Hi, everybody. Good morning. Thanks for joining us today. I'm Elizabeth Anderson, the healthcare technology and distribution analyst here at Evercore. Very pleased to be joined by Align Technology today, with three members of the team here. John Morici, CFO, who many of you know. Simon Beard, who is head of Americas and EMEA now, and also Madelyn Valente, who is at IR. So maybe today, I think, you know, with the current environment, that's always a big question, can you help us understand the puts and takes of, like, the current environment, right? We have, you know, we've been talking about sort of weaker equipment demand, you know, and also just sort of the visits.
Can you just sort of give us a lay of the land and how you're seeing things? I don't know which one of you wanna take that first.
I can start. Good morning, thank you. I think when you look at the overall environment, you have, as we, you know, went through the Q3 and kind of came out of the Q3, you know, you see the seasonality from the summer, where things were, you know, people go on vacation, holidays, and so on, and we definitely saw that, July and August. But the expectation is that you would see more people coming back, you know, especially on the adult side, coming back for the orthodontist or dentist for treatment. What we saw, related to that, especially in September, was less people coming to the dental offices.
Yeah.
People, traffic was down at orthodontists and so on. So you saw that, and what we also saw, and what we hear from our customers, that people, even the people that came back, they were taking longer to decide to go into treatment...
Sure
... making those decisions. When you look at the overall economy, they're making decisions based on a treatment that could be $5,000-$7,000, and they're just taking longer to decide. So it's not necessarily a no, but it's one where people are judging whether they go into treatment, you know, based on that. So that was on the adult side. Adults really it was slower than what we would've expected in September, and that carried on into October. On the teen side was a good quarter for us, teen season is big in the U.S., North America, in China as well.
We were up 8.5% year-over-year, 10% quarter-over-quarter. It was actually our highest volume of teen cases that we've ever done. So we felt really good about that. When you think about the overall environment, I think teen becomes a little bit less discretionary.
Yeah.
Adult is just more discretionary in that environment. So, that's what we saw, but, you know, it doesn't stop us from all the things that we're trying to do to drive conversion. I know we'll probably get into that as we go through, whether it's related to products or some of the go-to-market activities or other things that we're doing.
Yeah. I mean, maybe that's a good place to start. I mean, as we think about this current environment and things that could help, like, you know, obviously dentists and orthodontists from that patient traffic perspective are under a bit of pressure. You know, what are some things that you guys are offering? I know you've changed, you know, obviously the DSP cases, and sort of how the equipment is. Like, where are you seeing the most traction in terms of people saying like, "Oh, this would be an interesting way to sort of tweak what I'm getting from Align in order to better respond to patient conversion or uptake," or what have you?
Well, there's a number of things, as you know, that we do. I think, you know, on the financial side, you know, within a number of our programs, we offer doctors kind of extended credit. Hopefully, most of those pass that on to the patient so they can lower down payment or spread the costs.
Yeah.
And we know that that works with consumers. The other things we do, a lot of activity around kind of local marketing, these, what we call Invisalign practice days, where they tend to, you know, market Invisalign and have a special day or afternoon where they bring patients in with a special offer. So we do a lot of work around that. We do, literally thousands of those. Make it into an event for them.
Yeah.
Some customers are amazing at it, right? They'll bring in 30, 40, 50 patients...
Wow
... in a single day. And then, you know, the other things we do, you know, we're also working with some external financing companies. You know, you've probably heard of, you know, LendingPoint, OrthoFi, and also, HFD is a kind of a new one, which we're working with a number of our larger customers with, 'cause that's 100% approval.
Yeah.
Which you think about from a workflow perspective, is really good. So yeah, so there's a kind of number of things that we do. The other one that's probably less visible externally is we've also invested a lot of time recently into staff training, because, you know, customers invest in our technology, and they don't necessarily use that technology to an optimal level. And we know that when they use the IOSim Pro, the In-Face Visualization on the iTero conversion increases.
Yeah.
Patient can see what's gonna happen through treatment, and they're more likely to buy as well. So yeah, we're really zeroing in on all of those areas. And then, you know, we spend a lot of money on consumer. So we're constantly looking at what is our kind of consumer advertising mix? How do we... you know, putting new assets out there, what are we spending on social, what are we spending on search? And then how we can link our customers through that, through DocL ocator and Concierge as well.
That makes sense. Maybe touching upon the consumer advertising portion of it. You know, obviously, I don't know, not really call it a competitor, but market participant has, you know, no longer with us, and so how does...
They're still there.
Well, they're still financially, they're no longer with us. How do we think about the impact, and they were a huge advertiser in the market-
They were.
In terms of just awareness and that kind of thing. How has your advertising strategy changed in light of that?
I don't think it's changed.
Okay.
Because as you know, I know everybody's kind of waiting for maybe the impending doom or whatever, but they're still out there advertising.
Yeah.
They're still transacting as an organization. I think we've always run our own play, you know?
Yep.
Very, very clear messaging around we work through doctors, and so we partner with doctors. You know, I think there are some opportunities, you know, within our portfolio where doctors can respond to maybe that profile of patient. Using all the things I've talked about, you know, you know, a lot of the consumer research we do is patients aren't necessarily looking at the list price of a product. They're looking at how much they have to pay on a monthly basis. So you don't have to really match the direct-to-consumer, you know, kind of ticket price.
You just need to make sure that you keep a lower down payment, and then you have the low monthly cost to the patient. So, no, you know, we're, you know, obviously we're keeping abreast of what's happening there, but John, you can comment. I don't think we've changed what we're doing.
I would say, maybe not short- term. I think long- term you might have different spends that you have because you might not have to spend as much as...
Sure
... you're competing for certain, you know...
Yeah
... words, AdWords, and so on. But I think when we look at marketing, we're always trying to get that return on investment and, they have been in certain markets. You know, obviously, we're there. There's additional markets that we look to spend advertising. Even in tougher times, we can get that response. And so certain countries where you're not spending that much, and now you can spend just a little bit more, and it makes a big difference. So...
Yep
... it's just that right combination. This is, this is part of the investments that we make to try to drive conversion, and consumer advertising and also working locally with doctors, is a place to do that.
Yep. No, that makes sense. Can you update us on teen? I know it obviously had a nice step up in the Q3, and, you know, I think that's, like, the long-term opportunity that I, and I'm sure you guys, too, are excited about. So how do you kind of see... You know, where are practices now? You know, we've seen that penetration sort of be around the 10%-ish mark. So, like, how do we get that to... I mean, even if we don't get it to 50, where sort of adults is, like, you know, 30 is still a huge amount of growth from now. So, like, what are the levers we need to look for now?
Yeah. So when you look at teen, obviously, maybe even to take a step back and say that the opportunity-
Yeah, that's good.
... when you look at the orthodontic case starts that you have every year, it's 22 million worldwide. Of those, 15 or 16 million of them are teens.
Yep.
It's a massive market that's new teens or even pre-teens coming in every year looking, you know, for treatment. They get to a certain age. The way we've looked at this, you know, we've got a the market is built based on wires and brackets, where 85%+ of the teen market is wires and brackets.
Yep.
And then we're really making up the rest of, or the majority of the rest of the other non-wires and brackets. And to go after that market, we've had to invest into products to be able to give those doctors the confidence and the understanding on how to move teeth with our products. So the products that's, you know, that we've just launched in Canada, soon to be in the U.S., like mandibular advancement...
Yep
... where now it's a product that, you know, instead of that metal device that goes on the top of a child's mouth, 'cause a six or seven-year-old, to expand that upper palate to be able to make room for those permanent teeth, we have a 3D direct fab-printed product that snaps to the top of a child's mouth, every day, slowly moves that upper palate, and gets replaced that next day with a slightly larger one. It slowly moves, and in 30 or 40 days, you've created the space. Those are breakthroughs that we have to be able to give doctors the ability to treat 100% of the cases.
Many doctors now that we work with, with the product portfolio we have, and with some of the new products that we have, are gonna be able to treat 100% of the cases that they see. When you look at the product capability compared to, let's just say, we're 10%, or, you know, 10% or 12% of the teen market, there's a huge, huge opportunity to ramp up. Some of it's product, some of it is just the advertising. We talk about being able to make sure you reach teenagers or pre-teens, being able to reach their parents, giving them the understanding that there's an alternative.
Giving the parents an understanding that you might need to bring your child in for treatment to create that upper, in this case, the upper palate space that they might not know of, and so you're educating them. Educating parents that our product moves faster, your treatment is faster than wires and brackets.
Yep.
There's less visits. There's really no emergencies.
Yep.
You get into, you know, the better hygiene. There's just so many other benefits that you have. So some of it's just that education to be able to. And then lastly, it's working with doctors to make sure, with our direct sales team, to be able to get them to understand that there might be a difference in upfront price in our products versus wires and brackets, but the time that it takes within your practice, the not having to staff for emergencies, the productivity that you generate at a practice can turn into more profitability when you couple that with additional patients coming through and really make that a part of your practice. So we have many doctors who treat, you know, majority of their cases, teen cases.
There's still many doctors who they might give us the adults that come through their practice, but not necessarily the teens. So through all those things, whether it's product or some of the advertising that we do or the direct selling that we'll do with those doctors, that's the way that you can try to unlock this and get to some higher percentage. And even before the pandemic, we were seeing, we were seeing teens grow faster than adults. It's just that market opportunity is there.
Yeah.
I think now as we've invested more and more with products and kind of the go-to-market capabilities that we're providing our doctors, we can, you know, keep that volume and keep that acceleration going.
Right.
I think, I'll just add to that. I kind of start where John finished, is first of all, you know, we've got a very large direct sales force, and that is one of our kind of jewels, really. So you know, if you think about a practice where there's a mixture of wires and brackets and Invisalign being used, then we have to be constantly touching those customers and their staff because they can swing between both, right?
Yeah.
There's an habitual nature to try and break...
Yeah.
... with clear aligners. So that's where we start, and then we've invested a lot of time over the last few years in really defining just a better programmatic approach to supporting practices. So some of the newer things we've done this year, they're built on a number of things that we've done over the last couple of years. One of them, we introduced, so you know, John's talking about the interaction with the parents, and while some kids are very independent and can make their own decisions, parents still have a big say in what their, their kid gets. So we introduced a program called Teen Guarantee. Now, historically, we've had that program.
We've had it in bits before.
Yeah.
Yeah.
It was like, so if for some reason there was a concern about compliance, they used to get a $300 credit, from us.
Yeah
S o that they could pay for the wires and brackets to put...
The provider got the 300.
Yeah.
Yeah.
Yeah. And then if they wanted to pass it on to the parent, they could do. What we introduced in Q2 was a proper Teen Guarantee, which said if within 100 days of starting treatment, if the patient, you know, the teenager or the kid wasn't compliant, then we would credit the full case. Now, doctors really love that because...
Yeah, tat's right.
... we really had their back, and they were able to then use that in conversations with parents and say, "Look, I think this is the best for your child. If they're not... If you've got a concern about them wearing the aligners, then we'll, you know, credit it back.
Right, and that just takes that risk sort of off the...
It takes the risk totally...
...Table.
Yeah.
Yeah.
Funnily enough, we've had very few.
Well, that was gonna be my follow-up question.
Yeah.
Yeah, like...
Like onesie-twosies...
Okay
... across thousands of cases. So...
Yeah
... it kind of also reinforces our belief, and also doctors who've used Invisalign in that age group for a number of years, is compliance is not an issue. Most kids are actually more responsible than adults.
Right. I've always heard that...
Yeah
... the worst is, like, 30-40-year-olds.
Yeah.
They, they...
Yeah.
Yeah
A nd personal experience, I've seen that as well.
Yeah.
You know, throwing the aligners away, I've done that.
Nice.
But anyway, so that's one thing. The other thing we really zeroed in on clinical support, 'cause whatever you say about the financial piece and the habitual side, doctors have got... particularly orthodontists, they've gotta be confident in the treatment. And obviously there's a bit more complexity when you're treating teenagers. So we've really done a lot of you know, more peer-to-peer more structured learning, so that actually, when they're, when they're almost selling Invisalign to parents and children, they're confident in doing that. That makes a difference in the whole verbiage.
Yeah.
And then the third thing, which was different this year, is we were really invested around staff training. 'Cause if you go into any orthodontic office...
Yeah
... the staff that run the office, not the doctor.
Yeah.
And so if they believe in the treatment, they're talking to the patient, they're actually having the financial discussions with the patient.
Yeah
T hey're the ones who are scanning, et cetera. So those, I think those three elements are helping, and we'll continue to build on that as, you know, across, but not only just U.S., Canada, but also across Europe as well.
Okay, maybe just two follow-up questions from what you just said. The Teen Guarantee is out in the U.S., is it?
And Europe.
And Europe.
Yeah.
Okay.
And Canada.
And Canada. Okay, great. That was one question. And then secondarily, on the Palate Expander, when are we expecting U.S.?
Well, it's in Canada now.
Yep.
We got Health Canada approval about a month ago.
Great.
We start small, obviously with a smaller group. Then we'll ramp that up, and then hopefully early next year. You know, we're waiting for FDA approval.
Okay.
But early next year we'll launch in the U.S., and then we'll sequentially launch... I think we've got some MDR to get through in Europe, so later next year in Europe as well.
Got it. And the revenue that will come from the Palate Expanders will go into non-case revenue, or does that count as a case? Like, how does, how does that-
It'll count as a case.
It'll count as a case.
It's a case.
Okay.
I think of it more as,
Part of Invisalign First.
It won't be Invisalign First.
Okay.
Invisalign First is comprehensive.
Yeah.
This would be more non-comprehensive, 'cause it's really 30 to maybe 45 days...
Yeah
Yeah
... of treatment.
For sure, to try.
But will count as case revenue. You know-
You'll see, you'll see a lot of bundling as well, right?
Yeah.
So...
Yeah, I would imagine. Yeah.
They'll do rapid, and then they'll do Invisalign First to do...
Yeah
... to fully form the arch.
Okay.
So that'll be...
And when you think about that opportunity, in terms of the need that we're trying to have, so you think of the, like I was mentioning, 15-16 million teen cases every year...
Yeah
...globally.
Yeah.
About 10% of those cases need those children need some type of palate expansion, upper palate expansion. Sometimes the doctors get it with Invisalign first to kind of widen the arch or so on. But if you need to break...
Structure
... that suture and move that open. The only way to do it now is with that metal device that...
Right
... it gets...
Right
... put in the top, and then it's cranked open every day.
I say zero percent of parents enjoy doing that.
No, 0%. And that's, yeah. So, and it's...
Yeah
... painful.
Yeah.
It's just not a good experience for kids.
Yeah.
So this will give us an opportunity to go after, you know, say, 1.5 million different opportunities per year that we touch almost zero right now. So, a nd this is the type where you could start with a product like this, and as Simon said, you could then build that onto maybe Invisalign First, and you bundle that together, or maybe full Invisalign. But it gets the child, it gets the parent used to this type of technology, lets people know that there's an alternative, and the doctors that have used it so far love it. It works...
Yeah
...a nd it's one where it lends itself to other types of treatment in the future.
Right, 'cause it. Just, just to maybe level set with people, usually, you're if you do Invisalign First, with or without the Palate Expander, then you come back a few years later, right, as a later teenager usually to do.
They try to match those up.
Yeah.
Sometimes, you know, you try to get that Phase I and then get the phase II.
Yeah.
But we wanna be a part of the treatment from early on to...
Yeah
... finish, including retention and so on.
Right.
So we wanna be a part of the overall treatment, and this is a way to get in early and be a part of it.
Right, it seems like if you're accepting of it here, then your acceptance...
We think
...o f it later is probably much higher, right?
We think that that's a benefit, and...
Yeah
... it's a product that no one else has. But, you know, it's a direct printed product, direct fab printed product, and it's the first of many. So, and I know we'll maybe talk a little bit about Cubicure, the acquisition...
Yeah
... that we have. But to be able to help scale this up and do some of that work, really that 3D Direct Fab printing is gonna be critical.
Does that sort of make it, because it's direct printed, to, like, gross margin accretive to your core business?
As we scale this?
Yeah.
Yes, it will.
Yeah.
Really, anything that we direct fab print at scale...
Yeah
... is gonna be margin accretive...
Yeah
... because it's 80%-90% less material.
Yeah.
You don't have to break, you know, print the mold first, yeah...
Yeah
... the model first, and then put the plastic on top. You just actually print the plastic.
Yeah.
And you...
I appreciated your comments when I saw you in Las Vegas about what you do with all of those, like, you know, teeth models afterwards. They burn them or crush them into floor tiling or, you know, whatever.
We repurpose them.
It's just, like, a huge waste. Yeah, it's a waste.
We repurpose them.
But it's not...
But it's not safe.
Yes.
But it's not...
It's not one to one , yeah.
... we don't want that to be wasted. And then it's also...
Right
... less labor. There's less processing than others. And so having the direct fab printing gives us a lot of flexibility, not only just in the product itself...
Yeah
... so here you can make something thicker, stiffer, whatever.
Yeah.
When you get into making actual aligners with a direct fab printed product, you can - t he doctor has a lot of flexibility as to what he or she wants to make with the product. So that gives a lot of flexibility there. We do get that cost savings and material, as well as, labor. And then you also have some flexibility as to where you put your manufacturing. You know, you'd start in some of the hubs that we have, the main manufacturer in Mexico or Poland and so on, but you could get other places that are closer to the customers.
So it gives us a lot of flexibility to be able to really provide great products that for our customers, but then ultimately be able to manage the cost profile within our company, that we think is a game changer. No one has that. I mean, the...
No, one has that.
... plastic has been created, the process has been created. Cubicure, a company that we've been partnering with for years is really gonna help us scale, 'cause they can help make the machines...
Yeah
... they make the machines for us. And as we scale that up, we'll close that acquisition hopefully early next year, and that'll really help us scale not only all these other new products that we have, but what just came out with the Palate Expander.
That's... Yeah, just to build on what John said, is that, you know, I think it's sometimes difficult when you're on the outside to understand just the, the possibilities that this creates...
Yeah
... not only for us, but also for customers. It's, you know, when you can directly print an aligner, all of a sudden you can, the doctor can customize the appliance, right? At the moment, when we talk about customization, it's the treatment plan. Yeah. So they can design the treatment plan, and then, you know, there's a few features that can be added, but essentially, the appliance is what we make, right?
Yeah.
And you're restricted by the mold because you use the same thickness of plastic all the way around, et cetera. So with this, you can add any feature, you can change the thickness.
What would be an example of a feature that you would, you might add?
Well, you can, you can add hooks.
Oh, okay.
You can add...
Yeah
... palatal coverage, you can change thickness.
Yeah.
You can add the different kind of ramps, et cetera, onto there. You know, things like we're doing with the Precision Wings, we're gonna do the occlusal next year. Those, you can just directly print those, rather than actually having to add them to the aligner. So...
That makes sense.
... from a, like I say, you know, a design point of view, the customer. And the other thing is retainers as well. You know, you can design that retainer, you know. So there's a specific form of retainer that a Phase I patient needs...
Yeah
... that we don't currently make. You know, we make the Vivera, but...
Yeah
... so you, well, it just opens up a whole new world, not just to us from a cost perspective, but just for a customer to be able to design the appliance in exactly the way. So when you start to think about all the really complex Class III cases...
Yeah
... surgical cases that they're doing, they can really start to customize. So really exciting.
That makes sense. And sort of what's the timeline? I mean, obviously Cubicure hasn't even closed yet, but sort of how do we think about the timeline to that, like, more exciting world?
You know, I think what we'll do is we'll start with certain products, and you start to use, you know, the 3D direct 3D printing to help scale those products.
Yeah
S o the products will start to build off of that retention, like Simon said, and then you'll start to get into the actual aligners themselves, the core that we have. So you're looking at, you know, starting to scale this next year. It'll scale up in two or three years, you start to get a more significant part of our production related to that. And like Simon was saying, you'll have products that really can be customized as a product themselves.
Yeah.
We're still gonna have core manufacturing that we have, which is what we do now, the mass production that we have of that. But think of it as almost, you know, two types of products, things that are more customized, like we were saying, that not only the software but the actual product can be customized, and then you're gonna have the core manufacturing. And that'll scale up over time. But I would look at, you know, two or three years, you're gonna start to see more and more of the direct fab printing, and then we wanna scale that up and continue to scale that up because, like I said, there's a lot of intellectual property that we've put down, a lot of technical know-how that we have in terms of how to manufacture this and scale the plastic.
And it's all been created. It didn't exist. This process did not exist, and we think that it gives a lot of advantages to doctors and our customers, and ultimately their patients, but it gives us a lot of advantages in terms of our, you know, company know-how and how we're going about this that, you know, will be unique in the industry.
That makes sense. Maybe talking to sort of other new products that you've launched, what learnings have there been from the DSP rollout in North America that you can sort of apply to Europe, and sort of how are you thinking about that product now versus sort of the initial launch?
Yeah, well, it's... So yeah, it's been primarily U.S., Canada. You know, we started off quite slow with that, and then we've ramped for the last kind of 18 months. I think the key learning has been, first and foremost, we started with our higher volume customers. Now, the beauty of DSP is it just fits in with the way that they run their practice. You know, it essentially uses our platform, our manufacturing scale, and then it gives doctors control and freedom to be able to use their allocations in whatever way they want.
So we've kind of taken that principle of we start with our highest volume customers, many of which were previously either printing their own retainers or going to labs or going-even using competitive products for, like, the lower stage...
Yeah
... level. Whereas with this, they can just do anything they want and use it in any way that they want as well. So that's, that's kind of how we're starting. You know, we've just, you know, we're kind of a few months into it with Iberia. Well, we started in June, but then they disappeared for two months during the summer. So we're kind of...
Must be nice.
... back up and running there, and we're getting really good uptake in Iberia, a little bit in the Nordics. The second thing that's worked really well in U.S. and Canada is also DSOs. DSOs love it. 'Cause once again, it's a really simple process for them to follow. You know, they can buy larger bundles as well, so the economics, and then it just gives their customers, you know... They actually make a saving by using us instead of going to outsource into a lab, where, you know, they don't get the same quality. They get quick turnaround here, and it's all off the same platform again, so it's really nice and consistent for them. So we're starting to target some DSOs in Europe, and then we're progressively going country by country.
But, you know, in Europe, you know, we talk about Europe, but it's made up of individual countries that have certain idiosyncrasies...
Right, yeah
... that we need to take into account.
Yeah.
I think if you think about it, it is, you know, we start with our higher volume customers first, and then we work our way through the kind of our customer base, principally with orthos. There are some GPs that are starting to use it as well, but principally with orthos.
Right.
But yeah, it's been a great program for us. It continues to be.
We look at it as, as we said, it drives incremental volume. And this is volume that was going somewhere else. It's primarily retention, but we do have what we would call those touch-up cases. Now we've included those in our numbers, but it's incremental volume for us. It's great margin for us. It's some of our highest gross margin. Lower ASP on those touch-up cases-
Sure
... but that's okay. You're getting 5-stage, 7-stage, 10-stage product that we weren't getting before.
Yeah.
The cost to serve is very, very low for us, so the margin's good.
No, that makes sense. How do we think about the current demand environment in China? You know, I know obviously last year the comps are sort of crazy by quarter, but, you know, how do we think about that?
... I think when you look at China, you know, I think it was last year at this time that everybody was kind of free to move around, and everybody got COVID.
Yes, yeah.
And that impacted out of last year and into the beginning of this year. We're past that, and now with China, we had a good Q3 for us. A lot of teen patients and teen cases that came through our doctors there, which was a good environment for us. But overall, China's still a challenge. I mean, it is. It faces some of those same macro conditions that everywhere else has. We'll work through that. We have a lot of, you know, between having a direct sales force there, we've got treatment planning, we've got manufacturing. We've got a big presence within China-
Yeah
... to really help us go after that market and grow in that market. We've introduced new products there, adult and standard. That's been about a year and a half. So really when we were in China in the past, it was really just more of a high-end, comprehensive strategy that we have tier one, maybe tier two cities but kind of that high-end market. We've recently introduced products that kind of bridge the gap between some of those, high-end products that we have, the comprehensive products. Between that and with adult and standard, it's, it's maybe less features, but the price is, is better, so you have better adoption.
So we've grown the number of doctors that we sell to within China, which is good to see. We've gone into cities that we haven't been in, or tiers that we haven't been into, in tier, you know, 2s, 3s, and, and now into 4s. And we're also selling to GPs as well as the orthos. They really have been an ortho strategy there.
Is that GP strategy new this year, or is that from-
It's really this year. We've always had the intention to do more of it.
Right. Yeah.
COVID really shut a lot of things down.
Sure
... for a few years.
Yeah.
But now here we're actually seeing some of the traction related to that. So we're doing everything we can within China. It's a fragile market, but when you look at the opportunity with so many people, the market share is the dominant company or the dominant position there is wires and brackets.
Yeah.
You know, especially on teen, when you look at teen cases, there, 90+% of the cases are done with wires and brackets. So for us to be able to be there with the product portfolio that we've talked about, to be there, direct sales, to be there from a treatment planning and manufacturing side, we think we're properly positioned. You need that economy to stay more stable, and, you know, we'll be in a, in a good spot with that. But, you know, we feel that, you know, China has been a big market for us, and it will continue to be a big market, and our positioning should help it out.
Yeah. No, that makes sense. What about orthodontic VBP? I feel like that's been on sort of like this permafrost situation. Like, have you heard what are the updates that you've
It doesn't hit us. I mean, it's more on it's a public side.
Right.
So...
Yes
...i in our market, really, we...
But just in terms of the rollout.
Yeah, I think it's, it's been on the, on the more public side. There's certain products that...
Yeah
... that kind of play in there. It really hasn't hit us from a product standpoint. We've got this product portfolio that is a little bit insulated from that. The public, you know, it's less than 20% of our market that we sell to.
Yeah.
The majority of China, from an Invisalign standpoint, it's a cash market for us.
Right.
It's...
Yeah
... the private side of things. So I think they're still trying to kind of figure out how this rolls out...
Yeah
... and how the impact is, because there's so many different types of product. It's not like it's a...
Yeah
... a hip implant or something else, that's the product.
Right.
This is - w e've got a wide portfolio...
Okay, yeah
... of products to be able to sell within this.
Yeah.
Right now, it hasn't really hit us. We'll watch it closely...
Yeah
... and make sure that we could still grow within this market, but,
You haven't heard anything about expansion plans beyond the current provinces in terms of timing or anything like that?
We have not heard...
Okay.
...I've not heard...
Okay
... the timing on that. And we'll see what. Look, I think in the end, what you have in China, unlike maybe some other places, for Invisalign, the patient pays a premium for Invisalign...
Yes, for sure.
... versus wires and brackets.
Yeah.
In many places, like in the U.S., it's roughly the same price that a patient will pay.
Yeah.
So there you pay more. And if this ultimately gets people to get more access to clear aligners or Invisalign in China, I don't think that's a bad thing. Our portfolio could play in that market. We've got a sales force that could sell to those doctors and be able to help drive that conversion. If this gets us to a price point that, is, you know, drives more adoption within China, we're coming from such a low base in terms of the market share. This might help us in the end, but as of right now, it really hasn't impacted our business.
Got it. And any sort of changes in the competitive environment over the last year or so?
Within China?
Yeah.
You know, there are competitors. We've been facing competition within China for a number of years.
Forever. Yeah.
You know, so it's really not...
Yes
... nothing new there. You hear something about, on the outside the aligner side, on the scanner side, like lower price scanner companies.
Yeah.
That is one thing that you see. But in terms of the functionality that they bring, what that actual value proposition is, it's not something that we necessarily compete with. There's a value scanner market, which is essentially taking digital impressions...
Yeah
... in many cases.
Yeah.
Whereas our scanner's not just taking the view of the teeth, but it's also processing and doing a lot of other things to with the software that we have built in, to be able to show doctors and patients a lot more of the outcomes and simulations and other things that their scanners just aren't doing. It's just, it's different. So, I would say overall from a market standpoint, we're not seeing anything new or breakthrough on the clear aligner side. You know, like I said, the majority of the shares were wires and brackets, and on the scanner side, it's more the lower-priced scanners.
But when we think about our portfolio and how we go after that market, if a doctor's looking for a low-price scanner, we'll have a trade-in, where we take a scanner that's in the marketplace, maybe an older scanner, it becomes what we call a certified pre-owned CPO.
Yeah.
And then we could sell to that doctor who wants a lower-priced scanner, and it can compete with some of the other lower-priced scanners that are there in a better way, because it's part of our ecosystem...
Yeah
... software and so on, that lends itself to, you know, our digital platform. So we feel we can compete in, really any market. China as an example, but any market because of our product portfolio.
Yep, that makes sense. Maybe to talk about the sort of scanner demand more broadly, how are you sort of thinking about that now? I mean, you've obviously launched Certified Pre-Owned in many places, you know, the leasing. How should we sort of think about that growth trajectory in the current environment?
Well, I think, you know, I think there are, there are some similar dynamics going on, on there. I think there is, there's still... Like you say, we've got, we've got lots of different options now. You know, having that portfolio really helps. So where there are, there are maybe cost concerns, et cetera, we've not only have we got CPO, which I think is, has been a good move, but we've also got different ways that customers can acquire a scanner. So we have, we have leasing models, we have rental down in Brazil...
Mm-hmm
... which has been really successful. We have kind of Fusion or DEP, as we call it in Europe as well, which is where we not bundle, but doctor commits to a certain number of Invisalign cases, and we can lower the price of the scanner. So there's various ways we can do that. I think from a customer perspective, yeah, the, you know, people are a little bit concerned about the macro environment, particularly in Q3, I think, where they saw traffic going down. So committing to a piece of capital can essentially make them maybe stop and think about that.
Yeah.
But then there's also a group of customers that think, "Well, this is the time to invest, right? You know, if I can increase my conversion through scanning a patient or use that to market my practice, then it's a good investment to make. So I think, yeah, I think we see there is a macro piece there. You know, interest rates on leasing have increased. We've tried to do some things to obviously help customers with that as well. You know, one of the big concerns is kind of around the DSO side of the business as well.
They tend to manage their capital a lot tighter than an individual practice, but once again, I think a lot of them have seen the rationale for investing in latest technology, 'cause it's gonna help their business kind of plow through this current environment.
Yeah.
So no, I think we've seen actually a really strong mix around our premium range, the Plus Scanners, which has got kind of all the latest software on it. So we've got a kind of a healthy mix around that. It's not all suddenly gone to the lowest cost...
Sure
... part of our portfolio...
Yeah
... which has been good to see.
Are you seeing any, like, we've been hearing sort of DSOs, because of the higher cost of capital, have just been a little slower to open offices, too? Is that sort of playing into the current demand environment, you know, above and beyond sort of the general macro fears?
Well, I don't think it's kind of necessarily affected them more. I think we get a better view of the market through our DSO partners because, you know, we clearly, we work with them on, with Invisalign and iTero and, you know, we can get a good, a good feel for how, you know, what is actually happening from a conversion perspective, what's happening from a, kind of a patient traffic perspective.
Yeah.
But they, you know, I think they're dealing with the same dynamics that even retail customers are as well. So no, nothing - I don't think anything different there.
No. Okay. Makes sense. Maybe in the last couple of minutes, John, just switching topics away from the demand environment, how do we think about the right level of R&D spend for the company? 'Cause, you know, obviously, there's continued product innovation, obviously so much on the software side. Like, how do we think about, like, what the right sustainable spending rate is there?
Well, it's a good question, and, you know, when you think about the R&D that we spend, as you know, even during COVID, we committed to keeping those resources...
Yeah
... spending on those resources, and now we're seeing the innovation come through. I mean, Invisalign Palatal Expander and some of the...
Yeah
... Smile Architect and other products that have come to market are a result of that spend. So we don't necessarily target a spend. I look at the programs, and we as a team will look at what's the short-term, long-term benefits? Is this breakthrough technology? Is this just a modification of what we have, and how do we spend these dollars to be able to generate the return that we'll have? So we'll spend $300 million this year. It's a big, big amount. It's more than, I would say, all the companies combined from...
Yeah
... clear aligners.
That's it
... which is a huge amount, but it's centered around some of the products that are coming out with some of the inventions that we have on the 3D printing and the direct fab and some of the efforts around that. It's centered around some of the software improvements, the visualization. You know, as you know, we've put out Virtual Care and Smile Architect, where a dentist can, you know, does a scan and then show that patient while they're in the chair, "Here's what your teeth - w ith your dentition, here's what your teeth would look like with ortho." And it's clinical, and then here's what your teeth would look like with ortho plus restorative. And being able to show that and visualize, we think helps with conversion.
So a lot of the spending that we've done has helped with some of that software improvements and so on, and driving productivity there. Then on the scanner side, as we've said, we've got a premium scanner. We're always looking to further develop that scanner to make sure that it works well within our digital ecosystem that we have. I think going forward, what you'll see is some of these products come to market, we don't have to spend on those products, and you'll start to see some of the leverage. IPE is a great example. We've spent a lot to really have this be the first truly direct fab printed product to be able to solve a problem in a child's mouth.
Once it's released, there's certain things that you'll spend on it, whatever else, but it's really... a lot of the products that we have are really moving from the R side of R&D to D.
Yeah.
And that's exciting to see. You're actually seeing these come to market, and I think what you'll end up seeing is some leverage on the R&D side. You'll see some benefits, where we've been able to spend in the past, and now you don't have to spend as much in the future because these products are coming to market. But, you know, we always wanna be the leader in this industry, so we will spend to be that leader, the gold standard...
Makes sense
... within the industry. We'll just balance that. But it's, it is nice to see a lot of those products come to market.
That makes sense. Maybe one more question or two more, two more questions for me. I won't say last question. Let's be like. What... how do you think, given the volatile macro environment, how are you thinking about setting up sort of guidance for next year, whether it's sort of annual or this continued quarterly basis? Like, how do you, how do you think about that right now?
Well, right now, the way I think about it is, we'll give an update when we get through the Q4.
Yep.
You know, and look, I, our philosophy, we wanna be able to, to share the visibility that we have.
Yep.
So traditionally, it's been try to give an overall view from on a year basis, to be able to show where things are at from maybe a revenue and margin standpoint, and then get down to the quarterly view of something or a forecast and give, you know, revenue and, and margin, but then maybe some other metrics. That's the intention that we wanna get into.
Yep.
We just haven't had as much stability in the marketplace...
Yep
... to get the...
For sure
... granularity that we'd like to be able to get.
Yep.
Hopefully, next year we get more stability. If we have more of that, we'll get more of that, details for the forecast down the line.
Great. And real, real last question. As we sit here, what do you think the most misunderstood part of Align is, by, you know, from investors?
I think the biggest is just the under-penetrated market that we have, the huge opportunity. I think people lose sight of the fact that I'll do a blended rate between teens and adults. 80%+ of the worldwide cases are done with wires and brackets, and it's an old technology. It's how people have been trained. People get accustomed to a treatment that says, "This is how it should be done. And when we develop new products, when we go to market and help doctors and train doctors to really understand digital technology, that you don't have to use an analog way to solve a solution. There's a digital orthodontic way to solve solution to provide solutions for these doctors. I think people just, you know, if you didn't have the doctor in the middle, it would've... Digital always wins...
Yep
... when it comes to, when it comes to digital versus analog. And we will get there, and I think people just don't necessarily realize that there's still such a market opportunity, that if we can, you know, get further along in the adoption, we will tip the market. It's not a matter of if, you know, if it'll happen, it will happen. It's just the time that it's gonna take.
Awesome. Thank you so much, John.
Yep.
Thanks a lot.
Thank you.
Thank you, Madelyn.