Thanks for joining us. My name is Brandon Vazquez. For those of you I've never met, I am the covering analyst here at William Blair of Align Technology. I'm required to tell you to please go to williamblair.com for our full list of disclosures and conflicts of interest. We are happy to have Joe Hogan, CEO, and John Morici, CFO, from Align with us here. They're gonna go over some slides with us, and then we'll have a breakout session following. Thanks.
Thank you. Good afternoon. Thanks for attending. I feel like I got to say something energetic to get this room going, but I'll try to keep it clean as much as I can. So we're just gonna walk through kind of a just a series of slides on Align Technology, and where we've been and where we're going, and try to call out what I think are the important points. But along the way ... First of all, it's 27 years. It's hard to believe we've been moving teeth for 27 years. It started as a startup in San Jose, California, back in 1997. Kind of a counterintuitive invention when you think you can move teeth with plastic.
At that point in time, it was only metal that people thought you could move them, but actually, it's a smooth and constant force, that all you have to do to apply the teeth in the right way to get them to move. And that was the foundation of it. The only way to really make that product was to 3D print a mold, which is what we've been doing for 27 years. We're the world's largest 3D printing business, and we say that just, based on thermal polymer. So, you know, thermal polymer is what you use with an STL process. You shoot a laser, basically, in a bath of clear liquid, and the parts come out of that piece.
But we actually make negatives, and then we vacuum form plastic over top of that because we had to invent a plastic that could actually move teeth, and I'll talk about the chemistry of that and why that's so important over time. When you look at the slide, you know, basically, you know, green in general is a product, and then you can see you can see some maroon that has to do with with services and all, and then a lot of software that we've developed with the product line over the years. This has been a gradual evolution. I would say when we opened, we probably could do 30% of the cases, more like a SmileDirectClub kind of did when they they kind of started in their demise.
Over the years, we've been able to move to 90% of the ... And then most recently, with the launch of Invisalign Palatal Expander, we call IPE, we now can do 100% of the cases that are out there. And this is not like a stretch or anything like that. It's just we've done 20 million cases. We have the algorithms. We know how it works. We have the right materials. IPE is the first direct 3D printed device. It's not a negative that we vacuum form a plastic over top of it. And so we feel like we've gone the whole gamut. I think what's interesting about this slide, more than anything, is you can just see the history of innovation in the industry, and we build on this.
I'll talk about scale later on, and we talk about how important scale is in this business, on three specific pillars, and I'll get into it, but it's taken us years and hundreds and hundreds of millions of dollars to be able to scale in plastics, to be able to scale in 3D printing, to scale in clinical, to be able to how to, you know, do these cases, and to be able to scale from a sales force and a and an education standpoint overall to get us to the point that that where we are today. As you can see, in 2024, we talk about iTero Lumina. I have a slide on that. We'll go through it, but, it's, this is not like an iteration in scanning technology.
This is a brand new platform, a breakthrough, in the sense of the dental industry overall, and it's been well received in the first quarter. I'll talk about, you know, in the next step. iTero Multi-Direct Capture Technology, we'll explain that, too. We have a Smile Video out recently. We have a Smile Check we've had over the years, where you can take a picture of a patient, and you can show what the patient looks like, you know, after the treatment. Now we actually have a video piece, which is pretty compelling in the sense of how that works. And down below, you can see Invisalign Palatal Expander, and I'll expand on that some more.
But I think if you take this away, Align's a 27-year-old company, so we've been around for a period of time, but I still feel like we're a startup in a lot of ways. We have a lot we have learned. We have a strong foundation. We have good cash flow, but we have such an underpenetrated marketplace and such an opportunity that we feel we can seize. You know, this is a scale slide. So, you know, technology in general, we spend anywhere between $300-$400 million a year in technology. No one does that in dental. We're. I like to say we're a medical device company hiding out in the dental marketplace. We're focused on one thing: We move teeth. That's it.
Whether we have exocad or whether we use iTero or whatever we do, our focus is: How do you move teeth, both from an orthodontic standpoint or how you move it if you're a general dentist, and I'll explain that in more detail. We'll never surprise you as an investor with some stupid acquisition, that's some parallel thing, like we're gonna get into implants or anything like that. You won't see that from this leadership team. We will continue moving teeth. We'll invest aggressively in order to do that. We won't strategically surprise you, ever, in that sense. This is what you're gonna invest in us. You're investing in what we think we can do from a moving teeth standpoint and the huge market opportunity that presents just overall. We have 5,000 people we have together that in sales, service, and clinical education.
I call this a door-to-door sales operation. So the first thing you have to do is stay away from distribution. When you're selling a sophisticated product like this, and it's gonna change the way practices are done, you need educated salespeople and people that can really explain how this works clinically and how this works from a business standpoint, both from an orthodontic standpoint and also from a general practitioner standpoint. So those 5,000 people that we have in the organization are just critical for us in being able to deliver that. Look, you know, I worked for GE Healthcare for years. I ran GE Healthcare. John and I worked together. John was in finance at the time or whatever.
You know, we know medical devices and how it works, and there's a real advantage of that in sales because you're calling on large, sophisticated organizations. They're driven by business people, not just clinicians. You have to fit in some way. You know, when you're working with an orthodontist or a GP, these are clinicians. They're not necessarily business people. They don't think about, you know, how you leverage variable costs versus fixed costs and how those pieces are. They're clinicians in what they do, and it's so important that we're able to appeal to them in a sense, clinically, but also talk business-wise, because we're asking them to actually change the business equation, not just their clinical equation, too. And sometimes that's a high bar for us. You know, we have a consumer brand, which is great.
Our predecessors, Z and the team, Tom Prescott, and it was my left me a great business when I took over here 9 years ago, had to actually develop a brand, because there's no way we'd have ever gotten this product through orthodontists if consumers didn't come banging on the door, insisting on Invisalign. In a strange way, we created the adult market in orthodontics. Orthodontics was primarily 90%, 85% was teen back in the day, and, you know, 'cause adults wouldn't, wouldn't take wires and brackets. So many orthodontists that didn't want to go digital, what they did is they adopted Invisalign to do some adults, but then they would hold their teen patients from a clinical standpoint, 'cause they felt they could make more money on teens from a variable cost standpoint, and they can.
It's basically a $900 trade-off between what they pay for wires and brackets and what they pay for Invisalign. And if you don't use the economics of Invisalign from a standpoint of faster patient throughput and fewer visits to the office, then you can't realize that savings piece. The docs that do, and over 70%, 80% Invisalign, are extremely profitable. They do, like, 3x the number of patients a year. Invisalign finishes about 6 months faster than what wires and brackets do. No emergency visits. All these things are, you know, just part of what the clinical piece is.
So that brand, and the brand that, you know, that we push out there, is a real critical part of our strategy because it forces orthodontists to take a look at us, that normally wouldn't want to do that if consumers weren't pushing for it. And I hope that makes sense. You know, the thing on this slide is through doctors. So SmileDirectClub was a. And then you could use a, you know, a DrSmile that was launched by Straumann in Europe or whatever. There's several of them in Asia that went directly to consumers. And, you know, we didn't go directly to consumers. You know, we had a relationship with SmileDirectClub that, that's kind of historical in that way. But SmileDirectClub did two things very well.
They are great marketers, and they hit a price point of, like, $2,000, $1,800, that attracted a lot of patients. The problem is, they didn't have any clinical efficacy. They couldn't really finish the cases they'd do. They'd take any patient in that way. And then, you know, secondly, they had a great legal team that would sue anybody that even came close to them, right, that anyone would challenge that particular model. But SmileDirectClub proved it. Dr Smile in Europe under Straumann has proven it. We're seeing it in Asia, too. You can't make money going direct like this. You can't. You have to have, you have to have a-- You have to work this through doctors. Moving teeth is serious.
It's moving, it's moving tooth through bone, and you need some kind of critical way to look at that to make sure that you're not doing any harm to a patient in some way. And secondly, to really deliver the kind of care you want to do when you move teeth, you really want to make it through a doctor. It's expensive. It's a pain in the ass sometimes. You think you could probably do it better if you went to a consumer. You really can't. You really have to have this technology expressed through a doctor to do it the right way. So that's, that's our model. We'll stick with that model. We don't believe in it, and we've proved . . . That model has been proven in several geographies and at several different scale levels, not to work, if you bypass a doc.
We have four key strategic platforms. We've had that for nine years now. International expansion, patient demand, and what we call conversion, orthodontic utilization, and GP dentists. So if you look at the North American market today, about 45% of our sales go through general dentists, and about 55% go through orthodontists. Remember, with a general dentist, it's not a wire and brackets discussion, it's just how that fits in their overall, you know, clinical protocol in the sense of how they want to go through patients. Our orthodontic sales force is about, you know, how do you move them to a digital platform, the advantages of using digital versus, you know, analog wires and bracket kind of system. Our international expansion, we're in about 195 countries, like 200 countries now.
The patient demand piece is basically our Invisalign brand, and I feel we have some very sophisticated consumer advertising, and we use it all over the world. John and I both understand very well where we can advertise, what kind of return we get on those advertisements. You'll see us shortly on Invisalign Palatal Expander. We'll come out with another consumer ad here, July first. It's pretty definitive in the sense of why this is a superior product versus the devices that exist out there today, and I'll talk about it on the slide overall. But that brand is really critical to us. And then the GP dentist piece, we've been very successful with general dentists that really wanna, you know, to use Invisalign. Our feeling is we don't want to turn dentists into orthodontists.
We wanna use teeth straightening in the sense of how it makes sense to help patients maintain their dentition over time. We call that ortho-restorative, so we can fit orthodontics into restorative procedures, and I'll touch on that briefly. It is a different discussion with orthodontists as it is with dentists, but we've kind of freed teeth straightening. It's not confined to wires and brackets anymore. We've done 20 million cases. We know we can do any case out there. We can digitize it. We can make it a lot faster and much more predictable. And it's just, you know, working with both orthodontists and dentists to prove that and to get that into their workflow. We talk about Align Digital Platform. We didn't make this up. This is, you know, the foundation of what we do.
We actually, we connect, and we connect with patients and doctors through our brand and through our technology to start with, and again, our brand being really important in that. We have an iTero scanner, which we have 50% of the marketplace for installed scanners that are out there. iTero, you know, is a high-end scanner. It's known for that. But it's not just a PVS replacement machine. It's actually a workflow area, where doctors' workflow, they can scan a patient, they can actually do a treatment plan immediately through that, which we call IO simulation. That in order to be able to transfer that data to a lab or to us, you know, in a sense, to be able to process that case. It's really a hub in what we do.
What's interesting, if you look at scanning today, about 85% of the cases we do are scanned, and, 15% are PVS impressions, that are shipped in a box to a CT scanner or whatever. That is up from, it was about 10% scans when I joined the business nine years ago, and the rest of those were PVS impressions. So the market has changed really that fast. But the key here is this scanner is a critical tool in the whole process of straightening teeth. It's not just a PVS replacement.
We diagnose, we diagnose through our algorithms, and so as we scan a patient, we can immediately, you know, run a treatment plan and give a simulation to a patient and a doctor, in the sense of how long, how many aligners this is gonna take and what it's going to look like. Through that scan, too, we can also do some regression and say, Look, we scanned this patient six months ago. We can show how much enamel they've lost because their bite has been off in some way, and you can see. We have occlusograms. Occlusograms are color-coded areas that tell you where that interference is and how it's gonna be.
There's a whole, we call Oral Suite, that we have within that diagnosis piece, that can track patients, see how well they're doing, see if they're wearing their retainers, if they're coming offline, all those things. We have a thing with doctors, particularly GPs, to scan every patient that walks in the room. And then you have this digital footprint that you can regress against every time they come and see it, to see if they're making progress or they're regressing some way in their dentition. We plan. Obviously, we do a treatment plan. We've done 20 million patients, we've seen it all. You know, we can do cases, I'll show you some pictures that you can't believe you can actually treat those. We obviously treat, we have our algorithms for treatment. You know, and then we monitor.
You can monitor with iTero when the patient comes back, to see if they're on track or not. But we have a product called Virtual Care that connects to what's called Invisalign Practice App, which is basically an application that you can download as a patient, and we ship a lens to that patient when they're under a treatment. And so once a month, they can use that lens, and we take a picture of it, and we run AI algorithms against it to say, Are you on track? If you're on track, you don't have to go back to the doctor's office. Sometimes we can do a case that's a year long with three, it can be 14 months, three visits to the doctor, versus once every six weeks for wires and brackets.
You can imagine what that means for real estate and productivity and all those different things with an ortho, and that's what we try to make them realize, is how efficient those, you know, that. And then, you know, we, that monitoring, when that's done, then we go into retention. The retention is a very large retention business, and we make the best retainers in the world. We better. We make hundreds of millions of those retainers over the years. We know how to make them and vacuum form them, the material, the temperature profiles, and all those things overall. So, you know, consumers and patients focus, doctors, you know. Obviously, labs are a big part when you're working with GPs because they're critical areas.
But this digital platform, it's critical for us, and we invest heavily in each one of those areas, and scale in those areas is really important for us, too. We talked recently about direct 3D printing. So we, up until Invisalign Palatal Expander, everything we did was molds, and then we would vacuum form over top of that mold. And just so you get an idea, so when you, when you do that, you start with 30 mils of sheet. 30 mils of sheets, like, let's say a 16th of an inch, right? And you pull that down over top of a mold, and as you pull it down, it's gonna get thinner as it goes down.
So if you start to get the canines and incisors, molars, you'd ideally want to put more material on that because the thicker plastic gets, the higher modulus it has. It's just, you know, a function of physics. But for years, we couldn't do that, right? We know molars are tougher to move or whatever. You can 3D print a device, you can put that material right where you want to put it. So the idea of putting 40 mils on your molars and 40 mils on your canine to move them or rotate them, it's a whole lot better than having 10 mils or 20 mils or as you vacuum form down. The other part about 3D printing is you have ultimate design freedom, too.
If you want to put buttons or hooks, you want to print, you know, Mandibular Advancement devices or whatever, you can do all these things that are just very difficult to do and are impossible to do if you were, you know, 3D printing molds and vacuum forming as we do today. Okay? The last part about 3D printing is, we don't talk about it much, but 90% of the plastics that we... the thermoplastic we use, are thrown away or burned. Because that's never used in the-- that's just used in the fabrication of the product line. You can 3D print, you save 90% of the material that today that we just, we have to throw away because that's part of the process. So we announced recently an acquisition of a company called Cubicure.
We have a strong partnership with the University of Vienna over the years to be able to figure out a way to 3D print an aligner. We've been at this, Srini Kaza, that's really driven this product. He's been at this for 23 years. He wrote his PhD on 3D printing devices about back 30 years ago. We tried every way of working with existing printing companies and existing resin companies over the last 15 years to try to 3D print an aligner. We couldn't do it. John and I, about 7 years ago, realized we had to, we had to put a lab in San Jose, in our main headquarters.
We had to hire a bunch of polymer chemists and physicists to figure this out, and over a period of time, they came up with a resin formulation that actually works. We can 3D print the aligners today. We know that it'll function. We have to scale this thing into hundreds of millions. We have to scale both the resin, the resin is biosourced. It's not a petroleum-based product. We couldn't find anything that was consistent with the rest of the feed chain or food chain that you'd look at for polymer chemistry. I used to run divisions of GE Plastics years ago, so I kinda know a little bit about this to be dangerous.
We ended up with materials that are unconventional in the sense of what has to be used. And so we're gonna have to scale the resin, which is gonna be a challenge, but we know we can do it. We know it's out there, and we know it's available in bulk. It's just how you pull that bulk out. And then we have we own Cubicure now and Cubicure is a special process. These are high-viscosity resins, so what we process today is about the consistency of water from a viscosity standpoint. You didn't have to know what viscosity is, but it's how thick something pours, okay? The resins that we've found that can work with aligners are about the consistency and viscosity of butter at room temperature.
So you need a completely different way of making those things than the normal STL, you know, laser printing that had existed out there for years. So we have to control both ends of that chain. Long story short, we know how to do it. We have a lot of intellectual property behind that. We know there's few companies in the world that are, particularly in the dental industry, that can afford to do this kind of work and get this done. We feel really good about our path. It'll take two or three years to scale. We feel really confident in the sense of the formulation we have and the ability to move that forward. So John might not look excited about it up here, but he's very excited about this, and we'll talk about it in a second.
Align innovations powered by AI. Look, you know, we put this slide in here. Everyone wants to talk about AI today, and I'd say there's two layers of AI, okay? The artificial intelligence layer that's driven by internal machine learning, we've been doing this for 10 years. We have a huge amount of Russian scientists that have helped to write our algorithms, that are experts in computational math. And we've had this machine learning piece, which basically, you model things, and then we have our own AI algorithms that aggregate that information to allow us to do treatment planning the way we have. When we look at the buzz on AI today, boy, that really helps us. As you think about Copilot and things like that, that you can use for programming, are huge.
So our Java engineers and our 3D and our C++ engineers under Copilot, Microsoft Copilot, and some programs we use can be so much more productive than what they were before. So I like to think we are an AI-driven company before AI was even existed. It's how we basically formed this company and what it does, and we have a huge engineering staff that's very conversant in this, too. So we're excited about AI, but we think it's just another step in the road in the sense of tools that we've been developing over the years to help to move the business forward. Invisalign System overall, I don't want to take too much time on this. I've talked about this, but if you look at SmartTrack on the left, SmartTrack's a product we vacuum form today and we use.
That's a result of about 10 years of polymer science. There's a thing in polymers that's really interesting, is it, you want rigidity, and you want flexibility. And there's-- When you look at polymers that exist out there today, having one that's rigid but also flexible is an oxymoron. So what we had to do with SmartTrack, is we actually, that's a three-layer material, and the internal material is polyester, and the outside materials are basically polyurethane. And we, what we do is, you know, that's extruded together, and what happens, the polyester gives you the rigidity, and the polyurethane gives you the flexibility that you really need to drive this forward. Now, that doesn't sound like a big, but this took Srini and the team years, and be able to figure this out and find the right polymers in order to do that work.
Down below, there's another product that's been used out there. It's kind of reverse engineered in this, but you see 25% lower stiffness, you know, versus other polymers that are out there. And you need that stiffness, and there's a thing called hygroscopic capability, meaning when that product is in your mouth for about five hours, it's saturated with your saliva. And if it's not resistant to that, then someone can say, "I got 40,000 modulus," but four hours later, it's 5,000, and it's not going to move teeth. When we see a lot of competitors out there trying to move plastic with stuff that we kind of scratch our heads with, is we know what's going to happen in five hours after it's in their mouth.
So you really have to know something about polymer science, and one of the biggest frustrations for John and I in this business is, when you throw a plastic aligner on a table, you think, "I can do that." Looks like someone cut it out of a soda bottle in some way, right? But no, those polymers are very specific and designed to do a specific job that has taken us, you know, over 27 years to kind of learn. That's SmartForce features. A lot of people think that our aligners are just progressive, meaning that you take an aligner out, it moves your teeth, and then the next set is where the teeth go. Actually, the way we program this is to push those teeth.
So there's a certain amount of just residual force that we program inside that aligner that's not displacement technology, it's moving the teeth over, but driving that tooth forward. And often, that's the only way you can move a molar or you can move a canine, where you don't have a whole lot of material in it, is to make sure your teeth are loaded properly. And then the SmartStage technology on the end just means you have to know how to stage these things, right? When you move the molars, when you move the incisors, or when you intrude, when you extrude, there's just certain things you want to do as part of that process. We look at, you know, obviously, when you look at the orthodontic marketplace, it's 80% teens. 22 million case starts around the globe. It's 80% teens.
We break it up in primary dentition, a mixed dentition, and permanent dentition. When you look at our most successful product to date, has been Invisalign First, which fits in that mixed dentition area. It's basically used. It's called dental expansion, where you can expand a patient's teeth when they're younger, to make room for others. For years, we haven't been able to do what's called skeletal expansion, and that would be expanding the skeletal structure of the patient in order to create a lot more room for the teeth to drop. That's it. It's 10% of the marketplace is IPE, is skeletal expansion. About 10% has been dental expansion over the years.
We also have a product that fits in the mixed dentition called Mandibular Advancement, and that's for Class II, when a patient's jaw is somewhat recessed. And if you catch them during a bone growth period, which is between 9 and 12 years old, we have a product that can actually overcome that Class II in the overbite, and I'll show you some of that. We're really strong in that area. On the permanent dentition side, you know, we've struggled in the sense of continuing to drive this through orthodontists. Orthodontists that use our product, they'll be running over 70%-80% of Invisalign. They push hard through teens or whatever, but you have many doctors that don't want to make that move, just try to push teens as much as possible with the wires or brackets and use Invisalign for the mixed dentition piece and-...
Can answer questions about that when the time comes. I want you just to, you know, you can look at the Mandibular Advancement, Invisalign First, I just talked about that palate expander. But just look at those teeth, left to right, right? Look at the one on Mandibular Advancement. See how those bottom teeth are really recessed behind the front teeth? That's called a Class II. Look what happened. This is done in about 13 months. You can make that correction with a Mandibular Advancement. Now, the opposite of that is called a Herbst appliance, which is a bunch of metal with a composite strapped to a kid's upper and lower jaw, versus these things you can take out every night, brush your teeth, maintain your dentition, and move forward. Invisalign First, like I talked about, dental expansion. Look at those teeth. I mean, to me, it's amazing.
I've been here 9 years, still. In about 9 months, that's what you do. Look at those overlapping front teeth. Look at it. It's on the right-hand side of that. It's amazing. Now look at Invisalign Palatal Expander on the right. That's the same patient. See that tooth on the left, how it's stuck up in the upper jaw? This is about after 30 days, 9 millimeters of expansion, which is pretty severe. We do anywhere between 7 and 9 millimeters. Look at the way the teeth lay in. If you have kids or grandkids, and they're at, at age, like 7 years old, and you get this done to them in 30 days or so, that phase two will be so much easier. Because you just—it's simple physics. You're just creating room for those teeth to drop in.
If you don't create that room, those teeth are gonna find a way. When they come out, they, you know, they look like it does on the left side. So these are, these are incredible innovations by Align in areas that are incredibly invasive kind of process, products that we're replacing in an orthodontist office, specifically. There's the Invisalign Palatal Expander. The great thing about this, where, you know, sometimes it takes a year or year and a quarter to figure out an Invisalign case is going to land or not, we know in 30 days if this is going to work, and it works. We first launched it, the ortho said, "Oh, you can't split the suture. It's impossible to remove, removal device to split the suture." A suture is the middle of your mouth, and, yeah, you could, you split it.
You want to split it as part of this process, and we readily do it. I mean, we've been on-- Srini's been at this one for six years. It is-- The only way we could do it was to 3D print it to get that kind of modulus and capability, but we're excited about it. We're seeing good reorder rates on this right now. We're only launched in North America, in Canada, United States. We're moving into ANZ. We'll have Europe pretty much covered in the second half of this year. It's a good uptake so far. Anatomy of aligner, elasticity and modulus, I've already talked about that. You need those two things. It's critical what's inside that. Force over time is what moves those teeth. Obviously, safety.
How we work as a 510(k) device, the toxicity to us, to make sure that it works and it's not an issue for patients. It has to be aesthetic. I mean, that's what we sell, right? Aesthetics. You can move your teeth without people basically not knowing it because it's so clear. This is just a quick shot of 3D printing. That's a Cubicure printer, and then that's printing some what we call prefabbed attachments. These are attachments that we'll launch here in the next six months or so that allow doctors to be able to put attachments on teeth much faster and much more accurately than before. We use the same printing device that we use for aligners. Intraoral, you know, they talk about, you know, basically Lumina.
This is a product that we worked on for seven years. It is truly a breakthrough in scanning, intraoral scanning. When you see, you know, talk about these 100,000—we've sold 100,000 scanners so far. We have about 30,000-unit install base we can move. We have, you know, obviously, a lot of restorative scans are done a year, like 5 million, and we do a lot through labs, too. But this is truly a medical device, kind of a scanner. It, the breadth and width of the scan is unprecedented in the marketplace. The speed and ease of use is there. It's natural color. It's not augmented color, like almost all the other scanners have been in the marketplace.
So, the team in Israel has done a terrific job on this, and despite some issues, obviously, that country's had over the last year. And that's the Lumina. That Lumina is half the size and half the weight of what our previous confocal imaging piece was. The record for scan on that is 40 seconds. The record for 5D Plus was about 2.5 minutes, right? And it's so good, even John and I can scan. We were incapable of scanning before-
Yeah.
but we actually can.
That's true.
We can actually do it now, and you can see 3x wider field of view, so it's perfect for IPE, because you can, you want to scan the whole palate. You have to see the palate in order to make IPE 50% smaller. Superior visualization. It's primarily around the crispness of the image and the color. Every other scanner out there has to augment color for one reason or another. So with that, I'll turn it over to John, and he'll talk to you about the good stuff here.
Yeah, just a little bit of an update. Obviously, a few weeks ago, we released our Q1 numbers, and we're very pleased with our results. We beat the consensus revenue and margin as well as our high guide. You look at Q1 being up 6% or so on our revenue year over year. What we actually saw, as Joe describes, the new scanner that we had, we actually saw sequential improvement from Q4 to Q1 in our scanner business systems and services, up sequentially. Typically, with the capital equipment, you expect fourth quarter to be higher, but I think with the new scanner and the benefits it brought was really good performance.
You know, we're executing in what we've talked a lot about as a relatively stable environment when we look at things globally. Obviously, certain markets better or worse, but overall stability that, you know, we continue to see, and that it's a good thing. 2022, 2023, parts of that were not as stable. More stable now. And then coupled with the new products, a lot of what Joe just talked about with Lumina, really helping the systems and services, and then Invisalign Palatal Expander really helps with some of the new products and being able to go to market to be able to help grow in this market.
Really what we saw after Q1, and we looked at Q2, you know, in terms of where we think we're at, we upped our guidance on that, and then looked at the total year and said, What does that actually mean? So, the strength in Q1, being able to couple that in with our guidance in Q2, we took the year up to, on a midpoint basis, up 7%, revenue year-over-year. So we're starting to see some of that progressive improvement that we would expect, where we're that stable economy, stable market that we're seeing, and then the new products, being able to help deliver on those, and we're seeing it in the results.
You can see just a few pages just on revenue, where we've been and what we're trying to get to, kind of building off of for Q1, and we expect to be able to see that. Obviously, we're driven a lot by our volumes, very close attention to what our volumes are. Really, it's just a reflection of the new products that we have, what we're doing to try to go to market. And so we're pleased with some of that performance there. Now what we're trying to do is increase those volumes. So we have teen season coming up. North America really hits in the second and third quarter.
Third quarter is big for China from a teen standpoint, so we really wanna improve some of the go-to-market activities that we have to be able to drive that volume, and that's a reflection in our numbers. But volume is very important for us from a clear aligner standpoint to really help drive our revenue. So you look at the segments that we have between Americas and internationally, you can see kind of the growth. We're happy with some of the quarter-over-quarter numbers. That's something that we look at closely to see, are we seeing some of the seasonality that we expect as you start to go through the year? I wouldn't say it's fully back to how things were prior to COVID, but getting better, which is a good sign.
So that's good for us to see, and we wanna continue to help drive that with a lot of new initiatives we have, with new products, as well as what we're trying to do go-to-market, you know, and really get to the right spot here. We're also seeing a lot of good growth on our non-case revenue, so some of the work that we're doing from a retention standpoint, where you sell the clear aligners that goes into treatment, but then when somebody gets out of treatment, they're gonna need a retainer to make sure their teeth don't move or revert back. So we're seeing a lot of good work around that.
Some of the work that we're doing from a subscription standpoint, that we call Doctor Subscription Program, where doctors can sign up for a certain amount of aligners that they wanna use. They use them however he or she wants to use them. Sometimes they use them for just a relapse, mild relapse, or what we call a touch-up case, where they need three or four or five sets of aligners to kind of move those teeth back to where they need to be. But the majority of what they use it for is retention. They wanna be able to, instead of making them themselves or going to a lab, they use us to make these retainers for them. It gives them the right price point. It alleviates some of the do-it-yourself that they're doing within their labs to be able to...
Or in their offices, to be able to create those retainers. And, you know, it's something for us that gives us incremental volume from a touch-up standpoint, as well as incremental business from a retention standpoint. So it's been a good program for us. I mentioned a little bit about the systems and services, so you can see the benefits that we saw in terms of, you know, what the scanner's good. We know that, and the model has held for a number of years and continues if a doctor has a scanner in his or her business, we know that they're gonna do more Invisalign cases.
It just lends itself to that digital ecosystem that Joe described, and how easy it is for doctors to be able to use our system that we have with that scanner. And if they add another scanner, so now just one to two, we see incremental volume, and that really shows up in our case volume. So we're very focused on digitizing those practices to be able to help those doctors digitize. And as they digitize more, they scan more. They scan more, they end up doing more Invisalign. And so it's a good combination that we see. So we're really trying to get to, as Joe described, well over 90% of the cases that come to us are through a scanner.
That's a real big advantage versus the goop that you have to put in your mouth in the past, and some sadly still use, but for the most part, a lot of them are using it via scanner. This just looks at kind of the trailing twelve in terms of where we're at, just under $4 billion. You can see all the patients that we've helped doctors treat and how we wanna continue this. This continues to scale up and gives us a lot of information as to what we know works and doesn't work in terms of treatment, and so we have a lot of experience that way. A lot of employees to make sure this works the right way. A lot of them in...
From the fabrication standpoint or treatment planning standpoint, where we have people working on a lot of these, a lot of these, and we've trained a lot of doctors. We don't always sell to the same amount of doctors every quarter, but we've trained a lot of doctors, working to make sure that we can give them the clinical confidence to do more cases, and ultimately, we want to try to increase that utilization. So a lot of the new products that we have really help with that, but that's how we look back over those last 12 months. So as a takeaway to this, you know, we are continuing to drive innovation.
We invest a lot into this business with the sole purpose of moving teeth in a predictable and reliable way for orthodontists as well as general dentists, and we wanna continue that model. A lot of investments, as Joe described, with the 3D printing, the direct fab, the flexibility that it gives doctors, the cost benefit that it gives us when 90% of the material comes out. And as we scale this up, we've really gone from investing in the R part of R&D, to really now into the development. So it's really exciting to see that, you know, as we can start to scale this, there's a lot of benefits that we'll bring to the marketplace that, we know no one else can do.
It's also gonna give us benefits from a cost standpoint that will really change the market and give us a lot of flexibility as we move forward. So we're super excited about what that means. And in the end, we think that this is obviously a benefit for our customers and how they wanna treat their patients, but it's obviously a benefit for us as we wanna move the industry forward through digital orthodontics. So that... I'm kind of at time, but if there's anything, Brandon, you wanted to have -
Yep. Let's, we're gonna head out to the breakout now. We are going to the Maher room for the breakout.