Okay, good morning everyone. My name is Vik Chopra. I work on the medical devices team at Wells Fargo. Pleased to introduce management from Align Technology for this session. Joining us from the company are John Morici, CFO and EVP Global Finance, and Shirley Stacy, VP Finance, Global Communications and Investor Relations Officer. Thank you for being here.
Of course.
Let's start off with the most recent quarter in 2025. I'm just curious what investor feedback you've received since reporting Q2, and what have your investor conversations been focused on?
The majority of the discussions were just on kind of how the quarter played out and what our expectations were versus what actually happened. I mean, on a typical basis, you go from first quarter to second quarter, you see a sequential improvement in terms of volume. Most of the Western world, you have teens that go into treatment over that time period. You see some of that growth that you would expect as they get into that teen season. So you would see a sequential improvement in the second quarter, and then as you go through that second quarter, as teens get out of school and so on, you'd see that benefit where they go into treatment, and especially into June and so on. The way the quarter played out, we did not see. You saw some sequential, but not as much as we would have expected.
So a lot of the conversations are just around, okay, what's happened, why, and then more importantly, what we're doing about it. And I think we can get into a lot of that as you want.
Okay. So maybe just talk about how you see the rest of the year playing out for Q3 and Q4. I think you've given guidance for Q3, obviously. I think consensus has you modeling within your guidance range and then stepping up in Q4. Maybe talk about how you feel about current consensus estimates and what drives that step up in Q4 over Q3.
So as we guided for Q3, we used the latest information typically when we guide, but we really leaned on what we saw in June and used that to project out what we would expect for Q3. So that was based on our guidance, and then it translates to what we think the rest of the year is going to be, and that actually implies a fourth quarter as it's being modeled now. Like you said, it would be a step up from Q3 to Q4. And typically we see that. We see that step up into the fourth quarter. Europe comes back after the third quarter and really engages again just from an overall, the way they're set up, they come back at that time. China's a little bit less. North America is usually fairly strong in the fourth quarter.
The expectation in the fourth quarter for that step up is we've seen on the iTero side a lot of, with Lumina, a lot of volume that we've seen on upgrades and others with Lumina. We expect that more full systems will be sold in the fourth quarter, which helps us improve on a sequential basis. We also see in Europe where Europe being lower just from a seasonality standpoint in third quarter, they come back in the fourth quarter. Now they'll be able to use, and we've just introduced several new products there with mandibular advancement, with occlusal blocks and palatal expander, and some of the DSPs, the subscription program that we have. Their volume really kicks in there. We also see, and we've noted that in the U.K., we were withholding for some of the U.K. VAT.
Some of that, it started—we stopped doing that and kind of normalized things, which ends up increasing our ASP. We started that in August. We'll get a full quarter effect of that in the fourth quarter. So we use the most recent information to guide, and then we have some of these offsetting things that I mentioned to help us.
Okay, great. So also the margin guidance implies a pretty significant step up in Q4 from your 22% guidance in Q3. Maybe just talk about some of the drivers there on the margin side.
You'll have, as we noted, you have some of that sequential improvement, so you get volume leverage. So fourth quarter gives us some of that. We'll also see some of the benefits from the U.K. VAT. So we'll get on an annualized basis, it's $35 million or so. So you'll get a full fourth quarter benefit of that, as well as other cost initiatives that we have. So we talked about at the last certainly some of the restructuring and some of the changes that we're making around capacity and where we're planning our production and getting closer to customers so we can minimize freight and utilizing some of the latest equipment and so on. So some of that starts to play out as well as our overall restructuring that we have. So we've got multiple ways to get there.
It starts with some of that volume leverage, and then there's some discrete items that give us confidence to be able to get to our overall margin.
Okay, great. Let's switch topics with the overall macro environment. You've highlighted a number of items such as elevated interest rates, ongoing inflation, and unstable consumer confidence, which are all directly influencing patient purchasing behavior. Is any one of these having a more outsized impact on elective dental procedures than the others?
Well, typically what we hear from our doctors, especially some of the bigger DSOs, that when they can manage the interest rates, they can see a better conversion. So what you find is that those patients, those potential patients at that time, they like what they see from a scan. We can show them kind of an outcome simulator, and those doctors can really get those potential patients excited about what they see, what their treatment would look like when they're completed. So they're excited about that. The next question that comes out of that consumer potential patient's mouth is how much is it going to cost? And if they can get the pricing right, they can sustain that interest or maybe even get those potential patients back to the office with pricing.
But then that last mile that has to be crossed is usually around how much does it cost per month and what's the interest rate that they're going to charge. So doctors that partner with outside financing, HFD and others to be able to get them qualified, that they can apply for that loan and get approved. And then can they keep the interest rates low? Because look, in the end, it's discretionary to some extent, and they want to look to see that they're not paying a lot of interest. And that's usually the differentiator that helps drive the conversion. So I would say out of the ones that you mentioned, interest rates would really help. If they were lower, would help with those potential patients making the decision of going to treatment.
Okay. And just maybe talk about how you're thinking about the trajectory for the clear alignment market, which has obviously been pressured in the U.S. What's your visibility into recovery as you move into the back half of the year and into 2026?
We're seeing in many markets. The unfortunate part is they get overwhelmed a bit by North America and some parts of Western Europe. You see many markets that are in their double-digit growth. You see Southeast Asia, even China, Eastern Europe, India, Turkey, LATAM, and so on. They're double digits. You're seeing that growth. Even within the more challenging markets of, say, Europe and Western Europe and North America, you're seeing our DSOs, the dental service organizations, whether on the ortho side or the GP side, that are practicing more of this active conversion. What I was just describing about financing and interest rates and so on, those organizations that are taking more of an active approach to try to drive traffic and drive conversion within those practices, they're growing very strong. They're on average double-digit.
It's just we want to get more and more doctors behaving that way. Some will go because they're doing more as part of DSOs, and they end up getting part of those larger groups. Some of it is we've got to go and make sure we're working with those doctors, give them the clinical confidence of able to use our products, and then help them drive as much active conversion as possible. Whether you're on the GP side, the GP side where you've got to be scanning every patient, making sure those doctors can show the options on what your teeth would look like being straightened, and more importantly, if they're going to do restorative work, how they can then get your teeth straightened first, then do the restorative. It helps save healthy dentition and is much better ultimately for the patients.
There's a lot of work around that, doctor by doctor, or even working with labs. I mean, we acquired exocad a number of years back, and they have a good relationship with labs, and if we can work with labs that provide all the restorative outcome for those patients that are coming through, let them know that they can help with maybe getting the teeth straightened first, then do the restorative. It helps save or active ways that we can work with orthos. Make sure they understand the products and give them the clinical confidence to be able to treat maybe more and more complicated cases, but then also reaching out to those potential patients or in the teen's case, their parents, to be able to say, "Look, this gives you you have alternatives.
You have Invisalign, which will be able to help treat your child faster." So, less appointments, faster treatment time, no emergencies, outcomes that they would expect and be able to have a favorable outcome, but making sure they understand the differences there. But so it's not one size fits all in terms of how you try to drive that conversion, but the main point is you have to be active about driving conversion, especially in this challenging market.
Okay. You've talked about financing. Have you seen more people access patient financing to pay for their treatment?
Yes, it is definitely. It varies by market, but that is how people pay, especially if some of these treatments, especially on the orthodontic side, they might be $6,000-$8,000. And when it comes to, especially on the adult side, it becomes discretionary. Do I get my teeth straightened or not? Sometimes the only way they can get things done is by that external financing. Keeping that interest rate low as possible, getting the approval rate higher for some of those potential patients. We work a lot with our doctors to try to enable that.
Okay, great. On the second quarter call, you also talked about a shift to braces from aligners. And I think you said that's driven in part by recent economic uncertainty, among other things. Maybe just talk about specific strategies that are being deployed to overcome uneven patient case conversion. And do you think this is a structural shift?
Look, I think when you have in certain markets that have maybe the challenges from an economic standpoint or uncertainty, as we described in the last call, you have some of those market impacts where that orthodontist, let's just say on the ortho, where they maybe don't have as many patients coming through. And the patients that they do have, they want to look at their overall profitability and say, "Look, I've got my office. I have my staff. I have my own time." In the short term, it's fixed. So when they look at ways to save, they'll look at things to reduce, and they'll look at our cost for Invisalign compared to wires and brackets, and there's a gap, whatever depends on the practice and what pricing that you're using. But it could be up to a $1,000 difference.
So those orthodontists, primarily orthodontists, make trade-offs where they'll say, "Look, I'm going to use wires and brackets, and I'll push that for the children." Look, it's ultimately they're providing the care. So it's their choice with the parent or the patient to make sure that they provide the care that they need. But we're letting people know or being as active as we can to let people know that there's alternatives. There are differences. And what we find is that even in our product portfolio, we have a lot of different options as well. If you went back five years ago, the majority of what we sold at the company, 75%+ of the cases were done with Comprehensive Unlimited. It's basically five years unlimited refinement. It's the most expensive product that we have.
What we're finding is doctors, especially orthos, are utilizing different choices or different options that they have in that product portfolio. So we've introduced products like three years of Comprehensive aligners with three refinements. That's now our biggest selling product that we ever had. Didn't exist two and a half years ago. So if you take that concept further and say, there's other parts of our portfolio, we could have a Comprehensive with no refinements, and that will be at a lower list price, but that gross margin rate is better than a Comprehensive Unlimited. Now you have to manage your gross profit dollars to reflect that, and that's some of the structural changes that we announced after Q2. But we're doing things to leverage the portfolio that we have and essentially selling the way our customers want to buy.
Sometimes our customers, those doctors, want to trade down for a product that has a lower acquisition cost initially, but they might have to come back to us in a year or six months later and do refinements to make, and then they'll pay for it. They kind of pay as you go to be able to finish the case. Many doctors want to operate that way. We're happy to do that. We're a company that has a wide variety of products to sell in the portfolio, and we'll make trade-offs with that. We have to manage our cost structure accordingly. Those, like I said, the gross margin rate for products like that is the highest that we have. When you think about the non-Comprehensive products that we have, they might be 75%-80% gross margin. You just get less dollars for them.
But if we manage the cost to serve down below in OpEx and so on, you can generate margin improvement.
Okay. Let's shift gears to capital equipment. Would love to hear your thoughts on the overall dental capital equipment environment more broadly. What are you hearing from your customers?
Customers like the new technology that we've brought with Lumina. It's a platform change, moves from confocal to a camera-based. It's smaller wand, faster, better use, and that doctors really like. They like the technology. You've got to have the right product to be able to sell products within the capital market. They're a bit challenged, doctors are, in terms of as they go through their capital cycle. Do they have the resources to be able to upgrade? Do they have the resources to trade in and be able to use our scanner? We're seeing more and more doctors do that. Many of them are making trades, though. They'll upgrade the wand. They don't necessarily upgrade the entire system or add a new system. I think that's a reflection of some of the capital markets.
Interest rates drive a lot of decisions that those doctors have. They'll say, "Well, scanner's good enough. I don't need to trade off, especially if I have to finance it." So there's some trade-offs that way. But we've been very pleased with our growth that we've seen with Lumina and rounding out that product portfolio. What we're seeing on the capital markets regarding that equipment is more of having that portfolio. We've got a premium product that we put out, but then there's several different products that we still sell that maybe are more affordable. Or we have certified pre-owned where we've got trade-ins of our scanners where they're just at a lower price because they're pre-owned. And many of our doctors still want to shift to that. So it's a wide variety. Some of it's around technology and you'll be able to sell that.
Things that we do to help our doctors, we'll do extended payment terms or other things to give them more time to pay things back and maybe help from that standpoint, but it really comes down to what the doctor's goal is, what they're facing from a constrained standpoint, and we have a product portfolio as well as financing capabilities to help them.
Okay. Just talking about the iTero growth and the ongoing Lumina rollout, I'm trying to figure out how we should think about that going forward, right? In Q2, we saw more upgrades than we did full system sales. And I think earlier in the conversation, you alluded to the fact that maybe we'll see more system purchases as we go throughout the year. Maybe just elaborate on that.
So a lot of doctors upgraded. They like the size and the benefit that the new one brings that I was describing. But we still have many systems that are older systems that we have Element 1s and Element 2s . We have thousands of them in the field where doctors just are used to them, and they're just kind of the workhorse that they have. It's up to us to get to those doctors and say, "Well, here's the benefits that Lumina brings." And we can do a lot of creative things to essentially get them into a new Lumina, even if they keep the old system, get them into a new system, and they can see the benefits for themselves. Because many practices, if they have one scanner, they would benefit by having two.
We know that we would benefit because if they have more scanners, the more scanners they have, the more Invisalign they do. We know there's a direct correlation there. We're just very attuned to what those customers want, what we can serve them with, with the various products that we have. We'll do as much as we can to help drive that.
Okay. And can you maybe talk about the upgrade cycle or some of the incentives offered to existing iTero users to transition to the Lumina platform?
I mean, some of it's trade-in. They get a trade-in benefit. So they give us their old scanner or a competitive scanner, trade them in, and then we'll get a credit essentially and price benefit for that. Some things we'll do with extended payments so that they have a little bit more time to pay. But there's a lot of different features that we have here that really can help. But in the end, we want to help doctors digitize. We want to give them the latest digital technology. We know we have a great scanner here. We're constantly investing in it to try to continue to upgrade and make it faster and better and more of an everyday scanner so that it's great for the orthodontic side of things, the teeth and kind of how it scans and so on.
But it also can serve as an everyday restorative scanner too. So they can use that to do the restorative work and other work that they do on a day-in and day-out basis.
Okay. And is there a difference in capital demand between DSO and non-DSO customers?
I think DSO customers, they want to surround the good ones. They want to surround their practices with digital technology, so having the latest scanner, we saw that with Heartland. They've essentially upgraded all their scanners to Lumina now. We see that with other big DSOs where they want to make sure that their doctors in the network are using the best technology to help drive digital orthodontics. Because in the end, they know, and that's why they're growing double-digit, quite honestly, because they know that the more Invisalign that they do, the more they can digitize their workflow, it's certainly productive, but it also drives profitability, so I think the DSOs, we'll call them kind of a force multiplier. They can really push this across their practices, and when you're not in a DSO, we have to work them one by one. It's the reality of our business.
The majority of our business is sold to individual practices, but we have to be able to show that they can grow, and even in this challenging market, like in North America, DSOs are growing much faster than the regular individual practices because of that digital orthodontic mindset that those DSOs have taken.
Okay. I want to touch on teen and kid case starts. Maybe just talk about sort of some of the trends you saw in the second quarter, how they performed across your three major regions, EMEA, APAC, and the Americas, and how should we think about teen growth in the back half of the year?
Teens, and we've seen in our results and just as a market opportunity should grow faster than adults. When we think about the orthodontic case starts every year, 20+ million orthodontic case starts every year, 75% of them are teen. So when we think of our growth and the opportunity, if you've got 75% of the cases that are teen in the orthodontic side, and from our standpoint, maybe on average across the globe, we're maybe 10%. So there's a huge opportunity where we have better and better products. We've been able to essentially really work with orthodontists to give them that clinical capability, reach out to potential patients, and let them understand the difference. The market opportunity is there. And whether it was prior to COVID, COVID, and post-COVID, teen has been growing faster. It's just varying degrees as to how much faster.
So the market opportunity is there. We've got to be able to reach those potential patients and make sure that the best technology is in their hands. Give them sometimes the product portfolio that I was talking about, where there might be products that don't have Comprehensive Unlimited, but it's a product that is still Comprehensive, but it's kind of pay-as-you-go type product that gets them into a better price point. Sometimes that's the sticking point. Sometimes it's just educating teens and parents to be able to make sure they understand the differences and ask for the product by name and ultimately go into treatment. We have a majority of patients that come in on the teen side, they want to use 70%-80% of the time that a teen and parent come in, they ask for Invisalign. Only one out of three times they get it.
And so that's the challenge that we have trying to drive that conversion.
The features and functionality in the Invisalign First product that allows us to treat kids as young as six, and then the introduction of IPE and now MA, OB, the mandibular advancement feature, those things differentiate pretty significantly. We see good interest in that.
Okay. Looking at 2026, any puts, takes, headwinds, tailwinds that you'd sort of call out at this point?
Well, not knowing what the economies are going to do, you seem pretty much say, "Okay, same as it is. We'll see if things change, if interest rates or inflation or whatever changes." So if you assume kind of stability there, it's products that we have with the mandibular advancement, with the occlusal blocks, IPE, other things where we're rolling out to other markets. We want to continue with that product portfolio to be able to help doctors treat more and more patients, giving them flexibility in terms of what types of products that they want to buy. Maybe they're more price sensitive and don't want to pay for everything upfront. They want to start with a product that is lower priced, but still can get the work done that they need.
But giving them that flexibility going forward, I think that's important, especially in this market, and educating potential patients and their parents in case of teens of alternatives. And then ultimately, the market decides what they're going to use, whether a doctor puts them into treatment using our technology or something else. But we believe that we have still a huge opportunity. It's an under-penetrated market. Vast majority of cases are double wires and brackets. We're the clear aligner. We're driving the clear aligner market. We know that we can continue to grow the clear aligner market. It's a technology that really lends itself to how we think of more effective ways to treat patients.
We just have to, because we work through a doctor, we've got to make sure doctors are properly positioned to be able to use our products and some of its products, some of its pricing, and so on, and then we have to make sure that potential patients understand the benefits, and we stick to that. That's kind of the reason why Direct Fab is so important for us. It doesn't help as much next year, but years after that, where you have ultimate design flexibility. That doctor can dial up however he or she wants to make those aligners, thicker in some places, thinner in some places, open if there's mixed dentition or whatever else. It's unique. No one else has that type of performance plastic to be able to move teeth in a predictable and reliable way, but again, it's with that mindset.
We want to arm doctors with the best products. We want to be the leader from a product standpoint and get that product portfolio positioned in a right way that they can choose the more expensive products if that's what they want, or the lower price products if that's what serves those doctors' needs. We have to do a good job as a company to be able to help promote that, and then also make sure we do a good job from a cost structure standpoint that if that's where the market is, we have to be properly positioned. If they go to that and the doctors choose those types of products, we think that drives additional volume and revenue.
Okay. Super helpful. How should we think about price in 2026?
I think you would see pricing when you look at on aggregate from an ASP standpoint, you will see doctors trade to products that are at a lower price. It's just they either go to products that are in the Comprehensive family, and they choose the Comprehensive that doesn't have as many refinements. And if it doesn't have as many refinements, it's a lower price. It's just the way our structure is set up. Our cost to serve is different. You see many doctors, especially on the GP side or others, they're just doing some of these touch-up cases. They're doing something where they need five or six or seven sets of aligners to treat some type of malocclusion, and they use that. And it's a lower list price product, and you see that in the marketplace.
Then I think you see some of the growth areas that we have that are growing faster than average. So places like India, Southeast Asia, Eastern Europe, Turkey, they're growing very fast. They're just at a lower list price product. So the reality is when you aggregate it all together, ASPs will, I would expect to be slightly down in the future just from a mix standpoint. But don't look at it as there's some pricing or promotion difference that we're creating to be able to help drive. We're going to be able to help drive volume and increase utilization by leveraging the breadth of our portfolio. Some of it's on the high-end, most Comprehensive cases, Direct Fab, and so on, and some of it's on the low-end, less refinements. But those are lower list price, but still good gross margin.
We just have to manage what that means from a gross profit standpoint.
Okay. That makes sense. On the Q2 call, you also said that despite the performance in the quarter, you're sticking by the future of the business and your long-range plan, which costs a 5%-15% top-line growth. Can you talk about how you feel about achieving your LRP targets given the current macroeconomic conditions?
The market opportunity is there. If you start to say, "Look, the overall market grows," it depends on the country and region, but say it grows low single digits, the overall market in orthodontics and dentistry. Then when we look at the market opportunity, the fact that especially in teen, it's a vastly under-penetrated market for us. The majority are done with wires and brackets. We're doing everything we can to grow the category. We think we have an opportunity to be able to grow in excess of the market just by the fact that there'll be less wires and brackets and more Invisalign, and we think that. Then you also grow within GPs. GPs don't revert to wires and brackets, but they have to make clear aligners and Invisalign part of their practice, straighten teeth before you do restorative, and that helps us grow.
Continuing to work with DSOs, I think that's a force multiplier for us. Those are growing double-digit. There's many markets that are growing double-digit. They just get overwhelmed by Western Europe and North America, but they're already growing double digits, even above the 5%-15% range. Like I said, they just sometimes get overshadowed by everything else. So we have the playbook to be able to drive that growth. Look, I'm looking at macro as it's kind of what it is right now. It's not a great macro, especially for a higher-priced discretionary product that people have to choose from without a lot of reimbursement. But all the actions I just stated are ways to help overcome that.
If the economies get better, I think it's a tailwind for us, and I think that that would help us and get back to the higher growth that we know we can do. But certainly from a market opportunity, given the fact the vast majority of cases are wires and brackets, we can grow the category and therefore grow our revenue.
Okay. 5%-15% revenue growth, it's a pretty wide range. Maybe just any color you can provide on how you see that growth rate playing out over the planning period and maybe just how to think about the margin ramp going forward of 26%-28%?
So that range, look, it's a reflection of kind of what the market is in terms of that growth. We used to have a range that was higher, but it was still a 10-point difference. So it's just that reflection of where things are at. Things that we can drive to be able to build off of the overall market growth and drive higher utilization, sell to more doctors, do all the things that we can do with our product and our portfolio, that's one way to drive that. Look, if the economies get better, you're maybe on the higher end of that range. So we just have to work our way through this in controlling what we can control.
And as we go forward, we'll be able to update in terms of, "Okay, what does that mean for this quarter or the year?" and so on, and we'll give further updates to that. In the same way on a margin standpoint, we want to be able to pull levers that we can to drive volume. Like we said, it's an under-penetrated market. We're going to lean into volume and revenue, but also want to do it in a profitable way. And so that's part of some of that cost and restructuring that we talked about, getting closer to our customers with some of the manufacturing that we have, utilizing the latest and greatest manufacturing capabilities so that even on the existing production, we're as profitable as we can, and we'll be smart about that.
We get some of the benefits from some of the VAT and other things that have now stabilized a bit. So there's things that we have from an overall productivity standpoint and profitability standpoint that, look, as you have volume, we get a leverage benefit as we have more volume coming through our plants. As we have, we make over a million aligners a day, unique aligners a day. The more that you can put through your facilities, utilize that equipment and the labor that you have there, the more profitable it will be. But it really starts from getting that volume growth.
Okay. You recently filed patent infringement lawsuits against Angelalign in the U.S., Europe, and China. What's the latest you can share on this and any key milestones we should be on the lookout for?
Look, we had press releases and we talked about what we felt was happening, and we think just given the patents that we have, the intellectual property that we have, that we spend hundreds of millions of dollars a year, several billion dollars over the last several years, and when a company is spending significantly less than that, and it's just very clear from the materials to the treatment planning and other things that you're using, you're using our technology that we've developed. And so I think the fact that it's in all these jurisdictions might tell you how serious it is in terms of everywhere they're essentially using our technology. And we'll let it play out in the courts and go through the process. But look, we encourage innovation. We encourage companies to innovate and really move the category forward.
All for that, it's got to be on a level playing field, and we see that.
Competition.
Right. Okay. I think we're at time. Thanks so much for being here.
Great. Thank you.
Thanks.