there will be any, I would say, support on this side unless the fact that, as a clear leader on the premium side, these are more the high-end practice that are also working a lot and the specialists with our premium implants. And very often, they are having the higher-income patients category. But other than that, I think, to be honest and be transparent, the fact that implant is a standard of care now, we will have an impact with the recessions, and that's what we have clearly expressed. For clear aligner, when you see the average of clear aligner adults, and I'm not talking about the teams here, the clear aligner adults, they are a lot into the young population, the young active population, the 25 to 35, meaning that they have a lot of disposable income to do a lot of leisure activities or taking care of their appearance, which is very high in their spending ranking. And then we believe that clear aligner will still be an area where these young adults are going to spend their disposable income. When it comes to BLX, yes, we still have a very bold ambition with BLX. It will -- obviously, the market penetration will be delayed. Then the market share again will be delayed with the high impact of the crisis period. But as soon as we can start again visiting practices, we believe that BLX will gain significant shares. And the attractivity of all our digital forces, digital educations and digital events on immediacy, and BLX attracting more than 7,000 people, as an example, for 1 event, is really showing the appetite for clinicians for this new solution.

[Operator]

The last question is a follow-up one from Michael Jungling.

[Michael Klaus Jungling, MD, Head of MedTech & Services and Analyst]

Great. And I have 2 more. Firstly, on foreign exchange. I think for well over a decade now, we've observed the margin contraction at Straumann because of the deterioration of the euro and the dollar. And my question really is, with the new CEO in place, could we see more action with respect to more of a fundamental change in the location of your cost base? And question number two is on the distribution of revenues in 2019 for implants. Could you give us a sense of what proportion of your implant business was, in the end for the customer, a single tooth solution, a multiple tooth solution, maybe 2 to 3, and then for the fully edentulous patients. Just a basic share split of 20%, 30%, 40%, 50%, that would be useful.

[Peter Hackel, CFO & Member of Executive Management Board]

Let me start with your first question on the FX side. I think over the last couple of years, Michael, you might have noticed that our exposure did improve, not because we have reduced our cost base in Switzerland, but basically because we have built up more costs outside Switzerland due to some of the acquisitions, such as Anthogyr, Medentika and Neodent some years ago. So I think we have a better balanced FX exposure now where they stand a couple of years ago. However, we always said that we want to keep, for strategic purposes, also our headquarter in Basel as well as we are investing significantly into the expansion of production in Villeret because we want to keep the Swissness of the brand, not only from a marketing perspective, but still that's the big marketing assets in Latin American countries and in Asian countries. So due to the current situation, we will not on a short-term basis change our strategy in that respect.

[Guillaume Daniellot, CEO & Member of Executive Management Board]

When it comes to the share of our sales in '19 for single, partial edentulous case and fully edentulous cases, I would give you a very rough estimate. I would say 70% single tooth, 20% partially edentulous and only 10% for the full-arch cases. And that's the reason why we are very excited by the potential of BLX because we have historically been weak in penetrating this fully tapered segment where it's very much oriented towards full-arch reconstruction.

[Michael Klaus Jungling, MD, Head of MedTech & Services and Analyst]

Okay. Great. Briefly follow up on the foreign exchange. Since -- really, since the beginning of 2000, you guys have been subject to a 78% depreciation of the dollar against the Swiss franc, 56% depreciation of the euro against the Swiss franc. And literally, for most of my time following the stock, there's been downgrades on margins or transactional margin exposure, and yet the focus on building up production in Switzerland continues to be at a high rate. Why is that the right thing to do? I understand you want to keep the Swiss brand, but there's also other manufacturers out there who keep the Swiss brand but have the majority of their production offshore, and it has not impacted their image or their ability to do business. Why is it such an important part of chasing down or chasing up a Swiss currency that keeps on benefiting from the uncertainties that we're facing on a global perspective?

[Guillaume Daniellot, CEO & Member of Executive Management Board]

I think that's a good point. We believe, and our success on the marketplace has been built on the Swiss reliability and the Swissness, and the quality of our manufacturing and the location of our manufacturing has been a big part of our brand story. And if you look at our capability as a premium leader to sell our ASPs, we believe at the moment that a big part is linked to our location of manufacturing when it comes to our Straumann Swiss premium implant. This does not mean that we are not evaluating other manufacturing site because as we have seen also the crisis, localization of production in order to be more resilient to supply chain, potential crack, is important. But I think this is a big part of our brand and story, and our brand is a huge asset for us as an organization.

[Peter Hackel, CFO & Member of Executive Management Board]

If I may add, if I may ask you, all what we have said about Swissness of the brand is true for the Straumann brand. If we look at the value brands, we don't have any manufacturing activities or big R&D activities or whatever activities in Switzerland. These are always in the places in the home countries of the brands. So for Medentika in Germany, for Anthogyr in France or for Brazil -- for Neodent in Brazil. So if we look at the FX exposure for these brands, then it's not a Swiss FX exposure for the value brand, it's only for the Straumann brand.

[Guillaume Daniellot, CEO & Member of Executive Management Board]

Yes. And as in the future, we can expect to have faster growth on value versus premium. We will have any way -- some way to adapt this cost base over the long term, but there is no clear view on our side to accelerate that in the short term.

[Michael Klaus Jungling, MD, Head of MedTech & Services and Analyst]

Great. And finally, could you comment on what you think the transactional EBIT margin headwind will be for this fiscal year because of the strong Swiss francs? Are we talking about a 200 basis point margin headwind?

[Peter Hackel, CFO & Member of Executive Management Board]

Well, if you look at the full year presentation and Michael, in the backdrop, you see the impact on the EBIT with the fluctuation of the major currencies. And depending on the assumption of your currencies that you have, you can make that calculation. In the current presentation, we only have the sensitivity for sales in. But the sensitivity on the EBIT side has not changed since the closing of 2019. That is more or less the same.

[Guillaume Daniellot, CEO & Member of Executive Management Board]

Okay. Well, thank you then all for your interest and questions. If you need further assistance please get in touch with our colleagues in Investor Relations and Corporate Communication. In closing, I would like to draw your attention to our next reporting date, which you can find on Slide 31 and on our website also, of course. Thank you again for joining us. Have an excellent day. Stay healthy, and goodbye.