All right, good morning, everyone. My name's Mike Sarkon. I'm an analyst on the U.S. Medical Supplies and Devices team, and welcome to day one of Jefferies 2025 New York Healthcare Conference. This is a track for Align Technologies. From the company, we've got Simon Beard, EVP and Managing Director for the EMEA region, also joined by Shirley Stacy, who's VP Finance, Corporate Communications and Investor Relations. We also have Madelyn Valente, who's here as well. Thank you very much for joining us today.
Thanks for having us.
Just figured we can kick off high level. Align recently held its Investor Day. I was hoping maybe you could start with some of the key takeaways from the Investor Day more broadly, and then we can drill down and focus on some of the exciting things going on in the EMEA region.
Okay, so good morning, everyone. I think, Michael, broadly, if you look at kind of how we shaped the Investor Day, we focus very much on kind of the phase change that we're bringing from an innovation perspective. If you look at the market that we operate, we essentially have created this market and driven the majority of the innovation over the last 25 years. We're entering a phase now where we're really starting to see some kind of game-changing technology. When I talk about that, I talk to things like, you know, our ClinCheck software, which essentially has been, you know, a manual process between technicians and doctors, you know, with the use of our kind of algorithms and AI technology. That's moving to what we call a touchless kind of phase now.
You know, huge productivity gains there for both the clinician, but also ourselves. Things like direct printing, which is kind of the holy grail of our industry. If you look at the current product, the Invisalign product we make, it's a kind of a vacuum-formed manufacturing process. With direct printing, you remove the need to do vacuum form and you directly print the plastic. Once again, hugely exciting. If you look at some of our other technologies, you know, last year we introduced a brand new scanning technology, multidirectional capture. That once again opens up, you know, a whole new kind of phase of kind of development that we can bring.
Essentially how we'd kind of position that is if you put that all together, you know, you're talking about kind of three kind of game-changing changes in software, appliance, and scanning that really kind of put us kind of in a kind of a different direction and phase for us as a company. That was number one. There is a lot around innovation. I think the other thing that, you know, I certainly kind of took away from it is how our business has truly become a global business over the last few years. You look at the kind of the breadth and depth that we have within our business. You know, we've seen obviously strong growth in Asia Pacific, in EMEA, which obviously I look after. It is a kind of a more balanced kind of view that we've got.
You see it obviously across GP and ortho specialists and generalists. The last thing, which I think a lot of people in the room were kind of waiting for, was our kind of medium to long-term growth model. We made some adjustments. They talked more about medium term, that kind of five to 15, and then longer term kind of over 15 as we navigate through. It was a great opportunity. We do it every couple of years, but it felt as though everything that we have been invested in in the last five or six years really has come together for the next push.
Sounds great. Thanks for the overview. It sounds like key focus on innovation, geographic expansion, supporting some of that growth acceleration. Maybe we can dig into your region, EMEA. Maybe you can just level set us on how you view the opportunity there and provide some color on how the market looks relative to, you know, the Americas, U.S. Then maybe you can talk about the similarities and differences.
Okay, it's quite a few questions. Look, I think, you know, EMEA is, you know, it's a fantastic opportunity there. We're still obviously expanding the region into new geographies. Even in geographies where we've been present for the last kind of 20 years, we're still relatively under-penetrated based on the opportunity that we've got. I'm kind of excited when you put together kind of new market expansion. You look at obviously the customer channel opportunity and then the new innovations that we're bringing through that we're in a good place. We're really excited about that opportunity. If I talk to kind of the differences between, say, the kind of the North America market, Europe, I've managed both. I've kind of seen this firsthand. I think, you know, first and foremost, the similarities. There are a lot of similarities.
You know, essentially, you know, our business is providing support and digitizing doctors within their practices. They obviously treat patients using both analog and digital tools that exist everywhere. Very, very kind of similar. Some of the go-to markets can be replicated across multiple geographies. I think there are some kind of obvious differences. Clearly, when you talk about Europe, Europe is not a country. It is made up of many different countries. Across that landscape, what you find, there are different kind of regulatory hurdles that we need to kind of navigate. There are different laws around advertising. For example, there are a number of markets in Europe where we cannot advertise to consumers. Actually, there are even markets where doctors cannot advertise their services as well.
It just means that we, you know, our marketing mix has to be kind of slightly altered. We're more dependent on that kind of doctor interaction and their recommendation. Then there are also some kind of structural differences. If you look at the kind of North American market, you kind of have this very clear divide between the location of general dentists and orthodontists. They have individual offices. They run individual businesses. We have a number of markets where that doesn't exist. You have those specialties, but they operate in the same location. They're called multidisciplinary or interdisciplinary. We have to think about how we approach those different customer types within kind of one location. Those are the differences. They're not insurmountable. It just means that you just need to tweak and adjust your kind of go-to market.
Just to follow up there, for some of those European markets where you may not be able to advertise directly to the consumer, I mean, is it a longer ramp or, you know, it takes a little bit more time to penetrate that market? Or do you find it's, you know, when you adjust and you target the docs directly, it's kind of just as efficient?
No, I haven't seen any evidence where that's the case. I think I always think that, you know, if you're in a market where you can advertise, then, you know, everybody's advertising. If you're in a market that doesn't, then nobody's advertising. It kind of levels the playing field. I think, you know, in some of our markets where you can't advertise Invisalign, we've actually been as successful, if not even more successful in markets where we are, because I think it kind of hyper-focuses the organization on the clinician. No, no evidence of that.
Okay, helpful. And then, you know, I think at the Investor Day, you also mentioned in Europe, U.K. and Ireland are a bit different from other parts of Europe because they're dominated by the GP side rather than ortho. Just curious on, you know, what structurally drives that difference?
I know a little bit about the U.K. I think, first of all, there are a couple of things that I think kind of level set the difference. First and foremost, I think if you look at it numerically, if you look at markets like Italy or Spain or France, you know, roughly those population sizes, you know, slightly less than the U.K., but you've got 3X the number of orthodontic specialists. So there's actually quite a low number of orthodontic specialists in the U.K. For them to be able to manage that kind of demand of people looking for, you know, orthodontic treatment is going to be a struggle. I think the second one is historical. You know, by nature, U.K. doctors tend to be a little bit more conservative in some of the treatment choices that they make.
This is what I've kind of learned from kind of the history of the company in that country. When we launched Invisalign there, it was kind of pooh-poohed. It wasn't seen as a kind of a serious treatment choice or option. At the same time, we created a huge amount of interest and demand from consumers. The general dentists saw that opportunity and actually stepped in. Really from the very early days, they were trying to fulfill a need or a demand from patients. That's really stayed within that market ever since, because there are more general dentists, it's more of a way to go. Secondly, because of the lack of them. The other thing as well, which is, you know, which the U.K. shares with Germany, is it's also a reimbursed market.
There's an expectation within that culture that if you're going to get any kind of medical treatment, the government pays for it through the NHS. And so once again, that tends to focus the orthodontic specialists on doing, you know, reimbursed patients, not necessarily private patients, whereas the general dentists tend to look at more of the private market.
Understood. Okay, that's helpful, Simon. And then, you know, you talked about 5%-15% volume growth through the LRP period and accelerating past 15% after that. How do you think about growth expectations for the EMEA region? And then maybe, you know, can you speak to your confidence in the outlook there?
Confident, yeah. Yeah, I think I am. You know, I've been around this business for nearly 11 years now. And I've been around the EMEA region for over seven years. You know, I understand the market dynamics. I understand the customers. But more importantly, I understand the opportunity. When you then kind of base that around, you know, specific market, but also overall opportunity, you look at the innovation that we're bringing through, yeah, I think we've got a, we're in a good place as an organization. We've got a lot of, we've got a lot of experience. We've got a lot of know-how in the business. We've got great customers there as well. Yeah, I'm really committed to kind of driving the region as hard as we can.
Got it. And then, you know, on to specific, you know, ways to drive that growth, you did touch on EMEA being heavily skewed, excuse me, toward orthodontists. At the Investor Day, you talked about a heavy emphasis on the peer-to-peer program. Maybe you could just elaborate on your efforts there and talk about how that's going.
Yeah, you know, when we're looking to work with doctors, we try and take what we call a very programmatic approach because we know that, you know, over the years, we've learned what are the barriers and what are the things that most of our doctors need to kind of make that shift from kind of an analog, wires and brackets process to a digital clear aligner process. Peer-to-peer really is based on a lot of learnings. It was actually invented by our leadership team in Italy. Essentially what that does is we take our best customers, so we call them mentors, and we pair them with 10 to 15 mentees. These are inexperienced clear aligner orthodontists. What that enables us to do is to ensure that those doctors are getting kind of almost kind of real-time support from a peer.
We know that when doctors are able to teach doctors, it is more kind of credible. It is more kind of consistent because they speak the same language. They understand each other's issues. There is more trust there, obviously, because these mentors are highly experienced. They have treated a lot of patients. They can do complex cases. We run that program over 12 months. They get four or five kind of formalized kind of education sessions with each of the mentors. In between that, when they are actually putting treatment plans together for patients, they can share those treatment plans so that their mentor can just check and say, "Yeah, that case is set up right." If they are having a situation where a case is not tracking, they get that kind of real-time clinical support.
It just gives them the confidence to really step out there and start moving. There is a big clinical element to this, which we've learned in our business is so important, right? If you're a specialist, you want to be the best clinically. The second thing is just the general advice they're able to give around how do you implement technology in your practice. How do you set up the workflows differently? How do the roles change within your practice? You know, how is your kind of receptionist or your orthodontic assistant, how is their life going to change and how do you manage it through that? That is kind of a big element. Their business changes, right? How they charge patients, how they run their business also changes as well. We found this to be, you know, really well received.
I say we started in Italy. We've now introduced this across every market in the region. The great thing is, is that we're seeing similar feedback, similar results. Yeah, it's been really successful.
Yeah, that sounds pretty interesting. I guess, can you share any examples or anecdotes or even quantify, you know, for a doctor who becomes a mentee, you know, what type of volume increase, you know, could you see when they complete the program? Is there some type of metric you track there?
Yeah, I think, you know, based on our kind of like our general growth rates, we see kind of like a 5X or 6X increase in growth. More acutely, we see kind of nine to 10 increase in the kind of kids and teen side. That is obviously a specific interest to us is that that is the largest market segment for us. Yeah, we have seen a really, you know, if you look at the cohort in general, that is kind of the general multiplier that we get from this program.
Got it. And, you know, I guess, are there ways to incentivize some of your doctors to be mentors or do they just generally are very supportive of the process?
Yeah, I wouldn't call it incentivize. I'd say a lot of the specialists, a lot of the doctors that we've worked with over a number of years are always willing and generous around educating their colleagues. They love to teach. Yeah, that's the background they come from. Giving them that opportunity, they love that. You know, running an orthodontic practice, having a kind of an escape from that where you're teaching peers and colleagues is good. There has to be a general motivation to do that. We do reimburse them for their time, yeah, under kind of fair market value rules. If they spend an hour or two teaching, then they get remunerated for that. It's not going to replace their day-to-day income, right? It's not that lucrative.
Sure. Okay, that's helpful. You know, I just wanted to pivot to innovation. You talked about some of that earlier. You know, can you talk about some of the newer products that you're launching in EMEA, like the palatal expander, the MAOB? I think you're pretty early on in both launches, but would just like to get an update on how they're being received.
Yeah, there was, I think we had three major launches in Q1. One was palatal expander. One was the mandibular advancement with occlusal block. Then the Lumina Restorative came right at the end of Q1. We are obviously a little bit behind. We did not get MDR approval. We are about a year behind North America. I was actually there when we launched it. It was good to do it a second time around. We have had a really good response to the palatal expander. The way, you know, we launched it in February. General release was February. We had a few customers using the product in kind of January.
No, I think one of the really key things about the palatal expander is if you look at traditional devices, this is the first appliance that's been introduced to rapidly expand the palate for over 50 years. There has been really nothing new in this area. When you first talk to a doctor and ask them, well, you're going to use obviously a nylon polymer to essentially separate the jaw, they look at you in disbelief that this is not going to be possible. It has been really great to see doctors sharing cases. They're astonished with how consistently the product works. Added to that is just the different experience for the child and also the parent. You know, they're not having to, you know, turn a wrench every night. It's more comfortable.
It's more hygienic because they can remove it to brush their teeth. Overall, really great response in a number of markets. You know, we're three or four months in. The MA product, we only launched last month. We've done a kind of a limited release a couple of months before that. The difference between that and the palatal expander is the palatal expander, you see the results in 30 days. With the MA, it takes sometimes five or six months before you see the results. We're seeing early feedback from doctors, very promising. They're actually seeing the product work. It's advancing the mandibular. We're not at the stage where they're really at the end of that kind of first phase of have you corrected the jawline. We're seeing a kind of a similar adoption that we saw with the palatal expander.
Lumina Resto, once again, early days again, but very good market response. You know, we had a good response to Lumina in general from that technology. You know, the speed of scanning, the efficiency, the photo realism. Now adding in the, obviously, the restorative side. We have had a lot of customers who have obviously upgraded to the new kind of software so that they can do their kind of crown and bridge work, etc. Very, very good response.
Got it. And can you speak to, you know, how quickly you rolled that out across the different countries in the region? Do you just kind of pick a few key areas and then expand from there?
Yeah, so what we tend to do, and it kind of links back to just the conversation we had about peer-to-peer, we would tend to go to doctors who are kind of mentors. They would get, I suppose, earlier access. We learn a lot from those doctors around. There are always different kind of workflow or clinical tips that they've got that we can then kind of learn from so that when we go out, we can be more comprehensive in how we educate the wider clinician base. We usually start with a few hundred. Once, you know, if we have regulatory approval across all of our markets, we go to general release. That really is down to the individual market leaders and teams to drive adoption. We do the usual thing.
We ran kind of EMEA kind of online launch events that people could access. The countries will run smaller events where they'll bring clinicians in so they can spend more time actually talking through, you know, how to use the product. So yeah, but so far, so good.
Great. You know, understanding you just launched three of these products very recently, but on this side of the fence, we always get greedy with the information requests. What's up next for innovation and product launches?
I suppose the second half of the year, obviously, you know, it takes a good 12 to 18 months to really ramp these kind of new innovations. But we've started to really move to kind of the next generation of ClinCheck. This has been a labor of love, really, over the last five to two years where we've totally reimagined the treatment planning experience for our customers. Let me just ground this in what it used to be like. I remember when I joined, doctors sometimes would do a physical impression and not a scan. They would then go into this backwards and forwards with a technician who is located somewhere in the world, usually Costa Rica, to modify the treatment plan. That could take sometimes anywhere from, if you were lucky, two weeks to up to six to eight weeks.
You think about that lag between actually finalizing, then you had to make the product, ship the product, and then. You look at it two to three months before a patient could start treatment. What we've done now is, you know, using just this incredible kind of database that we've got, the algorithms that we can build. We've obviously been using AI as a company for a number of years. We've been able to essentially offer doctors a choice where we can actually code their protocols and their preferences. Their treatment philosophy is inside the computer. When they submit a case, the case comes back very quickly. Ultimately, it'll come back almost within five minutes because it doesn't have to touch a technician. You're taking a two to three-month process almost down to less than a 15-minute process. Almost becoming chairside.
What you'll see in the second half of the year is really starting to roll that out. Doctors can either do this, what we call IPP, which is Individual Personalized Plan, which is where they code. They can take a global template, which we've been introducing. This is based on, you know, 20 million patients treated, all the data in there. These are what's required. They can take that template, either use that global template, or they can actually edit that template to make modifications so that they can set the coding up in their own way. That's going to be a big element of the second half of the year. Clearly, that has obviously ramifications for us, but more importantly for our customers, it's going to create huge kind of productivity and efficiency gains.
I'll just mention one. If you think about if you're a doctor and you're creating a treatment plan for a patient, and then that patient leaves, and then the treatment plan doesn't come back for, say, a week, you've then got to go back and think about that patient. What is it we discussed? What is it they're looking for? What were the nuances in there? That's inefficient, right? Because you have to spend time thinking about it before you do it. If you can do it almost real time, it's there. It's present. You know, the patient might even still be in the practice. The fact that you can show them the treatment plan, it could reduce an additional visit, potentially.
Doctors can really think about how they can really optimize their treatment plan and actually show the patient there and then, this is what I can do for you. It is hugely exciting.
Yeah, that sounds very exciting. Can you talk about the learning curve there? Is it going to take time for the doctors to ramp up on the next-gen software?
Yeah.
Because it's pretty easy to learn.
Yeah, because the software isn't always perfect straight away. They sometimes have to go through a few cases to kind of modify their protocols a little bit. We have a number of general templates out there as well as global templates, as well as individual doctor. There will be 85%-90% of cases will be right first time. Huge efficiency gain.
Okay, great. I know we only have a few minutes left. I did want to switch to how you're addressing the GP opportunity. Maybe you can just give us a brief overview of the various ways you're looking at targeting that opportunity.
Yeah, look, if you look at my region, the GP channel is really dominated by the U.K., Ireland, Nordics. We have businesses, obviously, in France, Spain, Italy, Germany. Those are the predominant markets for us. Once again, link back to what I talked about in the beginning about the U.K. market structure. We really made a lot of changes at the end of last year. I've kind of been around that GP business for a while. You know, the one thing we've learned with the general dentists is iTero really does play an absolutely critical role. Where we have general dentists that use our scanner and use the tools on that scanner, it really lends itself to optimizing the workflow around using clear aligners. Because we know GPs are busy. They do lots of different procedures. They're not like orthodontists. They're not just doing tooth movement.
They're doing crowns, bridges, veneers, bonding, implants, diagnostics, drilling and filling, right? We need to make it as efficient as possible. What we did, now when we certify a new doctor, we don't certify them immediately with Invisalign. We actually train them with iTero. They get half a day, and we train them on how to use the tools. What we're trying to do with them is to get them to do a digital consultation, not the consultation where they bring a mirror and a probe and look in your mouth and shout out all these numbers that nobody understands. They can actually scan and then have a conversation with the patient, and they can see what's going on in their mouth. The initial focus is scanning. How many scans are you doing a day?
How many scans are you doing a week? And then once they've done that for about a month, we then certify them with Invisalign. And so they've got the workflow in place. We get the workflow in place, and then they can use the tools and have the right conversation with the patient. We launched that around February in a number of EMEA markets. We're just about to come up to the time when we'll start kind of measuring. If you look at the early signs around number of scans that are happening, number of cases that have been submitted, we're seeing a really dramatic improvement. Really excited about that. The second side is that's for new doctors. We've got obviously a large volume of doctors out there, general dentists who do a small number of cases a year.
A lot of the time is because, you know, they're inefficient. When you don't do many, you're inefficient. They're not as confident. We are looking at treatment planning services. Both partnering with third parties, but also utilizing our own kind of resources to really give them that ClinCheck support so that they have to do as little as possible in setting up a case and making sure that they're confident to approve that case and start treatment. That is the second one. The third one is we've got a really big push around what we call orthorestorative. If one of you in this room went in to see a dentist and asked them to improve your smile, often they'll go straight to restorative, which is they'll either do some bonding on you, some whitening. They might use implants or veneers.
What we're saying and what is shown is that like 50% of those cases, you need to move the teeth. The teeth aren't in the right position. Actually, the reason your teeth are chipped or they failed is because they're not contacting in the correct way. We've got a big push at the moment. We're building a kind of a longer-term strategy around how we can get more dentists driving that kind of orthorestorative approach.
Awesome.
Long answer, sorry.
No, that was great. We are at time. Thank you very much, team, for joining us today and for the audience. Thanks for your interest.
Thank you.
Thanks for having us.