Good morning. Welcome to Align Technologies Virtual Investor Day twenty twenty. Thank you for joining us. We've got a great meeting put together for you today. And I want to make sure that we give you a few housekeeping items before we get to the main presentation.
As you all know, we obviously are recording this. And so we were going to have the slide presentations available for you today on our website on investor.aligntech.com. Not only will the slide presentations be available, but after today's sessions, we'll have a recording, which will include the executive Q and A and the customer panel. And that will also be available on our website along with the hard copy slides or the soft copy slides. This presentation is being recorded.
And I want to remind you folks, of course, that it will include forward looking statements that are covered by the Safe Harbor and forward looking statements. We refer you to our disclosures on our SEC, including the 10 ks and 10 Qs. We refer you to those the company has no obligation to update any such forward looking statements. I also want to remind you that we will include non GAAP financial measures in our financial presentation. I'm going refer you again to the non GAAP reconciliations posted with our website slides as well as with our financial press release.
Now with that, I have the pleasure of introducing you to Align Technology's President and CEO, Joe Hogan.
Thanks, Shirley, and thanks for joining our Investor Day. I'm going to walk through some slides just to give you an overview of the business that many of you know, but hopefully, give you some insights that will reinforce the other presenters that follow me. You know, we're talking about bringing clear aligner treatment to the masses. And this is not just a statement. This is something we really believe.
Digital orthodontics is met more and more with society that's concerned about aesthetics. And those two things is the freedom of bringing digital orthodontics to patients and the desire for a better smile are coming together to create a huge marketplace. And that's one of the key items that we want to get across is the size of this market and how real this market truly is. The way we define our traditional orthodontic marketplace, and you know this from Shirley and me and everyone else who talks to you, is we talk about the orthodontic case starts, meaning the case starts around the globe that represent orthodontists and how they're handled from orthodontists overall. In the past, we've represented this market as a 12,000,000 patient marketplace.
We've expanded that to 15,000,000, and that's in line with our expansion from a business standpoint into Latin America, into The Middle East and Africa and also over in the APAC and areas like Vietnam and Korea and different places, too. So there are truly fifteen million orthodontic case starts around the world, and they break up roughly like this. About eleven million or seventy five percent are teens, and about twenty five percent, four million are adults. And if you go almost anywhere around the world, you'll have this kind of breakup in orthodontic treatments where it's predominantly teen and then twenty five percent adults. I think what's interesting here is our product line now with Invisalign First and mandibular advancement can whether it's teen or it's tween or it's adult, we have the broadest portfolio to address the number of malinclusions that exist, whether it's in the teen segment or if it's an adult segment.
And both Raj and Jelco will expand upon that even more. But what's more important is don't think about this as a static marketplace. When it's just an analog marketplace, it does only grow 1% to 3% a year depending on where it is. But with a digital spectrum on it and us looking at this market through a digital lens, it will attract more teens, it will attract more adults because it's just such a better way to address the malinclusion is with clear aligners through a digital platform like we have today with clear aligners than it is with wires and brackets and traditional analog processes. What's amazing to me and it's probably amazing to you too, that when you think about those 15,000,000 orthodontic patients overall, we have less than ten percent share.
But from a clinical viability standpoint, we can do ninety percent of those cases. And understanding that digital orthodontics is so much better than analog orthodontics is that our entitlement in this market is huge based on our experience and our portfolio. It's inevitable that this market's gonna move digital. I've been here five years. I think I understand this more than anything.
I think we'll talk about the COVID crisis in a moment and how much better it is to work under a digital format in this kind of a crisis than an analog format. But there's no question that this market will go digital, and Align is extremely well positioned to be able to address that market with our portfolio and our overall digital platform. In the past, when we talked about a broader marketplace that digital orthodontists that orthodontics really unleashes in the marketplace, we talked about three hundred million patients. The fact is it's zero five billion. It's five hundred million.
Just always keep in mind that seventy five percent of the people in the world have a malocclusion of some type. And there are five hundred million people who have the wherewithal and the means and the access to a digital treatment that could be treated through this. Now what's interesting about this marketplace, it won't be serviced strictly through the orthodontic marketplace. It can't be. This is the general dentistry market.
And often this won't be a complete malocclusion address. It will be just maybe addressing the Social six or maybe just straightening your front teeth in some way, but it's an aesthetic play. And it's very important that we work this through the general dentistry or what we call the GP marketplace. And what we've done over the years is, and you've seen that, we've been much more focused on this general dentistry marketplace, products like iGo, splitting up our sales force and segmenting our sales force between GP and ortho because it's a different discussion with a general dentist on orthodontics than it is working with an orthodontic in some way. And we also, from a marketing standpoint, have been able to split this up too.
So segmentation in this marketplace is really important. Our recent acquisition of exocad is geared toward this marketplace too because there are workflows in this marketplace that have to do with orthodontics or restorative dentistry that needs to be addressed in a digital way. And Exocad brought that to our portfolio along with iTero now and then our digital aligner that can really lead in this marketplace. And Jelco and both Raj will expand on that more. But this is an important market for us.
And if anything, it's real. And I just want to mention something. We've been together now for five years, and we're running the company for five years. There's the one frustration that I often have with analysts, but also anyone else that I talk to about a line, is explaining two things. And if we can get this across to you with the presentations in our Investor Day, successful.
One is this market is real. It's massive and it's been unleashed by digital. And secondly is what we do is we don't just deliver a clear aligner. We deliver a whole system, a digital platform around the doctor and patient to make this real. And it's a cumulation of twenty four years of understanding how to do this in 9,000,000 patients.
So what we do is hard to do. And I hope that you'll be able to pick that up through my presentation and subsequent presentations behind this. There's decades of disruptive innovation and digital transformation is the title of this slide. And we are a digital disruptor, and this is how Align got started. When you think about Align, people they say we're an orthodontics, an orthodontic company.
We are. We address the orthodontic market, and we probably understand orthodontics better than anyone because we've done 9,000,000 patients. We've digitized that. We learn from that database of orthodontics cases of what works or what doesn't work. But what you don't think about is we're really just a technology company that's disrupting the overall orthodontic marketplace or the dental marketplace.
We're a true disruptor. Our roots in the Silicon Valley and how we started up and the work we've done around digital makes it that way. So as we talk about digital and disruption and all those things, think about us more and more as I mean, we have 700 to 1,000 engineers in this business. We are, at our core, a technology company bringing disruptive technology to the marketplace. COVID, in a macro sense, COVID, when you look at it, has really accentuated the digital economy.
You look at some of the, obviously, valuations of company like Google right now and Facebook and Apple and all, that have actually increased in Amazon during the crisis. Tools like Zoom, tools like Microsoft Teams that are being used to keep people working and in tune with their teams. And so there's COVID-nineteen, with all its problems from society or whatever, has actually increased the need for digital and accelerated the influx of digital into markets, orthodontics included. When you see that what our results were in the third quarter, you could tell there was a real preference, a demand from patients and a preference from a doctor standpoint to address those treatments with a digital kind of a format. Because obviously, with digital, it's just it's a process where you don't have to come into the office so much.
Don't have your hands in a person's mouth so much, so the infection rates can be much low with this. So a lot of reasons why digital would be accentuated in this downturn and that we saw in the third quarter and continued interest in the fourth quarter also that John will talk about. Disruptive innovative platforms. It's part of the whole lexicon in business these days and particularly digitally disruptive kinds of things. There's three key areas.
It's enabling technology that's a core of this, innovative business model and a value network. When you think about Align and our disruption, that enabling technology is digital orthodontics, understanding how to move teeth digitally with plastic. And the 4,000,000 lines of code that we have in treat and the scale that we can actually bring to three d printing and to make these items. And so our enabling technology was so different from what the analog technology is. And it's been one of the reasons why penetration in this marketplace was slow in the beginning because this technology is hard to develop.
We learn more and more over time. And the business model for orthodontists is significantly different in a digital format than it is in an analog format. Innovative business model overall, how we take that, and that's our digital platform, and how we work that piece. And that's an end to end digital platform from iTero all the way to our patient app, through the doctor, through ClinCheck, through the world's and Emery will talk about this, through the world's largest mass customized business. We're the largest three d printing business in the world.
We do up to 700,000 unique parts a day. It's never been done before in the history of the world. And we've been able to build that brick by brick over time. And we had to do it internally because there wasn't really a company around there that we could ever shadow to learn how to do that. Our value network is circled around the doctor.
We truly believe in this business. The doctor needs to be the center of this in order to ensure the patient with the right amount of safety and the highest predictability from an outcome standpoint. And our network was 2,000 salespeople or sales related people, strong engineering group to be able to work with doctors to understand what their needs are, using AI on our database to understand like our most recent product called G8 is how to do deep bite cases better that we've learned over time of what works well and what doesn't work well and then code that into our new products. And so each one of these areas, Align is embedded in very strongly, enabling technologies, innovative business model and that value network that we work around our customer base of doctors. Our Align digital platform, you're going to see this chart in a lot of different variations.
But our digital platform, as I mentioned before, you can say it starts with the Align cloud, where you have exocad, iTera, all the data that we've had in the past that's in that database that we mine constantly. Our consumer piece and having a consumer brand and being the most well known brand in the orthodontic segment is really an important asset to us overall. And so advertising the patients, capturing those patients on our patient app or moving that on to our concierge service and then moving that increasingly into doctors' offices to convert those patients. And there's a flywheel associated with this too, more and more doctors go digital and we address more patients into those doctors, we're certain we'll convert them into DigitalLine, it just makes into Invisalign, it just makes this advertising much more efficient for us and helps to load this flywheel as more and more of our customers move on to digital practices overall. The Invisalign IDS system, our new virtual care, our ClinCheck system, all those things are hard coded systems that work in conjunction with patients and doctors that deliver the best outcome.
And then you see with dental labs, obviously, a really important workflow component of the GP base and how they work with labs. And this is where Exocad and iTero come in an extremely big way. End to end, seamless digital platforms are expensive to build, and you constantly have to upgrade them. You see that in other industries, too. This is key to our competitive advantage and the moat that we drive in the business.
Our doctor driven model, again, as I mentioned before, really important to us. Our doctor partners in this sense. And I just want to reinforce that we are not planning to go direct to consumer, that we don't think that is the right way to process this. We think a doctor in the center of this is the right way to deliver this kind of orthodontic care. I think you know that, as I mentioned before and we talk to you often, the GP and GP segment or general dentistry segment is a big part of what we do.
And then DSOs or dental service organizations are important ones because they have such a large number of dental practices underneath them that they can reach and help. The largest and the, obviously, highest value DSO out there is Heartland. And it's run by a terrific CEO called Pat Bauer. And Pat has offered generously to talk about the strong partnership that we have between Align and Heartland Dental. So I'll let Pat talk to you.
The industry is really quite varied right now. While many practices have recovered well, others have struggled considerably. And many of our supportive doctors have solo practitioner friends who have even decided to close their practices as a result of the external environment. We're fortunate in that all of our supportive practices have returned safely and successfully. We're seeing patients returning to their dentists with trust and confidence.
This is because the dentists and their teams that we support have confidently returned to their practices, and patients can sense that. It's part of their experience when they visit the dental office. The pandemic has accelerated numerous shifts in dental care, many of which will likely become permanent changes for the industry. We're seeing trends with both patients and doctors. As for patient trends, the acceleration and acceptance of teledentistry has made a tremendous impact in a dentist's ability to connect with their patients safely in order to decide next steps for treatment.
During the shutdown, treatment didn't have to come to a halt. We had supportive doctors who continued consulting and communicating with their patients via teledentistry, monitoring treatment and providing the connection patients needed, all in accordance with what was permitted by their state law, of course. At the same time, the industry is benefiting from the high demand for beautiful smiles. Adult orthodontics continues to be a strong driver of patients right now. As for doctor trends, many solo practitioners are suddenly realizing the value of community and security during times of uncertainty.
I believe these two needs are near the top of the list for dentists who are seeking more information about affiliating with the DSO this year. Dentists need to feel the support and encouragement of their colleagues. Within Heartland, our supportive doctors are not in competition with each other. On the contrary, they help each other succeed. At the same time, doctors who are supported by Heartland Dental no longer have the risks and worries associated with owning their own practice.
Because of this shift, we have an incredible pipeline of doctors looking to join Heartland Dental. What we're seeing is that consumer expectations are continuing to evolve, and we expect that dental professionals will rise to meet those expectations. Things like text based reminders and payment links, one click appointment scheduling, and easy payment processes all create a hassle free patient experience. Of course technological advancements have already greatly impacted the dental space and it's constantly changing and improving. The next generation of scanners and future tools that will assist a doctor in diagnosing without the use of x rays, dental professionals have and will continue to improve their ability to confidently diagnose and achieve greater case acceptance.
Looking to the future, oral health care could include the use of artificial intelligence to enhance the patient experience. In addition, the advancement of patient record systems using analytics and patient communications could also increase business performance and improve patient workflows. As we forge ahead through a constantly changing environment, there's really no limit to Heartland Dental's growth. We will continue to remain focused on supporting dentists and their teams as they deliver the highest quality dental care and experiences to the communities they serve, and we are finding more and more doctors choosing our support than ever before. There's a tremendous amount of opportunity for digital orthodontics.
Our supportive doctors recently celebrated their most successful Invisalign week ever, with more than a thousand patients scheduling their treatment. Yet I believe most of our supportive practices have barely scratched the surface on the number of potential Invisalign opportunities. Most cases are started from existing patients who are being reactivated, but now we're seeing even more cases started from new patients who are interested in a straighter smile. Patients are consuming and responding to the Align marketing messages, which prompt them to see their clinician to more quickly and conveniently achieve that perfect smile. For many adults, digital orthodontics will enable dentists not only move teeth, but also to help break down barriers to restorative dentistry.
The use of digital orthodontics has already greatly improved patient comfort levels by eliminating the use of impression material, which has been a barrier to treatment for some patients. At the same time, it continues to enhance the doctor's ability to confidently treat a patient by utilizing simulation and guided workflows and improving patient communications. Through the structure of Heartland Dental, our supported doctors are able to increase their offerings while lowering the cost of care. What's important to Heartland Dental must also be important to those we select as our partners. We know that innovation and research and development are top priorities for Align.
And because of Align's industry leading technologies, our supportive doctors are able to maintain their state of the art capabilities. As more and more supportive doctors are becoming well versed in orthodontics, it's important for us to partner with Align to leverage their branding and marketing abilities, will help to drive new patients to their practices. Most importantly, the clinical education and support from Align in helping to train our supportive doctors and teams positively affects the overall satisfaction of the patients and thus the success of the practices. In summary, because of the innovation in orthodontic care by Align, along with the innovations and support for dentists from Heartland, this is a great time to be in dentistry.
We've had four key strategic priorities in this business over the last five years since I've been here. They haven't changed. We've changed them in the sense of the orientation, but it helps to guide our investment and where we're going to put people and where we put dollars. First of all, the international expansion. I think you've seen our tremendous growth from an international standpoint and how we've worked that.
And what's changed in the last few years is not just selling internationally, but being able to manufacture, to do treatment planning, but to be more and more domestic in those areas to allow us some growth and also to help to shield us from having any kind of supply disruptions that might happen, like as an example, is COVID-nineteen or different kinds of issues. Patient demand and conversion, I mentioned before. This is extremely important for us. Leveraging the Invisalign brand, not just in North America, but all around the world, is critical. It's, again, the most well known orthodontic brand in the world, and we're seeing great returns on marketing that name and driving more and more patients to doctors.
Orthodontic utilization, when you really break down orthodontic utilization, remember that market is 75% teens. And so it's so important that our advertising and then our product portfolio is able to address that teen marketplace in a meaningful way. And then the GP segment I talked about before and Pat just talked about from a DSO standpoint, it's really the most important segment when it comes to driving that 500,000,000 patients that are out there. So just to sum this up, 9,000,000 patients we've done, broad portfolio, incredibly strong operations, consistent 20% growth rate, AI, machine learning, all those different things you hear about associated with a digital company. Align is really unique.
And again, I'll reemphasize where I started. Massive opportunity unleashed by digital and orthodontics on the world, and it has we have an incredible opportunity to grow. Secondly is what we do is hard to do. It takes money, and it takes time. And hopefully, hear that.
So thank you so much for your attention, and I'll turn it over to Jelco Relek, who is our CTO, our Chief Technology Officer. Jelco?
Thank you, Joe, and good morning. I'm really happy to be with you today. As Joe just explained it well, there is no question our market potential is enormous. 500,000,000 does sound like a big number, but it's not unreasonable. We know that three out of four people need or would benefit from an orthodontic treatment.
Today too many are not aware of the value and life changing effect of straight teeth. And our job has always been to not only design a great orthodontic device, but also connect people who need a treatment with a doctor, trained doctor who can provide it. Align Digital Orthodontic System with fully integrated digital end to end workflows allows doctors to better leverage their expertise and experience and deliver great clinical results. We give them the ability to easily acquire and manage digital patient data. We'll help them analyze patient condition, make a clinical diagnosis and when necessary treat the patient with confidence and efficiency, leveraging our best in class treatment planning software and Invisalign clear aligners.
Our digital tools powered by our clinical data with more than 9,000,000 patients, AI, machine learning, visual tools also help our doctors to efficiently communicate with their patients, show and explain any issues and visualize potential treatment outcomes. Our goal is the highest quality of care, great clinical outcomes and a great treatment experience for both our doctors and their patients. Invisalign is a result of decades of scientific research and innovations to advance the field of orthodontics. This is how we earned the trust and support of orthodontists as we gave them the power and confidence to treat patients of all ages and deliver excellent clinical results. Invisalign First is a perfect example of our innovation leadership, helping doctors treat their youngest patients, develop proper dental arch form, create space for erupting permanent dentition, deliver healthy and beautiful smiles to last a lifetime.
And our innovation in intraoral scanning with the iTero Element family of products is as critical and valuable as it provides a gateway into our digital platform. Increased ortho acceptance and continued growth in Invisalign ortho utilization is the best proof of the power and value we provide to orthodontists and their trust in the line. And we will do everything to continue to support them to the very best of our abilities. Our recent strong business performance is the result of decades long work and investments in technology and product innovation. I think that COVID-nineteen pandemic has only accelerated the inevitable: digital, clear aligner orthodontics as the standard of care.
This has always been our mission, even in those early times when very few believed in us. Another goal of ours with the same level of conviction is making orthodontics a pillar of dentistry. Most patients need interdisciplinary dental treatments and sadly too few get the ortho part, which is absolutely essential for creating a healthy, stable bite and proper function. Without ortho, it is highly unlikely to achieve the best clinical outcome in almost any dental treatment. This is not a new goal for us.
We have actually been talking to you about it for quite some time. So let me quickly remind you of a few things we shared in our past meetings. Last year we met in person in Las Vegas, so here are a few slides from my presentation. I talked about how life changing ortho treatment can be and what's possible. Again many people don't know that and that's why it's so important to be able to visualize a potential treatment outcome to any person patient or a consumer.
This is an example of our Smart View, consumer model solution. I also gave you an example of a clinical treatment simulation highlighting the benefits of not only the Invisalign treatment but also the value of restorative treatment after Invisalign to achieve even better aesthetic result especially for adults with worn, chipped or maybe missing teeth. You can see here that her upper front teeth are shorter due to tooth wear or possibly tooth grinding. So the restorative procedure after Invisalign creates much better aesthetic outcome. Here is the visualization in ClinCheck.
You can see it better. Few slides from my presentation at our twenty eighteen meeting in New York. I gave you an example of a patient who definitely needs more than just a tooth movement. He's missing some teeth. But he definitely needs an ortho treatment to first put his existing teeth in the right place.
I showed you how a doctor would be able to plan the Invisalign treatment with the restoration in mind, also restorative treatment, in this case with implants. And then I gave you another example, a member of our R and D team in Moscow, comprehensive dentistry with interdisciplinary solutions. In the future, majority of restorations will likely start with tooth straightening first and then most of adult orthodontic treatments will likely end with restorations, hopefully minimally invasive restorations, preserving as much healthy tooth mass as possible. And then four point five years ago, at twenty sixteen aligner Investor Day in New York, I shared this slide in my presentation. Or terrestriality workflow, we call it smile architect workflow.
It is all about end to end interdisciplinary treatment workflows from consumer or patient engagement to digital record taking, diagnosis and education to visualization for better treatment acceptance to treatment planning and treatment delivery with confidence, predictability and efficiency. Our vision has been very consistent and we've been investing and working very hard to make it a reality. Number one, make clear aligner therapy the standard of care in orthodontics. Second, lead the transformation to digital dentistry and ultimately build a comprehensive interdisciplinary digital dental platform. We know this is the future of dentistry and some doctors are already doing it today.
Doctor. Millie Morrison, a talented young doctor from London, she says she is committed to providing top quality ethical dental services to all of her patients. Ethical means do only good, no harm to the patient, minimally invasive procedures. Doctor. Morrison can't wait to see and use our comprehensive digital platform, but she's doing her best to provide top service to her patients with the tools she currently has.
There are certainly more doctors like her. Later on, you will hear from Doctor. Afan Salgar. Our job is to help them provide the highest quality ethical services with confidence and efficiency. So here is one of Doctor.
Morrison's patients, a handsome young man, a teenager. He says that he's someone who loves to smile and laugh a lot, which was difficult before the treatment because his teeth were far from straight. So here are his teeth. Good condition overall. He's a young man.
But he's got gaps between his upper teeth and some mild crowding in his lower anterior segment. He has irregular small arc and tooth size discrepancy. His upper canines are sticking out and catching the lip and his teeth are chipped. He also has deep overbite as well as increased overjet. Here you can see it better in ClinCheck.
Doctor. Morrison is a GP and she loves Invisalign Go, which was suitable for this patient. If the patient required more complex treatment she would have probably referred him to an orthodontist. You can see the treatment, 20 stages. Doctor.
Morrison closed spaces between the upper teeth, greatly addressed the DeepBite as well
as the
Overjet. She had ordered one additional set of refinement aligners and her total treatment time was less than nine months. Here is the initial photo again and then his teeth after Invisalign treatment was complete. Looks pretty good. No gaps, good bite, stable and functional, and a pretty nice smile.
But Doctor. Morrison did not stop here. She went further and did additional restorative work in a truly ethical way. Edge composite bonding to perfectly shape his teeth and get an amazing aesthetic outcome. Look at this, before the treatment and the final outcome after Invisalign and restorative work.
You can see the quote from the patient. The Invisalign treatment completely changed my life. Invisalign ortho restorative treatment minimally invasive, ethical. This is why Align acquired Exocad, to expand our digital platform and enable comprehensive dentistry. With over 40,000 installations, global presence, more than 30% lab market share, Exocad is the most advanced dental CADCAM software platform with the largest global dental lab installed base.
Exocad partner list is significant. Majority of the biggest players in our industry leverage and partner with Exocad. Because Exocad is a comprehensive dental CADCAM platform with a full array of dental solutions. Here you can see a few examples. Solutions for both dental labs as well as chair side solutions for the doctor at the practice.
Really amazing stuff. And of course, one of my favorites, exocad smile creator, a perfect match for our smile architect workflow. By adding Exica to Invisalign EyeThera, we can now successfully deliver a full, comprehensive, interdisciplinary digital dental platform. This will drive the adoption and utilization of Invisalign clear aligner orthodontics with GPs. There are about 10 times as many GPs as orthos and they see about 10 times as many patients annually.
Just in North America, GPs see about two hundred million patients annually and three out of four of them need an orthodontic treatment. Great opportunity for GPs but also for the orthos whom GPs refer their patients to. Here is the view of a future digital ortho restorative workflow, leveraging the combined power of iTero, Invisalign and Exocad. With Exocad, we now have all the building blocks to make it happen, seamlessly integrated, providing the tools for doctor to analyze, diagnose, plan, communicate, visualize and deliver the best possible treatment outcomes for their patients with confidence, speed and efficiency. Comprehensive digital dental platform with all dentistry solutions.
For doctors of all dental disciplines and specialties working together and transforming smiles and changing lives of hundreds of millions of people around the world. Thank you. Let me now introduce Rajputipiti, our Chief Innovation, Product and Marketing Officer.
Good morning. I am really excited to be here with you to talk about Alliance plans to capitalize on the tremendous opportunity that Joe talked about. Listen, I think we are at a unique point. After twenty three years of investment in great technology, great innovation and a digital platform, I think we are now in a position where we offer the best treatment planning experience to both our doctors and patients. As we go forward, we have the opportunity to change, transform 500,000,000 smiles and change 500,000,000 lives.
Joe referenced this, out of the 15,000,000 orthodontic cases, we have less than 10% share, less than 10% share in a core category that we play in. Let me talk about who Align is. We are a 2,300,000,000 revenue company with 9,000,000 patients, 189,000 doctors that we've trained and more than 17,000 employees. We've got the broadest portfolio from an orthodontic play standpoint, starting with iTero scanners, different types of Invisalign treatments for orthodontists and GPs, and then Jelco just referenced, exocad, to enable a seamless workflow between our dentists and labs. Let's talk about what makes Invisalign unique.
You know, these days, you hear a lot of news about a new aligner launching, some markets, some countries. Are all aligners the same? Let's talk about it a little. Let me start first with Smartrac. We have a multilayered material, which is soft, where it touches the teeth so that it's comfortable to the patient, still has the strength and resilience to move teeth as is needed.
Then let's talk about SmartFold's features. Right? So most aligners that are being launched today just try to move teeth with plastic, right, or just displacement. We are a force based system. Because we use a force couple, we get torque, and we are able to rotate teeth, which is very uncommon, right?
Last, I want to talk about smart stage technology. We move every tooth deliberately in a treatment plan, and that's based on AI from 9,000,000 patients. So yes, you can design a treatment plan, anybody can, but that's anybody's guess. Our treatment plans are based on artificial intelligence from 9,000,000 patients and twenty three years of experience. This is why Invisalign's smart technology advantage is completely unmatched.
Right? Let's talk about patients. We have products for young kids. Talk about seven to eight year olds who've got primary dentition, 11 12 year olds who have mixed dentition, and older teens and adults who've got permanent dentition. Right?
Our doctor driven model, know, kind of Joe's reinforced this, we believe that the best care a patient can get is from a doctor. And our job is to enable our customers with the best treatment planning and the best technology so that they can offer the best treatment experience to patients. Let's keep going and really talk about segmentation. A year ago, I think we're all here together, we talked about segmentation. What does this mean?
We took all of the GPs and orthos separately. We put them in different buckets based on their level of experience with Invisalign and their comfort with treating complex cases. Okay? So, you you have new doctors who you just bring in and you train them, you know, and then they become active. Right?
These guys have some understanding of Invisalign. They are not necessarily as comfortable. You go to the next segment, which is engaged. This set of doctors are actually pretty familiar with Invisalign, although they are still not treating the most complex cases with Invisalign. And then you go to the expert segment, who treat almost any case with Invisalign simply because of their mastery of the system.
So when you move a doctor from an active segment to an engaged segment, we get three times the volume from the dock, 3x. And when we move a dock from engaged to expert, we get three to four times. So if you move a doctor from active to expert, you get between nine and sixteen times the volume. Right? What I'm really happy to share is we've been able to grow our orthodontists from active to engaged.
So we've been able to grow by 13%. We've been able to grow our experts in orthodontists by twenty two percent. The same two numbers from GPs are 34% each. Now this is the heart. This is the engine.
Getting our doctors more comfortable, more trained, more confident to use Invisalign, that's what drives our business. That's what drives patient satisfaction, and that's what drove revenue in third quarter. Let's actually just talk a little bit about our twenty three year old journey. What a glorious journey. Right?
Starting with 1997. Then 02/2007, you hit one million patients. 2014, we hit three million patients. And six short years later, 2020, we're at 9,000,000 patients with three times the revenue that we had in 2014. The only way we got here is because of our commitment to innovation, commitment to technology, commitment to serving our customers to offer the best treatments for their patients, and a wonderful committed group of passionate Align employees.
Joe alluded to 2020. 2020 is an year like none other. I think all of us will remember this forever. Right? The one thing it did do, though, it compressed a decade of change into just a few months.
Now more so than ever, companies that go digital and companies that have a digital platform are going to win. They were winning in the past. That's accelerated. Let's talk about platforms. Right?
I'm excited to talk to you about platforms and the LINE digital platform today. Generally, there are four kinds of platforms. Transaction platforms, which is all about Uber, right, or Airbnb or DoorDash. Right? Then you have innovation platforms.
There you have Microsoft, you have Oracle, you know, who you can innovate. Right? Then you have investment platforms, which is like SoftBank. And then you have integrated platforms. So what's an integrated platform?
So I put a little example here, which is, let's say, Peloton, Apple, Google. It's a combination of goods and services, right, that get into an integrated platform. Let me share a little bit more with you on how we define integrated platforms, right? We define an integrated platform as an integrated suite of unique proprietary technologies and services delivered as a seamless end to end solution to transform smiles and change labs. So let me share a little bit more about what I think there, right?
Unique proprietary technologies. We just went through this, right? A treatment plan is not a treatment plan. An aligner is not an aligner. What we have based on 9,000,000 patients and twenty three years of experience is truly proprietary.
And then, if you take our iTero, our treatment planning, our consumer mastery, we brought that together into a seamless end to end solution. Remember, integrated is not about buying separate pieces, putting them together and calling them one system. It's not. Integrated is truly creating a seamless end to end solution. And that's why we believe Align digital platform is truly unique.
Okay? Joe talked about this. Several of my colleagues will actually take you through details of what this platform is. Right? But what's the platform?
So it starts with iTero, our scanners. All the treatment planning expertise that we have, our incredible manufacturing expertise and scale that we have. We have exocad for the authoritative workflows, right? Then we have the mastery, the brand that we've created with the consumer. So the consumer and patient web and app.
We have the doctor, patient, and web and app. And then we have labs. So I'm usually asked this question, so Raj, what's important about this platform? Platform? How How does does it create competitive advantage for Align?
Allow me to explain to you, right? So we've already talked about 9,000,000 patients and artificial intelligence and machine learning based on twenty three years of experience driving treatment plans. 35,000 iTeros installed. 35,000 iTeros installed, right? And if you look at our consumer work, right, have by far the most well known and trusted brand for orthodontists and patients globally, bar none.
You know, we spend $150,000,000 every year to drive demand with consumers. Just in quarter three in The U. S, we delivered 3,300,000,000 impressions. Okay? I want to kind of come back to that level of investment in the consumer, very difficult to replicate.
Now when you combine that with 9,000,000 patients, 2,500,000,000.0 of technology investment for the last twenty three years, now that becomes a little more difficult. Right? Now let's talk about doctors. We have 2,000 plus sales teams selling to 189,000 doctors. Now think about this.
Like, 189,000 doctors across 100 plus countries. Now you combine the technology, the scale, the consumer, the doctor, and then you connect it to 45,000 labs that we have Exocad installed in. This is what makes Alliance Digital Platform truly proprietary, truly unique, and builds competitive advantage because others may replicate maybe one piece, two pieces. Nobody can replicate what we do as a digital platform. Let me take you through what this platform is from a patient and a doc's point of view.
Right? A young lady is sitting at home, sees something on TV, gets interested, says, you know what? I'm on inside the same time on my phone. Shows up. A post shows up.
So, well, I'm interested. Clicks on the post, goes to Amazon website. Said, yeah. This looks interesting. Downloads our app.
Use a smile view and says, I really love my smile, presses a button, gets connected to concierge, who sets up an appointment with a doc, goes into the doc, gets scanned by iTero, and the doc, our doctor, our customer actually shows to the potential patient the transformation of the smile and the treatment plan on the iTero iosim. The doctor is critical, as we have been reinforced in the past, to helping a patient understand what the treatment needs to look like and what it can do for him or her. So in this case, the doctor convinces the patient, the consumer becomes a patient, and once she becomes a patient, she is able to stay in touch with her doctor via virtual care. She is able to send photographs, the doctor can look at the photographs and provide comments on whether a patient is on track or not. The patient finishes her treatment, buys Invisalign accessories, then moves on to Vivere retainers.
So the end to end journey that you see is what this digital platform creates. Now that is if the patient only has orthodontic needs. If the patient actually finishes their orthodontic treatment and then we need some restoration, like Jelco talked about, then the doc designs a restoration plan, and that plan actually gets sent to a lab who works on veneers and crowns and bridges using exocad, comes back to the doc, gets back onto the patient. So this ortho restorative journey is completely seamless and digital based on our platform. Okay?
Let me take you through a few terms. A lot of us have actually used a lot of terms. I thought it might be good to kind of just clarify these. From a consumer standpoint, we have an app. It's called My Invisalign app.
It can be used by both consumers and patients. We also have a website that provides helpful information to consumers, who are potential patients for us. Let's look at it from a doc standpoint. From a doc standpoint, you actually have an iTero, which is a scanner that a doctor uses. And then you have a doctor website where our doctors go and initiate a treatment plan.
Once the treatment plan is initiated, once somebody becomes a patient, then we have the ClinCheck software, which is a world class software to help plan treatment. And then, once this is done, the doctor actually stays in touch with the patient with the virtual care app. So these are the tools that we will use names for today. Just want to make sure I spend a couple of minutes. Okay?
Four strategic priorities Joe called out: international expansion, patient demand creation and conversion, orthodontist utilization, GP adoption. My colleagues, Markus and Julie, will talk about international expansion. So I'll give you a quick update on what's happening on the remaining three. Let's start with patient demand and creation and conversion, right? A year ago, I talked to you about how Alliant used to work with 100 plus agencies, advertising agencies and media agencies, and we didn't have enough capacity for the concierge.
I shared with you we're to move to one agency, which we did. We moved to the Publicis Group, who's our agency globally for both creative and media. We identified a great partner who's serving as a concierge called Alorica. And, and and so both of these were impacted Jan one of this year. Right?
What so so what happens if if both of these come together? Well, what happens is we have a global campaign. Let's roll the two TV ads.
Look at you. No braces, all the Internet you can handle. I wasn't so lucky. Invis is not your parents' braces. Invis is predictable, less painful, more comfortable.
Invisalign. Invisalign is teeth straightening at its best, taking over 9,000,000 smiles from no to woah.
Only Invisalign aligners are made with smart track technology.
It moves teeth more comfortably and predictably.
Invisalign, transforming smiles, changing lives.
What makes a campaign global? The ability to take a message and translate it across cultures by also accepting relevant nuances, but keeping the core of the message constant. Right? Think about Coke. Anybody recognizes Coke where Coca Cola, wherever you go, right?
Why they maintain their brand assets? Indosaline is on the same journey because think about connecting with consumers. We've been able to do take communication and really, really kind of translate it in each language. The first social post, I don't know if you can read it, says, Invisalign is hard to see but impossible to ignore. And we've been able to kind of translate that in Spanish, right?
We've also been able to translate it in Arabic, German. Not just consumers. We've been able to take Invizaz as a campaign and connect with doctors to help them build their practices, right? Let's talk about converting consumers to patients globally. I'm really happy, and Joe alluded to it, I'm really happy that we're bringing a multichannel campaign to more markets.
So we started in U. K, Australia, Germany, Japan. Very promising results as we see forward, right? Acceleration of digital. 2020, an acceleration of digital.
This was our opportunity. This was Alliance opportunity. We expanded our app to 49 countries, and we expanded our website to 16 plus markets. 80% of leads now flow through our new website, which actually gives us 50% more effectiveness actually from converting lead standpoint, right? And we did this in five months, right?
This is the impact of when a crisis comes in and a group of committed employees gets behind it, what you get is acceleration that's unprecedented, right? So what did all of this do? Well, it increased our leads our website visitors 65, increased our leads by 109%. So we basically doubled our leads versus a year ago, right? Just an illustration of what that means, right?
Just one market, let's just take The U. S, right? Our leads scheduled increased 85% in quarter three, eighty five percent. Now that's the momentum you saw our revenue. That's the momentum you saw in our leads and our consumer impressions in quarter three, right?
Let's talk about how do we win betweens, how do we win among orthos, right? 11,000,000 orthodontic cases, just 3% share, When we talked about winning with orthos and among teams last year, we talked about four key priorities, four key strategies. We wanted to become better partners. We wanted to prove the value of the platform. We wanted to become the standard of care, and we wanted to drive younger patients.
I'm happy to share with you our organization has made significant progress on every one of these. First, let's really talk about becoming better partners. We recently launched ClinCheck six point zero, which takes a world class treatment planning software, puts it up on the cloud. Now our customers can access it with a laptop, with an iPad, with a Mac from anywhere, right? Second thing that I wanted to call out is a recent upgrade that Joe alluded to, which is G8.
It's an upgrade of our treatment planning for patients with crossbite and deep bite malocclusions. It improves our predictability very, very significantly. The third thing I want to kind of highlight really is we've now started to take our doctor's preferences and script them better so that the first treatment plan we get back to them, it's much closer to what they want. This actually significantly improves their experience. Right?
You've all heard about Joe talking about Adapt, which is Align Digital and Practice Transformation. Well, we were able to expand it globally. With all of this work so where do you see the impact of all of this work? Because we talked about kind of the four strategies for winning among orthos. Well, you see it in the increase in utilization.
So if you look at North America, it's about a 20% increase in utilization. If you look at international, it's about a 15% increase in utilization per dock. Per dock. Remember, if every dock gives us 20% more cases, that's the momentum that you're seeing. Let me talk to you about Invisalign G8 and ClinCheck Pro six point o.
But rather than me do so, I think this video does a much better job. Let's roll the video.
And The g eight features are designed to bring you better clinical results with up to two times improvement in the predictability of incisor intrusion. But we didn't stop there. We're on a multiyear journey to reimagine end to end digital treatment planning. So we upgraded ClinCheck Pro six point o to give you better visualization and more flexibility than ever. The new in face visualization tool is designed to show you how your patient's smile will be transformed before they even begin their treatment.
And all of ClinCheck's capabilities are now cloud based, giving you the freedom of treatment planning from any Mac, PC, or tablet wherever you choose. The g eight aligners paired with this reimagined suite of digital lot And lot of of in a business. Excited are to
We
You know that Adapt was basically based on workflow optimization for practices. Really provide them the relevant support, help them transform their business, provide marketing support as well as clinical support. Really happy to share that we've started to expand Adapt globally. We're seeing really, really strong results without exception. So if you think about the strategies, right, so we basically improved the standard of care with G8.
We became a platform of value by getting ADAPT. We improved treatment planning and became a better partner with Princess Kids. And now I want to talk to you about how do we drive younger consumers, younger teens to doctors. We recently launched a new teen campaign. I don't know if you've had a chance to look at it, but I think let's see it here.
Let's roll the video.
People is asking me what I got on. They were like, hey, Brandon. What you got on? Don't worry about it. Don't worry about it.
It's too hard. Don't worry about it too hard. Invisible is everything braces isn't. More comfortable, fewer emergency appointments. Invisalign.
I
hope you enjoyed it. Right? See, the teams, right, what we need is we need an idea, but we also need that idea translated to relatable content to teens via the right influencers. So our idea is very clear. Invisalign is not your parents' braces.
By the way, teens love that. But the way we made it relatable was we actually leveraged influencers. So we signed up with Charlie D'Amelio, Marci Martin, 20 plus influencers globally. But Charlie has 95,000,000 TikTok followers, 32,000,000 Instagram followers. Okay?
And and and what Charlie says influences a lot of teams. Let's see what she says right here.
I'm outside in an AMG. Play outside. PG. Two time baby.
A 20 plus roster of key influencers globally and partnerships with several sports teams that make us relatable. Remember, with teams, the message matters, but how you actually deliver the message also matters. Last time, if I remember right, we had a conversation about, hey, you drive all this demand. How do you convert Right? So this year, in North America, Simon and his team have done a great job of tightening conversion because what we've done is we've opened teen awesomeness centers, which is basically practices that are experts in teen treatments, which is where our teams go to so that then they get the best possible treatment.
That also allows us to close the loop on conversion. So we talked about each of the ortho strategies. Now let's talk about GPs. Remember, winning with GPs is absolutely critical. 500,000,000 patients, 1,700,000 GPs.
Of course, we've got to win with them. Now what do we need to do to win with GPs? Well, we've got to understand the segments of the GPs. We've got to increase their clinical confidence. We've got to be partners in the restorative, the comprehensive digital journey that they have, and we need to be relevant to them by critical partnerships.
What are the critical partnerships? DSD, labs. Exocad acquisition is a key move there, right? It enables us to have a seamless workflow for GPs with labs. The same question again.
So what did all of this do for us? You can see the increase in utilization in North America as well as international gain, right? So all of the strategies that we had and the plans that we used increased our utilization by 15% to 20% gain. Let's talk about Invisalign Go. Invisalign Go is a product that's designed uniquely for GPs, right?
And it's a product that actually simplifies the whole treatment planning process for GPs. Let's roll the video and see what the product is. So board has three things. Simple, quick, chairside assessment of cases. Is it too complex or it can be done?
Multiple treatment plans the GP can choose from. And three, kind of limited movements, right, so that there is higher clinical confidence. Invisalign Go has worked really, really well for us. And as it has, it has actually helped us drive GP adoption. I want to wrap up with three points for you.
The first one, aligned digital platform is a true competitive advantage. There's no other company that's got as holistic and as stronger digital program digital platform, sorry, with each of these carefully chosen No other company. Two, the plans we have: international expansion, patient demand creation and conversion, orthodontist utilization, GP adoption, they're working. They're working. You see them in the numbers.
You see them in our revenue and earnings. Last, you know, I you know, on a personal note, right, I spent twenty three years with Procter and Gamble, a couple of years in telecom, and I've spent almost two years at Align. I have never seen an opportunity this big in my career. I've never seen, you know, a half a billion dollar consumer market, which basically translates to half a trillion dollar revenue market, never ever. And I sincerely believe this.
There is no other company better suited to capitalize on this market than Align. With that, let me pass it on to my friend, SVP and MD of iTero, Yuval Shaked. It all starts with iTero, so let's roll.
Hi, everyone. It's a great beer. My name is Yuval, and I run the iTero business. As you heard from Raj, iTero is truly the gateway to Align's digital platform. It all starts with iTero.
Any digital workflow starts with a digital scan. And with Iterra and Visalign and now Exocad being developed as one digital platform, we can provide the best customer experience with the top three brands in the market. And one of the key indicators for the adoption of Alliance Digital Platform is the number of scans we see with iTero. Over the past two years, we more than doubled the number of scans we see with iTero. Today we have more than 30,000,000 scans with iTero.
Out of them, about 6,000,000 are restorative scans. And now we have more than a million scans per month. And our vision continues to be to scan every patient at every visit. The more scans we see with iTero, the more scanners our customer needs. And over the past three years, we've seen significant growth for iTero business.
And we are expecting this growth to continue as the adoption of digital is accelerating. When you look at 2020, COVID-nineteen caught us in the peak of Q1 in March into April and May. So we had a challenging first half. We used this time to be prepared to get back to business with strong momentum. One of the key assets we have is our direct sales force.
So we use this time to have in-depth training on iTero capabilities, including restorative and diagnostics. We also introduced new ways to set iTero through virtual events and provided attractive financing programs to reduce the barriers of entry for our customers. And beyond all of that, earlier this year, we get approval for the five gs in The U. S. And we had great Q3 with the five gs in The U.
S. Overall, we see a lot of success and enthusiasm with our five gs product. And we continue to be optimistic about the future. We have unique assets that differentiate us and position us very well to continue the growth we have seen in the business. With more than 2,000 people in our sales force around the world and success penetrating not only in North America, but also in APAC, EMEA and LatAm.
With more than 35,000 Antero units in our installed base around the world. And beyond all of that, as I mentioned, we are part of the unique digital platform between Invisalign, Antero, and Exocad. In iTero, innovation is our DNA. If you remember, Acadian to iTero was established in 1994. And over the last twenty five years, we continuously introduce new breakthroughs for GPs and orthos.
And during this time, we gained huge amount of expertise in this dentistry technology and commercialization of scanners and applications, with the latest innovation being the 5D. The 5D is the first and only scanner in the world that with one scan can do two d, three d impression, and mirror images. That's another great step to provide doctors more reasons to scan every patient at every visit. Our doctors reported with the 5D they can diagnose more, they can have more treatment acceptance, and eventually they can treat more and grow their practice. Let's listen to some of our 5D doctors.
Have a new solution for you, presenting the iTero 5D. With the same dental health scan that we take for every single patient anyway, we could turn on the Niri, and we could look at all the teeth in near infrared. So the Niri saves us time and money in terms of taking more x rays and exposing people more radiation with a clear indication of the cavity.
The other thing that I'm just amazed by is this new Neri technology. And that's really, I would say, the biggest thing that sets this 5D apart. So pretty amazing that we can diagnose this. And as an orthodontic perspective, it's great because it allows me to keep working closely with the dentist because I did a lot of these scans in my practice that I can send over to them to make sure our patients are getting the best care, taking care of their oral health, and then also making sure that the dentists are aware of
it so that they can fix them up.
Okay. To summarize, my top favorite things that I love about my iTero five b. Number one, quality of the image is incredible. Intra proximal carrier detection has to be up there. I mean, I I was skeptic, but I am a true believer now, and I've only had it for a few weeks, and I can see how much more I'm diagnosing.
So that's cool.
And we are committed to continue and innovate in these three pillars, data acquisition, like we did with the five d and Niri, and overall to continue and improve the scanning experience. We're gonna continue to innovate with new visualization tools like the IO theme and time lapse. And we're gonna continue to create streamlined workflow for our doctors and integration with clear focus to integrate deeper with Exocad. So now I'm going to talk about the four main growth drivers for Iterra business, our InVisand customers, our Iterra installed base, the mass market of non InVisand GPs and our services business. When we look at our Invisalign customers, we know that when they buy iTero, the return on investment is significant and it is between six to twelve months.
And iTero really transformed their practice. And while we know that more than seventy percent of the Invisalign cases are being submitted with iTero, we also know that more than fifty percent of our doctors still do not submit with iTero, and we have a great opportunity to have them buy an iTero. And out of the ones that do submit with iTero, know that the majority has only one scanner. And as digital adoption is accelerating, we have an opportunity for them to have more than one scanner. And our vision is that we're gonna see a scanner at every chair.
And then beyond all of that, we are qualifying thousands of new Invisalign customers every quarter. And we have a great opportunity for them to start with our complete digital platform with iTero. The second is our iTero installed base. As I mentioned, we have more than 35,000 units around the world. And when we introduce new technology like the 5D, we have a great opportunity to upgrade our installed base to the latest technology.
And since our installed base is growing rapidly and we are committed to continue and innovate, we see this as a significant growth opportunity for our business. And then beyond our Envisan customers and our ITER installed base, we know there are more than a million GPs around the world that do not have any scanner yet. We have a great value proposition for them with a 5D or restorative workflow in our ecosystem with Exocad. And in order to accelerate the penetration into this segment, we are gonna leverage our strategic partners like Zimmer Biomet and our relationships with labs around the world. And last but not least is our services business.
This is a solid recurring revenue business, and we expect this business to continue to grow as our installed base is growing, and we're introducing new business models like software subscription. So to summarize, we are very excited about the huge opportunity we have in front of us. We have a clear and consistent strategy that we are executing on, And we have clear differentiation that position us very well to continue the growth we've seen with the business. Align digital platform starts with Akeria. Thank you.
And now I'm going to hand it off to Sree, our CIO.
Good morning, everyone. I want to spend the next five minutes going over the two unique differentiating aspects of the Align digital platform. One, it's the ability to provide integrated seamless experiences and two, it's the scale of the platform. Today's consumers are all digitally connected. For this always on consumer, our platform offers integrated experiences that flow seamlessly across all channels and devices.
Whether they are looking for information about teeth straightening or trying to find an Invisalign doctor, to sharing their great experiences as a patient on a social platform, whether they are at home, office or on the go, whether they are using a computer or a phone, whether they are on the web, mobile app, e mails or on social networks. Our digital solutions stitch together all of the different touch points in their journey and offer the same consistent, relevant and contextual experiences as they go from a consumer to an Invisalign patient and beyond. We heard about the global rollout of the Invisalign Envisus campaign. And as part of that, we also upgraded to new technology stack that enables rapid experimentation and AB testing. We all know different people react very differently to say the color of a button or the size of a font or a placement of an image, different messages.
Every little thing matters in getting that click to the next step. We run a lot of analytics with all of this data. The marketing teams make data driven decisions to understand what is working. And if something is not working, they are able to iterate through different permutations to see what makes a message stick. When something is working, we have the agility in the platform to deploy its scale as locally or as globally as we like at any time.
Let's look at a short clip to see how this journey comes to life. As we move on to patient experiences, virtual care is one of the many features on the My Invisalign app. We are very uniquely positioned to provide integrated experience between the patient on the app and the doctor on the Invisalign doctor portal that they use to engage with Align. We are focused on two aspects of virtual care. One is to improve the quality of the images.
So far, have had good adoption rates with the majority of the patients uploading all of the nine pictures that we request. We will soon be rolling out an AI based photo buddy with voice guidance that will further help the patients get good quality images with the right lighting, reducing blurs, getting good right oral angles. And all of these quality images are the foundation to deliver good AI based diagnostics. We are looking at AI models to determine aligner fit, detect attachments, and we are very uniquely positioned for AI models to determine progress tracking against ClinCheck and also further other oral care diagnostics. We are very excited about the possibilities from this image data and AI to further extend virtual care capabilities and also provide digital solutions to doctors who can then offer great patient experiences and also allow for practice scalability, all within the Align digital platform.
Moving on to treatment planning and treatment visualization, we just released the next generation of digital treatment planning with ClinCheck six point zero. This platform gives the doctors the freedom to treatment plan anywhere, anytime on any device. The wide angle pictures from the Photo Uploader app is integrated with the ClinCheck. It provides in face visualization that allows the doctor the ability to assess and plan a case in relation to the patient's facial features such as the midline, lip line, all on the same ClinCheck software platform. The doctors can also do modifications using three d controls.
They can refresh to see the changes in the treatment plan real time. We have received lots of positive feedback and several thousands of ClinCheck on this new platform, and we will continue to deliver transformational experiences on this platform next year. We are reimagining digital treatment planning, and we are on a multiyear journey to completely revolutionize doctors' treatment planning experience. Doctors can start a simplified treatment form from any device, anywhere. We have made progress using AI for segmentation of the teeth from iTero scans.
We are able to send 100% of the scans and impressions through these AI algorithms, and we are able to get very high accuracy consistent with a CAD designer led segmentation. We are codifying doctors' treatment preferences with our proprietary Invisalign Protocol language, which we are in the technical design assessment phase with 20 plus doctors. We're learning lots of good lessons, and we're continuing to improve the automation of the final position and aligner staging. We expect to make significant progress in the automation and using AI to deliver treatment plans next year. We will go from delivering ClinCheck from several days to just minutes, delivering consistent quality ClinCheck after ClinCheck and also provide ability for the operations team to scale globally.
Anchoring all of these digital solutions and integrated experiences is the cloud infrastructure. It provides us the scale of computing and storage needed to deliver the same performance around the world. Technology like data lakes make AI and machine learning all pervasive inside the line as every team continues to imagine and build digital products and services using data. Our technology transformation roadmap involves migrating to new application architectures using APIs and cloud native design patterns. We have several million APIs that are traversing our platform and growing rapidly as we drive towards modular design that also allows for release agility.
We will continue to invest in our infrastructure to scale securely and reliably to process all of those millions of website requests, millions of iTero scans, process orders real time from over 100 countries and manufacture greater than 5,000,000 aligners per day 20 fourseven. With that, I'm going to hand over to Emory, who will help us understand how technology scales manufacturing and operations. Thank you.
Thank you, Sri. Good morning, everyone, and welcome again to our Investor Day twenty twenty. I want to take the time in my segment to talk about our global manufacturing operations and how it contributes to significant competitive advantage for the business. I'm going to focus on three areas. The first is scale.
So that's scale of our footprint that allows us to be responsive and flexible for customers, but also scale in our infrastructure that drives our manufacturing. I want to focus on our know how and innovation and our ability to continue to drive improvements in our efficiency as well as product quality. I also want to talk about kind of our efficiency and how that enables growth and investment in the business. So in order for us to meet the complex needs of the global market, we have to have a footprint with distributor resources that allows us to have direct access to the customers, to support them in their local language, in their local time zone and in some cases, even in their local culture. We also have to have the ability to grow rapidly.
And in many cases, in certain markets, that growth is nonlinear, which adds another challenge. And we also need to be able to deliver our products and services in a very responsive manner to our customers. Over time, we've built that footprint you see here on the slide, and we'll continue to do so. Just to give you a little understanding of what our footprint looks like, we have over 10 facilities spread across seven countries. We have over 10,000 employees who make over 47,000 treatment plans and well over 500,000 aligners unique aligners every single day, seven days a week.
This infrastructure and this scale that we've built has the flexibility to support the greater than one and ninety thousand customers across 100 countries. We actually had the I guess, the I don't know if it's a privilege, but our flexibility was tested recently during the COVID pandemic that's kind of disrupted all of our lives. And so this footprint enabled us to continue our business while we had temporary shutdowns starting in China as the virus temporarily shut down our operations in China. We're able to move our production to our other locations that we're still operating. As China came back up and got healthy and our operations in Europe were temporarily closed, we were also able to move that.
So this footprint we've created not only creates flexibility for us to support our customers, but it also creates a lot of business continuity for us, which is important. So given the importance of, obviously, business continuity and the flexibility that we need in this footprint, we have plans to continue that expansion to really, our strategy is to build a treatment planning, a large treatment planning hub in each of our regions. So one in The Americas, one in EMEA, one in APAC. And then also create smaller, let's call them satellite treatment planning offices in the major markets so that we can get that close connection with the customer, which is very important in the treatment planning process. We also will open up or finish our building a large aligner manufacturing hub in each of our regions.
And also likely some smaller manufacturing presence in a couple of our critical markets. So in addition to as I mentioned, we service over 190,000 customers. Those all those customers are not the same. There are distinct groups or segments of customers that have distinct requirements and needs for support. And so our scale and our distributor footprint allow us to actually specialize to meet the needs of those individual groups.
So for instance, you have expert users, maybe orthodontists that are doing very complex treatments. That requires a certain kind of support that's much different than, say, maybe a brand new Invisalign user, maybe they're a generalist and they had never done orthodontics before. That's a whole different kind of education and support that we need to provide. And without the scale and the ability to specialize, you can't really meet those needs of those customer segments. So in addition to flexibility, there's an incredible amount of control and tracking that's necessary to just handle the sheer volume of treatment plans and aligners that we do every day.
And so we've had to create this end to end integrated digital ecosystem, if you will, that allows us to track the mind blowing amount of data that we move every day, the number the millions and millions of transactions that happen every day, the trillions of computations that happen every day. And so think about the way it works. For every one of those greater than 500,000 aligners we make every day, our manufacturing equipment have to go to this ecosystem, and they have it has to bring down all the recipe instructions and computations to make to ensure we can make a very high quality, high precision aligner at an incredible rate. And so the amount of infrastructure, which we kind of call the our central nervous system, is the sophistication of that infrastructure is unparalleled in the industry. The other part of this that's important is given the connection of our manufacturing process with the customers and then workflow, our digital ecosystem and manufacturing needs to be directly connected to the our overall digital dental platform, which again creates this the sophistication of that is blows my mind.
And it's really that is something that's coveted in the industry. People know they need that to scale, and it's very hard to build. So talking about hard to build scale, it certainly is not easy. It requires an incredible amount of investment in technology development, buying equipment, buildings, building this infrastructure. And so as an example, over the past several years, we spent over $500,000,000 in scaling and advancing our manufacturing platform, which is that by itself is an enormous barrier for other people in the industry to try to get over in order to reach the scale that we have.
And that scale and flexibility and control that we've built in our system is significantly contributes to the competitive moat that we've built around our business. So in addition to so we've talked about this in the past. We have built the largest mass customized manufacturing operation on the planet. By itself, that is very unique. There's I don't think there's anybody else that has that degree of mass customization.
Something else that's unique about our operation is that we kind of live in between two manufacturing worlds, in between the discrete manufacturing on one hand, which is characterized by things like automotive or electronics or med device, where you're assembling things that can be broken down into their component parts. And on the other hand, we live in the continuous manufacturing world, which is characterized by industries like chemicals or paint or pharmaceuticals, where there's a high degree of processing that happens to those. You can't disassemble the end product into its component parts. There's more of a process manufacturing. And so most businesses are one or the other.
They're experts in one. We're actually a true hybrid of both of those manufacturing worlds. And so we have to be graded both of those in order to do what we do at scale. So in order to be able to do that, there's an incredible amount of expertise that's involved with in many different disciplines to build and advance that scale. These are disciplines from manufacturing engineering to three d software development, statisticians.
Sri mentioned artificial intelligence, machine learning, a significant amount of that, and all the way into orthodontists, dentists and other dental professionals. If you look at our global operations in total, and this is just in global operations, we have over 700 clinical and technology employees across 17 different disciplines working every day to scale our technology and advance our and improve our technology. And if you look back over history, cumulatively, we have over seventeen thousand person years experience in innovating in clear aligner manufacturing. I've been around the business for quite some time, and I sometimes take that fact for granted. It's really incredible the amount of experience and years that we have in doing what we do.
It relies a lot on the talent we hire, but really, it's ingrained in the culture of the business. We just have a culture of continuous improvement and continuous innovation that I think that you can't very hard to build, you certainly can't buy it. And so that's something that's very unique about our business. So what's fortunate for us, and I think this is unique in the industry, all of that expertise and know how enables us to kind of reinvent ourselves from a technology standpoint frequently. So we're able to move up a technology curve before we get into a point of diminishing returns and get to the next technology curve, which allows us to, again, continue that pace of innovation improvement in product quality and throughput, etcetera.
So just on this slide on the left is examples of some of the improvements that we've driven in our individual technologies over the past few years. That's pretty incredible performance in that we just keep doing that over and over again. So one thing about businesses that get at scale, typically manufacturing operations, is they tend to slow down in innovation. They tend to leverage their technology over a long period of time. Given our capabilities internally, our the fact that mass customization is not very common in the industry and that a lot of the technologies are, let's call it, the other nonexistent or very immature, we have the capability of continuing to that pace and increasing our pace of innovation.
But in addition to increasing pace, our technologies are getting more and more complex and more and more sophisticated, integrating a lot of the machine learning and artificial intelligence that Shree was talking about. And so I want to go through one example. I think a couple of years ago, we talked about this vision system. It was more of a concept than an idea at the time. We've actually developed that over the past couple of years and are now using it in our manufacturing operation.
But we've been able to essentially take a vision system and teach it how to look for things defects in our aligners, happen occasionally, like a deformed aligner or a small crack in the aligner. Those are just a couple of examples. And the only way we can do that is by leveraging the massive database we have of over 100,000,000 aligners we've made over time for the more than 9,000,000 patients that we've treated to be able to use machine learning to teach the system. Nobody else has that kind database and that kind of ability to develop a system like this one. And a system like this is necessary because we're talking about very small, transparent, clear parts with organic shapes that very difficult or impossible to inspect by the human eye.
So I got a couple videos here I want to show of our kind of final, call it, a preproduction system to explain how this works. So on the left side, there's a rotary table with a liner on it that's being photographed many times, many different angles. It's actually real time going to this ecosystem I talked about and understanding what that aligner should look like, what's its shape, what's its measurements, etcetera, and then comparing it to all those images that we're taking. And when it finds an error, like the one here on the right, it essentially brings it up so that we can identify it, pull it out of production and then rework that aligner. In this particular case, that's a deformed aligner that likely happened in the removal process.
And we have an interface that allows the operators to easily identify those issues and intervene. Another application is on the packaging side. So again, this system, real time for every set of aligners, goes to our ecosystem, pulls what it knows should be in that package. The system takes a picture of what's in that package. And based on the machine learning, which is really difficult to read a human readable font on a three-dimensional surface that's clear.
It's able to read that and it's able to indicate whether it's the right it has the right number of aligners, the right aligners in that package. And if it's not, it identifies that error. Again, someone can intervene and take that out of production. So with most of our technologies, this is no different. We there's no nobody else in the industry does this.
And so we haven't been able to rely on experts in the industry, although we try to develop this for us. We actually have to develop it ourselves, which great because it gives us again, it reinforces that competitive advantage. But it also kind of helps you understand the sophistication of our technology and our teams that are able to solve problems that industry experts can't solve. So over history, we've been able to continue our innovation and improve our performance, our throughput, our quality and cost. We've been able to do that at a very large scale.
Nobody comes close to that scale. We've been able to do that while supporting growth of 20% to 30. There's really no competitor can do what we do at scale. So in the final thought here I have is really around that this platform and this capability that we've built and with the scale and the performance of that, the world's largest mass customized manufacturing operation really enables us to drive significant investment back into the business. We on a yearly basis, we generate an incredible amount of gross margin dollars It then enables us to have the capacity to invest in advancing our products, the pure R and D, advertising, incremental sales heads and ultimately, build out this digital dental platform that will be unmet by anybody else.
And if you look at in this chart, you look at the blue bars are really our investment capacity. I just want to do a comparison here. And in 2018, 2019, you see a little white dot. That's the total revenue of pure play other aligner manufacturers out there. And you just see that our just our investment capability towers over their total revenue.
So I want to just close here, leave you with just a few thoughts. Moving from analog to digital, whether it's us internally as a business or whether it's our customers, is hard. It takes a lot of complex technology. It's a reasonably complicated business model. And certainly, for our customers to redo the way their offices work is hard.
We have the scale and know how and the investment available to help continue to advance that, to continue to improve product quality and continue to improve the efficiency of our customers. We have a proven track record of driving innovation on not only the product side, but the manufacturing side. And so we truly believe that we're best positioned to continue to drive and lead this digital transformation in the dental industry. So that's all for me. Thank you for your time.
Next up, Simon Beard will be up here to talk about The Americas. But first, we're going to take a fifteen minute break. Thank you.
So welcome back, everybody. I hope you enjoyed your coffee and Danish or croissant, whatever your poison is. My name is Simon. I'm here to talk to you about the Americas region. As you've heard earlier in presentations, we stand on the edge of really a unique moment where Align's near twenty five years of experience, our understanding of end to end digital platforms and our brand appeal has really accelerated our relevance for doctors, patients and consumers.
Digital solutions are presenting Align and its customers with an even greater opportunity to grow our business and the potential for doctors to transform even more of the 200,000,000 plus potential new smiles across the region. Currently, The Americas orthodontic market represents
more
than 5,000,000 plus new starts each year. Amazing. And we continue to see strong case growth in the adult segment, but also a growing percentage in our team business across The Americas. As you would have seen from the Q3 earnings announcement, this was our strongest team performance in the last six quarters, and we believe that there's still an incredible opportunity to expand this further. Now about roughly a year ago, I had the chance to connect with many of you on the call and talk about the tremendous opportunity that lies ahead for the Americas region.
We just made significant investments in our sales teams, refocusing our efforts into dedicated channel teams for orthos and GPs to drive more focus. We made initial moves to localize resources in The U. S, Canada and LatAm, and we really strengthened our focus on iTero across the business. And importantly, we started to make a more targeted approach in our consumer investments. These changes were important to ensure we built the right foundations in the organization to drive a more aggressive business growth.
Now the strategic decisions that we made late in 2019 around focus and segmentation paved the way for programs and product launches like three sixty, Adapt, Teen Awesomeness Centers and the ITER Element five d launch. These moves were also critical in our ability to pivot our attention and focus and support of our customers during the lockdowns in late March through to May. In addition, our financial relief, our Come Back Stronger campaigns help doctors maintain continuity of care for their patients. For example, the Wires and Brackets buyback and switch programs were a core component of our campaign and help doctors convert over 10,000 patients to Invisalign treatment. Importantly, we continue to invest in consumer advertising throughout the lockdown to build lead generation pipelines for our doctors, but at the same time, we gave them ongoing access to education.
Our Teen Forum, which was a virtual addition, was actually instrumental in helping a number of doctors understand the highly visual online and on demand world of today's teams. As noted earlier, following this forum, Align reported really strong team performance that we've seen really before over the past six quarters. So today, when you look at the size and the scale of The Americas region, it's just a fraction of the total available market. We've seen what we've always believed, that The Americas is very much a growth region. And there are several ways that we will look to accelerate our performance.
By 2021, we will have further expanded our field sales teams across the whole Americas, and we'll finalize a shift to dedicated channel focused field sales teams in Canada. Localization of resources in The U. S, Canada and LatAm really helps us become more agile and respond to market specific needs and ultimately bring us closer to our customers. We remain very committed to investing in advertising and marketing. And as mentioned earlier, our InvizEars campaign continues to gain traction, and we're seeing really positive results from the work with popular social media influencers and our sports sponsorship, especially the NFL, is creating significant buzz with our customer base.
So these efforts are all reflected in our Q3 performance where case volumes were up and we continue to see penetration across all segments and all regions. So as we think about the future of The Americas region, there are the four key growth drivers for the business, and I'll talk about the order of the priority for this region and then dig into the three key markets, The U. S, Canada and Brazil in a little bit more detail. Over the last four years, our four pillars have remained pretty consistent. Patient demand and conversion has always been in our DNA and it's taking a front seat this year.
Consumer expectations, digital adoption and a growing number of market entrants, these three things are influencing and changing how doctors interact with their patients and prospects. And we have to ensure that we're capturing consumer demand and directing those leads to Invisalign trained doctors for an unparalleled digital experience. We're pulling on this through on multiple fronts with clinical education and team focused programs for our orthodontists. And then in the GP channel, which also represents an enormous opportunity for Align, the addition of ExaCAD opens up new possibilities to further develop the GP restorative workflow, a key focus area for us in 2021. Now when you turn to international expansion, it's a pillar that we're kind of reframing for the Americas region.
So while Latano has been growing consistently led by Brazil, there are clear opportunities for growth and expansion across the full Americas region. We see an incredible amount of untapped potential in The U. S. And Canada, where localization of resources is becoming increasingly important for us to scale and grow. So let's look specifically at The U.
S. This is our largest market globally and clearly the biggest influence on our regional performance. Over the last few years, we've invested significantly in building brand awareness to ensure we win the consumer share of mind and capture and funnel consumers to our doctors by either our concierge or doctor locator site. Our investments in media, social, digital search and more recently, partnerships with the NFL and TikTok stars like Charlie D'Amelio are key to us targeting and attracting a wider audience. We'll continue to prioritize and evolve this focus in 2021 and beyond.
In Ortho, our goal is to capture more teen share of share, simple as that. It remains in single digits. So this year, we focused on building a teen conversion network of over 1,100 plus practices in The U. S. Who help us attract, capture and convert more teen patients.
We'll expand this program further in the next few years. We'll also look to grow our three sixty program for lower volume doctors and then Adapt, which provides a rapid share of chair shift to help move the needle in our team growth. Our GP approach is a little bit different. We're focused on helping practices capture the demand generated by our consumer advertising, convert this demand through the hygiene chair or directly with GPs and then introducing the simplicity of the iGo system, which is a helpful tool to many GPs as they're juggling their multiple demands in their practice. Many of the GPs are finding the diagnostic capabilities and pre restorative workflow powered by iTero and the Align digital platform as a really attractive way to differentiate their practices.
Now the cool thing with GPs is that they can generate additional revenue from Invisalign. But almost every patient who has Invisalign has some form of restorative procedure, things like whitening, white fillings, composite, and this is an additional revenue. And then there's additional revenue from patients that they treat who also refer friends and family. So think about this as a triple revenue impact, and it's a game changer. Now moving to our DSOs, it's becoming even greater in revenue and strategic importance as we see consolidation occurring across both The U.
S. And Canada. Now we've seen over 40% growth in our DSO case volume compared to pre COVID rates. Now Align's digital platform helps DSOs create end to end digital workflows that they can implement across a wide number of practices driving consistency in the patient experience. Overall efficiency and provide a competitive edge of a direct to consumer clear aligner options.
It's important to understand that there's a lot of variation among DSOs. There are a number of DSOs with just a handful of doctors looking for cost efficiencies. At the same time, there are also a growing number of larger DSOs looking at how to create state of the art digitally powered customer experiences. This is where we are focused. We continue to partner with those DSOs that prioritize quality, digital innovation and Invisalign growth as part of their business strategy.
If they see the value, then our partnership works really well for both. Today, we've been growing our DSO business with dedicated sales, marketing and education expertise, all focused on supporting these organizations. As we grow in The U. S, we need to build a more localized infrastructure for our customers. We're resourcing larger local presence across seven of The U.
S. Regions. Now think about this, each of these regions is larger than most of our individual countries globally. So resourcing locally empowers our leadership to act faster and be more relevant to our customers. But at the same time, we're also aligning our resources around customer success and treat in Costa Rica to support these teams.
But also the teams we have in Raleigh and San Jose will be aligned to improve the overall customer experience. So let's move to Canada. Canada shares the same strategic focus areas with The U. S. However, it's distinctly different in market and culture with unique opportunities.
Canada is our most penetrated market in The Americas to the teen segment of the market. So we're in the process of finalizing our move to fully dedicated sales teams for all 1,000 GPs. We have the right structure and focus to address the different needs of our Canadian customers and prospects across both English speaking and French speaking provinces. We're also expanding our Canadian iTero team, and we're looking to expand our footprint across all of the channels. We also have a number of initiatives in place to raise awareness, increase demand and drive digital transformation.
We've been really energized by the interest and adoption in our Bracket Switch and Teen Ignite programs, an indicator that a growing number of practices are open to digital ways of working. These efforts include investments in marketing, such as our partnership with the Toronto Raptors, and this continues to be highly successful in generating interest and leads amongst a diverse consumer base. We'll really lean into the Raptors to leverage our multimedia campaigns to further build interest in Invisalign. And then moving to Latin America. The market for orthodontic treatment is huge.
Brazil specifically is a breathtaking opportunity, an important dynamically growing market, not only for Align, but for the dental industry in general. Brazil is currently the second largest market for cosmetic treatments worldwide, and we estimate 1,000,000 plus orthodontic starts each year. I fully expect Brazil to be the third largest market for Lyme within the next two years. Now while there are certain amounts of volatility in the market, we've been continuing to invest in the team and the infrastructure who are delivering rapid growth within the orthodontic channel. We're also seeing growing consumer engagement and trust resulting from our investments in building relationships with social media mega influencers like Anita and Giovanna Ubank.
Most recently, we launched a new partnership with the Itau Unibanco that facilitates access to Invisalign trained orthodontists for Invisalign treatment evaluation and care for nearly 140,000,000 Brazilians, including bank employees, Itau Card, credit card, cardholders and their direct dependents. Amazing. Orthodontists continue to be our primary channel throughout Latin America as we are expanding our ortho customer base in Brazil. We're also growing our presence in Mexico throughout 2021. And we'll also move to introduce iTero technology to GPs and labs in Brazil.
So 2020 was a challenging year, and we launched a number of new products and programs, including virtual tools, improved ClinCheck and invisible stickables to support doctors in engaging with their patients and building their clinical expertise. This weekend, we held our Ortho Summit as a virtual event, attracting over 2,500 orthodontists from across the region. So agility, accountability and customer focus are the guiding principles of all that we do at Align. Our teams from the front lines to the back office are all committed to providing our customers with unparalleled experience and resources to transform their practices and their patients' smiles. I've been very fortunate to have inherited a very talented leadership team in The Americas, committed to driving our growth across the region.
The improvements in our NPS or Net Promoter Score over the last six months is a signal that we're moving in the right direction, But we believe there is more that we can do to build trust and relationships with our existing and new customers across The Americas. Look, the understanding and appreciation of digital orthodontics and dentistry is growing. And with this growth comes opportunity. Consumer advertising, channel focus, segmentation and the localization of resources and support will continue to drive utilization amongst orthos and increased adoption amongst GPs across the region. There are 200,000,000 potential smiles across The Americas, and we enter twenty twenty one well positioned with the right people, the right strategy, programs and technology to help doctors transform their practices and millions of patients' lives.
Thank you for listening. And I'd now like to hand over to Marcus Sebastian, our leader of Europe, Middle East and Africa.
Thank you, Simon. My name is Markus, and it's my pleasure to be here with you today to present how my region, EMEA, has grown over the past twelve months, lessons we have learned from the pandemic and the incredible opportunity for further growth with not only Invisalign and iTero brands, but the entire Align digital platform. So Align's presence in the EMEA region has been growing since 02/2001. During those nineteen years, we have built a very strong robust operations in our five core markets: Iberia, which is the third largest Invisalign market globally as well as the UKI, France, Italy and the DACH markets. For the past five years, we have also focused on others, growing geographies, which we refer to as the expansion markets, scaling our successful business model to Scandinavia, Benelux, Poland, Central Eastern Europe and The Middle East and more recently, Russia and Turkey.
However, the potential of the region is well beyond that, with as many as 150,000,000 consumers who could benefit from a beautiful smile and a healthy teeth. Let me talk to you today about our formula for success and our plans to reach those consumers. Despite 2020 being challenging for all business globally, the potential for growth and utilization remains strong with the majority of practices in EMEA open and operating again and Invisalign doctors working hard to service consumer demand. Let's take a look of some of the key metrics to see where the growth is coming from. Historically, we focused a lot of our attention and investment into training orthodontists.
Beginning in 2016, we have started training the GP channel in EMEA as well as dental dentists, many of whom are digital natives and open to digital orthodontics. Our current utilization numbers are strong, but the potential for growth remains with over 600,000 GPs and thousands of orthodontists looking to add Invisalign and Antero to their portfolios. And with that, we have only scratched the surface. Our share of the market is still a little above 10% of annual orthodontic case starts, presenting wonderful opportunities for growth. As you can see from our numbers, we continue to grow at a very healthy pace.
And the dental market in EMEA is expected to grow as well in double digits in the years to come with such vast markets like Russia or Turkey still largely untapped or with Spain and Italy, two of the largest markets for aesthetic and orthodontic treatments with strong economies and consumers able to invest into their smile. We are proud to take part in this growth and tap into this market opportunity. Globally, EMEA represents approximately 26% of worldwide Align revenues, a number we hope to ambitiously grow in the years to come. One of the drivers for us in EMEA is digitization of dental practices and iTero scanners with over 1,500,000 scans per day, submitted by doctors representing approximately 60% of case submissions, an amazing result and one that I hope when we meet next year has increased significantly as we strive to one day entirely replace dental impressions. When I presented here on the stage last year, I mentioned that over the years, we found a format for success that we can easily scale and implement in all of the new markets, leveraging existing resources, knowledge and experience.
What is the algorithm for success? So each of the 44 markets in EMEA are totally unique, not only from a geographic and cultural standpoint or language or currency, but also from regulatory and legal perspectives, which only adds to the overall complexity. To be successful in core markets and still drive significant and healthy growth and utilization amongst doctors, we focused on these three pillars, which I would like to discuss with you now. So several years ago, we made a strategic decision to build local capacity and strong sales operations in each core market in which we operate. This move has allowed us to be closer to our doctors, to meet with them, learn from them and also educate them in their local language by local teams based on-site.
Our Net Promoter Score and feedback from doctors keeps telling us that this is the right decision to make and our investments into local markets has helped us build strong partnerships with our customers via sales, marketing, clinical and treatment planning coordinators. But a real game changer for us in EMEA was channel segmentation into GPs and orthodontists. We have truly transformed our business internally by building two dedicated organizations with own employees supporting only one group of doctors, either general dentists or orthodontists. These are very different groups. Orthodontists are experts in treating patients of all ages and treat a majority of the most complex cases, for which they expect a comprehensive product portfolio supported by in-depth education and highly trained clinical experts skilled in developing intricate treatment plans.
In contrast, General Dentists focus on a wider variety of patients' treatment needs for which they leverage Invisalign treatment and iTero scanners for pre restorative work and for aesthetic cases. We have launched products which support these specific needs and offer education focused around comprehensive dentistry. Finally, let me mention our commercialization efforts driven by great results from iTero and ADAPT. The ADAPT program, which stands for Align Digital and Practice Transformation, was launched in 2018 as a pilot in The Netherlands and Belgium. Over the two years, the results have been amazing.
We have learned from doctors and taken that learning to help doctors identify and understand their pain points and to then drive efficiencies and practice optimization. This year, we made the program our strategic focus, and we will continue to do so in 2021. Let me present a video of our four doctors, Doctor. Kauschen from The U. K, Doctor.
Duomo from Belgium, Doctor. Widdo and Doctor. Bitner from Germany, who have shared with us their stories on why they joined Adapt and what changes they made in their practices as a result of our collaboration.
I learned about the program in autumn last year on an Invisalign summit in Munich, and I was immediately excited.
So I joined Adapt in 2019.
I was approached by Adapt at the 2018 as they were looking for a pilot practice.
I joined the Adapt program in March 2020.
And at first, I didn't wanna hear about it. I I found it too invasive, but I know that the first step to grow is to know your strength and your weaknesses.
Since I have an office chain, for me, it is important to have controllable processes that work even if I'm not there. I wanted to implement a structure and tools to measure good outcomes and to detect where we are weak.
And they were able to give me a full assessment of my practice. And, you know, even if you are the next few jobs of your generation, you have blind spots, and then showed me that I had blind spots. We had
immediate improvements after implementing the ADAPT program. Even though we had situation, we still have the COVID-nineteen situation, we managed to get an increase of our monthly cases from sixteen to twenty four.
We've established
a strong brand in the market with aligning ourselves with Invisalign. Secondly, we've been able to digitize the practice and the workflow within the practice. And the practice has grown in terms of patient numbers. Our capacity has increased and our profitability has increased. We are much more streamlined in our workflow.
So they helped me to work on my workflow. They, helped me to find a TC. They helped me, with my team. They helped me with my patient. They helped me with digital.
So now we are paperless. We are not like another orthodontic practice. We are different, and that's what ADAPT gave me.
The conclusion is that it was a tremendous help to structure my offices and to implement tools to be able to scale what we have now.
I think the biggest impact of the ADAPT program for us was that we learned that it can treat many more patients per day with Invisalign than we can do with patients with braces.
We've been able to create more time. And with that, we have the capacity to see more patients. Our take has increased, so from an averaging of thirty percent per year of Invisalign, and now we're approximately ninety percent.
We went from two hundred Invisalign cases to six hundred Invisalign cases in one year.
I hope you agree that these are inspirational stories of continuous improvement and growth despite the pandemic impact in 2020, which brings me to addressing one of the most challenging moments for us as a successful business, the COVID-nineteen pandemic. The first wave of COVID-nineteen came to Europe in mid February and by mid March. Most of practices were closed during lockdown. The situation lasted until practices began reopening over summer. Naturally, the COVID-nineteen situation was reflected in our Q2 and Q3 results.
We are very proud of the business performance rebound in the 2020. These results have been our strongest quarter in our history. What an amazing result, over 100% growth quarter on quarter and over 37% year on year. It would not have been possible without our outstanding teams and the employees who supported Invisalign doctors during the time and executed very strongly. When I reflect on our performance, I believe that one of the reasons we were so successful is because we reacted very fast and have been one of the first to respond to COVID-nineteen situation and offered a full range of support to our doctors.
We also made iTero and digitization our core areas of focus, and we managed to show the doctors the digital wins over analog. Doctors continue to realize that digital workflows are essential in times like these and driving digitization by, for example, buying the first intraoral scanner, and they can see clearly the difference it can make to their practice. And currently, we are responding to a second wave of the pandemic as many countries go into a second lockdown with our recovery Part two program. We will continue to be there for our customers, offering proactive support to avoid the worst impact of any additional lockdown restrictions. Let me focus briefly on our recovery efforts, which we launched in Q2 and split into three core pillars: the business viability, practice recovery and patient engagement.
Based on various conversations with our doctors, we launched a number of solutions that helped our customers keeping going during the pandemic, a mix of commercial and growth programs, digital tools for remote care and virtual education. For our education efforts, we built a TV studio and recorded our events with presenters and a mix of excellent global speakers. We have attracted over 20,000 dentists and orthodontists in Q2 alone and had 50,000 more touch points than in 2019 due to going digital. Our core events were GP Summit and Certificate Symposium attended by over 3,000 doctors. Digital Academy efforts will continue in 2021.
Our increasing NPS score clearly indicates that doctors are taking notice of these efforts and appreciate them and not just amongst orthodontists, also under GPs. What is equally encouraging is the feedback from our employees who have appreciated our efforts to focus on their health and security, which was our top priority. In 2020 and 2021, we will keep the momentum going in our core markets to drive utilization even more aggressively. To help us grow market share, we intend to make a major investment in consumer advertising in select markets such as The U. K.
We are planning to launch TV advertising to complement with a successful mix of digital and influencer marketing. The objective is to keep the Invisalign brand top of our consumers' mind and to tap into what we call the zoom effect that drives more consumers to Invisalign doctors. We did great in 2020 in Germany and expect to further increase our investments to explore other opportunities. Germany is one of our strategic markets in 2021 With a population of over 82,000,000 and a strong economy, we still have a lot of work ahead of us. We will work on driving team utilization, which is key to expanding our reach in the German speaking countries.
With a strong local team, a great number of trained doctors and the planned investments, we are in a strong position to change the market dynamic. We will continue to encourage doctors to become more digital, and our Align digital platform will help us build an even stronger position with Invisalign, iTero, Exacart solutions and our digital tools and digital workflows. And finally, we will tap into the GP market opportunity with the right portfolio addressing specific needs of our GP doctors. So our efforts in the GP sector started back in 2016 when we launched Invisalign Go in Germany as the first market globally. Invisalign Go is dedicated product for GPs to help them explore the huge opportunity of the millions of consumers deciding for teeth straightening.
Since 2016, we have received tremendous feedback from GPs and made significant investment into growing our collaboration. In September 2020, we were the first region to launch Invisalign Go plus to give GPs an opportunity to do more complex cases. First reactions have been very positive. And now let's hear from Doctor. Afan Zagier, one of our biggest Invisalign GP providers globally, working with the Invisalign Go system on the role our products have played in his practice.
Hi, guys. My name is Doctor. Afan. It's a really hard name to remember, so it's like a fan that blows out with an A on it, a fan. And by the end of today, you will become a fan of me.
So I'm very lucky that I'm known for being someone who's at the forefront of minimally invasive aesthetic ethical dentistry. So we do a lot of teeth straightening with Invisalign, then some teeth whitening, and then add some composite on the edges. And I coin it a b c. So we start off by aligning the teeth, a. Then we brighten the teeth, b.
And then we contour, c, contour the edges with composite. So that's in essence what I do on a regular basis. Over the last two and a half years, I have been able to complete over 700 Invisalign Go and Invisalign Go Plus cases. And all I do for my orthodontics is just Invisalign Go and Invisalign Go Plus. So I don't use any of the systems.
I just use this, and I'm very lucky that it's helped me help so many patients. My team have benefited. I've benefited, and I'm really happy. I'm very lucky to, be one of the Invisalign Go, trainers. So I train many, many dentists.
And many of them contact me and say how many cases they are getting in terms of acceptance with the the products and the system that is Invisalign Go on a regular basis. Now that begs the question, why are there dentists out there that are using different clear aligner systems? We need to educate those dentists in particular why Invisalign Go and Invisalign Go Plus is the answer. And for me, it's the predictability. It's the system.
It's the actual way that things are done. It's the platform. So if we have that platform and that niche to be able to do the digital impressions, to do the digital photo upload, to do the ClinCheck monitoring, to do the assessments, all of that together warrants that lab bill. What do patients come and ask? I want Invisalign.
So it's the leading brand. There's over, I think, over millions of smiles now that have been completed with this, And the systematic review articles are actually corroborating the benefits and the precision of the product itself. I think it offers a platform. So you can use your iPhone to take photo uploader app photos. That then goes on to the computer.
You can do the in face visualization, so you can show them their own smile, their own face with their own smile edited with the new smile. You can show a clincheck simulation which shows you the smile and what it's going to look like and how many weeks it's going to be. You can use the online tools where you can actually give the patient a smile view and you give them a link. They click on the link and before they've even seen you, they can see their own face with a new smile before they've even come to see you in the clinic. All these things and the marketing campaigns and all of the free support and education network that Invisalign offers, it's incredible.
Thank you, Doctor. Afan. Truly a great success story. 2021 will be a big year growing the expansion markets, which are already helping us grow the market share in EMEA with much higher potential in the years to come. I'm excited to announce we will focus on launching direct operations in Africa as well as expanding our presence and growing market share in Turkey, Poland, Middle East and Russia, all presenting a huge potential.
When we launched our operations in a new territory, we leveraged the model we had successfully implemented in each of our core markets, which allows us to go direct and establish a strong initial presence in two to three years. We will leverage these best practices by building awareness of the clear aligner category and Invisalign brand. We will also focus on launching our full Altera portfolio across all expansion markets, including Russia or Middle East, to meet the doctors' demand and help them grow their digital practices. Twenty twenty one is going to be a year of new opportunities for us for a number of reasons. As I mentioned, we will make significant investment and launch one of our biggest advertising campaigns in certain core markets, reaching consumers with our In This Is campaign.
We will continue to offer our signature offering and service, including adapt and virtual education. We will scale our business to grow market share in strategic territories with proper investment and resources behind. With this in mind, I'm proud to announce we will drive localization by opening a local Tweed facility in France with plans for further markets to follow in the coming years as well as the first manufacturing facility in EMEA where we will produce clear aligner parts for the EMEA region. And we will continue to focus on building strong partnerships with our doctors, with DSOs and distributors. As we have seen over the course of 2020, the understanding and appreciation for digital orthodontics and dentistry keeps growing.
And with this growth comes the opportunity to expand it even further. So 2021 is going to be exciting. We don't know what lays ahead of us, but we are all well sourced and prepared with many learnings, investments, the strongest technology and products, a fantastic and highly dedicated team and our commitment to transforming smiles and changing patients' life. I hope you can see the opportunity to grow is still enormous for EMEA. Thank you.
And now over to Julie Tei.
Hi, everyone. Welcome to Asia Pacific. I'm Julie, and I look after the region. You have heard Joe talk about the 150,000,000 opportunities that we have in Asia Pacific, of which we have 5,000,000 case starts. With growing affluence and access into new markets, we are able to really go after expansion of potential consumers in Asia Pacific.
Of course, the number one focus and the single largest opportunity remains with teens, And we continue to focus on that and work with the autos to go after that opportunities. But we also see a growing opportunity with adult consumers, who goes to the general practitioners for treatment, who wants to straighten their teeth and also as part of comprehensive dentistry. So that 1,000,000 potential also presents an opportunity for us to go after. I want to change gear a little bit and give you a glance of Asia Pacific. Over the past few years, we have made significant contributions to global business, almost 20% of global revenues is from Asia.
On a year to date basis, we are also seeing more than 12% increase in utilization. ITero was launched about two point five years ago. And to date, we have done more than 1,000,000 scans and almost 65% of all Invisalign cases are submitted through iTero. And as you know, that's critical for us because iTero is the first step to a digital workflow. If you look on the left, despite all the growth that we are looking at, we are still at less than 10% of auto Kstart shares.
And you can see that more than 5,000,000 are general practitioners in Asia Pacific. So that gives us an opportunity for us to go after. I want to also now move to really Q3 itself. I have about three slides to talk about Q3. We see strength across the region in Q3.
In first half of the year, we've trained 32,000 doctors and in Q3 alone, we've trained 28,000 doctors. And our ability to do this during even COVID, it's mainly because we've been working on a lot of these programs. And these programs have allowed us to pivot when COVID hits. Now remember, Asia is a diverse region and the impact of COVID is varied by markets. But we are able to respond accordingly to what is important in that market.
I'll give you some examples. We've been able to do online training during COVID. We've been able to do online demonstration of iTero and including online and offline selling events. So some of these skill sets, some of these new muscles have been acquired and have serviced really, really well in Q3. In Q3, we also marked a very important milestone for us.
We celebrated the one million patient in Asia Pacific. Took us a little bit more than seven years to get there. Ms. Saito san is an aspiring fencer who is looking forward to participate in the Olympics. She's a Japanese patient.
Going closer to the next step, how do we actually work with the doctors in supporting them for a very quick recovery in every market that we operate in? Of course, you heard about Raj talk about all the digital solutions and the tools that we launched. We were able to work very closely with regulators to roll them up very quickly to each of the markets. We work with the doctors on safe reopening. And more importantly, we also continue to invest and educate our consumers about Invisalign, about their treatment options and how they could actually check out things and check out the brand virtually.
And not forgetting, we continue to invest with we invest doctors training. So let me change a little bit, and I'll talk a little bit about what we spoke about at the last Investor Day, right? A year ago, we talked about these are the key priorities. And I'm happy to say that we are tracking very well on each of these key priorities. And while we hire hundreds of employees every year, our engagement score has been in excess of 80% for the past five years.
So when we survey our employees every year and we ask them about how engaged they are, you're talking about really fairly good results in excess of 80% for consistent five years. And this is critical because the employees an engaged employee matters a lot as we continue with our aggressive growth. I'm going to go to the next slide and talk a little bit about the strategic priorities. You've heard Joe, you've heard Raj talk about these global strategic priorities and drivers. But it's important to understand that this strategic and international drivers and how they are actually localized and executed locally.
I want to be able to take you through the next few slides to see how these growth drivers are layered over each of the key markets and how they are executed. So you get a sense of how we do it. Let's start with China. Number two market globally for us, we continue to make strategic investment. In fact, China is the only market from first scan to manufacturing.
We have it all integrated in a single market. So when the doctor first use an iTero scan to treatment planning, to manufacturing of the aligners, it is seamless and it is all in China. In fact, just in September, we opened our AFAB manufacturing factory in Zhejiang in China's Tooth Valley. It is the single largest investment in the Tooth Valley. Moving forward, we also have partnerships with the China Oral Health Association, really three key pillars: one, to continue to educate doctors two, to support doctors and their research and three, really to raise the standard of oral care in China.
In year one alone, we're looking to reach 10,000,000 consumers in China. In addition, over the past few years, we have also built one of the largest, if not the largest, direct auto sales team. Moving forward, we're going to continue to expand and go deeper into cities, and we are setting up dedicated sales team to go after those opportunities. As you know, Invisalign is a well recognized brand in China, and we have the ability to treat one of the most complex malocclusion in that market. So all in all, you're talking about Invisalign, a live technology, very, very well positioned to go after the huge opportunities that we see.
It gives me great pleasure to invite two of our key opinion leaders, Professor Chou, who is really the very first doctor to use Invisalign in China some ten years ago from Peking University and Professor Lai from Sichuan University to share with us their experience with Invisalign and iTero. It's nothing like listening to the users themselves. So Professor. Joe and Professor. Lai, please.
I think China's orthodontic market is a huge market. Actually, I think it's Blue Ocean. In the future, orthodontic treatment more and more people will get such kind of treatment, especially after gradual improvement of living standards.
With the continuous increase of resident income, Chinese people pay more attention to oral health. There are huge market opportunities in China actually. According to statistics, the proportion of people with malaggression in China is as high as eighty percent but the actual treatment proportion only accounts for five percent in some of the total population with malocclusion. Twenty years ago, I learned about Invisalign technology when I was studying abroad. As the leader in clear aligner industry, I'm very optimistic about Invisalign treatment, so I took the lead to introduce Invisalign Tactra into China ten years ago and also I became the first certified doctor in China and vigorously promote Invisalign treatment in China.
After doing a lot of Invisalign cases and get good results, I found that Invisalign system can actually do a lot of work, which give me a lot of confidence. Now we can see every case is clear aligner cases.
Very important point of Invisalign treatment is to create a fully digital workflow from intra scanning, the diagnosis, the treatment planning which bring good medical experience to patients also. Digitalization will improve the practice and patient appearance. I believe digital will definitely be the trend of the future dentistry. Athyra can obtain patients intra scanning data very conveniently and L3M based on big data generates preliminary treatment plans which greatly improve doctor diagnosis and treatment efficiency and enable doctor to focus on professional aspects. At the same time, Eteri is a good tool to promote the digitalization of the clinic which greatly helps the doctor patient communication and brings good medical experience for patients.
So I want to say thank you to Professor Joe and Professor LIFE. And you've heard it, huge opportunities, growing affluence, very complex cases and complex mild occlusion, the medical device, doctors' training is critical and four, digitalization of practices. Invisalign is the most well positioned. We offer a fully integrated digital workflow using iTero from First Scan to ISA manufacturing, we have it all. Two, it's a recognized brand.
Three, Invisalign can treat one of the most complex mild occlusions that you see in Asia, particularly in China. And fourth, we have two world class state of the art training center in China, where we used to train doctors. So thank you once again, Professor. Joe and Professor. Light.
With this, I'm going to move to Japan. A very fairly conservative, complex market that demands the highest quality. About two years ago, we have created a dedicated GP team. And I must say, we have seen exceptional success for us to go after that particular segment. We continue to work with the autos.
We launched first and the response has been very, very positive. We launched iTero, and now the number of iTero installed in Japan is number two globally, which is critical for us as we drive the digital workflow. And as we continue, I said the last at the last Investor Day, I talked about building Japan Treat. We look to expanding the Japan Treat and in supporting our doctors. We are also looking to expand regionally beyond Osaka and Tokyo and going into the other cities.
A lot of opportunities beyond these two major cities. We also experimented with consumer marketing in Q3. In fact, we've invested and see how it goes. And from the results, we are really, really encouraged. We see 100% increase in website visitors and search for clinic locations was five times, 5x.
And as you heard, we just celebrated the 1,000,000 patient from Japan. So complex market, but huge opportunities and the way we're approaching it is very unique to Japan. Let's go to another market, Australia, New Zealand, a very established growth market. And as you can see, continues to be in the 30s growth. We see strong teens demand.
In fact, in Q3 alone, teen growth was 37%. And Q3 growth alone is in excess of 40%, even though we have the state of Victoria that was in lockdown for a few weeks. Having said that, it's also good to see that we have also piloted a consumer marketing, this time, the very first TV campaign that we did. Again, we saw 100% increase in website visitors and 128% increase in opt ins. Invisalign is one of the most recognized brand in ANZ.
In fact, it is number six out of top 20 brands. So we are right there with Apple and with Samsung, speaks volumes about what we have been able to do in Australia. I'll move on to the next growth markets for us. I call this term Pivot, South Korea, India, Vietnam, Thailand, represents a wide region of growth, a sub region of growth for us. We continue to see very, very good results in these four markets.
In fact, in Korea, Invisalign is rated the best brand in one of the top three newspapers. We see a very high adoption of Invisalign Virtual Solutions in India. And in August, we went direct in Vietnam, creating a direct presence with our direct teams so that we can better serve our doctors and respond to that market. In Thailand, we continue with our geographic expansion beyond Bangkok. So as you can see, well, our response to the markets, each market has been quite different.
And we've been able to really work within the framework of that market to support the doctors and the consumers. I want to now move to a topic that's very close to heart, doctors' training. I mentioned training centers in China, but in fact, we have six training centers across the region. We just opened two more, one in Vietnam and one in Thailand. Doctors' training is such a critical part of Invisalign Asia Pacific.
So we had this virtual symposium. We have more than 1,500 participants, 25 world class speakers. They came to look at all the virtual solutions that we've been able to roll out. We have speakers sharing about how they use it, the success. And there's no better way than doctors learning from another doctors and how they pivot and come out of COVID really, really well.
More than thirty percent of the tenants told us that they want to be able to digitalize their practice. And so we're well positioned, as you know, Adept is now being rolled out in Asia Pacific, and we're now well positioned to actually help the doctors in that journey. And as I said earlier, on a year to date basis, we're trained 60,000 doctors, 32,000 in first half and 28,000 in Q3 alone. And this is something that it's a commitment, it's an investment that we'll continue to make for our doctors to support them. I'll go on to talk a little bit about the integrated journey that we spoke about.
You heard about all the digital tools that was rolled out, But it's very important to kind of put it all together and say, what does it look like from a consumer's perspective? So from creating that awareness through social media to exploring, so they could explore and say, hey, I download my Invisalign app, they could use a smile view and have a look and say, how would I look like? Do I want to do Invisalign? Two, going for consultation, we have rolled out virtual consults, they could do a scan, you could get a simulation, do a two d, three d in face visualization, which we have just launched. If a consumer should decide to go on treatment with Invisalign, the entire onboarding program, it's a whole comprehensive tool that we gave to consumers to get them on board.
And they could use those and actually continue to be in virtual consult if they are in lockdown situations with their doctors. Two, finally, say, hey, I love what I've gone through, and I would like to recommend my friends to do it. So if you look at this, it's a fully integrated consumer patient journey that we have been able to pull everything together. And in markets like China, for instance, we use WeChat, and these are all translated into local languages so that the local markets consumers can use them. I'll take you to the Invisalign center.
I spoke about that. In Asia, we have five of these centers. And during a lockdown situation, we still want to provide solutions or allow the consumers to still be able to experience the brand and talk about what they need to do and how is it like and all the questions. So let me take you virtually to our Invisalign center. So as you can see, you could visit the centers, of course, in person or you can do it virtually.
And if consumers have questions, we're able to answer those questions. If they want to make appointments to see a doctor, our patient concierge can arrange to make appointments to see the doctor. On an average, we are seeing about eight appointments a day, which is fairly good. And of course, much more in terms of net receipts. I'll move on to show you a little bit about how we actually execute the brand itself in these aligned brand engagement across the different markets, right?
And execution has very much a local flavor to it. We continue to focus on digital, consumer online, social media, so that we can continue to engage the consumers. At the end of the day, we have made some very big strategic decisions, including investing in markets, including building a direct presence, including training of doctors, including all the brand engagement. So how do we know that we're really on the right track? And really, we use the NPS score.
As you can see, we have made really, really good progress. In fact, our NPS score, it's a record for us this year despite COVID. We continue to delight our customers by being close to our doctors whom we serve, close to the patients and the consumers. We understand them, we speak the language and having a direct presence there, we're able to better partner and support our doctors. I guess the NPS score will be the best testimony that we are on the right track.
Focusing on 2021, we continue with the four priorities. Of course, going after the teens growth is the single largest opportunity as we know, and we continue to work with orthodontists on that. Offering comprehensive dentistry with iTero, with Exocad and working with general practitioners to reach out to those consumers who goes to see them. I talk about regional expansion into new segments, into new cities, and we continue to push and to expand geographically. And of course, supported by a strong brand, We continue to invest in our engagement with consumers and patients.
With that, I want to thank you for your attendance. Thank
you.
Great. Thank you so much, Julie. Hello, everyone. It's a pleasure to be with you again to take a minute to talk about Align's continued commitment to excellence in customer experience. Before I talk about what we've done recently with Align, I thought it would be good just to touch on how customer experience and customers' expectations are changing.
The importance of a good customer experience, and actually what defines a good customer experience, is rapidly changing in the digital world. Key themes have emerged, such as convenience, transparency, personalization, on demand support and truly having a connection, a personal connection, to the companies with which we do business. As customers move more and more onto platforms, they make choices and almost equally weighted, not just on the products, but also on their experiences. And that is consistent not only in their experience with the product, but loyalty comes in the form of experiences when they deal with these companies. Now as you've seen today already is how rapidly digital adoption is occurring for our customers.
We truly are transforming and moving from a product company to a platform. And the implications of this digital acceleration apply not only to the products and the technologies that we provide, but also to how we are responding to our customers' ever changing needs. Now this isn't a new focus for Align necessarily. Customers have always been at the heart of what we do. But as doctors move more and more onto the platform, inherently, they're trusting us with a higher percentage of their business.
So it's imperative that we remain focused on service. Now as an executive team, we saw this move from products to platform, and we knew we had to not only invest but focus resources on making service a key pillar for our future success in order to scale to meet customer needs. And these needs are very diverse. You've seen from the regions the geographical differences. We also have different channel needs between orthodontists and general dentists as well as iTero.
So it's a complex and an important initiative for us to tackle. Now from a big picture, these are the pillars that we look at for how we think through improvements in customer experience. The first is around humanizing data. And what this really means is that we go beyond just survey feedback, that we ensure that we are closing the loop with our customers so that they feel that connection with the company. Next is personalized choices.
Now this is all about reducing friction so that when they do have issues with us, they have means and personalized options in which to interact with us. And the last and probably the most important of these is connecting with empathy. And this isn't just doctors to us. This is doctors to us, us with each other in the way that we solve for our doctors and in the way we close the loop and communicate back with our partners. Now this empathy connection also emphasizes the importance of localization and empowerment of local teams to have the support to be as close to customer as we possibly can.
Now I wanted to dive a little bit into some of the work that's been going on this year. Now in reducing friction, our aim is to reduce, eliminate or automate issues that cause our customers' and doctors' frustration. So let me touch on each of these. The first is Service Console. Essentially, Console enabled our frontline employees to have more insight and connection to doctors when they called them with issues.
What we did is provide them essentially a dash board or three sixty degree view of doctors who are calling it at a glance. And this enabled not only an efficiency gain of almost 61% of them not having to go through multiple systems to find answers for things, but also enable them to tailor their responses so that when the customer gets on the phone, the agent already is familiar with the account and many open issues that might they may be calling about. The second initiative is knowledge base, and this comes with self help. What we wanted to do is to provide doctors who are very busy in their practices seeing patients other opportunities outside of having to call us. And this is all about them being able to find information on demand for frequently asked questions at their fingertips.
The last is live chat. And I think at some point, we've all probably worked with live chat. But what was a little bit more complex for us is that our customers rarely call us with a single issue. They may have a clinical issue, a customer support issue, a billing issue. And what we wanted to do was to make sure that, that experience felt seamless to the customer so they didn't feel like they were getting bounced around.
Now we've had a pilot going on in The Americas. We've also scaled this technology to our global partners in EMEA and APAC, and we'll continue to invest and scale this into next year. What we know is this: Doctors really like it. And they consistently, on a global basis, rank us or give our agents scores of 4.8 out of five with high satisfaction. Mainly the satisfaction comes because, again, they're very busy.
And live chat enables them to talk to an agent, go back to their practice, see a patient and then return with that seamless interaction to resolve their issues. Now aside from reducing friction, what I wanted to touch on is service culture transformation. Now this was a brand new approach to service that we piloted this year. And it's as much an organizational move as it is making sure that customer centricity is in the fabric of our being. Now where physically possible, we were able to pull together a cross functional group of people to sit together with a dedicated group of customers that they supported in order to provide more personalized support when doctors contacted us.
Now our customers immediately noticed this three sixty personalized support and the more attention as well as that closing the loop personal touch that was paid by these teams. What we noticed also is our customer effort scores or how much effort it takes a customer to do business with us decreased, and Net Promoter Scores increased. Based on this success, we've continued to roll these out into other global markets, and we'll scale this as we move into 2021. Now I wanted to touch a little bit more on empathy. And what you've heard from the region centered around our response, especially during COVID.
You know, when the world goes quiet, the only voices you can really listen to are your customers and your employees. And in these unprecedented times, the fact that we were this connected to our employees and our customers allowed us to pivot to do things that were unique in this time. Some of those resulted in extended payment terms, regional promotions. And I think what you saw from Shree this morning was how rapid we were able to advance and launch key technology that enabled doctors in this new virtual world as well as the success. And I have to give Emory and his manufacturing team a ton of credit with the way they immediately pivoted to meet the needs of our doctors who were struggling to obtain PPE in order for them to be able to open up their practices.
And the fact that they were able to manufacture and deliver this to our doctors enabled some of our doctors who couldn't access this PPE to open up their businesses even earlier. So what we want our customers to know is this is our commitment. We are listening, we understand their needs, and we're responding to their changing needs and changing environment with quick action. You know, you saw from the regions that there's been an increase in our Net Promoter Score. So doctors are noticing this increased commitment to them as an organization.
On a global scale, we've seen this increase from 42.5 in 2017 to a global number of 49.7 this year. And what we know from this is this direct correlation between NPS, our doctors' likelihood to recommend us to their peers, and our revenue numbers. And so with that in mind, we will continue to be committed to be the best possible partner to our doctors, not only in the products we provide, in the technology that we enable, but even in our service as they go more digital with Align. Along with that, we'll continue to, through these initiatives, scale internally through new ways of working so that we can be as responsible and quick moving as we can to our global expansion and these ever changing needs of our customers. With that, I thank you so much for your time, and I'll turn things over now to John Maricci.
Thank you, Jen. My name is John, and I'd like to talk to you today about what we're doing to drive shareholder value. The way I'll get through that and to explain this is to talk about our investment allocations, our financial strength that we've had, the long term model that we follow and also give you a quick view of our Q4 update. As has been discussed earlier, we've added 3,000,000 more to our orthodontic potential case starts every year to 15,000,000, and roughly 1,000,000 per each of the regions. And what we see and what we saw when it was $12,000,000 now that we see that it's at $15,000,000 we are in a vastly underpenetrated market.
And many of my colleagues have talked about ways that we can get at that underpenetrated market. On a similar side, when we look at the global opportunity that we have for market expansion, there's 500,000,000 potential patients, 200,000,000 more than we were talking about earlier, spread across the various regions. And what that underlies is just a vastly underpenetrated market that we're just starting to tap into. These are people with mild corrections that are needed. These are adults or others who just didn't go into treatment when they were younger who now want to go into treatment.
And we have a huge opportunity to get into this market. So how are we doing as we are progressing through and looking at our volume that we've had over this three years? When you look at our volume that we've had over the last three years, we've grown about 30% a year. And what we see is non comprehensive. We've talked about this many times in the past.
Noncomprehensive is growing much faster than even on the comprehensive side, close to 40%. What this means overall and what we've seen with many of my colleagues is talking about the moderate growth that we've had, various light products that we have, iGo. These are products that really help grow in that segment. But what we've seen over this time, too, ASP has been relatively flat. And in fact, what we've seen is non comprehensive ASP is actually increasing and improving over this time period.
What we also see, and we talk a lot about teen growth, is how the teen utilization or how the products that we have for teens have been growing. And we see that we're growing close to 40% a year in teens. And really, when you look at the orthodontic case starts every year, the fifteen million that we have, the vast majority of those are teenage. And we are working and with products, with promotions, with consumer awareness to really drive into that teen segment, very critical for us. And we've seen good growth over this time period.
So how do we get at driving additional shareholder growth and shareholder value in our portfolio? It starts with the investments that we're making in an underpenetrated market, as we spoke, Going direct to investments that we're making with our R and D, with sales teams, with marketing that we spend, working with customers to try to increase utilization has really drove a lot of our increase. And you can see how it's changed over time. Much more of our revenue that we have is really going to making these investments to be able to drive that shareholder value. So across these investments that we've made, adding capacity, as Emory talked about, to be able to add to our manufacturing capabilities.
And then ultimately, anything that we have left over goes back to our shareholders, goes back to you to be able to generate additional shareholder value. When we look at how we've done over this time after those investments, we've seen revenue grow close to 30% a year. We've seen our earnings grow close to that 30% as well. And the cash flow from operations, what generation we have from a cash flow standpoint, growing 45% on a year over year basis, tremendous growth across the business and gives us a lot of flexibility to be able to continue to invest back into the business. So that strategic investments that we made is translating to company growth and ultimately translating to shareholder value.
Another way to look at this and just taking it across this same time period 2016 to 2019, we're seeing our strategic priorities being accomplished operational execution. We've seen revenue grow over 2x over this three year period. Our earnings have grown 2x. What we've seen is our free cash flow has dramatically improved to growing over 3x over this time period, which gives us a lot of flexibility that I'll talk about. And our market cap, what we've been able to drive for shareholder value significantly increasing over this time period to 3x over three years.
And if you looked at the share price most recently, over 4x. Cash flow has been very critical for us as we look to make continued investments into our business. Our free cash flow has increased 50% a year over this time period. Dramatic improvements that we've had in terms of being able to manage our cash flow, being able to still give investments that we need based on what areas are needing investments that we have across the business, being able to invest back into added capacity to be able to accommodate that volume growth. So while doing all that, we've been able to grow our cash balances to over $500,000,000 at the end of last year.
That was really very critical because when many of my colleagues have talked about when we were in the crisis, when we started the crisis, our focus has been to protect our employees, making sure that we continue those jobs that they have, making sure that we didn't cut salaries, giving people the security within the company to really make sure that we're reaching out to our customers and providing our customer needs. And that was very, very critical. And many of my colleagues talked about what they did in their regions to be able to help with that. Because that was very important because in the vastly underpenetrated market that we've talked about and I showed at the beginning of my slides, we have this vastly underpenetrated market. So we wanted to keep investing.
We invested in programs. We kept investing in marketing. We added salespeople. We added capacity. We did things during the crisis that helped in our recovery.
And we continue to make investments during this during our recovery. In fact, as you know, we closed on our Exocad, our biggest acquisition that we've done ever, right in the middle of this crisis because we believe in this market and the market opportunities that we see. So what did it do for us in the third quarter? We reported third quarter results a few weeks ago. We achieved $700,000,000 in sales for the first time ever in the third quarter.
It was our most profitable quarter ever that we've had. Really, we went from one of our worst quarters or the worst quarter in the second quarter to really our best quarter in the third quarter. And it was due to the continued investments that we made across the business, knowing that if we continue to invest, we would aid in the recovery, we'd see results such as this. And so really, across the line, whether you're looking from revenue all the way down to earnings, great improvement. And in fact, you can see from a cash standpoint, we added, on a year over year basis, dollars 125,000,000 of cash.
That includes the acquisition from ExoPad. So adding ExoPad with using our cash, we still increased our cash on a year over year basis, which is tremendous from a cash generation standpoint. Many of my colleagues have talked about the sustainable competitive advantage that we see. And really, when you look at the advantages that we have, you look at what we have from a business standpoint. No other business in our space has what we have, from the sales side to the consumer, the brand awareness, the manufacturing that Emory talked about, the scale that we have, the digital platform that has been discussed, really just the financial results that we've been able to see.
Nobody brings this together. Many times we talk about, you hear us talk about a multi variable equation. Well, this is the multi variable equation. It's not one piece of this. It's multifaceted that the investments that we make, how we think about going to market, this helps us with our competitive advantage.
And it's multifaceted and it's very global. And quite honestly, it's taken us twenty years to be able to get to something like this. And it's been over time that we've been able to see this type of sustainable advantage. So what does this mean for us when we think about strong leadership and the position that we're in and the momentum? This gives us that momentum to be able to talk about when we think about our long term growth model.
It's all the other facets that you've heard today during the investor presentations, all the facets of the company that bringing together digital orthodontics, a digital dentistry to the masses, to these opportunities that we talk about, whether it's on the traditional orthodontic side or the expansive market that we talk a lot about. And it's really this background that we have as a company that gives us comfort when we talk about our long term growth model. The model that we have as a company will reiterate as we've seen across these targets. This is how we think about when we invest in programs and projects within the company, when we're investing in marketing, when we're investing in salespeople, when we have R and D programs that we want to fund, when we think about adding manufacturing capacity, we use this model as a basis for our investments. And we adhere to this.
And it's because we have all the other pieces that have been described that give us confidence to be able to invest in this and ultimately deliver shareholder value for you. So lastly, I wanted to give a quick update in terms of where we're at from a quarter standpoint. I wanted to tell you that the strong momentum we experienced across the business in October has continued into November. Similar to Q3, we're continuing to see a higher mix of new cases versus additional aligner cases as doctors continue to ramp up practices. We remain committed to supporting our doctors and their practices through the recovery and beyond.
Our prior investments have helped us have helped drive adoption of top line growth, and we are encouraged by the return of our investments. Therefore, we are adding significant investments in sales, marketing, innovation and manufacturing capacity to continue to drive momentum and penetrate the huge market opportunity. At the same time, there continues to be uncertainty around the pandemic and the global environment. And any additional lockdown, changes in consumer behavior or practice closures could impact our operations and financial results. And with that, I thank you, and I thank you for your support.
And I will turn it over to Shirley Sacey. Thank you.
Thanks, John. Well, thank you, everyone. We really appreciate you spending time with us today. I hope you have a greater appreciation for the tremendous opportunity in front of us. But I think more importantly, I hope you have a great appreciation for the team that's driving the execution of this strategy and helping us to achieve the 500,000,000 potential consumers who want and deserve a better smile.
Before I turn it over to the break, just a reminder, we're going to go actually now to a live Zoom Q and A session panel with Doctor. Sam Darr and Doctor. Regina Blevins, and it will be hosted with our very own Americas, Simon Beard. And then we'll turn it into an open Q and A so that you can ask your questions, and we can have an interactive session with the rest of the executive team. Thank you again.
We really appreciate your time and look forward to following up with you in Q and A.