Welcome to 2021 Investor Day. Please welcome Shirley Stacy.
Okay. Good afternoon, everyone. Thank you for joining us. Appreciate all of you who are joining us here in Las Vegas. It's great to see people face to face. Welcome everyone online. Just a couple of housekeeping items before we get started today. There we go. Welcome. A couple of quick reminders. The presentation's being live streamed today. It's available on the investor relations site of our website. Please, refer to our presentation materials. If you have questions, for those of you online, you can submit those via the chat, and we'll get to those questions in the Q&A session at the end of today's meeting.
Presentation soft copies will be posted on our website, approximately 48 hours in the next, you know, day or two, once we pull this all together and get it posted online, along with the meeting recording and the Q&A from today's Q&A session. For those of you looking for follow-up information, it'll be available. Do you want me to switch? One minute, please.
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Okay. This is probably the most important slide for those of you in the audience. Here is the Wi-Fi network and the password. I'll leave it here for just another second so you can see it. Everybody took a quick screenshot of it? Okay. Quick reminder, we will likely have some forward-looking statements. I refer you to our disclosures in our 10-Qs and 10-Ks, and the company expressly assumes no obligation to update any forward-looking statements. We also have a non-GAAP financial measure in our presentation today. Please refer to the reconciliation for the non-GAAP in our slide presentation, which will be posted on our website. We have a terrific agenda for you.
We're really excited to have the opportunity to speak to you directly about our strategy, our vision, the Align Digital Platform, and how that enables better experiences for our doctors and consumers and patients alike. I'm not gonna go through the detail here of the agenda. We've got a couple of breaks for those of you here in the room. We're gonna try to be really efficient with time because we've got a lot to cover, and we really wanna have the opportunity to allow you to have questions at the end of the session. Without further ado, I'd like to turn the meeting over to Align President and CEO Joe Hogan.
Thanks, Shirley. Thanks for all the applause. I appreciate it. It's great. Hey, thanks for coming and making the trip. We really appreciate it. Look, I'm excited about the program we have to show you today. Obviously excited about the business. You come at the right time too with the GP Summit going on and the chance to rub shoulders with you know, with customers, with doctors, and kind of fact check what we tell you, what the doctors say too. I think it's a rare opportunity. Look, making clear aligner treatment available for everyone through doctors, there's three things when you go through these presentations today I want you to focus on, 'cause if you don't focus on those, you really will never understand the company to the depth of what it is.
First of all is the breadth and depth of our technology. We've been at this for 24 years. We've done 11 million patients. It's all based on digital. We have all that data. We mine it all the time. We understand it. We use that to extend the product line. It is a competitive position that's incredibly strong that we use and leverage really well throughout the business, and it's just I hope you can get appreciation for that through the day. Number two is the power of the brand. We have an incredible brand in Invisalign. You could see some of the materials that were flashed up before you came in, that 60% of patients that see an Invisalign simulator in the chair of a dentist or an orthodontist go ahead with the treatment. It's amazing.
People come in and ask for Invisalign. They know it. There's a real important part of that. It's counterintuitive that plastics can move teeth. You know, we all grew up thinking only metal can move teeth, only metal's strong enough to move teeth. Just having it reinforced that plastic is better than metal, it's just such a better kind of a system to do that, and educating consumers about that is what we've taken responsibility for for a quarter of a century. It's really important that we keep doing that, and it builds the brand, and it helps to generate demand for our product. Last, and I'm telling you most importantly, is the size of this marketplace. It's huge. I think. Look, you're analysts. You go about it. You go about the competitive forces. You look at things.
You're always thinking about, and we're all trained to do that. Here's the pie. We have competition. How's the pie gonna respond to that competition? The pie here is almost undefinable. So just this. I show you this data in a minute. These are orthodontic case starts a year. We've raised it to 21 million because we've expanded internationally across the world. We're now at what I'd say our saturation point in the sense of being exposed to 21 million orthodontic cases that go around the world. So that orthodontic piece, remember 80% teens, relatively wealthy people and their children getting orthodontic treatment. What's changed that was wires and brackets, an arcane kind of an analog process, only could be done by orthodontists. It was very limited treatment for a period of time. We've blown the doors off of that with digital.
It's opened a whole marketplace, and everybody wants straight teeth. You break it down, 75% teens, 5% adults. Our ratio is almost reversed of that, right? 75% adults and teens. When we talk about orthodontic utilization, our teen progress is really important in those changes. We are asked often how big the iTero market is. There's 2 million dentists and orthodontists out there. 2 million. We have a 50,000 unit installed base. Let's just round that up and say competition has another 150,000. We're guessing, right? There's 200,000 units out there. Let's just say that each one of these practices needs two scanners. The market's huge. It's less than 5% penetration. The digital technology and intraoral scanners keeps getting better, so which drives the installed base, churns the install base, creates more opportunity.
As we mentioned at the earnings announcement the other day, there's a 30% service level that's part of our iTero scanner base that keeps replenishing itself. Here's that market size I was talking about. 21 million orthodontic case starts a year. Remember, 75%-80% of those are teens. 500 million people that have a malocclusion, they could afford to have it addressed. Could never do this with analog. It's just analog is too confined, it's too specialized, it's too everything, as you can guess. When we came up with digital orthodontics, we expanded the number of malocclusions we can do. 90% of almost all cases we can do today, and it's not a problem. We have history in doing it. We can tackle just about everything. It opens up this market, and it's huge.
To really understand Align, you have to believe this. Less than 10% share of the orthodontic case starts. Let's just say equivalent to 10%. That's it. Superior technology, easier to use, faster, better outcomes. Eat what you want, live your life. Aesthetics are there. You can't see the bra. It's just. You can't name. There's still not one thing with wires and brackets that you could say is better than Align, except you know they're on the teeth. You know the compliance piece. That's it. There's not nothing else in their column to say they're better in any way. Now, that's just the orthodontic case starts. It's just incredibly under-penetrated in that marketplace. Okay. For five years, six years, these have been our strategic imperatives. International expansion, patient demand and conversion, orthodontic utilization, GPs. It's a great thing it's a GP Summit.
Now, we've come a long way. I'll go backwards on this. We've come a long way to GPs since 2015 when I first started. I gave a talk this morning and said I'd been in the job about three weeks, and the GP Summit occurred, and I had to come down and talk and, you know, it was different back then. We were still trying to turn GPs into orthodontists. We weren't necessarily working within the workflow of a GP, that restorative workflow that's really the cash generation when they have that business. Today, we're so relevant with the exocad acquisition, with iTero being such a great intraoral scanner and a great restorative scanner.
Us with products like, you know, Invisalign Go, and making it more simple through some of the new technology we have, like IPL, that makes these cases easier, and they fit into the workflow slots and give GPs confidence. I can't tell you how much better it feels here in 2021 than it did in 2016 when I was here for the first one. When we talk about orthodontic utilization, that's not an adult kind of a focus. That's a teen focus. Orthodontists hold on to their teens. It used to be they didn't have the clinical confidence to do teens. Today, it's about they don't have the business confidence to do teens. They think they can't make as much money. They can't make the margin accretion. That's why we have ADAPT programs.
That's why we put those programs in place to convince doctors and help doctors really get over that piece. You know, we're having, I think, good success in each region on ADAPT. Patient demand and conversion, meaning making patients aware, getting their interest, moving them to our concierge service or moving them into DocLock, and then moving it into doctors specifically that we know will give them Invisalign. We just don't want them to get the old wires and brackets head fake as they go into that, and we've gotten much better on the conversion piece of the demand generation over the last three years or so. Raj has helped a lot in that. Last thing is international expansion. Look, international expansion has been incredible for us. It's really helped to change the business.
You know, it's much more balanced now in the sense of not just being reliant on the United States. Europe has grown. The regional leaders will come up here and talk about it. You see that we wanna sell to customers and be as close to them as we can. That's why we have our manufacturing operations and treat operations in China. We're building in Poland right now. You know, Jen will talk too about our treatment planning and how we move our treatment planning as close to customers as we can, so it's very international now. We wanna be close to customers. We wanna respond to them.
I've learned that it's just you wanna be local as much as you can when you have a global business, and you want that locality to have the flexibility to adapt to the cultures that are out there. Relentless focus and execution around our strategic priorities. We meet 12 times a year as an EMC. We understand what our AOPs are. We know what our numbers are. We track them rigorously. There's great execution and accountability in this business that we live by. Look, this chart's really interesting, and you can read it, but let me just summarize it for you as much as I can.
Between 1997 and 2012, I would say we were learning the physics of moving teeth. If you look at what was going on, and Shree will talk to you today, we were really learning force systems, mechanics, attachments, power ridges, what kind of plastics work. ClinCheck is in there, but you don't see it being predominant. It was just a functional program. It wasn't in the cloud. It worked, but we were really churning through the physics of how you move teeth. It takes a long time. It's really complicated. Shree will talk to you about it. I remember back when we had our meeting in New York City, you know, for Investor Day, and we talked about when competition would come in, they're gonna be hanging around this 1997 to 2007 range.
Remember our CAD/CAM patents burned off in the fourth quarter of 2017. Our demise of competition has been overestimated unbelievably, right? I can tell you, in all those years, four years, John and I, and the regions have never reacted one time to a competitive aligner price at any situation anywhere in the world. Not once. If our ASP's moving, it's only 'cause we're trying to move more wires and brackets into Invisalign. It's not responding. We have such a competitive advantage in the breadth and depth of our technology. If you look from 2016 to 2023, you can see that we're really refining those physics with SmartTrack, SmartForce, SmartStage, Bite Ramps, Mandibular. You start to see, like, G-Series come in. You start to see Invisalign Outcome Simulator. You start to see software becoming more and more important in the portfolio.
Start to look at 2017 to 2022. Software becomes front and center. We really start to put a lot of time and energy into making it simpler, more predictable. We start to segment it being GP software, scan for Invisalign Go, have that treatment plan done when you scan, and ship it on. We continue to put more and more money into that range. In building a digital platform, it is expensive, it takes time, but the team's made tremendous progress on that. Along the way, like iTero 5D, I think you saw the announcement of the near-infrared scanning and seeing caries or cavities detection at a specificity level that's much higher than what you have with X-ray. That's a big deal.
Remember, that's above the gum line, but that's a huge deal, and that's a killer app in a scanner application that obviously dentists are gonna take a look at 'cause it helps their revenue line in a big way. Invisalign First was kind of the final dimension of that dynamic in the sense of, you know, of the physics and how you take young children really and morphologically change their bite without wires and brackets, without something to turn, you know, like a rapid palatal expander. Smile Architect we announced today. Virtual Care. Look, my Invisalign app. I can go through it, but you can see the rise of software that takes care of that physics and really backs up that physics that took us 20 years to really refine and understand.
What we announced the other day at the earnings announcement, you start to see things like professional whitening, right? You start to see us focus on retainers. These are just natural brand extensions where there's an entitlement for us to go after. I don't want anyone here to think that we need that revenue to meet the 20%-30% growth rates. That's not why we're doing that. That's an entitlement based on our brand, based on we know that we should be leveraging, and you'll see us leveraging that more. You're gonna see a lot on the Align Digital Platform. It starts with iTero, Invisalign, and exocad is supporting it. Walk through that whole phase treatment. You connect, you scan, you plan, you treat, you monitor, you retain. Look at the doctors, consumers, and dental labs.
Now, other people are gonna walk you through the specificity of this, but each one of these things are extensions and branches of this digital platform that have to have an interconnect and a constant flow of information across those boundaries to be part of a platform and not just to be discrete information that's on an island somewhere, that you can't leverage it or hurts the workflow of ortho or a GP. This is. You cannot just be in the clear aligner business. You get killed here. You have to have this kind of a system because this is about workflow. This is about predictability. This is about confidence. If you're a doctor, saying, "Hey, I have a plastic aligner, and it's half the price of Align," you know, you might get a few people open the door.
After they use it a few times, I question it, and that's what we've seen for the last four years too. 1,000 , you know, patents. Right now we say 800,000 aligners a day. There has never been a company that has mass-produced, from a customization standpoint, more parts in one day. Remember when we started with 3D printing, and Emory's in the room here, Emory Wright, who's been with us all along, is that it was all. It's a prototyping business. They didn't know how to do full-scale production. We had to figure that out. Years of people trying to figure out how you make 800,000 parts a day. This whole page is about scale. When you think, if you go to Amazon, if you talk to really digitally based companies, they always talk about scale. Scale, scale.
It's hard to scale in this business. 50,000 iTero scanners. Look at. You know, when you think about 100,000 Invisalign-trained doctors, right? 100 million iTero scans. 100 million. It's really an incredible amount of scale that we've built, that we have to keep investing in to keep this up, but we do know how to scale. Our integrated operations and international expansion as being a strategic imperative. I don't need to go through this, but we really have become more localized in our production, our treatment planning, how we go to market, how we deploy our sales force. You know, I'd be remiss not to tell you that our sales force is one of our most important assets. 'Cause you just can't knock on a door. You have to be well-trained.
You have to understand who you're talking to, whether it's a GP, an ortho, what's important to those specific segments, critical. It's just critical that we hire great salespeople, we train them, and we retain them. It's an incredible asset for the company. You know, I just like this slide aesthetically. This is what the software's come to. Just imagine, this is a doctor sitting somewhere in Hawaii just doing a treatment plan. They're gonna take that treatment plan, gonna superimpose it on that lady's mouth, inside her mouth, automatically from a 3D standpoint, and she can see exactly what she's gonna look like after the treatment. He can just send that thing from Hawaii to New Jersey, and, "Hey, are you in or not?" Right? I guarantee you she's in. That's where the software has come. It's been that flexible.
You can do it on your iPhone if you wanna do it now. Shree and the team have done a terrific job of putting you in that position and giving us that flexibility. Customer experience. I'm gonna come up and talk about customer experience, but we, you know, we had a lot of work to do about four years ago, and we have invested significantly. We track it based on our NPS score. We're making, you know, great progress in this way. It's critical that we don't have an analog process to service our customers, but we digitize it as much as we can too. This year as a culmination of a lot of work, we'll be able to do that much better. Brand. It's what I opened with. Understand the brand.
It drives confidence, it drives recognition, it drives interest overall. We have experts that know how to do this. We're spending about, like we've mentioned, about $250 million a year advertising all over the world. We understand our returns. We know our returns by country. We understand our returns by channel. It's really that sophisticated. There's no one in this industry that can really touch us in the sense of what we know and what we spend. Look, you know, smiles are so important today, right? Everybody, you know, you're on Zoom, you know, with the social media, passing pictures. You know, it's, you know.
I was thinking about this one night I was going home and just thinking about, you know, the whole phenomenon of people with white teeth, and I thought there was a lady. Ever hear of Wallis Simpson? Right? Duchess of Windsor back in the 30s. She said, "You're never too rich and never too thin." Our comment on the line is your teeth are never too straight or never too white. It's an arms race out there, right? I saw in one of the dental presentations today, there was a picture of a woman who wanted her teeth straightened, and you stare at it and you say, "Why?" Right? Why? Just because there was one little space on her lateral that she wanted filled in. It's amazing. It really is an arms race.
You see people drinking through straws, coffee, so they don't stain their teeth. It's just a phenomena of our age. We have 80-year-old people be doing Invisalign. 80 years old. Everybody cares. It's really a phenomena, and it's something we've really, I think, ignited because of digital orthodontics and what we can do, and it makes it possible for a lot of people that couldn't consider it before. That's my story, and I'm sticking to it. Zelko's coming up here, and he's gonna tell you much more and much more articulately about ortho restorative and what we can do. Zelko.
Hello. Good to see you all. I'm talking about discovering the Align Digital Platform, which is a little bit ironic since we've been developing this platform for the last 24 years. We've been meeting year after year, and we always talk about the long history of innovation. I don't say that over and over again to brag about it. I say that for you to understand how much it takes to build a system like Invisalign. As Joe said, from figuring out how to move teeth with plastic to building a platform. On the iTero scanner side, the same thing. Accuracy, speed, being able to see more like NIRI. That's what it takes to have a platform that can deliver everything that a doctor needs to create best clinical outcomes. Of course, we acquired exocad last year, all digital.
The best company for digital CAD/CAM. We've invested so much because this is fundamental to who we are, and we continue to invest. We're gonna probably spend around $ 250 million just this year on technology. This is what it takes to build a platform that is the future of dentistry. Of course, our investments in technology have supported our growth. You guys know that more than anybody else. Our penetration is still only 10%, 10% of the 21 million orthodontic case starts. Now, where I think, and I think, you know, what else can we do? We're gonna do everything we can to accelerate the adoption of clear aligner therapy. We always say we're gonna make clear aligner therapy standard of care in orthodontists. I don't think I have to say that anymore. It's obvious.
It's just a matter of time how fast that happens. The same way you can talk about electric cars. They are the standard in automotive industry. Same thing with clear aligners. We're gonna treat patients of all ages and all indications, and we're gonna ramp up that percentage. The true opportunity for us goes far beyond 21 million. We know that three out of four people, 75% of people, would need or benefit from an orthodontic treatment. The problem is that they don't know it, and the problem is that even their doctors don't explain it to them.
We wanna make sure that we make this treatment available to everybody by building the best orthodontic system and by connecting them with doctors trained to provide the best. Going from making clear aligner therapy a standard of care in orthodontics, we are going to making orthodontics the standard of care in dentistry. I want you to understand what it means. It means that today, too many people are not getting the care that they need and they deserve. Without ortho, most of the dental treatments will not deliver the best outcomes. Most of the issues, chipped teeth, broken teeth, come from malocclusion. When you have restorative procedures, you're fixing the consequences, you're not fixing the root cause. Our job is to make sure that orthodontics is not something else. It's part of everyday work for every single dental professional.
Interdisciplinary dental treatments are the future. I'm gonna show you a case. Actually, I'm gonna show you two cases, so you have to watch and see some teeth. This is the doctor I used last time I presented her case, Kamila Morrison. Five years out of school. She's about 30 years old. She talks about top-quality and ethical dental services. Again, ethical means do the best job with minimum harm. Minimum invasive restorations. Preserve the tooth mass. When they do your crown, they grind your teeth so they can fit it on. You don't want that. Here is her case. The lady comes, she's about to get married. It was last year, and she says, "There's gonna be a lot of photos. I don't like this chip on my central. Can you fix it?" That was last year.
Of course, Millie can fix it, but Millie also knows why she has that chipped tooth. The issue is a very severe malocclusion. It's called crossbite. You can see how her teeth are crossing each other, and you have these unwanted contacts that are wearing out teeth. A good example is the central, but you can see it also on the side. Millie knows she can fix the chipped tooth, but it's gonna go away pretty soon because you have this hammer. She talks to the patient and convinces her, because it was pandemic, they delay their wedding to do the right thing, to do the ortho restorative treatment. Look at this. Invisalign Go with 11 stages. 11. Take a look at the videos, how nicely she's shaping the arch and fixing the crossbite. This is the outcome.
The patient still has the attachments at the very end of the treatment. You can see her bite is nice. There is no area where this tooth will be hitting the lower teeth and getting chipped more and more. Now she can do the restoration. Again, 11 stages, 11 weeks. I think maybe she did additional aligners. I think she said five or six. Very, very short treatment. Fundamental to getting the right outcome. What she did is edge composite. She did not touch her teeth. No tooth mass removal. Nothing. Zero. She just added the material. She was able to do that because she moved her teeth in the right place. She got the stable and functional bite, good aesthetic outcome, minimally invasive. What she says is ethical. If you look at her teeth, she's probably around 30 years old.
She has pretty healthy teeth. She's one of the three out of four people that truly needs and has to get this type of treatment. If she didn't get her crossbite fixed, she would have more and more problems with wearing out her teeth. Look at this. Ortho restorative. Very fast tooth movement. Of course, you can do it with Invisalign. Good luck doing that with braces. Minimally invasive. Actually, non-invasive restoration. Beautiful. One more and I'll speed up. Doctor from Finland. He say, "Deliver the job maximally with minimal invasion into healthy tissue." In the future, that's gonna be a prerequisite. Every dentist will say, "How do I do my restoration without causing any damage to the tooth?" The only way you can do that is to move teeth. With Invisalign, individual tooth control, you can get exactly the outcome that you need.
Hannu gets the patient, also young lady. She's got these little peg laterals. She wants more beautiful smile. Of course, he goes on doing Invisalign treatment, align her arches, and create enough space for those peg laterals to get a veneer on top of it. This was after Invisalign treatment. Again, I need to say again and again, you need to have the appliance that delivers what the doctor prescribes. Invisalign is a medicine, so the doctor prescribed that or this and got this. This is about clinical confidence and predictability because what doctor prescribed, Invisalign system delivered. Now he can go and do the rest. This is align teeth, veneers, and he put some edge composites on one of the centrals. Beautiful smile.
You have two patients that have healthy teeth. Minor aesthetic needs, but actually a real need to get their teeth aligned. This is what I mean by making orthodontics the standard of care in dentistry, that every single patient that comes to a dental practice will get the analysis that will show I need to align teeth before I do anything else. I need to fix the root cause before it gets worse and worse and worse. It's about interdisciplinary dentistry. It's about bringing all of the solutions into one platform. With Invisalign, iTero and exocad, we have all the building blocks to give the tools in a platform into the hands of doctors so they can deliver superior patient outcomes. I will repeat, I'm not a clinician. Without ortho, you're not getting good clinical outcomes in most restorative cases.
The platform is to bring all of the key stakeholders together. Number one, doctors with their patients or consumers, with the labs that they work with, supported by Invisalign, bringing everything into seamlessly connected end-to-end workflow, from connected consumers through to their doctors, to keeping the retention out of the treatment. Interdisciplinary ortho-restorative treatment, the future of dentistry, future of dental digital dentistry. My colleagues will explain a little bit more about the detail about what we are doing. Shree, please come.
Thank you, Zelko. For the next few minutes, I'm gonna walk through some of the digital products and services like the My Invisalign app, Live Update, Virtual Care, Smile Architect, that are all available on the platform for consumers, patients and doctors, and are accessible from anywhere, whether you're in the car, or in your home, in your office, on the go, from anywhere in the world. All of these products are built with data and AI. They're personalized to the customer, and they deliver the entire end-to-end value chain for our customers. This is a strong competitive differentiator for us that is very unique and no one else has it. Consumers today are looking for very easy online experiences that are personalized to them, and also with the ability to take immediate action.
If you are standing in the Starbucks line downstairs, you know, the lines are long, you know, you're looking at your Instagram page, you get an Invisalign ad, you click on it, you go to invisalign.com, you learn why it's the best product out there, and the line still has not moved. You decide to download the My Invisalign app, you know, take a few selfies, run SmileView. You visualize what your smile could look like, and now you really want it. You connect with your doctor back home, schedule an appointment, and while the line is still moving, you're checking out your insurance and fill out a few lines. You get your patient financing options. You select the option you like, and you're presented with a virtual credit card that you can use immediately to start your Invisalign treatment.
By the time you get your coffee, you have already connected with your doctor, you're ready to discuss treatment options and get started with Invisalign right away. When you become a patient, the journey continues on the My Invisalign app. You know, after a few days, after visiting the doctor, you're sitting in the subway, you're trying to get to work, you know, you're wondering why what you're doing in this morning meeting, and then you get a notification on the app saying the doctor has shared their ClinCheck with you. You love the treatment plan. You're so excited about it. You rush to work, you get to the meeting, and you share with all your colleagues what your smile could look like. Now they're all excited. You go, refer your patients, connect them to your doctor, and you get a $50 gift card.
You go to the e-commerce store, you know, looking for merchandise, and if you actually went today, you can buy some Halloween stickables, and tomorrow you could have your Invisalign spooky smile. That is the power of the platform. Everyone has apps. Middle school kids build apps. But what's different is the integrated seamless experiences, the ability for the doctors to share ClinChecks, you know, the better retention options, payment options for the patients, you know, checking your aligner wear on your app and your phone looks very seamless. All of these integrated experiences that are personalized, that are actionable, is what makes our platform really powerful. Our app works in 60 countries, 24 different languages, 1.2 million downloads, 4.7 rating on the App Store.
Those are some tough metrics, we know that when we release a feature that the patients don't like, our ratings go down. The marketing and the technology expertise and the agility to be able to experiment and take that feedback and release makes the platform and the app so much more better. This end-to-end consumer-to-patient journey and the digitization of all the touch points with invisalign.com, the My Invisalign app, it is very unique to us and it's a huge differentiation from a competitive standpoint on the Align Digital Platform. Moving on to doctor experiences. We are reimagining what the doctor's treatment planning experience looks like. We want to revolutionize what they've experienced so far and what the future can bring about.
We have made great progress using AI for auto segmentation of the iTero scans, and we are codifying the doctor's preferences with our proprietary Invisalign protocol language, IPL. We're also improving the automation to final position and staging movements. All of this AI and automation means that the ClinCheck that takes today days will actually be available in minutes, and we will get consistent quality initial ClinChecks. Doctors can then use three controls and the live update feature to make modifications and view their treatment plan real-time. I just wanna show a video of how simple this is to use. You see the initial setup. You can get the three controls. They drag and drop the controls. This is all working in the cloud.
It has the desktop feel like it's running right in front of you, but all of these are powerful millions of lines of computations that are running in the cloud, auto-resolving the conflicts. You click Live Update, you see the new treatment plan. There are features where you can compare the initial treatment plan to the updated treatment plan. You like what you see, and you can approve the ClinCheck, and it's over. If you don't like it, then you can discard it and start all over again. What we just saw takes several days today, back and forth between the doctor and the CAD designer, and we have simplified it with AI and automation to just doing it in a few minutes. It's a huge productivity win for our doctors.
The concept of treatment planning has always been with us, you know, for the last 20 years. What has actually happened in the last few years is the technology advancements around the scan quality from the iTero scanner and the AI models to be able to segment the teeth from those scans have gotten so much better. We have figured out a way to automate all of the individualized treatment preferences, which are like infinite degrees of freedom from a doctor's perspective. The elasticity of the cloud computing to be able to deliver performances real-time at the scale that we just saw, which is almost like it's unbelievable that there are transactions that are going to the cloud and coming back. It feels like you are looking at the tool, the usability of it on the desktop right in front of you.
Along with the generated treatment plan being manufacturable with quality, all of this technology expertise and depth is needed to make what you just saw look simple, which is just dragging and dropping a few controls and running live update and getting in a minute. This is what it takes. With all of this AI and automation, we're putting the power in the hands of the doctors to create the treatment plan, to modify the treatment plan, and decide, look at the changes real-time and decide what option works best for the patients. We heard a lot about virtual care this morning, in the doctor's panel about how important this tool was, especially the last two years. We are continuously improving the quality of the images. We have an AI photo buddy with voice guidance that helps the patients take good quality pictures.
You know, reduces blurs, better lighting, good different angles. With all of these good quality images, the AI models are so much more better. Now we can detect attachments. You know, we can look at a line of fit. We can look at progress tracking towards ClinCheck. We can look at restorative diagnostics. I mean, the possibilities of what this image data along with AI models can deliver, that help the doctors deliver great experiences for the patients and also, help them with practice scalability because they can now decide, you know, which patients they want to bring in, which patients they can, work with remotely. It helps them immensely, and all of these tools are available in the Align Digital Platform. The next one is Smile Architect.
It's exciting about how we are leveraging four powerful platforms, which is the practice app to do digital records transfers, iTero scanner to get iTero scans, and use both the dental records and the facial records to set up a treatment plan. Using the same ClinCheck software with reusable services that looks at facial landmarks. You know, you get realistic face rendering with in-face visualization. We have developed a tooth mask tool that gives us analysis about minimally invasive treatment plans that preserve the healthy natural tooth structure, and exocad to talk to labs. All of these solutions come together to deliver an automated, facially driven ortho-restorative treatment plan. Let's take a look at how the whole solution comes together.
You know, Zelko talked about making orthodontics part of comprehensive dentistry, and this is a solution that enables it, and we are very excited about the possibilities. You know, the example that Zelko gave with Dr. Morrison now can be done by all the doctors using the Smile Architect solution. You can see how efficient it is to just drag and drop the controls. You know, how much technology has gone into it for the computations to get the facial smile lines and to be able to deliver and plan and sell Invisalign as part of a comprehensive treatment plan, all using the same tool sets that everybody is already used to, like the Practice App and ClinCheck and exocad and the iTero scanner all coming together to build a great Smile Architect solution.
Joe talked about scale a few minutes ago, and one of the big competitive differentiators we have is our world-class infrastructure that supports the kind of scale that we need. You know, connecting millions of leads to doctors, processing hundreds of thousands of orders from over 120 countries, uploading millions of iTero scans, manufacturing 800,000 aligners a day. Running all of the AI computations and automation that you just saw real-time, 24/7, delivering desktop kind of performance globally is something that needs a lot of technology expertise. We have thousands of passionate engineers with interdisciplinary skills, you know, from biomechanics, data science, computational algorithm, software, hardware, cloud, manufacturing, engineering, all of them working really hard to put together solutions on the platform.
We have also adopted agile engineering practices, so we get continuous feedback from doctors, you know, lend itself to continuous delivery. All of these continuous improvement cycles make the platform so much more better. With all of the infrastructure and the products and the services, you know, we're actually really excited about the future for our doctors and our patients to get personalized experiences and a great clinical outcomes. Thank you, all. With that, I'm gonna hand over to Till, who's gonna talk about the power of exocad platform for doctors and labs. Thank you.
Thank you, Shree. Since this is the first time I'm here, let me first introduce myself. I'm Till. I'm one of the founders of exocad and CEO. Before founding exocad, I used to work at the Fraunhofer Institute for Computer Graphics Research as a research associate, and they are already working on dental CAD related projects. I have around 15 years of experience in the industry. What is exocad? exocad is a leading provider of CAD/CAM software for digital dentistry. What does that mean? I'll give you a simple example. You go to the doctor because you need a crown. Well, chances are pretty high that the shape of that crown will be designed in our software. The same way if you need an implant, the precise location of the implant can be planned in our software as well.
We have dedicated products for both dental labs and clinicians. The software is only sold via manufacturer and distributor. The typical setup is that a manufacturer would bundle the software with, for example, a desktop scanner, intraoral scanner or a milling machine. exocad was founded over 11 years ago, so we have well over a decade of a solid track record of sustained innovation. The headquarters is in Darmstadt, around 20 minutes from the Frankfurt Airport, and we have five offices worldwide and users in over 150 countries. Really, very good coverage with over 45,000 installations worldwide. Mostly in labs, but the install base in clinics is growing as well. For people who are not dental professionals, it's often surprising what complexity there is with regard to the different types of restorations and appliances in restorative dentistry.
It's really much more than just crown bridge. There's implant-based restorations, there's removables, so full dentures, partial dentures, there's guided surgery, design of drill guides. Really it's a plethora of different applications and modules that we provide for these different applications. It's not just the design, but we also connect the software through software solutions to manufacturing equipment such as milling machines, 3D printers, and of course, on the input side, to scanners of various kinds, including CBCT machines. We bring a lot to the Align Digital Platform, and I'm very excited about that specifically because this enables more holistic treatments, specifically talking about ortho-restorative treatments. The vision is really that every dental technician and every dentist planning a restorative treatment will ask himself or herself first, would that patient benefit from orthodontic treatment first?
Very often the answer will be yes. This leads to less invasive treatments. It can lead to better aesthetic outcomes. It can ultimately be clinically better. Zelko Relic earlier talked about the importance of explaining to patients, well, the message will preserve more of your tooth mass, will keep more of your natural body. That's really a message that's very easy to explain to a patient. Let me show you. This is a young lady from Brazil who is missing a left lateral incisor. Genetically, it was never there, and on the other side, the right lateral incisor is too small. So we're placing an implant, putting a crown on top of the implant, and on the other side we'll apply veneer. So we start with the ClinCheck.
You can see that there's actually a canine where the lateral incisor should be, and we move over the canine to create space for the crown as opposed to grinding it down to make it look like an incisor. That's the result after the orthodontic treatment. Let's have a closer look. Next, we proceed with the restorative planning. For that, we use exocad Smile Creator with in-phase visualization as well. We have all the helpful aligns that the dental professionals working with the software appreciate. We can get a realistic preview. On the left, you see here the preview. That is the visualization in the exocad software, how the restorative outcome will look. We don't just plan the aesthetics.
We also plan the implant placement, bringing together data from various sources, from a cone-beam CT machine, and of course, an intraoral scanner. What we do here, as you can see on the top right, is so-called backward planning. We start from the desired restorative outcome, and then we plan the placement of the implant in a way that this outcome can be achieved. It's not easy here. If you look how close this implant is to the roots of the adjacent teeth, that is not easy. Thanks to precise guided surgery, we can achieve such results. We design the drill guide, again, in our software, you can see it on the bottom right, and we can even design and even produce the restorations before the surgery. We can produce the final veneer already here.
We use a ceramic material and for the crown on top of the implant, we 3D print a temporary. This is the so-called immediate load case. The crown will be placed on the implant right after the surgery. We place the implant with the drill guide we've previously designed and 3D printed as well, and we place the restorations, the crown and the final veneer. This is the result with the temporary. I would assume most of you would not have realized that this is a temporary. Already with the temporary, we get such a good aesthetic result, minimally invasive. This is really what I am so excited about. This is why I'm excited that exocad is part of Align, because we bring together these key technologies in digital dentistry ultimately to allow better patient outcomes and better dentistry.
With that, I would like to pass the word to Yuval, who is not joining us physically here, but by video. Thank you.
Thank you, Till, and hello everyone. I'm Yuval Shaked, and I'm excited to have the opportunity to speak with you today about our iTero business. Unfortunately, I cannot be there in person, but I look forward to connecting with you next time. As you have just heard, the Align Digital Platform provides end-to-end digital workflows, enabling seamless treatment experiences. As I said before, the iTero scanner is the gateway to our platform. One of the key indicators for the adoption of Align's digital platform is the number of scans performed with iTero. We continue to see acceleration of digital with the number of scans performed growing significantly year over year. As of Q3, we have more than 44 million orthodontic scans and more than 9 million restorative scans performed with iTero.
This means more doctors are increasing their use of iTero scanners and are seeing the benefits of our digital technology. Which creates more demand for scanners and also helps drive further adoption of Invisalign treatment. Our vision continues to be giving doctors more reasons to scan every patient at every visit and to have an iTero scanner at every dental chair. While we have experienced strong growth, we still see huge opportunity to expand and grow. Today, when we look at the total available market for intraoral scanners, we see about 4 million dental chairs and less than 10% of those chairs have intraoral scanner. We continue to see strong growth in our business with great results year-to-date. This growth is fueled by the unique technology we bring to the market.
With our i5 products, we offer the most comprehensive scan and workflows for Invisalign treatment, and now with the NIRI technology and the integration with exocad, we are stronger than ever also for restorative workflows. Since we last talked, we have introduced a lot of innovation, both hardware and software, and we are delivering more value to our customers and their patients. Innovation is core to our growth strategy. We are committed to continue to innovate across these three pillars. The first is data acquisition. We are going to continue to leverage our AI capabilities to improve the scan experience and gather more data with one scan. Second is communication and decision support tools. We know that visualization capabilities are a key enabler for doctors to monitor and communicate with patients and drive increased treatment acceptance. The third pillar is seamless workflows for both Invisalign system and restorative.
We will continue to drive deeper integration with exocad software to further unlock the potential of Align's Digital Platform. Our strategy to capitalize on the market opportunities for the iTero business and continue to drive our growth has not changed. We remain focused on these four market opportunities, Invisalign doctors, iTero install base, global GPs, and our services business. Let me walk you through each one of them. The first is our Invisalign doctors. We know that the ROI for Invisalign doctors who purchase an iTero scanner is significant. We still see substantial opportunity with existing Invisalign doctors. While the vast majority of Invisalign cases are submitting digitally, roughly half of the Invisalign doctors are still not submitting Invisalign cases with an iTero scanner. Of those who submit, the majority have only one scanner and could benefit from multiple scanners.
On top of that, we have thousands of new doctors we train for Invisalign every quarter that will benefit from starting with an iTero scanner. In order to accelerate the adoption of iTero scanners used by Invisalign doctors, there are a few initiatives I would like to highlight. The first is innovation. With the iTero Element 5D Auto-Upload release, 94% of surveyed doctors agree that submitting Invisalign cases is faster and easier than ever with 5D. Dr. Tai, who is featured here in this quote, recently upgraded their last Element 2s to the new 5D Plus, and we are expecting many doctors like Dr. Tai to do the same. Secondly, we launched Go Digital, a try and buy program, to give doctors more confidence to move to digital and an opportunity to experience the iTero technology before they buy.
We provide doctors with up to three months rental program to experience the iTero scanner in their practice. The initial uptake from this program has been high, with doctors deciding to buy an iTero scanner following this program. The second growth driver is our iTero installed base. Our strategy is working. Continuous innovation is accelerating our installed base, which represent an upgrade opportunity as well. Today, we have more than 50,000 scanners installed around the world. With the iTero Element 5D Plus release, along with future innovation, we believe that they may be replaced or upgraded in the coming few years. Approximately 30% of the installed base of scanners today may be replaced or upgraded over the next two to three years. The third growth driver is the mass market of GPs. We estimate that there are millions of dental chairs without scanners.
Today, more than ever, we have unique value proposition for GPs. Through further integration with exocad, we will continue to streamline the workflows for GPs and labs. Secondly, we are the only scanner in the world that with one scan, we can provide 3D impressions and NIRI images. In fact, a recent study found that the NIRI technology of the iTero Element 5D imaging system was 66% more sensitive than bitewing X-ray for posterior proximal lesions. This provides GPs and their patients great value by allowing them to detect more caries and without radiation. Last but not least is our services business. This is solid recurring revenue, and we expect this business to continue to grow as our installed base grows.
I'd like to share with you a short video, so you can hear directly from our customers about their experience with us and the value that our iTero system and services business brings them.
The iTero Element 5D was really a pretty simple choice for my restorative needs. Why? Because it has this open platform that allows me to send to any laboratory that I need to. The icing on the cake.
It's all of the adjunctive procedures that you can do now. The ability to get into things like making bite splints, doing more restorative dentistry by virtue of having the iTero Element 5D scanner in your practice. The hygienists were like, "When do I get a hold of this thing?" That's why I ended up buying a second scanner just so I could keep one down on the hygiene side so that they could use it. Probably one of the best pieces of technology that I've ever integrated into my practice.
We have seven iTero scanners. We recently traded our Element 1 for two more Element 5D Pluses. I love the 5D Plus because of the color and the ability to have the auto uploader feature. With the auto uploader feature, for each new consultation, it's saving me at least five minutes.
I've tried several scanners out there, and by far, the iTero Element 5D has been my most favorite. When there was an opportunity to go for the trial program, I jumped on it right away. I have seen immense growth with not just Invisalign cases, but with restorative cases, and we actually converted a lot of treatment, up to 80% of the cases presented, compared to 50% before. I would recommend the Go Digital trial for any colleague. I've actually been telling everybody about it. Talking about, "Hey, do you have a scanner in mind?" I'm like, "Oh, yeah. Go iTero.
To summarize, we have huge market opportunity, and we have the right strategy and the best assets to continue to grow our iTero business. Thank you again for your time.
Please welcome Srini Kaza.
Thank you very much. It's a pleasure to be here. Most of you don't know me, so let me introduce myself to start with. My name is Srini Kaza. I've been with Align for most of its history. I just crossed 22 years. I've been involved with pretty much every technology that's behind the scenes that creates Invisalign today. I'm also the guy pulling my hair 'cause there's a lot of noise going on out there in terms of competition and products being offered and things like that. I'm pulling my hair because I've tried that 15 years back. It doesn't work. That probably explains why I lost most of my hair.
I can talk about this all day, but what I hope to do in the next few minutes is give you a little bit of a flavor of what makes Invisalign the best performing system in the world by far. By far. I hope I'll, you know, I can make that case towards the end. You know, we talked about the digital platform, but we all know that at the end of the day, unless you produce the results, the clinical results for the patients and for the doctors, you can have the best workflows in the world, but it's not gonna matter. So really, you know, Invisalign is the most advanced clear aligner system in the world to get you that result that you see on the screen.
You know, one key point, you know, before we get into all that is, at the end of the day, clear aligner and orthodontic treatment, it's a medical device, right? You're trying to deliver a medical treatment to the patients. You can't mess around with it. You gotta get to the results that you need, that the doctor needs or the patient needs. There's many aspects to it, you know, that create the world's best aligner system. They're all interconnected. They all work together to create the end result, you know, that we're talking about. There's you know, multiple aspects to it. You know, one easy example I can use is the case that Zelko showed with, you know, Dr. Millie Morrison's case. It presents with the crossbite.
Although it looks simple, you know, it's 11 stages of treatment, right? If you don't execute it right, you're gonna end up with problems. Most common problem with that type of case that Zelko showed is something called a posterior open bite. If you don't move the teeth out of the way correctly, they're gonna end up colliding with each other, which means the teeth in the back are not gonna be able to touch each other. If you walk around, talk to the doctors, they'll tell you they do not want that outcome. It might look simple, but you need to execute it very, very nicely to be able to get to that endpoint. There's, you know, multiple aspects to it, and I'll quickly get into, you know, some of these aspects.
You know, I already talked about this in terms of, you know, it being a medical device. We gotta be able to deliver the treatment. There's a lot of research out there in terms of how you move your teeth has an impact on your health, and that's why we call it healthy, beautiful smiles, right? It has an impact on your health. It has an impact on the long-term stability of your mouth, has an impact on a lot of different things. You know, you can go and look at the research out there. You gotta deliver the results. It's not just about looks, it's also about health. We're very passionate about that, you know, about getting healthy, beautiful smiles. Not just beautiful, but healthy, beautiful smiles.
That's really what drives us to create, you know, even better and better Invisalign system going forward. It all starts with iTero. I'm not gonna talk too much about it because, you know, other speakers have already talked about it. I've been involved with scanners for a long time, even before scanners became, you know, commercial. I knew the founders of iTero way back. When we bought iTero, we knew it was the best system in the world by far. That continues to be the case. You know, again, this is another one I can talk about all day, but, you know, with the latest advancement with NIRI technology, you know, it's a great asset in the doc...
In the doctor's offices in terms of diagnosing their case and figuring out what to do. But it's not just that, right? iTero is also one of the most accurate scanners in the world. There's, you know, a lot of data to support that. The resolution that you get in terms of, you know, how you distinguish the space between the teeth or the margins and things like that, they're all critical to ensuring that the your aligner treatment works well. So it's also tightly integrated with the rest of the system. So, you know, we believe it continues to be the best system out there in the world. Till already talked about the exocad platform. You know, I talked to Till probably a year after he started his company.
You know, I could see that they've got something going on there, right? They're moving in the right direction. We're very excited to have exocad in our family, and there's a lot of tools in there that are gonna be beneficial for aligner treatment that we hope to bring into the Invisalign system over a period of time. With that, let me just get into, you know, how the aligners themselves perform. We call our system to be a force-driven system. The easiest way to explain that is just because you see a movement on the screen and you make an aligner from that movement does not mean you're gonna get that movement. The easiest example I can give you is, let's say you're trying to move a tooth along with its root.
You just program that movement in your ClinCheck or, you know, or some software, and you just make the aligner from the next stage. You grab it. If you take a long stick and grab it at the end and move it, you're just gonna move the crown, right? The root is not gonna move. It's very critical, you know, during your treatment planning and also how you design the appliance to get your force system right. Just because you see it's not gonna happen. You gotta plan for it. You gotta build all that know-how into your device, so you can get the outcomes that we get with Invisalign. Let me get in a little bit deeper into that.
There are, you know, three things that we talked about—we talk about when we talk about Invisalign performing superior performance of Invisalign. SmartForce, SmartTrack, and SmartStage. Let me talk about the two ends first, starting with SmartStage. SmartStage is a sequential movement from start to finish to get to the final position that the doctor wants. It has a huge influence on how your case is gonna end up. A few examples of that is you gotta move the teeth in the right sequence. You move them in the wrong sequence, you're not gonna get the right conditions for you to get to the results that you need. Yeah, you gotta take care of things like anchorage. And also, you know, the s
How you move your teeth, for example, a posterior expansion with G8, which I'll talk about later. The sequence with which you move. You don't move all your teeth at the same time. The sequence is very critical to it. SmartStage creates the right environment, let's put it that way, for you to build your force systems on top. You create the right staging first, then you go to the left, then you build your appliance on top with the right force systems. Whether that's attachment systems that we've, you know, that we regularly talk about, changing the shape of the aligner itself, or activating the aligner at certain spaces. What you're doing is you're applying the right forces in the right direction to be able to get, you know, your teeth to the right position.
It's basic mechanics, you know, when you talk about that, but when you're talking about teeth, they're biomechanics, right? They're not simple mechanical systems. There's a root, there's a PDL, there's a bone, there's a whole bunch of stuff that you don't see with your eye that you have to take care of when you apply these force systems to get the right movement. Once you design all that, you gotta deliver that, and that's really what SmartTrack is. If you apply too high a force, say if your material is too stiff, your biology is not gonna respond. If you apply too low a force, obviously it's not gonna respond. You gotta apply the optimal amount of force over a period of time.
It's not enough if you apply the force right at the beginning, so it's gotta be sustained over a period of time. That's what SmartTrack does. It's a balance between the right stiffness, the right elasticity, and the right force application over a period of time. We believe it's the best material out there in the world, and that's really the carrier for all the force systems that we design. We talked a little bit about ClinCheck, and just to reiterate my point before, it's not just ClinCheck for the sake of looking at what's going from initial to final. It's gotta take care of the force systems behind it as well. A lot of the things that we do take care.
You know, use digital tools behind the scenes to create the right ClinCheck, the right sequence of movements, so you get the right force system. I just wanna, you know, talk to you. I've talked to you about the SmartForce, SmartTrack, SmartStage. I just wanna show you a video of an example of the recent release that we have done, which is G8, which addresses two movements that are very common in the doctor's office. One is deep bite, which is where your top teeth are completely covering a majority of your lower teeth, so you can't see your lower teeth. And the other one is crowding. So there's, you know, your teeth are crowded, so you gotta expand your arch to be able to resolve that crowding. These are the two conditions that we've solved with G8.
Let's take a look at the video, please.
Invisalign G8 further improves on Invisalign's proprietary features that you know and trust, such as SmartTrack material, SmartStage technology, and by enhancing SmartForce features with our newest innovation, SmartForce aligner activation. SmartForce aligner activation improves clinical predictability for both deep bite correction and posterior arch expansion for resolving crowding and dental crossbite and reducing the chance of posterior open bite. What is SmartForce aligner activation? It contours specific aligner surfaces to apply forces to the tooth in the proper direction to produce the desired movement. SmartForce aligner activation is automatically built into Invisalign aligners to give you more predictable results and your patients the smile they expect. SmartForce aligner activation improves clinical predictability of incisor intrusion in deep bite cases by up to two times. The activation is designed individually for anterior teeth to optimize intrusion force levels for every stage of treatment.
The new generation of Invisalign aligners with SmartForce aligner activation is designed to control the level and distribution of expansion forces on the posterior segment. SmartForce aligner activation, along with the new optimized expansion support attachment, automatically applies buccal root torques to the premolars and first molars, reducing unwanted tipping during expansion. Our newest innovation also reduces the likelihood of posterior open bite by controlling buccal crown tipping during expansion. By designing for more predictable anterior intrusion, Invisalign G8 with SmartForce aligner activation minimizes premature anterior contacts and reduces the likelihood of posterior open bite. Using data from millions of patients and 20 years of research, Align Technology is constantly working to help you solve your biggest challenges and to make Invisalign aligners even better, so you can keep giving your patients the best.
I would make the case to you that you've seen two movements. They're fairly complex movements, but the cases are not uncommon. If you look at a doctor's office, the patients who walk in, there's a very high probability that you're gonna see these cases. You know, movements like posterior, you know, molars, the big teeth, moving them right without tipping them and causing posterior open bite is extremely complex, but also very common. You know, it's a very common problem. I would also say to you that it's only possible using this method. It's only possible using digital, because you see, you know, you're controlling almost on a tooth-by-tooth basis, and it's only possible using the approach that I've talked about.
You gotta know what you're doing, you know, to design these type of solutions. One quick point as a follow-up to that is, you know, we've talked a little bit about how we design the forces into the appliance and all that, but we gotta be able to produce the appliance on a consistent basis. You cannot take an appliance off, right? Every one of them has to be accurate, precise, and repeatable, and that's really what our manufacturing process does. That was one of my first jobs when I started the company, is to build a 3D printing process. What I can tell you is, again, there's a lot of noise out there in terms of 3D printing. Not even close. Not even close in terms of the productivity that we have.
How we use 3D printing, you can do the quick numbers by yourself. Just take any printer off the shelf and look at how many parts they fit into a platform and think about making 100,000 of those. Not even close. You know, we make about 800,000. The level of scale and the magnitude of difference between everyone else out there and our, you know, how we use our production technologies is massive. That's really my case here in terms of our production process. You gotta deliver all that on a consistent basis, you know, to the patients. This is not just talk. I'm an engineer, so you know, I love to look at data.
We have lots of data, and we're showing two complex cases here. One is extraction space closure. The other one's more skeletal correction. We have data. You know, we have a lot of publications out there showing that these things work. You know, the efficacy improves every time we make these improvements. There's a lot of other stuff behind that as well. The last point I wanna make before I finish is that we talked about these three smarts and how we customize it to get the right movement. It also needs to be customized based on your case type, probably by age, and probably other things in the future, right? A good example of that is Invisalign First, where everything is different.
It's not the same as the adult treatment. What the kind of forces that we apply, the sequence of movements that we do, it's all different because you gotta account for a lot of other things than you do with adults. That's really what we're doing across the spectrum. You know, whether it's a simple case or a complex case, simple tooth movement or a skeletal correction, they all need individual solutions, and it can only be done with digital. It can only be done when you combine all of these technologies together to work as one. You know, if you see anything out there saying, "I've got a more clear material. Yes, all aligner materials are clear, right? But does it do the job? Does it work with all the other components of your system to produce the results that you need?
I would argue that the answer is typically no. With that, I hope I gave you a little bit of insight into how our appliances work. Thank you for listening.
We will now take a short break. Refreshments are located next door in Marcello 4501 AB. Please return at 2:40 P.M. Thank you.
The program is about to begin. Hi, everyone. Great to have you back in the room after our quick break. We're gonna go ahead and get the second part of our session started today, and it's my pleasure to introduce Raj Pudipeddi, Chief Product Marketing Officer and Senior Vice President of Asia Pacific. I turn it over to you now.
Thanks, Shirley.
Good afternoon, everybody. I'm the product and marketing guy. Shirley gave me very clear instructions. Here it is. We've got a great set of leaders talking about the breadth and depth of our technology. Joe talked about three things we've got to keep in mind, the breadth and depth of our technology, the strength of a brand, and then how all of this comes together in our go-to-market strategies. I couldn't have asked for a better setup with the technology leaders talking about the breadth and depth of our technology. What I'd love to do is bring to life the strength of a brand, and then how all of it comes together as we go to market. What is the key question I'm trying to answer for you guys? Okay? With that, let's get started.
21 million ortho starts, 16 million teens, 4 million adults, and then you combine that with 500 million potential consumers who could benefit from orthodontics. Superb marketing math. At a $1,000 ASP, that's a $500 million market size. $500 million market size just for aligners, if you just think about the potential market. I'm not counting the 4 million chairs which could actually use a scanner or how every one of these consumers, after using aligners, needs to use retainers, right? When you add up this market opportunity, I don't think there is a bigger category that I've seen in terms of what we could go after. Let's just talk about iTero. All of you know about the importance of iTero in terms of digitization.
We also know, and you've tracked these numbers closely, the number of Invisalign cases submitted via iTero has grown 32 points if you take the last four years. What I tell you is what we know now, every doctor who buys iTero grows Invisalign faster, and practice revenue grows faster than a doctor who doesn't use iTero. The conversation here is not about, is it an imaging device. The conversation here is about, is it a key catalyst to digitization of this entire industry, right. I think that part sometimes it's lost, right. It's not just the revenue from an imaging device, it is how it's actually driving the digitization of this entire industry. Let's talk a little bit about growth strategies.
In this first section, what I'll talk to you about is our core strategies, how do they all work together, and what are the results from these. Some of you would recall, we talked about the impact of these strategies on every element of our business in 2019. I had a chance to do the same thing in 2020. I'll follow the same approach here. Joe hit it, right? Relentless focus and execution on these four strategic priorities. Let's start with international expansion. All of you have seen this data. The diversity that we have because of a geographic expansion gives us the stability and frankly, a buffer from any one event that might happen in any market, okay? You can very clearly see, you know, EMEA, 39% CAGR, APAC, 39% CAGR, Americas, 23%.
You would see on the right side, we've entered multiple markets in North Africa, multiple markets in CE, right? Not just that, we now have three operations. Emory and his team have expanded us to get local. What Joe said is you've got to be local if you want to kind of be closer to your customers and delight them, and that's what we've been able to do from an expansion standpoint. Our next strategy is patient demand creation and conversion. You know, just a couple of data points. 20 billion impressions. 20 billion impressions, right? The next thing I tell you is 65 million visits to our website. Now, I tell you, we are not a fashion apparel website where somebody comes to check out what's the latest color going on. Should I wear my jeans tighter on my waist or on my knees?
That's not what's a part, right? 65 million consumers come to our website, which is an orthodontic device website, to find out more. Now, scale. Think about scale. Scale of a brand, right? I come from brand world. The brand scale is based on how many consumers think of you. I'm telling you, in just last year, 65 million consumers came to our websites across the world. Second data point, right? All you numbers guys. Our influencers. We've got 150 influencers, global and local. 150 influencers whose net reach is 250 million consumers. When Charli D'Amelio tweets saying, "Hey, look at my pink clamshell case," you know, it goes to 120 million people in one go, right? This is not something that any brand can replicate or do or do so globally, right?
Next piece I want to talk to you is My Invisalign app. You know, it's a fun ride, right? 2019, I shared with you, we're gonna launch the app. 2020, November, we talked about how the app is both a consumer and patient app. This app is now available in 60 markets, 1.2 million downloads. Just think about it, right? 250,000 patients use our app every month. I know who's actually putting aligners on at what time. I know who's sending a photograph to a doctor. If you want to kind of think about how do you actually scale a technology, this is called scaling a technology. We've got 1.5 million photographs from consumers from virtual care. What's virtual care, right? You're a consumer. You're two weeks into an aligner treatment.
You have a question. Am I on track, not on track? Doesn't feel right. You know, there's a little pain here. Feels loose. I don't know. Okay. We've got now a technology where you can take photographs, send it to the doc. The doc looks at it, tells you, "You're good," or tells you, "You've got to come back to the practice. An attachment fell off." I just wanted to kind of lay out for you what it means. You also saw there that we've rolled out our consumer website to 34 markets. I want to now talk to you about segmentation. You know, we introduced this concept to you two years ago. What's segmentation? We took all the docs we have, let's say, orthos. We put them in different buckets. There are folks who are new, there are folks who are occasional.
There are folks who are active, kinda give you one case in a year. Then there are folks who are a little more engaged, and then the highest end of the spectrum, which is experts. Now, when you move a doctor from active to engaged, you get a 3x bump. Not a 30% bump, a 3x bump in throughput. When you move a doctor from engaged to expert, you get another 3x bump. Again, marketing math, when you move a doctor from active to expert, you get a 9x bump. Now look at the data, right? Last time I only talked to you about the concept. What I'm really happy to share, this is called relentless execution that Joe called out. We were able to grow our expert orthos by 56%, expert GPs by 138%.
Now when you see utilization numbers increase, what do you think is increasing utilization? This, right? Our ability to have growth programs tailored to every segment to drive utilization. We were able to grow our engaged orthos 29%, engaged GPs 75%, right? This is an engine that keeps giving team. I just wanted to call out what does segmentation do, and then lead you up to orthodontic utilization, right? In this massive market, we've got just 1/10 share. You would see, right, North America has had a phenomenal growth in utilization, close to 50% growth in utilization. International utilization among orthos has increased 15%. What drove that? We stay focused on the same four things. One, we have to become better partners. You know, Shree talked about, you know, Live Update, right?
I wanna talk to you about this concept called personalized plans. What's a personalized plan, right? You're a high-throughput doc. I've talked to any of the high-throughput docs. What they do on weekends, what they do on nights is approve ClinChecks. Review ClinChecks, approve ClinChecks. At some point, what happens is that becomes a bottleneck to growing, right? Because how many ClinChecks are you going to kinda, you know, approve? You're constantly making a decision between, "Hey, do I have dinner with my family or do I do ClinChecks?" Right? Now, what if you could actually take the friction out of the system? We take the highest volume docs, we take the treatment protocol, we automate them. We automate the treatment protocol so that when he or she gets it the first time, it's almost close to perfection, right? What are we doing?
For all of you guys who play golf, we got the ball on the green. We got it within putting range. When it's within putting range, they use the Live Update, make the small changes, get the hole in, send it out for approval, done. We've actually taken the friction out of the system in terms of what this whole thing does, right? That's the impact of the technology. If you take all of the technology, what does it mean? It improves efficiency, it improves effectiveness of our docs. Second thing, proving platform value. You know, I'm happy to report to you that our ADAPT program is incredibly successful. I'll talk a little bit about that. For folks who are new, ADAPT stands for Align Digital and Practice Transformation. Standard of care. Shree talked incredibly well about G8, what it does, right?
For a layman marketing guy like me, when an arch needs to be expanded, it expands the arch. When teeth need to be intruded, especially the anterior teeth, it does it with much more predictability. Now, why is this important? Why is G8 important? I tell you, go to Asia. Cases there are incredibly complex. Many of them involve intruding teeth, extracting teeth, deep bite, cross bite, arch expansion. When you introduce something like this, what happens is you expand the applicability of Invisalign. You expand the trust a doctor has to use Invisalign, right? Last thing, driving younger patients. Of course, you saw the brand building that we do. What we also do is improve the Mandibular Advancement Device. You know, we have little wings. You know, the lower jaw needs to be positioned forward. That's what our Mandibular Advancement does.
What we've done, thanks to Srini and his team, is we've improved the wings so that they actually lock better. The outcome is much, much better, right? One of the things that you saw is the size of the teen opportunity, which I absolutely call out. I also wanted to kinda share this encouraging data. Teens, as a percentage of the cases, are increasing, right? Not just that, right? You know, if you really look at appeal of Invisalign among teens, it's night and day, right? In every market, we have better awareness, better engagement from teens. ADAPT, as I said, every market, every region has ADAPT programs going on. At least 100% growth incremental to the market. Let me say it again. At least 100% growth incremental to the market.
That's what ADAPT does at every practice that's in, okay? Next is GP Option, right? 2 million dentists, 4 million shares, 500 million patients. We had the team talk about comprehensive dentistry today. Smile Architect. I just wanted to take a minute to kinda explain my view on why that's critical, right? What does a dentist do day in and day out? His or her office does cleaning of teeth, which is hygiene. Looking for cavities, drill and fill. Crowns, veneers, bridges. Where does Invisalign fit in a normal dentist's life? Not easy. Now, a normal dentist does restoration every day. So when Invisalign can come up with an ortho-restorative plan, we immediately become more relevant to a dentist, right?
If you just kinda connect the technology to why does it make sense, why is it important, I tell you, with ortho-restorative, we immediately become relevant to dentists. Now remember, Till talked about with labs, we've already got Smile Creator. What does Smile Creator do? I'm a dentist. I send a scan over to the lab. The lab has to make the veneer or the crown. As it does it uses Smile Creator, which is a far more detailed package, which enables the lab to come up with a veneer or crown that fits best, right? When you take ortho-restorative, when you take exocad, what we've done over the last year is we've become significantly more relevant to a GP than we've ever been. It's as simple as all that, right? Next is segmentation.
You know, the same segmentation works with what's working for us is Invisalign Go. Invisalign Go and total integration with iTero. Third, clinical education. Clinical education is absolutely critical. If a dentist doesn't have comfort with Invisalign, he or she won't be able to get to the throughput we want. So we've invested on this across regions, working well, and we continue our critical partnerships, okay? I'm pleased to share with you saw Invis is a consumer campaign. This is the strength of the brand. Now the same Invis is, we've now made it a global doctor campaign. Every market, every region, same look, same feel, same campaign, Invis. Not just that. If you actually look at any of these pictures, you would actually say this is one brand. It's not two brands, it's one brand, right? Let me move you along. iTero. We have a global campaign for iTero.
It's called Expand. Expand your practice, expand your vision, expand your possibilities because it all starts with iTero. We now have a global campaign that we're driving using the same approach that we've taken with Invisalign across the world. You can start to see some of the results, you know, that you all shared. A part of that is driven by our ability to go to market in a consistent way, okay? Let's talk about now the incredible Align Digital Platform. Raj, tell me what it means. Tell me what it means in terms of translation. Okay? Let me just quickly take you through this. Here is the workflow. The workflow has connect, scan, plan, treat, monitor, and retail. I take our entire innovation and put it in this framework, and then we can talk about why it makes sense, right?
Let's start with connect first. Marketing guy, I had to show you some stuff, right? Let's see some fun social stuff. Can we play this, please?
Wow. No braces. Everything's hands-free.
I wasn't so lucky.
Invis is not your parent's braces. Invis is faster than braces and the clear aligner brand most trusted by doctors. Invisalign.
Okay, the hand crank there was completely accidental. I didn't mean for the sound to be close to something else that you're used to. Just braces. Can we run this, please?
Girl, don't do it. It's not worth it.
I'm not gonna do it, girl. I was just thinking about it. I'm not gonna do it. I did it.
Invis is everything braces isn't. Eating the foods you love, no compromises. Invisalign. How powerful is an Invisalign smile?
Who's ready to learn?
Powerful you can face anything, even these faces. Invis is a powerful thing. Invis is the clear aligner brand most trusted by doctors and 10 million smiles strong. Invisalign.
You know, I just wanna make a point here, right? We've all lived through the Zoom era the last two years. You know, we were doing this research virtually within the U.K. with some consumers, and this lady says something which stuck with me and the team where we developed this, right? She said, "You know, when you look at yourself in the mirror, what you're seeing is a very fleeting, almost surreal image of yourself. But when you actually look at yourself in the video, you finally see yourself the way others do for the first time," right? If you want to kinda understand what drove this immense surge in wellness and health, this has been the key thought. Therefore, our campaign is Invis is a powerful thing. So powerful it can transform your lives, transform your smile, and give you confidence.
Let's talk a little bit about globalizing campaigns, and this is our work in China. Let's run it, please. Culturally relevant. Now let's talk about our ad in Brazil. Let's run it, please. Gives you just a snapshot of what we're trying to do to build a brand globally, right? Globally consistent, locally relevant, customized with the right media principles. Some of you actually asked this question, right? As we went through the earnings. You know, do you use different media vehicles? We do. We're very heavy on social media. We're heavy on digital. We've expanded to Snapchat and TikTok across the world. If you look at EMEA plans, Europe plans, basically, Asia Pacific plans, you will see them pretty intensive on Snapchat and TikTok. Our digital presence continues to ramp up, right?
Now let me, you know, kinda move on from the connect demand creation to why the Align Digital Platform is unique in the industry. I really like Shree's example of, you know, hey, you're in coffee, you've got the app downloaded, you can see it end to end. Now I think. You're a potential consumer. What are the questions in your mind you think? Because technology serves a business purpose. There are three questions that the consumer has. Why Invisalign? How much does it cost? How long does it last? What do you think our app does? Answers three questions. Why Invisalign? Because it's superior, and it helps you visualize your smile. How much does it cost? We give you the range, and we give you an ability to find a doctor. How long does the treatment?
We actually enable you to connect with the doctor, understand what the treatment outcomes are. Technology drives and addresses the business need that we have, right? Let's actually keep going. We've redesigned the consumer and patient experience over the last year, so you would see that we've addressed these three questions. Yesterday, we launched Invisalign Practice App. What's the Invisalign Practice App? I'll go back to the friction. You're a doctor, you're home, you have to go now and look at the Invisalign Doctor Site for what your tasks tomorrow are. Yesterday, we launched an app which enables a doctor to kinda take any regular routine task, connect it to Invisalign, and do it at the click of a button. Our vision for this app is practice at your fingertips. Practice at your fingertips. It enables, you know, kinda clinical activities to be easily visualized.
It enables user-driven prioritization, but again, all of this is geared to remove friction in the system, so to increase the throughput for the doctor, right? Just wanted to kinda talk about scan, right? You all mentioned it. I just wanted you to kinda, you know, kinda internalize this, right? We did a study with, you know, bitewing radiology versus NIRI. NIRI found was more sensitive at finding early enamel lesions and was 66% better, more sensitive at finding interproximal lesions, right? Because our vision for iTero, if you really look at it, is to move from a passive imaging device to becoming an active partner in a dialogue that focuses on oral health and well-being. We are not an imaging device anymore.
The scan piece will actually become an active dialogue that you foster with the patient with a variety of adjacencies that we have on how you improve oral health, right? Treat. My friend Srini Kaza talked about G8, mandibular advancement. Monitor. Shree talked about virtual care, but I want to kinda, you know, just again, give you some perspective on so what, right? Today, patients send photographs. Doctor has to look at them very manually. The workflow is bad, the UI is bad. What we've done throughout this year is we've simplified the UI, we made it seamless, and our vision is to do intelligent automation. What if the doc could actually see photographs that seem to be off track first? What if the doc could have easily customizable messages that he or she could send to patients?
What that does is, again, it improves the efficiency of the process, effectiveness of the practice. Next, I wanna talk about retainers. This is a well-kept secret. You know, we have a wonderful brand. I told Jojo, "I think I've done a great job at keeping it a secret." He said, "Maybe you can do less good of a job. Maybe tell a few people, we'll sell a little more." But that's what it is, right? You know, Vivera is an incredibly well-kept secret because it's the best retainer. Think about this, right? You've just spent thousands of dollars on Invisalign treatment. Don't you want to protect the beautiful smile you have? The challenge is, we need to get this message out, and the potential is 500 million consumers plus annuity. Plus annuity, remember, right? Because they need to keep coming back.
You all lose retainers, we know that. You'll have a glass of wine without realizing it. Sorry. Let's get you a new one, right? What's the strategy? Our strategy is to make it relevant to orthodontists. Our strategy is to increase the attach rate with GPs, right, by making it much more integrated and relevant. Most importantly, we want to make it an indispensable part of a consumer's routine. You would see we have a new brand identity. We have a new website. We are enabling doc lock for Vivera. We have a new advertising campaign for Vivera, and we're going to roll it out internationally. Same core strategies, same approach that we had, right? If you take our entire innovation, what does it all translate to? It translates to more volume, more revenue, more effectiveness, more efficiency, better customer experience, better patient outcomes.
I wanted to spend a couple of minutes on a couple of strategic opportunities that we talked about in our earnings. Whitening. Now look at this data point, right? 54% of Invisalign treatments with a GP already include whitening. More than 88% of U.S. dentists already do whitening. Now, what's the best way to deliver whitening? What happens in whitening, you know, kinda for the folks who are just understanding this, you take a chemical, and you apply it on your tooth, okay? And it actually penetrates your enamel, goes inside, and changes the color of your dentin. That's how your teeth become whiter. Now, what do you think is the best device to administer whitening? A tray. Invisalign tray. That's essentially what it is. What we've been able to do is we've been able to work with the world's leading whitening manufacturer.
More than 50% share, has been in the market since 1976. Ultradent, founded by a dentist called Dan Fischer. This is one of those things, right, you know, kinda, you know, which looks so intuitive in hindsight, but you look at the opportunity and say, "Wow," right? Why is this better? Today, an in-office whitening requires this. You build a dam. That's a patient's mouth, by the way. That's a patient sitting in a chair with the mouth. You build this rubber dam and just move the teeth outside, and you put a clasp here, the metal clasp. Sometimes when the patients can't open their jaws wide, you put occlusal blocks. Somebody is sitting with their jaw open, praying for whitening to be done. Okay. That's today what your whitening experience is. Tomorrow, you know, our.
We've now got a formula with carbamide peroxide, which gives you the efficacy without the sensitivity. No barrier needed, no special lights needed, no rubber dam needed. Significant saving in time for dentists, you know, as they do it, and a clear opportunity, right? You know, it's so intuitive that, you know, hey, you take this, it's better in every way for a patient, for you. Next opportunity I wanna talk about was e-commerce. You all saw, we've got the most trusted brand in orthodontics and dentistry globally. We've got 11 million patients, 210,000+ doctors. This is a prime opportunity for us to come up with accessories that make sense, and that's what we're trying to do, accessories that make sense.
You will see clamshells, you will see chewies, you will see munchies, you will see mints, you will see things that actually enable and enhance the Invisalign experience. Okay? Last, I wanted to touch on doctor subscription for low stage and retention. This is a program that's been piloted by Simon and his team, and he's going to talk about it. But the concept is very simple. You've got an opportunity to drive volume of low stage. You've got an opportunity to drive retainers. What if you could get volume commitment from some of the doctors who are not giving you any volume, and in return, they get a more attractive price, right? Simple, straightforward program that leverages our digital platform and our world-class manufacturing.
I bring you back to our Align Digital program, our Align Digital platform and workflow, and why it makes sense. In doing so, I'll hand it over to Simon to talk about Americas. Come on over, Simon.
Okay, good afternoon. Thanks, Raj. It was a great update. As you can hear already, I've been in the U.S. for two and a half years, and I've embraced a full American accent. Hopefully you can see I've been working hard on that. I'm delighted to be able to give you an update on how the Americas region is progressing. If you look at the Americas region, we've really focused around a few areas to really drive ongoing momentum and growth. You know, we continue to invest heavily, as you've heard earlier today and also at the GP Summit, around sales and marketing. A lot of that focus has been around differentiating with teens, and Raj gave you a good overview of how we've been doing that from a consumer perspective, and I'll talk a little bit about that.
One of the key things we're trying to do as well is really these principles of localize, channel, and segment. I'll talk about that. The growing importance of some of the DSO partnerships we've got there, from the smaller DSOs, but also the elite DSOs, which are really fundamental to some of our growth. I'll close, I'll talk a little bit about Brazil. I talked about that last year. It remains a really exciting opportunity for us. As you can see, you know, Americas is a large region. We principally focus around three markets when it comes to investment, Canada, U.S., which is obviously important to the global business, and Brazil. But we've got some exciting opportunities that we see in Mexico and CALA, specifically in Colombia, Peru, et cetera.
We've made some great progress in the last couple of years, particularly around our utilization in both the ortho channel and the GP channel. When you look at our growth, we've got a reasonable, I'd say, good growth over the last five years. I think what excites us all in this business is kind of not where we are or what we've done, it's really looking at the future opportunity that we've got. When you look across this region, there's 7 million orthodontic starts, split across adult and teen. You'll see a little skewing in those numbers because principally in Latin America, you know, when we compare it with North America, you're kind of looking at a 75-25 split between teen and adult. It's reversed in LatAm.
There's an immediate opportunity to go after in adult, but longer term, as we develop the teen market, that's also gonna be really exciting for us. I said earlier, you know, 23.3% CAGR across the Americas. The one thing I'd point out here is you can start to see the Latin America business. You know, 2017, it was a. You can barely see it when it comes to our revenue, but moving into 2021, you start to see it having a more impact on how we're building our business here. Raj went through these in some detail, so I won't kind of go through them individually. But we, you know, we apply our business around these same growth pillars.
The one slight caveat I'd add is we call out DSOs as a really important pillar of our strategy and how we organize. I'll talk a little bit more in detail about that. It's not just dental service organizations, it's also orthodontic service organizations as well. When we look to 2022, even though we've not finished 2021, we do see some real focus areas that we can continue to both improve but also refine our strategy. I'm gonna deal with each of these individually, give you an update on some of the progress, but also where we're gonna focus going forward. This first one, I called this out on the first slide.
You know, what we've really focused on across every market are these three core principles. Really, it is the foundational element as to how we prepare the channel for all the great innovation that the guys talked about earlier. I talk in my business about we've got to feel smaller to get bigger. It's important because we're dealing with tens of thousands of small businesses. As you move across markets, even within the U.S., you see differences in what people wanna focus on and what their needs are. From the channel side, you know, about two years ago, or just under two years ago, we went to these dedicated teams around GP, ortho, and also DSO. What that enables us to do is then to segment with a greater level of sophistication.
That segmentation then allows us to build sales process or programs of education that talk specifically to what those customers need. What a general dentist needs is very, very different, as you know, to an orthodontist, and historically, we've had a kind of a vanilla approach, and hence why we've not been as successful as we potentially could be. These strategic opportunities, I won't go into these. Raj has covered them in some detail. These revenue opportunities, you know, fit perfectly with how our install base enables us to grow and add on. You know, if we make it convenient for the customer, and we provide quality solutions, our platform enables us to build on those adjacencies, including e-commerce.
You know, when Shree was talking about the My Invisalign app, you know, we've got about nearly 1 million consumers in the U.S. have signed up to the My Invisalign app. As well, can those consumers also be directed to our e-commerce site to buy accessories, et cetera. Really exciting. One thing I'll focus on is the doctor subscription program, which Joe and John talked about during earnings. This is a pilot we've been running. Really this is something we've been working on for a while to really focus on this unmet need that we've seen, but also our customers have talked about to provide a more convenient way for them to use our retention product, which they all say is the best in the world, but also touch up, provide them with more flexibility.
When we talk about touch up, it's less than 10 stages, and they can order any amount of stages depending on their case. It's either a relapse, it's a minor case, or in many cases, they want to finish wires and brackets cases with Invisalign. We've limited this to just the U.S. and Canada at the moment, and we've gone to our highest volume customers, our most experienced customers, who have tended not to use our products in these kind of categories. In some cases, they haven't really thought about using, say, a milder product. The feedback we've received so far has been really pleasing. They find the user experience really easy. They're using the same platform. The quality of the product, they're very confident in. They're using the same ClinCheck. They can scan off iTero.
One of the keys in all of this is, you know, the world-class manufacturing that Emory's built really enables us to provide that consistency in delivery and speed that the customers need. We do this by just offering a monthly subscription, so a set price for a certain amount of aligners, and then the doctor decides how they use them. They can use them more for retention. They can use them more for touch-up cases. They really like that freedom to decide rather than us dictating a certain number of aligners. We're really excited about this. We continue to learn. We've learned an awful lot in the last few months, and as we enhance this program and experience for our customers. Importantly, we're adding value to our existing customers, and therefore the integration into their workflows is relatively straightforward.
The teen opportunity. You know, this is the biggest and most exciting opportunity we've got. As has been stated earlier, this is three-quarters of the cases that are done in the U.S. You know, we're very underpenetrated with teen. While we've made significant progress in the last few years, it's still a big opportunity for us to grow. The thing that we've really learned and what dawned on us in recent years is when a doctor decides to move more of their case starts to teen, then what you're talking about there is they're moving to a fully digitized practice. What we've learned and what really drove us to build the ADAPT program is that that creates challenges for them to really shift that business, that workflow, and that whole model.
We've had a number of programs where we're working very closely with doctors who are now very confident to shift 70%+ of their business to Invisalign. That creates a network for us. When it comes to creating leads, and you've seen the great campaigns that our consumer teams have developed, we have a network of doctors now that we are confident when we send a patient there, that they will be converted into Invisalign rather than wires and brackets. Now, to achieve this, it's not one thing or the other. It is a truly 360 approach. It's a combination of, you know, targeted, relevant consumer advertising across a mix of media. It's about making sure that through professional marketing, we're really engaging the customers in that journey as well and giving them the content that they can extend that experience.
It's making sure that our sales teams have the right segmentation and targeting, but also are confident to support either the clinical needs or the practice development needs. We're excited with the progress we're making there. As referenced earlier, the iTero scanner adoption is. It's been an exciting experience for us in recent years. Particularly, you know, the 5D Plus, which we launched in Q1 of this year, has really kind of upped the capabilities that our doctors see in the iTero platform. You know, the 5D application is a real preference now for doctors, both GP and ortho. You know, the NIRI technology, particularly in dentistry, is a real enhancement when they're interacting with patients. Recently, the Auto-Upload really is a game changer as far as workflow efficiency.
We're seeing doctors getting really excited about how they can use that to simplify the whole process. As you know, across the marketplace, it's just this increasing awareness and adoption of digital dentistry as doctors learn how patients react so much differently when they show them, and they can have a conversation about actually what's happening in the oral cavity. When we look at DSOs, clearly you see that there's some significant consolidation occurring. DSOs are important across every market that I cover in the Americas. What's important to us is when we're engaging with DSOs, you know, we understand the value that they bring. We work with some really, really smart business people and clinical people who are really trying to build really quality organizations that deliver healthcare.
It's important that they understand the value that we bring as a company. Where it works best is where there's that mutual understanding and respect and partnership to really drive the platform and the opportunity that we believe exists. We work very closely with them around business model development and workflow development. Because ultimately, you're not dealing with a single practice here, you're dealing at scale. I think that's what Align Technology brings. We have a direct sales force, a skilled sales force with specialist resources that can build that scale and work with that scale and really drive value throughout their chain. Importantly, we drive consistency and quality, which is so important to these organizations. We're delighted with the partnerships that are growing across the U.S., Canada, and Latin America. Just to summarize the Americas growth drivers, really.
I've talked about localizing our infrastructure. That really sets us up from a channel segment perspective. You know, it's making sure that our teams are able to make decisions, react or be proactive with customers in areas, and really pick up on trends, and really deliver that intimate, empathetic approach, what our customers desire. It's also ensuring that, you know, through developing specialist teams in ortho, GP, and DSO, when we're creating consumer awareness or when we're delivering new product innovation, where we are preparing the channels to be able to best understand how we execute that and really integrate that within our customers' ecosystem. Finally, with, obviously with iTero, it is really a game changer for us and also for our customers as far as how it enables that process, connects everything together, and really builds that value within the practice in front of the patient.
Within Brazil, and you could also reference Latin America, but I'll speak specifically about Brazil. I think you're all aware of the dynamics of that market, both the positives and sometimes some of the potential negatives and challenges that we have. We balance our investments in those areas. We're prudent, but at the same time, we're aggressive in certain areas. The great thing about the way that the business has been built and scaled in Brazil particularly is the leadership there have been outstanding at taking best practice from different regions and implementing it in exactly the same way, and then refining it for their own market. Our leader down there, Ritesh Sharma, worked in Europe. He understood how the European business. He's also worked closely with Asia-Pacific, and he's taken those learnings also from North America and built that across there.
A great example of that is when you look at how they're expanding partnerships. They've been very innovative in how they want to get to consumers out there. They partnered with two major banks in Brazil, Itaú and Bradesco. Itaú was the first. The exposure that we're now getting through their preferred members program is really ensuring that we're reaching more consumers. Essentially, these are consumers in Brazil who can also afford the treatment. It's been a really smart play, a really successful play, and about three or four months ago, we added Bradesco to that. We've got a number of partnerships in progress there as how we can actually access the right consumer segments.
Look, to close, you know, we'll continue to invest behind our go-to-market strategy, because the market is still so under-penetrated, even in the U.S., and I know that's sometimes seen as a mature market. We need to invest in salespeople and in consumer to really drive the message around Invisalign and iTero. As I said earlier, that's important because we have such incredible innovation our teams develop, that we need to have the right channel structure to be able to maximize that impact. Also utilizing our Align Digital Platform so that we're providing a seamless experience for our customers. What I will say is that we'll continue to localize, and that will enable us to scale for our customers and ensure that we can take full advantage of the opportunity ahead.
I look forward to catching up with some of you, and I'm now gonna hand over to our SVP for EMEA, Markus Sebastian. Thank you.
Good afternoon, everybody. I'm very happy to be here in order to share with you our progress we have made in the EMEA region. Just a couple of stats for you in order to understand a little bit better what we are talking about. We are actually into 49 markets, and we are subdividing them into core markets, which are nine markets in five regions, which is Germany, Austria, Switzerland, U.K., Ireland, France, Iberia, Spain, Portugal, and Italy. These are the core markets for us. All the rest are our expansion markets. In each of the markets, we have dedicated teams. We have, you know, an office established, very strong teams around these markets and covering in total 600,000 general dentists and 25,000 orthodontists.
We actually have 2.6 million patients treated over the years, over the 20 years we are in the EMEA region. You know, it took us more than 15, 16 years in order to generate the first million, and then only two and a half years generate the second million. Now really ramping up. It's going very fast. The utilization, if you look to the entire scope of the doctors, the GPs and the orthos, is around 23, which is a huge ramp up to previous times. We also have increased the cases submitted digitally, which is actually 76%. Our revenues are fitted into 70% is for ortho and 30% is for the GP business. Both segments are growing very fast. During the last 18 months, during the pandemic times, digital was really the winner.
We have accelerated the digitalization in our market, not only with the iTero sites. It's more within the practice. We brought the digital tools much closer to our doctors. You know, in order with all the tools which Shree and also Raj have explained earlier on with virtual care and virtual appointment, that we help the practice to really stay in contact with their patients during that time. But also within ourselves, with our teams, the recovery programs we made was really useful in order to use the momentum nowadays for the strong growth in the EMEA market. Practice workflows and also the e-learning programs was something very important. We had over 1,000 virtual programs running in this time, which was really great.
Obviously, we changed our strategy a little bit and invested much more into the consumer marketing, especially in quarter four last year and the entire year in 2021, and this is something we will continue in the future as well. 7 million case starts a year, 4 million for teenagers and 3 million for the adults, and the potential is huge with the 150 million potential consumers in the future. This is something where we have to make our market ready and to prepare the infrastructure accordingly in order to be ready to capture this. Our five-year CAGR for the revenue is 39%, and the five-year CAGR for the submitters growth is 26%. You can see a lot of movement in our area, in our region.
This shows you how the revenues are split between the core market and the expansion market. You see the growth and also in 2021 how this has accelerated and how important the expansion markets are getting with 39% in total. Our winning strategies, and I think Simon has said this for the Americas, are very similar. We want to go in the segmentation of the orthos and the general practices, the general dentists. We will lead with iTero, look to the teenagers segment, especially in the orthos, and also to drive the demand to bring the patients into the doctor's practice. Let me go into all the four subjects a little bit deeper.
For me, hindsight, 2017, when Simon was running the EMEA region, this was the moment where the success really started, when we segmented it, when we split it into the GP channel and the ortho channel. We could really see the ramp up since that time. It was very strong, you know, with dedicated portfolio, our iGo portfolio, Invisalign Go, what Raj explained early on. This is just dedicated for the general dentist and then our advantage program for the orthodontist to keep them as a specialist of our treatment, but also with dedicated teams, especially in the core markets, where we tried really to offer them special strategies and special way on how to address this market in the individual markets.
As I said earlier on, the 49 markets we are in are all totally different with different languages, different regulatory subjects and regulatory rules. This was the word I was looking for. It is really good to have individual successful streams to utilize the growth in those markets. This is what we want to drive also in the expansion markets in the future. Wherever we are ready in the markets, and you could see from the previous slide, they are growing really fast. We will go with dedicated teams and also portfolio, and of course, with our iTero in order to spread this throughout the entire region. This is, you know, for me, the basis for tapping into the 150 million of the potential consumers in the future.
This can only be done with the 600,000 dental practices. This is exactly what we want to do in order to integrate the teeth straightening in the comprehensive dentistry of the dentist, in everyday's treatment, what they're doing. In order to optimize, several of my colleagues have already mentioned, to optimize the restorative treatments in the dental practice. Of course, digitalized with a strong impact from iTero in order to enable the superior outcome in the practice transformation. Because to switch from the analog into digital, this is our main goal within Align Technology in order, you know, to improve and to accelerate this. This is also something which we want to do much stronger next year throughout the entire region.
The key element for us, and I think everybody said this, all of the speakers said this, is iTero. With the launch of the Plus series in quarter two, it was really for me, changing point. You could see that all the doctors, no matter whether they are GPs or orthodontists, really run into this segment in order to get the superior product, the superior scanner in the market, and to use the entire adoption and the entire opportunity of the digital platform what we offer to our customers. This is exactly what we want to expand in 2022, especially in the ortho segment with the ADAPT program. Raj has briefly mentioned this. That's for us the important thing for the practice development within the orthodontic practice.
Teenagers, number one, we still have not the market share which we want to have. Brackets and wires are much stronger. With all the activities we have mentioned early on, with the very strong focus also on media spend, but also for educating the patients, but also the clinics, the doctors, to make them more secure in the treatment of the teenagers. This is one of our drivers in the future. This is obviously supported by huge investment into the media spends, in order to bring the patients and the consumers into the practice. We have done this in the U.K., in France, Germany, and we'll do it in the Netherlands. We are quite restricted in the European market. We cannot do it everywhere.
There are some local rules, but the impact for the market and for the outcome for us is really tremendous with all the campaigns which has been shown with Invis is and with a very strong influencer program for the EMEA market. This is the focus, what we have in 2022. I think I have mentioned all of them. It's the patient demand and conversion. It's the digitalization of the market and to grow our utilization even stronger, and that together with the portfolio and the programs in order to accelerate this. Let me just dip into two other items. The first one is Africa. As I mentioned last year at the Investor Day, we have started to go direct into Africa, and we will expand this even further in 2022 and onwards.
This is our real expansion market in the future. With 54 markets, we will not go obviously in all of them, but we are focusing in North Africa with Morocco, Algeria, Tunisia, and Egypt, and then go in the Sub-Saharan part with Ghana, Nigeria, and Kenya, and then go more south into South Africa. That's such an exciting time and an untapped potential for us, which we want to explore with the ways, you know, we know how to address new markets. We did this in Turkey and Russia, in many other markets, and this is our number one potential here in the future. The second one I would like to share with you is the operational expansion EMEA.
Because of the specialty of our region, we have actually four treatment centers in Spain, in Germany, in Poland, and in France, and we will have more in the future in order to support the doctors individually in their time zones with their language, and that's something which we will explore more. We are all very excited that in a few months from now, we will go live with our EMEA manufacturing facility, which is huge. I will show you a video in a second, and this will launch early 2022. We will hire more than 2,500 new people in order to be there and to help us in this area.
Training center will be established, so Poland will be an important part of our strategy in the EMEA region. I will show you a video now in order to explore this a little bit better. I hope this gives you a sense of what we are building up there. This video was taken two months ago. In the meantime, it looks totally different, so it's almost finished and then we will be ready at the beginning of the year to start our manufacturing there. Let me finish up by telling you what I said in the last 15 minutes to summarize this. Drive digitalization in EMEA is our top priority amongst the GPs and the orthos.
We will go more into restorative, ortho restorative cases in the GP practice over the entire region and grow the team business with the specialists of the orthodontist. We will always keep our doctors in the center of everything we are doing and try to support them in the best way we can with the consumer activities we have, but also with the best-in-class customer experience and also education. Then, you know, with the manufacturing, the treat centers, localized and Africa in the future, I think we will be ready for 2022 and onwards. With having said this, I will hand over to Raj, SVP for APAC.
As I share our thoughts on our plans for APAC, I wanted to take a minute to thank and recognize Julie K. Julie K has been our leader for APAC for the last 5+ years, and she has done an amazing job. I'm honored to continue her legacy and try to continue the momentum we have as a company in APAC. 7 million orthodontic starts, 150 million consumers. Think about this, right? 150 million potential consumers, only 1.6 million patients to date. It's not even last year. 1.6 million patients to date out of 150 million consumers, right? The largest region, the most digitized region, the fastest-growing middle class. If you look at the last seven years, APAC has grown by a CAGR of 39%. Has served us incredibly well as a region for the company.
Our strategies for APAC will continue to be the same. You know, for those of you, one of the questions I recently got asked because I started serving in APAC as a leader is, "Hey, Raj, what are you gonna change?" We're not gonna change anything. The formula works. Double down on the formula. Relentless execution on the same four strategies. I'll share a couple of thoughts with you on what we're doing by market. Okay? How are we gonna maintain momentum in APAC? We're going to continue the momentum in Japan, China, ANZ. We're going to scale up Korea, Taiwan, Vietnam, Thailand, India. Okay? Our scale up is gonna be five markets. Our momentum drivers are gonna be three markets, and we're going to use the same playbook. Segmented sales teams. Ortho penetration.
Ortho penetration via more salespeople, but also segmented salespeople. GP penetration via Invisalign Go and iTero scanner. Marcus actually touched on this and this is really important, right? If you're a GP, one of the biggest barriers to using Invisalign is clinical confidence, right? GP doesn't learn orthodontics. How do you actually get a GP to take on cases? You start with the simpler cases, which is what Invisalign Go enables, right? Second one is disciplined execution of new doctor and growth programs. I'll talk a little bit about this, but this is truly a critical engine for our company. Third one is invest in brand building. Here I'd like to stress that, you know, kinda sometimes there's a misconception as you try and do brand building.
The misconception is, "Hey, if you put in more money into a market, you're gonna win." That's like saying the person who gets the most money to a poker table wins the most money. He or she tends to be usually the biggest donator. If you don't know what you're doing, you're gonna lose your money, right? Reality is brand building, especially in a region like APAC, is going to be a very nuanced task because of the regulatory landscape, because of consumer differences and our ability to afford. Last, foster a vibrant culture. You know, APAC is the youngest region. We need to be a digitally friendly, employee friendly, young, vibrant organization. Let's talk a little bit about, you know, my two passion areas, right? New doctor onboarding and growth programs. Now, look at the APAC data, right?
It shouldn't surprise you, but it kinda, it really, really got my attention. When you move a doctor from active to engaged, it's 5.4x increase. From engaged to expert is 3.1x increase. Last year, if you just look at last year, the team has done a nice job of growing experts among orthos and GPs, right? We're gonna come back to, you know, what does it take to do this? What it takes to do this is for every segment of doctors, execute the right growth programs. You saw this, right? We have 1.6 million potential doctors that we could reach out to. Out of this, we have to choose every year. Who we put into a new doctor onboarding program is critical as much as how do you actually run the onboarding program.
I'll share a little bit of detail with you as we think about our different markets. I wanted to kind of stress on differentiating Invisalign brand. As most of you know, we started with spending on brand building in North America, then we moved to EMEA. I think we need to do a much stronger job of building our brand and driving differentiation in APAC, and we've started across multiple markets.
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I mean, I'm always smiling now, and I'm currently wearing my Invisalign, so I think it's amazing.
As you can see, brand building in Australia is a little bit different from brand building in Japan and brand building in China, and we need to be locally nuanced to win. I'd like to showcase Japan. You know, for most of us who come from the business world, Japan is associated with low single-digit growth, a very mature market, nothing changes. This team in Japan has done an amazing job, more than 50% growth CAGR across multiple years. How have they been able to do it? The same four strategies. Let me talk about the international expansion, and I'll reference the treatment planning localization there. Orthodontist utilization, relentless discipline on the growth programs.
GP adoption, complete integration with iTero, as well as with Invisalign Go, and then focused demand creation despite regulatory constraints. Look at this, right? Japan Net Promoter Score. This is the score our customers give us based on how they evaluate our service, was -23. It's not possible, but it was -23 in 2018, which now moved to 29. 52-point swing driven by one key thing, which is localized treatment planning. Localized treatment planning, customized training clinical education, localized customer engagement with local faculty, right? This is absolutely critical for us as a company in terms of our strategy. Let me talk to you about the next one. Can you go to the next slide?
Hello, everyone. My name is Kenji Ojima. I'm working Tokyo of the Japan. I'm a specialized orthodontist. I using Invisalign system specialized in my clinic. The future of orthodontics is the dream treatment of all patients, invisible, hygienic, and comfortable. This future is made possible through technology such as scanners, simulation system, and aligners. Align Technology has always placed this element at the center of product and technology development, and their efforts to revolutionize orthodontics. This system and Align Digital Platform represents future orthodontics and has built strong foundation of excitement and trust in the patient and the doctor alike. Align Technology is the one of the only the original founder of future orthodontics. It has set and will continue to be the standard for the rest of the orthodontic world to follow.
Dr. Ojima is one of our top providers in Japan and has been associated with us for many years. He's an absolute perfectionist. To get his endorsement just tells you the strength and the superiority of our end-to-end system. Now let me take you to China. China is the second-largest market by far, the most important future market, if you really look at 10, 15, 20 years down the line. We need to win, we need to invest to win. What are we gonna do? We're gonna expand to tier two, three, four cities. You know, we've got a world-class manufacturing facility, thanks to Emory and team in Xi'an, and a treatment planning facility in Chengdu. We're gonna segment public hospitals and private hospitals.
The segmentation that you saw for orthos and GPs, we're gonna kinda take it two levels down. We're gonna do the same thing for public hospitals, we're gonna do the same thing for private hospitals, and have customized programs for each of those. Next, you know, we've recently announced a partnership with Wuhan. Wuhan University is one of the top two universities in China, has incredible, you know, power and authority in the orthodontic world for China. They endorsed us. We plan to kind of continue to partner with them on co-developing innovation. I've already talked to you about our GP adoption. Patient demand creation and conversion. I think China offers us an incredible opportunity to drive differentiation of a brand. I'll talk to you a little bit about how we do this, right? I wanted to take our digital workflow, showcase how it comes together in China.
China, we have to be present in WeChat, we have to be present in Weibo, and we have to win the search on Baidu. At the same time, we've got to use KOLs as our influencers, you know, on all online TV. By the way, almost 100% of video watching by Chinese teenagers is online, so we've got to play where our consumers are. Second, we recently got approval for 5D and 5D Plus in China, so we're excited about commercializing 5D and 5D Plus of iTero in China. Third, dedicated treatment planning. We now have created treatment planning pods, which are focused on segments of doctors within public and private to improve the level of service that we can offer to customers.
Fourth, we want to kind of use our world-class manufacturing facility to drive agility, cut down lead times, and really help us figure out how to win with them. Innovations. Chinese cases are one of the most complex cases that we have in the world. We are working on developing a protocol that helps us deliver better treatment outcomes for the Chinese consumers. Moreover, lastly, you know, we all talked about virtual care. Given the Chinese digital ecosystem, we've integrated our capability into WeChat, right? And the vision really is that it becomes a seamless journey for consumers, especially young adults and teenagers in China. We have a tremendous opportunity in APAC. You've got a rising middle class, you've got a brand-conscious and young population which adopts digital far faster than the rest of the world.
If I look at APAC, it's a heady concoction of everything you want to be. I sincerely believe it's ours to make. Talk more about it soon enough. With that, let me hand it over to Jen Olson, who is our SVP and MD for customer experience. Over to Jen.
All right. Good afternoon, everyone. It's really good to see some familiar faces in the room. Thank you so much for traveling out to see us here in Vegas, and to those of you online as well. I'm thrilled to be able to provide you a little bit of an update on our customer success and customer experience initiatives. You know, just to start, this area of customer experience I think is much more understood as a primary driver in the following areas. Revenue growth, probably near and dear to your guys' hearts, customer satisfaction, of course, and also employee engagement.
Now, there was a recent Forbes article that I read that said in a McKinsey study, 63% of customers were willing to pay a premium for products and services contingent on the fact that the customer experience they had with those products and services as a reflection of the company matched. Now, focusing on customers or keeping customers central to Align is not new for us. We have always been a customer-obsessed company. However, there's a change that you're seeing and that the fruits of labor and our products, technology, innovation that you've seen from my peers is requiring our doctors to do two things, to think of us as a platform instead of individual products.
Implicit in that, when you move from product to platform, there's an element of trust that goes with that as they shift more and more of their business to Align. We had to ensure, focus, invest to make sure that our customer support and experiences matched our products, technology, and innovation. Now, on that note, we've had a number of successes as we've focused our efforts in several areas. Now, I know when you probably think of customer experience, what might come top of mind is customer support or that frontline support, and they are in fact critical to our success. You've heard that through the regions about how they're investing in their frontline support. We think about it a little bit more holistically than that.
We have been focusing on things like our service culture, which is really the backbone of how we think about putting customers in the center of everything we do. Looking at new support models through localization and segmentation. Our omni-channel approach, which is all about giving customers options in the way that they work with us, and improving inefficiencies in any of our products, business streams, work streams in partnership with our doctors as they move more and more onto the platform. In the last 12 months, I'm pleased to provide an update in all of these areas. In our service culture transformation, the last time we were together, I talked about a new way of focusing on empathy and action as a framework for our interactions. This kicked off in early 2020 in EMEA.
We have since scaled this framework, training, and focus into APAC and the Americas, and through our continuous improvement teams, continue to evolve the best way in which we interact with our customers. Now, the more physical manifestation of this service culture framework is what we called the hives, and this is simply new support models with how we get as close as we possibly can to customers in the way that we support them through collaborative teams to solve for issues should they arise. I've been incredibly pleased by the progress made in these teams, and because of their success, we'll continue to look at investing and creating other teams similar to these in the future. Just to note, as you've heard from the regions, these hives can look different by region. In some regions, they will focus them on geographical areas.
In some regions, the markets will focus on subsets or segments of customers in order to make sure we're meeting their needs. As you can see, GPs, orthos, experienced, inexperienced, there's a wide range of customers, and our intention with these hives is just to make sure that our support mechanisms are as relevant to them in their journey as we possibly can. The next is omni-channel support. The last time we were together, I told you we had been doing live chat. That's been incredibly well adopted, and we have high satisfaction scores from our doctors. As you can imagine, they're very busy people, and so to step away and have a call, which is how we were traditionally based, can take time, and so this has offered them some flexibility in the way they contact us. In addition to that, we've rolled out chatbots and WhatsApp.
Again, this is all about moving to digital. The last is on improving inefficiencies. This has to do with customer journey mapping, something you're probably familiar with, which is to take our customers' journeys as they work with our products, technologies, and services, find out if there's any inefficiency, work collaboratively with them. We've established customer experience panels globally. We work hand in hand through design thinking and other methods to find areas where we can improve, smooth out, or innovate along these journeys to make sure we're being the best possible and most responsive partner along the way. As a result of these efforts, we've been able to launch a number of initiatives over the past 12 months and will continue to evolve.
On the business side of things, we have real-time case visibility, Knowledge Base 2.0, which is kind of a fancy term for an FAQ or self-help site, and service console. In the product area of continuous improvement, we've been able to launch Rulers and ClinCheck, Bolton improvements, and ArchTool redesign just to name a few. How do we know if we're actually hitting the mark here? We measure this through a number of areas. Raj spoke about our net promoter score. That's more of a well-understood standard of how to measure your customer experience. In addition to that, I talked about those journeys. We measure points in time of customer satisfaction along those journeys. We also measure our customer effort. In other words, how difficult is it for customers when they do contact us to solve for their issues?
The last is this CX to EX connection, which is what we're really measuring in our service culture markets to better understand. What we're seeing is the more empowered and customer-obsessed our local teams are, it tends to translate into exactly how our customers feel about the level of support we're providing. We'll continue to evaluate that as well. One of the things that I'm most pleased about this year is that we launched our CARE at Align campaign. Now, this is our umbrella term for our customer-centric activities and programs. We call this empathy and action. Empathy without action is nice, but it doesn't solve the issue. We were very intentional about making sure that CARE at Align is all about listening to customers, understanding their needs, wants, and frustrations, and then putting action plans around them.
We launched this in April of 2020 with an internal CX-focused week. This was a global program. It included, thanks to Shree and her team, a CX hackathon, where 100 of our brightest minds internally took some of those journey pain points and put true action plans around how we might solve for customer. What I liked so much about this is that it really brought the customers to life for our employees, especially employees who don't get the opportunity to regularly interact with customers and yet whose insights and influence directly affect their experiences with our products and technology. This CARE at Align CX week will become a cultural anchor for us, and we'll do this every year going forward.
We will start to talk about this a little bit more externally, again, as an umbrella term for our customer-centric campaigns in the months and quarters to follow. I guess you probably wanna know how we're doing. Well, I'm pleased to report that our NPS score for our organization as of the month of October is at an all-time high globally at 55.7. We are incredibly proud of this. This is a direct reflection of both our internal focus as well as the trust and partnership and collaboration that we're seeing from our doctors as we go out and work with them and solicit their feedback, again, along all these journeys. In addition to our NPS score being at an all-time high, I'm thrilled that we have active programs now in all regions.
We've redefined what service culture means at Align, and the launch of CARE at Align is a cultural anchor for us and our business moving forward. We have dedicated regionally specific SPO-support teams in our hives, and we'll continue to invest in that. Ultimately, this is resulting in stronger relations with our doctor partners. Our vision for 2022 remains clear. We'll continue to humanize data so that we don't speak in one-size-fits-all terms for things like GP, ortho, platinum, or regionally specific. We'll reduce complexity along those customer journeys wherever we find it based on collaboration with our doctors on solutions. We'll provide personalized choices wherever we can, and ultimately, our goal is to connect with empathy with our customers always. With that, I'm pleased to bring up John Morici, our CFO.
Thank you, Jen. Hello, everybody. It's great to see some of you in person here. It's been a long time. Really excited to be here today and take you through some numbers and get us grounded on a few things, and really appreciate you being here, either in person or online. Wanted to start with, you know, our purpose, transforming smiles, changing lives. It's something that I hope you see has come out in the presentations that we've had. It's really something that we're all believe in. It's a part of what we do, and it really ties into our CSR. We believe this as employees. We believe that doing better for our customers and their patients makes a difference.
We also know that as investors, they believe in CSR, and you'll see more actions and information coming from us in the future. I want to kind of bring things together. You know, we've seen a lot of great information about the massive opportunity, the positioning that we're in, and the opportunity that we have. I wanna talk a little bit about reliable execution, things that we're doing to be able to help drive the business, and then talk about our long-term growth model. We'll take that through. You know, as we've seen, and I hope you see, that the global opportunity is massive. 21 million annual orthodontic case starts, split evenly pretty much across all the regions. Massive opportunity and a growing opportunity that we see. We talk about the 500 million potential patients and the incremental opportunity that we see.
It's everywhere. It's all the different regions that we see, all the different presentations that you see now. Huge opportunity to be able to grow and be able to have new opportunities to get people who need some type of teeth straightening. This massive opportunity that we have with not only in Invisalign side, but also on the iTero side. I hope you're getting a good understanding of what that opportunity really is, 'cause on the iTero side, we say it all the time, but it really is true. It's as underpenetrated or even more so than Invisalign. We have a huge opportunity, and it's something that we're gonna continue to grow.
When you take that all together, it's one thing to have this great opportunity, and you see it with all the different potential case starts that we have and so on. It really comes together, and I hope you see from my colleagues, I think their presentations were excellent. When you start to think about what we do as a company, from innovation to manufacturing, from the marketing opportunities and the awareness that has driven to the sales opportunities. You could see all the unique things that we drive as a company. Really the end result and what I'll talk in the next few slides about in my presentation is how it translates to reliable execution, reliable financial results that upper right there. From a top-line standpoint to profitability, cash generation, and all the other good things that we bring.
Let's start with just raw numbers from 2016 to where we're at this year. You look at the numbers. In 2016 was the first year that we ever got to $1 billion. Took us 19 years to get to $1 billion. Big milestone for the company. A lot of great things, all the different innovations, things that we were driving to be able to get to that first billion. Five years later, almost got four times larger than that, almost to $4 billion. You can see that growth that we have. While doing that, not just to get revenue, but actually get profitable revenue and profits that drive through that.
You can see what we've been able to do from an operating margin leverage to be able to drive that. From not just the strong revenue growth to finding that return on investment, and I'll talk more about that. Just another way to look at the numbers and say, "Okay, what does that mean to go from $1 billion to almost $4 billion in five years?" Well, the CAGR that we've seen on that is 29% growth there from a revenue standpoint. Again, not just the revenue, but also the profitability at 32%, which is impressive. Then the continuing cash generation as a company, and I'll talk a little bit about cash in the future, to be able to drive that up 37% on a year-over-year basis over this time period.
Driving growth, driving profitable growth, being able to generate cash and being able to invest back into the business and give back to our shareholders. What we talked a lot, and really the presentations kinda led to this, when you look at our strategic priorities and the operational execution ultimately driving to return on investment. Many times you push to the financials and you see, oh, you know, this is the end result. It takes all the different things that are going on in the regions, things that are going on from a technology standpoint, all the investments and innovation that we have to drive to be able to help grow the business. It takes all the different aspects that you see from a presentation before you to drive this financial strength and ultimately provide that shareholder value.
Another way to look at the revenue, you can see the growth that we've seen over those five years and the profitability and the free cash flow, and then ultimately the market cap. Are we driving shareholder value over those five years? I think that's what shows through. Balance sheet has been, and our cash generation has been very important over the last several quarters, and really the pandemic and crisis, never more so. When you look at our free cash flow that we've been able to generate, back from 2016 to now 2021, incredible amount of cash flow that this business. It starts with having a good business model. It starts with having discipline to be able to make the right investments, get that return on investments, and ultimately drive cash.
You know, Jen talked about NPS, and it came up in a lot of different presentations. If you have a high NPS, you're gonna get more volume, and those customers are actually gonna pay us, and we actually see that cash coming through, and it's a great thing to have. Especially a great thing to have when you look at our balance and what we've been able to bring back to that healthy balance, where when the pandemic started, we kept our employees, and not only that, we also continued to invest, and we think that made a difference. That's what's really helped us grow. Being able to have that healthy balance sheet, you know, really gives us strength in the future.
You know, when we talk about, you know, we talk about, which Joe and I on the calls, we, you know, there's always these variables that people are talking about, and they'll say, "Well, it's kind of this multivariable equation." This is the multivariable equation when we think of things. There's brand awareness. You saw a lot of great presentations about this, you know, growing customers, expanding out. You know, how can we train more doctors? What can we do to help grow our business? All the operational excellence that you have, 800,000 aligners a day, manufacturing in different locations, treatment planning, but all being able to provide consistent, reliable output every day in and day out. It's unique.
The digital dentistry that you saw a lot about today and the platform and the growth, these are all investments that we have to make. We've gotta make these investments at certain points in time. Sometimes you lean into one side or another based on the needs. If you're adding capacity, you're gonna spend the CapEx, spend the investments to be able to get that capacity up, then you leverage that facility or leverage that plant to be able to grow. Other times it's digital innovations. Sometimes you're making bets on marketing to try to grow and drive awareness in certain places. You're trying to bring it all together to try to ultimately find what's the best return on investment so that we can grow as a company.
One thing I wanted to take from Joe's chart, initially, when you start to say, look, we're moving from an appliance to a platform. I wanted to break it out from a year-over-year growth standpoint. If you look at our first 19 years, we've grown 23% a year since our inception through 2016. It's impressive. Great growth. It's some innovations that we've had, building things up from an appliance standpoint. You look at the growth that we've been able to see from 2016 to 2021, 29% growth. That growth reflects the innovations that we have, the digitization that we've been doing, the increases that we've been able to see from our digital platform standpoint, and really helping transform our business.
That's something that we see as we go into these last few years. When we look at what that all means, and we look at the digital platform that's being established, the innovation that goes in, all the other pieces around it, you saw bits and pieces of it as we went through the presentation, e-commerce and subscription program and retention and all the other pieces.
In addition to all the other work that we're doing as a company, we feel that we have all the pieces that it takes to be able to drive and continue to drive growth within the business in this from the standpoint of having a market that has a huge opportunity that you saw from the beginning, that whether it's orthodontic case starts or the general opportunity that we have the technology and the innovation that we bring as a company, bringing those two together gives us a long-term growth model that as we look at our opportunity and how we think about investing for the business, we're reiterating the three- to five-year financial model targets. We believe that we can grow revenue 20%-30%.
These are investments that we're making as a business to be able to capture the huge market opportunity. Growing 20%-30% is something that we've been able to do. We've shown what we've been able to do over the years. Do it in a way that drives profitability. We can't let down our balance that we need to be able to drive revenue and drive opportunity, but do it in a financially disciplined way. Gross margin in the 73%-78%. Operating expenses around 50%, netting our operating margin to 25%+. Those are the ways that we have from a discipline standpoint that we think by the investments that we're making, through all the multivariable equation that we're talking about, sometimes you're spending more on marketing, sometimes it's more in R&D, sometimes you're expanding.
These are all different levers that we have, but taken all together, this is the model that we have. As we look at 2022, not giving specific guidance for all the categories, but when we look at our revenue for next year, we feel very comfortable with revenue growth in the 20%-30%. With that, I'll close my presentation, and I believe there's a break after that. Thank you.
We will now take a short break. Please return by 4:25 P.M. for Q&A. Thank you.
Q&A is about to begin. Please take your seat.
Okay, can we get started? Shirley, we'll start off with a few questions over there.
Sounds good. Let's start off, we've gotten a couple questions online. Can you discuss the TAM going from 15 million annual case starts to 21 million annual orthodontic case starts? How did we go up so quickly? In the last year since the last analyst meeting.
Yeah. I know that's a fair question 'cause we've had $15 million for what, Shirley? Going on, you know, three years or so. We've done a lot of expansion since then. When you look at Brazil and Latin America, we were just entering into that marketplace. We really never included that data in our TAM. A significant part of Southeast Asia where we hadn't really migrated to yet, including India and different parts there. Also, our clinical viability, when we started, this was about 75% that we could cover in those orthodontic case starts, and now we approach 90%-95%, depending on how you measure it. That was another variable too. Markets moving into Africa, you can see, the Middle East, and we start to count that. Together, I think we're at that saturation point right now, given our international expansion.
You know, a few more clinical moves will get us to 100% here in the next couple years in the sense of the cases that we can handle. Overall, I feel like 21 is a good accurate representation from a global standpoint and what our clinical competency is. Any other questions, Shirley, that kind of they're pressing right now?
Yeah, maybe we'll go to one more online, and then we'll go to the room. Question about the new treatment planning, shortening down two-three days faster and manufacturing closer to customers in more places. How does this impact your turnaround time? Has it shortened significantly, and does that reduce your visibility into when you're reporting and giving guidance?
Jen, you wanna answer that question? I'm teasing you, Jen. That's not good. You know, I honestly don't. I think our visibility is really good. I mean, we start with gross receipts. We move with CCAs. There'll just be time compression, you know, in that particular thing. You know, this is. I mean, we're talking about millions, you know, and millions of transactions in that sense. So I don't think that, John, that there's any kind of a, if I'm misinterpreting the question, I hope I'm not, there's any kind of misalignment in the sense of how we could read those orders at any point in time.
Yeah, we have good visibility to, you know, from early volume that we have, how it gets to ClinCheck, and then ultimately gets to the manufacturing, and then shipments. Just in general, we wanna be as close to as we can to our customers. That means treatment planning closer, same time zone, same language, that helps. Manufacturing closer, in this day and age to be able to help doctors and be closer to their practice, it's a great customer satisfaction. You know, also some of the freight savings that we have. You have a lot of pressure to ship things, you know, around the world, and being able to be closer to our customers, you know, and reduce some of those costs back and forth are very helpful. From a visibility standpoint, we have great visibility into the business and that doesn't change.
Yeah. Yes. Sorry. Yeah.
We have a question about the retainer opportunity and how we think about the growth rate in the next couple of years.
Raj, do you wanna?
As I said, right, you know, kind of for us, retainers has been a well-kept secret. Today, it's primarily in the U.S. and somewhat in the U.K., so we think we have an incredible runway ahead of us. I'll just kinda give some metrics, right, in terms of what you do. Orthodontists attach rate is very, very low. Even GPs don't attach, you know, kind of retainers to every case they do in a developed market like the U.S. Right? First metric. Second metric, awareness of retainers is actually not very high if you go outside the North American business. You know, kind of there is a clear opportunity for us to educate even doctors, you know, across multiple markets, especially in APAC and CE. Awareness of patients is very, very low, right? You know, nobody understands the criticality of maintaining their smile.
If you take these three together, we see an incredible opportunity. The right way to kind of think about it is, you know, I talked about how every one of the 500 million consumers who could be potential Invisalign patients could also use retainers. I'd say, you know, kind of, and John and Joe have talked about this opportunity in the past. You know, in the next few years, I think it's at least a billion-dollar opportunity.
That's good.
All right. Right now, about $200 million a year?
I know that one was 67.
Okay.
Four years of line item raises.
Since the third quarter.
Yeah. We're running up against the high end of our operating margin, and how do you think about that in the next few years, and why not raise it higher?
You want me to take?
Yeah, John. Yeah.
When we look at our operating margin, as we said in my presentation. Look, we wanna keep that balance, and then there's levers that you're pulling as you go through. We're very pleased with what we've seen as we've gone through this year. As you say, I mean, you know, we've seen, you know, good operating margin. You know, we feel that that's the right range to find, that growth balance that we want. You know, we look at this incredible market opportunity, and, you know, we have these growth drivers that we continue to invest in. You know, that gets us in that 20%-30% range that we look at from a revenue standpoint. Last five years, we've been at the high end of that, which is how that plays out.
We wanna be able to do it in a way that drives some of that leverage and profitability. You know, I think when we get to a point where you don't have-
Maybe as much opportunity then, you know, you don't have to maybe make those investments. Right now, we have to continue to make those investments to drive that awareness, drive the technology, drive into the regions that we talk about and really try to find that right volume growth that we can get. Right now, I think we're comfortable with the range that we have provided. It's just that you're gonna find, you know, certain areas you might get more leverage because you've been more established, but on balance, we feel that that's the right mix for our company.
[audio distortion] DSO
Yes. How do you see the consumer channels growing, whether it's through DSO or otherwise?
The consumer channels through DSO, is that...
Sorry. It's not good.
How do you see the channels where the consumer accesses care?
Oh, I'm sorry.
Direct translation or through a provider growing forward, how they meld together.
Where you see the consumer going forward and how they meld together.
Madeline, is the question how do we see the consumer going forward?
The clinical channel and how they meld together.
Great. Okay.
Sorry, Chris.
Is that okay?
I was just trying to get at how the consumer accesses care going forward, whether it's a direct-to-consumer channel or through a clinician, a DSO, just how you see the relative growth rates and how your end-to-end digital solution really positions you more so to play better, if you will, in that direct-to-consumer type access.
Well, you know I can grab that. We're not-
I didn't mean to be that complex.
If your question is, are we going direct to consumer? We're not gonna do that. It's just, to us, doesn't make any sense. You want a doctor in the middle of this thing. You know, it's fairly serious when you're moving teeth through bone. You wanna make sure that they actually see a doctor up front, understand the dentition that they have, make any corrections needed so you don't lose teeth during treatment. Follow this thing, make sure there's no root resorption. You know, obviously, you know, you see, you know, some of our competitors decide to go straight to consumer. These are strategies that I just think are difficult and no one has really proven you can make any money by doing that either so far. SDC being primarily it. Yeah, sure.
Why don't we take one online? CapEx rose a lot in 2021, in part on the new Poland facility. Should investors expect more normalized cost, CapEx to sales beginning in 2022, or will it remain elevated versus pre-2021 levels?
I think when you look at that in total, you're right. It did raise this year because of some of that expansion that we saw, primarily Poland, some other facilities that we added. Next year starts to normalize a little bit more. It still will be elevated, maybe not as high as this year. Going forward, I think it'll come down to more historic levels. How would you think of it, John, as a percentage of revenue? 'Cause we're growing so quickly, I think people you look at that aggregate number more in the sense of what we have to spend as the business grows. Yeah. I think on a steady state basis, 7%-8% of revenue. At the higher end, sometimes you run into, you know, adding capacity like we see this year.
It might be nine or 10, but on a steady state basis, 7% or 8%.
Yeah. If you're trying to model it, I think you can use those statistics and it will help.
John.
Here we go.
Come on, John, you can talk to us.
Oh, you're gonna make it easier.
I didn't see Madeline hiding behind you there. Sorry.
How global restorations require orthodontic correction first.
Yeah, number of orthodontic corrections that require an orthodontist first.
How many restorations do you think require an orthodontic fix first?
How many restorations? Oh, that's a great question. Zelko, what would you say?
I would say, as I said, it's about 3/4. About 3/4. I mean, you can go without it, but you're much, much better off going with it. I would say three-quarters, and it's a pretty good number.
You know, it's maybe Zelko, I'm kind of in my danger zone, but that's restorations. Once you have GPs really looking for malocclusions that are colliding and chipping teeth, that wouldn't have been a normal restoration, so you kinda have to think that one through too, right?
I mean, what we wanna do, we wanna, you know, every patient that comes to a GP practice should be evaluated for their condition. That's why we say scan every patient every time. We can do the analysis at point in time, we can do it longitudinally. If you do the analysis, you will find out that three out of four people would probably need a treatment. Now you can make that treatment as a standalone ortho, you can make it in conjunction with the restoration. But it's about 75% of the people, when you do the analysis, it will say you're better off, and if you don't do it, there will be consequences over time.
Does that change the math?
Does that change the math for the 500 million person market?
Well, I mean, if you wanna raise it, John, I mean, but 500 million is pretty good. I think, you know, there is, you know, a certain amount of just windage on a number like that and what you wanna call. But calling a half a billion people and being, like, 2% into that piece, I think it's adequate expression of what the opportunity is the meaning of that kind of a thing.
I think it's a good starting point, and it'll take it from there, right?
Can Emory give us an update on manufacturing, what we've learned going from centralized to decentralized?
Sure. I think on some levels, you get, you know, some of the questions before, we get a lot of efficiency in reduced lead times. Some of that's in freight, for instance, on the manufacturing side. On the treatment side, a lot of it is we don't have to do as much translation, language translation, which takes a lot of time. Those are things that, you know, are front of mind. I think on the treatment side, the connection you can make with a doctor in the local market makes the communication side much easier and the, you know, kind of both sides learn how to communicate better. That tends to reduce modifications. It reduces lead time between, you know, between modifications or treatment. Then I...
Those are all things that I'd say, you know, we're gaining efficiency or customers are gaining efficiency. I think certainly being more distributed makes it a little bit more complicated now that we have, we'll soon have, you know, a regional factory in each of the regions and learning how to really drive the most optimized system through that will take some learning for sure. The way we look at it is it's all positive from a customer experience standpoint, from an efficiency standpoint, and in many cases, from a cost standpoint, as John mentioned earlier, from freight savings. We don't have to ship things from Mexico to China. You can do it, you know, within China, as an example.
Make sense, John? Shirley.
Okay, we'll take another one online. Let's see. You said you were very comfortable with 20%-30% revenue growth next year. The comps are gonna be tough in early 2022. How should we think about the comps next year relative to that?
I think when we talk about the 20%-30%, we think about that for the year. We'll have tougher comps in the first half, so you should think about it that way and maybe slightly easier comps in the second half. You think about modeling it that way. In total, for the year, when we're talking 20%-30%, as part of our long-term model, we feel comfortable with that for the year next year. Just be mindful of kind of first half, second half. Yeah. Yeah, John.
Sure. Just a little color on whitening and retention and how that hits the P&L and gross margins.
A little more color on whitening and retention and how that hits the P&L and gross margin in most markets.
Well, I can start with from a financial standpoint. From the standpoint of ASPs, it's not retention, and whitening does not show up in our ASPs for Invisalign. It'll show up as non-case revenue, so other revenue. From a margin standpoint, it's very similar margin rates that we would see for clear aligners. It's very healthy margin. As discussed, we've been selling retention for a number of years. It's just a matter of having focus and being able to focus to be able to drive a higher attachment rate, really educating our doctors and ultimately their patients on the benefits of retention and the products that we have. From a growth standpoint, a huge growth opportunity.
You know, we think about Invisalign being under-penetrated. Our retention business is even more under-penetrated, and we have a huge opportunity there. Think about it from a profitable standpoint that it's as good or better than the profitability that we have.
Just for Joe, why now with the brand? For Simon, will Brazil be easier since it's more adult benefits that you typically find when you do it?
For Joe, why now with the brand?
One more time?
Why now with the brand?
Why now with the big push behind the brand?
Branding
sort of the initiative to go ahead and get a ton of money. You've had the brand for years, arguably, right?
Yeah.
It's been selling for years. Why this additional push now to kind of move forward and take Invisalign to the next level?
I just, you know, honestly, if you're talking about the brand in the sense of the extension for whitening and things like that, John, it's just been screaming at us for a long time, right? That opportunity's out there. You have doctors asking for it. We know through our e-commerce site, at least that end of whitening is in demand too. It was just a culmination of pressure over time to say, to move ahead on this and time and people to do it, John. You know, we allocate resources, I think, pretty specifically to things. We make sure we wanna invest in things. This is not a big investment. It's not a heavy lift. It's an extension in that sense. You think, why not? You know, you're satisfying consumer demand, doctor demand. Like John said, it's margin accretive for us, too.
You know, frankly, when you think about it, when people straighten their teeth, they want them white, too. There's nothing like having, you know, Invisalign as a whitening tray or really to make that happen. It's just logical. This is not a push. It's a pull from the market.
You know, to Bill and Joe's point, right? We also were able to find a great partner in Ultradent.
Yes.
Right? Because they've got a product that works. Remember, Ultradent is the market leader globally in whitening. They've got 50% share. They've been in the business since 1976. They know whitening really, really well, right? To have a partner like that, to kinda create the chemistry and the interaction with the aligners so that, you know, you could deliver the best experience for the doctor and the patient, right? Just came together at the same time, to Joe's point, and that's what we've been kinda doing.
Hey, you know, John, I ask you a question, right? I'm always think in my mind the question behind the question. What would you worry about with us doing that? Is there some concern?
No, I'm not. I guess, yes. No concern, it's just one of those typical, "Hey, your primary market is 2%, 3%, 4% penetrated," and you know, the typical take your eye off the ball.
Yeah.
Is this company gonna be able to, with such a massive opportunity in front of them, not get distracted, not get the reps distracted, and keep the blinders on and-
Hey, John, that's a good honest, that's a good question. This isn't sleep apnea, okay? Sleep apnea means Shree's involved, that means Srini's involved. That's something I gotta change treatment planning. It sucks resources out of the business. Whitening? Not even close. It's front end, it's consumer, it's a very light touch.
Natural extension.
Same thing.
No sales team involved as well.
Yep.
It's not gonna distract our sales force.
That's a good point, Simon. Yeah.
Hey, can I just throw one last one in there while I'm speaking? Sorry.
Yep. Yeah.
Just Simon, for you, maybe I got these numbers wrong. Hopefully, I got them right, but just on Brazil, I think you said the breakdown's the inverse between teen and adult. Does that allow you to penetrate the market faster, just the push, just because you don't have a friction point with teen, which when we think about the adoption of Invisalign and that market opportunity going forward?
Yeah, I'm not sure it is necessarily faster. We've obviously seen rapid growth down there, and I think the fact that it's been mainly adult has helped us. You know, there are other barriers in Brazil that we don't experience in North America, but I think the exciting thing is while you know, I suppose the market that we've done very well with globally, the kind of market is set up for us in an ideal situation, but then there is a developmental opportunity for the teen market. I think our initial focus is, well, let's go after the market that exists today, and then we can build on the back of that. Yeah, there are a few markets around the world where you get that.
It's totally invert ed, John, and Latin America is one of those. Thanks, John.
Shirley.
Can you talk a bit about how the branded software products interact with each other, especially those that seem to have overlapping functionalities?
You got that one, Raj?
I'll start, and I'm sure Shree will build on.
Shree.
Yeah. Our multiple virtual capabilities actually are complementary, and they build off each other. I don't think there is any intersection. Let me just kinda make sure, you know, that's clear. I might have not been clear. If you take My Invisalign app, there is a consumer portion, there is a patient portion. There is no overlap. The consumer portion focuses on addressing key questions consumers have to drive conversion to patients. The patient portion focuses on how do they get the standard of care from doctors, right? That's what the patient portion focuses on. As an example, there is a way to track aligners. As an example, there is a way to kinda send photographs to the doctor to get doctor's advice. As an example, there is a way to refer, you know, friends to it, right?
Yeah.
If you look at the next tool, so that's one for patients and consumers. Now, if you look at another tool which we have, which is the Invisalign Practice App that I talked about, that we launched yesterday, this is solely for the doctor. The doctor can go into the app, look at all the appointments he or she has, how many ClinChecks he or she has, knows how many patients are scheduled, how many prospects are there, what are the tasks to be done, how many patients have sent Virtual Care photographs for the doctor to look, okay? It's completely complementary, doesn't touch any of this. Now, let me take it to one level further. You've got a consumer patient tool. You've got a doctor tool. Takes scanner. If I'm a patient, I've gotten interested, and I've come to the practice.
When I come to the practice, the doctor scans, and then he's able to show me my treatment plan in my face on the scanner. That's a far more detailed visualization of what transformation of a smile looks like versus what we'd show in the app. Again, it builds off that. Just those are just three examples for you to kinda understand that every one of our tools is complementary, right? Now, if you go to the treatment planning side of things, Invisalign personalized protocols help make treatment planning efficient for the doc. We send a treatment plan that the doc likes the first time. Live Update takes the friction out of the process for the doc by enabling him or her to kinda make changes then and there and see what the plan is. Again, completely complementary, doesn't touch it.
You take Smile Architect, it enables the doctor to incorporate restoration into orthodontic treatment planning, right? Nothing to do with, you know, any overlap with anything else. Let me pause there and see Shree if you'd like to kinda add in.
From my perspective, you know, there's gonna be web, mobile, and the scanner as three primary interfaces. Every stakeholder will have an app, and they will most likely have their own website. We're working really hard on integrating the exocad iTero and the Invisalign website, the doctor sites into one as well. So there is a lot of synergy to be had on the platform side with consolidating on the different technology pieces.
Shirley, does that answer the question?
Why don't I add one more while Madeline goes and gets another one from the room? The Invisalign story has long been about reducing friction in the treatment process, and we saw a lot of that again here today. What are some of the other frictions that still exist? Are there case examples on a regional basis where we should expect Align to continue to reduce friction over the next few years?
That's a really good question. I think we have a lot of programs to address friction. You know, our ADAPT program is to address friction at the doctor's office in sense of the business model and workflow and how they can actually monetize, you know, digital orthodontics in the sense of, you know, they do an overall analog process today. Our advertising is designed to overcome friction because you educate patients to go to doctors and almost force doctors more to move to Invisalign care. There are friction pieces all across our model that equals the amount of OpEx that we spend as a percentage of revenue throughout the business. Unfortunately, that's just the way this market is.
I mean, we have known over time where to spend, how much we can spend, where we think we get the fastest returns and, you know, across the board. This is just. It's just harder than it would seem that it should be because digital is so much better than analog. It just takes time, particularly to work it through the orthodontic community. Frankly, the friction in the GP market, which you can see today, and you can talk to doctors and ask them too, that friction is not any kind of, I would say, resistance to digital aligners. In fact, it's very acceptance. It's their workflow. It's how they work and what they do every day. They can't take up too much time on one kind of application.
You often think they have an hour to make so many thousand dollars, and you have to make sure that your application works inside that workflow. What's so good about the ortho restorative vision is we can combine that with what they normally do, and we fit into their workflow side, and they can think that way. There are frictions all across this value chain that you have to get at, but we get better at it all the time. It still takes money. It still takes focus. I feel we're much more in the last three and four years, much more along in understanding where to invest and where to get the best return. Yeah.
Could you talk a little bit about how increasing levels of automation and AI within software can impact the role of treatment planning centers and the workflow or whether it can reduce reliance on human touch versus more impact of software over time?
Yeah. Yeah. I'm gonna ask Shree to answer the first part, and then Emory is on the receiving end of that with the resources. Okay.
You know, when Joe talked about reducing friction, our job in the technology team is to continue to figure out how we can use all of the data we have and all of the experiences we have with the treatment planning of 11 million+ cases, and continue to personalize the treatment plan and automate as much as possible. Because at the end of the day, we wanna put the power of AI and digital technologies in the hands of the doctors so that they can design the best treatment plan for the patients.
I guess on the resource side, I've been here for a bit, and when I started, it took about 24 hours of work content to do one treatment. Most of that work was just busywork, you know, cleaning up a scan, just really preparation. It wasn't really value-added work, I wouldn't call it value-added work. The way I look at it is we wanna move from that, which we have been over time, you know, pulling out some of the non-value-added work to actually helping customers solve clinical problems, right? Many of them know exactly what they're doing, and they just wanna be able to do it.
That's where the power tools come into play and some of the AI and the automation will get them, as Raj says, on the green, and then they just gotta do a quick putt and they're done. There are many people that they don't really know or they have questions or they wanna try different options. The software allow them to do that very quickly. Then our resources that are experts with the tools and the process and the appliance will shift over to helping to solve those problems when you know, our doctors can't do it all on their own, essentially, right? It becomes more of a support and a problem-solving than a doing busywork. I guess that's it.
You know, if I could just, you know, from a high level view, 'cause obviously Shree and Emory just are in it every day, but as I walked into this business early, six years ago in June, and you look at treatment planning and you look at how many resources we have tied up and how long it takes, it's just a huge frictional point you know you have to address. What the team's done is by using AI and your question or whatever is to really get at this thing, in a big way. It's taken a huge amount of time and a huge amount of focus to get to where we are. Like Emory would say is, if we didn't do this, we'd have 30,000 treatment planners. The way we scale, you can't scale. You can't.
You know, even now, even Costa Rica, we're up against the wall in the sense of being able to find people to actually do this. This is a frictional point, but there's also a necessity in doing it too, because you just can't keep hiring the number of people we have in this kind of inefficient process and think that we can continue.
Just kinda, I mean, I think Shree touched on it in her presentation, but kind of, you know, it's not that this is a new concept or something that we like all of a sudden, "Oh, hey, we should, you know, we should automate this and use AI." We've been automating from day one. It just takes a long time to learn the interface between the customers and their, like how they approach philosophy. It takes a lot of years to learn how to communicate and get on the same page so that you can actually use that information to drive AI and drive automation in the tool, right?
We have a ton of smart programmers and developers that do incredible things, but you have to be able to get inside the head of the clinician and really understand that in order to be able to execute that. I think the expansions that we've done by putting treatment planning closer to customers where we can have that intimate relationship with them, you know, kind of face to face, kind of enabled us to be able to actually start to really accelerate that program over the past few years.
Okay. Madeline, anything over there? John?
Do you want me to tell you or shout it out? Can we just come back to this notion of the digital ecosystem? It seems like that's a big theme of this meeting. If I were a dentist, I'm thinking, all right, you guys have a great digital ecosystem, but what about practice management? What about billing? The restorative guys have their own digital ecosystem that they're trying to push on me. How are you guys thinking about, are you gonna sort of try to just be open with those other systems, or do you wanna add that functionality so that you are the dominant sort of digital presence to a typical GP?
Yeah, you know, John, I mean, we understand PMS systems. We see them out there. You know, they're not the most attractive systems in the sense of what you can do or growth-based systems, you know, I mean, like, you know, when we went into Heartland, right? With their PMS's Dentrix out of Henry Schein, you know, they just leaned on Henry Schein to make sure we integrate with the Dentrix system, and we do. I think from a strategic standpoint, at least at this point in time, the best thing for us to do is at least be open to those kinds of things and to interface with those programs.
As far as the practice management system that a Straumann would offer or, you know, an Envista or someone would offer, I see those as very discrete systems around one specific item like an implant or something like that. Those aren't the robust kind of digital platform that we've been talking about here and, you know, over the last couple days. Raj, would you
I'd agree.
Agree.
I'd agree. If I might just add, and then I'm sure, you know, Karan, you know, I'll showcase something that Simon and his team are doing. John, there are three pieces to it, right? First, there is a digital ecosystem that we espouse, and that needs to be seamlessly integrated at the back end between Invisalign, iTero and exocad. We started a significant effort to kinda do that so that it's completely seamless. As we do this, your question is, are you going to be willing to open up your APIs to get integrated into some of the other systems to make it easier for doctors? I think that's a second step. I think we are absolutely open to kinda integrating so that it becomes easier for the practice. In fact, Simon and his team are doing a pilot on that, right?
To kinda learn on this. There's a third step, right? Because the second step is integration of APIs. Then there is an overarching structure that you could actually put in over the top of an API to really improve practice, you know, and efficiency. This is what Joe was saying, the current systems are not attractive at all. Our approach to this is let's clean up our shop, make it truly seamless. Let's make sure we offer easy APIs for people to integrate with, and then we can take it from there.
Shree, would you, when you look at it, I mean, you work with this every day. Do you have anything to-
You know, the last mile has always been a problem for us. We are always looking for newer technologies. You know, if it's in the cloud, you know, it supports APIs, it supports some of the new identity platforms, then, you know, we can sort of do uploads and downloads and integrate imaging data. Much of these platforms that the doctors use are very fragmented. Even in the U.S., between orthodontists and GPs, and in the world, it's even worse. We are always on the lookout for something that works well for majority of the practices.
You know, John, one last thing about that too. We started talking about digital platforms about two years ago, right? Our competitors pick up the speak immediately and start to talk about their digital platform or whatever. You know, we're spending $250 million a year on developing our. It just takes a lot of money, takes a lot of time and a lot of expertise. You're gonna hear a lot of people, AI, machine learning. Dig down. What is it really? How much are you spending? Describe to me what it is. I mean, if you're gonna be in this market right now under a digital umbrella, you have to have the speak, but the real delivery of it takes time and money and good conceptual thinking the way you're hearing here on this stage. Shirley?
I think we've got one more question before we're wrapping up in time.
Yep.
Okay. Can you talk about the leverage in the model? I'm gonna throw maybe two or three at you guys, and you can decide how you wanna handle it. How should we be thinking about, obviously, leverage in the model over the long term? Can you talk a little bit about the scanner opportunity, and how is the GP Summit in attendance this year compared to prior years?
Leverage, I guess the concern is about margin, you know, and how you leverage margin over time. That goes back to the frictional question, which is how much money you have to really spend to remove friction in order to grow. I actually think, you know, our GAAP numbers are pretty good this year. Even our non-GAAP numbers are, I mean, obviously pretty good. John, what would you answer that one?
Look, I think it's there are frictional components. There are investments that we're making to be able to grow into this market. To be able to grow a company organically 20%-30% takes investments. You might find, like I said, some regions you don't have to invest as much or some technology once you've established them, you don't have to do as much. It continues to take investments and you know, we're very aware of the model. We wanna do things to be able to grow the revenue, but grow it on a profitable basis. With so much opportunity, the investments just make a lot of sense to grow into the opportunity.
Frankly, we feel really good about our cash generation and our EBITDA levels. I mean
That ultimately gives us flexibility that when we talk about all these different investments that we're making, we're taking the cash that we generate. It generates you know the opportunities that we talk about adding OpEx where it makes sense, being able to invest back in capacity like we're talking about in Poland and other places, and then ultimately driving it you know driving that shareholder value in some of the buybacks and other things. It makes everything go round. You know right now we have a huge market opportunity with an under-penetrated market. We want our company investments to be able to grow into that market.
Sure as far as GP Summit goes, I think we have 1,000 people here. I'd say 600 doctors and people with us. I'd say that's probably, you know, 60%-70% of what we'd normally have. We have a lot of people that have been joining online too, from a virtual standpoint. Actually, I'm pretty pleased that we had this many people show up with a concern from a COVID standpoint and people not being not traveling. Over, you know, so far the enthusiasm from the doctors is great and just wonderful to be here to feel it. I'm glad that the people that attended too, that you came in, you get a chance to walk around, talk to them too. There's a lot of enthusiasm here. All right. Hey, thanks everyone.
Really, thanks for coming. Appreciate the questions and the interest and the intent here. I did ask you this, you know, go kick the tires, see what you can find out. We're, you know, full disclosure here. We feel great about our position in the business, feel great about our growth projections, great about where we're investing our technology and why, and the future of this business overall. Hopefully you can feel that from us, the confidence that we have and the enthusiasm we have for the future. Thanks.