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. 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 a 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 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 a 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 point five billion. It's five hundred million. Just always keep in mind that seventy five percent of the people in the world have a malinclusion 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 a 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 of 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, we'll be 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 accumulation 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 in 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 orthodontic 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 and 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 overall. 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 companies like Google right now and Facebook and Apple and all, they've 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.
You 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 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 plastics. 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, a line 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 could say it starts with the Align cloud, where you have exocad, iTero, 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 orthodontics 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 that 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 the 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 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 that business.
Our doctor driven model, again, as I mentioned before, is 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 is the right way to deliver this kind of orthodontic care. I think you know that, as I mentioned before, we've talked 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, the highest value DSO out there is Heartland. 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 dentist with trust and confidence. This is because the dentist 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 orthodontic 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. With 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, which 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, with 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, you 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. 100,000,000 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 mobile 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. A 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, ortho 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.
Orterrestority 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 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 Sagar.
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, ExtraCad Smile Creator, a perfect match for our smile architect workflow. By adding Exica to Invisalign iThera, 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 or terrestrial 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 Rajput Dipiti, 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 the 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? Well, let's talk about it a little bit. 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 smartphones' features, right? So most aligners that are being launched today just try to move teeth with plastic, right, 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, yeah, 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 23 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, you know, Ghanshu has 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 were 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 the 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 22%. 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 a 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 Align 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 kind of 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. 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.
Right? So let me just 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. But what's the platform? So it starts with iTero, our scanners. All the treatment planning expertise that we have are incredible manufacturing expertise and scale that we have. We have exocad for the ortho recertive 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?
How 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 plants. 35,000 iTeros installed. 35,000 iTeros installed, right?
And if you look at our consumer work, right, we have by far the most well known and trusted brand for orthodontists and patients globally, bar none. 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, dollars 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, right? 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 Insight at 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 IO SIM. The doctor is critical, as we have been reinforced in the past, to helping the 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, and then moves on to Viveira retainers. So the end to end journey that you see is what this visual platform creates.
Now that is if the patient only has orthodontic needs. If the patient actually finishes the 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 the scanner that the 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.
It's 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, Marcus 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 going 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 Elorica. 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? Invisalign 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.
2028 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 schedule 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 with teens, how do we win among orthos, right? Eleven million orthodontic cases, just three percent share.
When we talked about winning with orthos and among teens 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.
And 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 zero. But rather than me do so, I think this video does a much better job.
Let's roll the video.
In
get going to We're
do
a sense
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 planning tools creates an elevated experience for both you and your patients. Starting from the first iTero scan through using the Invisalign photo uploader all the way to your patient receiving their custom Invisalign aligners.
So your workflow can be easier than ever and your patient smiles can be more brilliant than ever.
Adapt. 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, okay? 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 Clinches Creek S. O. 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.
She's hard. Don't worry about it. She's hard. Invis is everything braces isn't. The more comfortable, fewer emergency appointments.
Invisalign. Envis is everything braces isn't. Eating the food you love, life uninterrupted. Invisalign.
I hope you enjoyed it. Right? See, with teens, 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 we actually, you know, 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 teens. Let's see what she says right here.
I'm outside in a Angie, right outside. TT, two turn, 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 it? 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 teens go to so that then they get the best possible treatment. That also allows us to close the loop on conversion. Okay? So we talked about each of the ortho strategies. Now let's talk about GPs.
Remember, winning with GPs is absolutely critical. Five hundred million patients, one point seven million 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. 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% again. 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 GO does 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, know, kind of limited movement, 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 assets. 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. Right? 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 the line. 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 aligned 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're 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 challenge in 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 5D in The U.
S. Overall, we see a lot of success and enthusiasm with our 5D 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 digital 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 your 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.
I have a new solution for you, presenting the iTero five d. 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 Neri 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 five d apart. So pretty amazing that we can diagnose this. And then as an orthodontic perspective, it's great because it allows me to keep working closely with the dentist because I take a lot of these scans in my practice, and 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 d. Number one, quality of the image is incredible. Interproximal carrier detection has to be up there. I mean, 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 Exvocat. So now we're going to talk about the four main growth drivers for iTero business, our EnvisaN customers, our iTero installed base, the mass market of non EnvisaN GPs, and our services business. When we look at our EnvisaN 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, we have a great opportunity to have them buy an iTero. And out of the ones that do submit with iTero, we 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 Invisalign customers and our iTero 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 the 5D or restorative workflow and our ecosystem with Exocad. And in order to accelerate the penetration into this segment, are going to 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 a care.
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're at home, office or on the go, whether they're using a computer or a phone, whether they're on
the web,
mobile app, emails 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 in this 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 at 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, we 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 are learning lots of good lessons, and we are 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 500,000 aligners per day 20. 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, Shri. 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 want 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. And 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 distributed 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 distributed 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 5,000,000 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 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 it 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 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 $05,000,000,000 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 just some 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 in defects in our aligners, which 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 of 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 the liner on it that's being photographed many times from 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 measurement, 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 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 a 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 that 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 wanted 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, your 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 Wise and Brackets buyback and switch programs were a core component of our campaign and helped doctors convert over 10,000 patients to Invisalign treatment.
Importantly, we continue to invest 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 teens. 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 Invizizz campaign continues to gain traction, and we're seeing really positive results from the work with popular social media influencers and 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 via 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 a 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 a 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 for the theme segment of the market. So we're in the process of finalizing our move to a 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 orthodontics 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 relationship to 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 2021 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 Altero 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 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 this month. 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 sixty percent 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 among 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 the 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 UK, Doctor. Duhmo from Belgium, Doctor.
Widdo and Doctor. Bittner 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've joined ADAPT in 02/2019.
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 they showed me that I had blind spots.
We had immediate improvements after implementing the ADAPT program. Even though we had the COVID-nineteen situation, we still have the COVID-nineteen situation. We managed to get an increase of our monthly monthly cases from sixteen to 20 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 work flow 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 help me to work on my workflow. They help me to find a TC. They help me with my team. They help me with my patient. They help 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 uptake has increased. So from an averaging of a 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 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 Scientific 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, Exocad 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 Sagir, 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. 2021 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 treat 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 the 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 sixty five percent 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 served us really, really well in Q3. In Q3, we also mark 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. Zhou, 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, chance of people pay more attention to oral health. There are huge market opportunity in China actually. According to statistics, the proportion of people with malocclusion 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 while I was studying abroad. As the leader in clear aligner industry, I'm very optimistic about Invisalign treatment.
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 intraoral 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 intraoral scanning data very conveniently and algorithm 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, Eterra is a good tool to promote 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 Lai. 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 use to train doctors. So thank you once again, Professor. Joe and Professor. Lai.
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've 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 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 KEVIT, 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, 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 have 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. Even consumers 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 market 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 can 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, Invisalign 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 is 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 a 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 dashboard 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 enabled 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 disconnected to our 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 are 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 noncomprehensive. 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 ASPs 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 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 from 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 our 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 continued 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 Emery 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 Sassy. 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. Hi, everyone. Welcome back. Thanks for joining us.
We are now going to welcome our doctor panel, and I'm going to introduce Simon Beard, Senior Vice President and Managing Director of the Americas region. Simon, take it away.
Thanks, Julie, and welcome back, everybody. I'm delighted to introduce to you today two stalwarts of Invisalign and the whole digital platform, Doctor. Regina Blevins from Minnesota, and Doctor. Sam Dyer from Vancouver in Canada. So both Regina and Sam spoke at our Ortho Summit this weekend.
They're also featured in the opening video you saw today, which is Digital is the Answer. What I'd like to do before we get into some questions is just hand it over to these guys to briefly introduce themselves rather than me doing it myself. So Regina, would you like to kick off first?
Sure. Well, I've been an orthodontist for almost thirty years now. I started out with a private practice and over the years have grown it into a partnership with another orthodontist. We have 13 locations and six doctors now. We've treated over 9,000 aligned cases to date.
It's been really amazing to see our practice grow even during this time that's very challenging with the pandemic. We've tried to bring forth the idea that if we're going to do it, we're going to try to be the absolute best at it. That's our practice motto and our goal. And aside from private practice, I teach at the University of Minnesota to their orthodontic residents. My main task there is to treat aligner or to teach aligner therapy to the residents.
And then I'm also a wife and a mother of four. So that's me, kind of round it out.
Fantastic, Regina. Thanks. And Sam.
Good day, everyone. I'm an early user. I'm an orthodontist by training, and I'm one of the early users of the Invisalign technique. I've been using this technology for about seventeen years. And in 02/2009, I turned my my practice, my downtown main practice in Vancouver into an Invisalign only practice, which means I treated every single malocclusion with Invisalign starting in 02/2009.
I grew my practices into six different locations across Canada in three different provinces. And just before Christmas, I sold five of them, and I only kept the one in Toronto because I'm actually embarking on a big project to start, an Invisalign based group of chains of orthodontic practices or, sort of fortuitous alignment. I've been I've enjoyed I've I've I've grew with Invisalign. My practice grew quite a bit, and I've I've I've learned a lot over the years. And at the end of the day, giving the patients what they wanted is what helped me succeed.
And when they come in asking for it by name, was was instrumental in my growth. So, I've treated personally a little over 7,000 patients myself. I'm an international speaker. I speak and and share my experience with my colleagues. And I'm also a father of three wonderful children, and my wife gets some credit for helping me raise those beautiful kids.
So I'm I'm I'm happy to answer any questions you have today.
Thanks, Sam. Well, welcome to you both. I really appreciate I know you're extremely busy people. So I wanted to start off with the first question really was, and this is, we'll kick off with you, Regina. When you think about orthodontic treatment, what's the most important to you and your practice?
Well, I think Sam would probably agree the utmost thing that we consider is the quality outcome and making sure that we have efficacy and that we do no harm. And second on the list is being efficient and making it comfortable for the patient. How can we do it and deliver on a quality outcome in the least amount of time in the most comfortable manner. And also on the list is in an affordable way. So those are kind of the touch points that I think Sam and I probably both agree that a consumer facing practice that's going to be successful has to be on top of.
Okay. Thanks, Eugene. Sam, have you got anything to add to that?
No. I agree. Good results. That's the first thing that comes to mind is good results and patient satisfaction. And once we check that box, usually, all of us, the index will be profitability probably.
And I think we're we're right on line with what Regina said.
Okay. So the great answers. So you've both talked about quality, efficiency, profitability, affordability. So, Sam, could I get your kind of overall thoughts? Obviously, you've been involved with the Invisalign system for a while.
Talk about the system and how it's impacted your practice.
Absolutely. When I saw when I was first introduced, and that was in the early two thousand to the Invisalign, to the to the ClinCheck software, it just clicked in. It was it's just something sort of clicked in there, and I absolutely loved it. And I saw it as the future. But you know what?
It also spiced up my day rather than putting brackets and wires in, all day. I started I adopted this technology. And over the years, as I my experience grew with with with the product and with the system and as Align actually grew and became and the Invisalign system became a lot more efficient, we started treating more and more cases to a point where, in 02/2009, when I turned my practice into an Invisalign only practice, was exciting. It was actually even more profitable than doing brackets and wires, but it also led to an indirect partnership with Align. So it was in my best interest to see Invisalign and Align succeed.
So I kept a close eye. So I I was internally, I was a critic because your success meant meant my success. So I focus a lot on the clinical results and if on the innovation, anything that comes up. And without it, you know, my life would have taken a different path quite frankly.
Okay. And Regina, know, you mentioned earlier you're in partnership where you manage 13 different locations, which is which is incredible. So with that in mind, your thoughts on the system and how it kind of impacts on your practice.
Well, the bottom line is we would never have been able to scale at this volume trying to corporate just brackets and wires. It would have been impossible. Quite frankly, the doctor labor involved with brackets and wires is, on average for us, double the chair time. So we can see a much higher volume of patients at a particular location, which allows our doctors to actually go to more than one location and still make enough money at a location to to be viable. So scalability and and additional locations without this product, yes, maybe you could have one office and a satellite, but 13?
Are you kidding me? Right? It it'd be very difficult. And just the ease in your workday. Seeing 60 plus 70 bracket wire patients in a day, you go home beat.
You don't have any energy to do anything else. But an Invisalign day where you see 50 patients, a lot of the time you spend checking in on them and how are they doing and things like that. A lot of the work is done upfront, frankly, in the digital treatment planning. And I've incorporated ClinCheck coordinators that I've trained to be my virtual lab assistant. So they help me on the front end with all the prep work of getting things ready.
I remember this weekend listening to your presentation on the ClinCheck side especially, and as Sam mentioned that, how you kind of evolved your team, right, to help you kind of scale, which is really a fantastic presentation. Sam, if I could come back to you, obviously you said you've been involved with Invisalign for, did you say seventeen years? That's a long So just tell us a little bit how the treatments evolved, the systems evolved really since you began using it in the noughties, yeah?
Yes. Well, when when Invisalign started and it was sort of plastic versus stainless steel or plastic versus wire,
it
was it was a it was a novelty, but it was already started off on the right foot, sort of looking at treatment planning and and, planning ahead. So you sort of foresee any problems. But but when it first started, when Invisalign first started in 02/2003, you know, 02/2002, 02/2003, it was for minor movement. But as it evolved, and and and my head off to a line for relying on input from doctors, not only its own research and development, but they got feedback from the doctors. And I know I am one of those doctors that gave feedback as to what can improve our sort of patient's life and and make the results even more efficient.
So as it grew, as more innovation came, I was involved in many of those innovations myself and see firsthand what that does. So it improved, and that allows us to to sort of widen the pool of patients that we can treat. But probably the biggest impact was on adults. It started on adults that never wanted to get braces. Now all of a sudden, they're willing to get their teeth straightened.
And then from there on, it grew back sort of in reverse engineering back into children and and mixed dentition. And so at every step of the way, every innovation widened that pool of patients and ultimately made my life easier because I don't have to select braces versus aligners. Now I can treat everybody with aligners. So that made my life easier, but it also grew my practice, and it made it a little bit more exciting as well.
So if you think of a I know, Sam, you've you've got a kind of a wider industry view. So when you look at other clear aligners Yeah. What what would you say, you know, if you were to compare and contrast?
And I've had a chance. I'm loyal to Invisalign as a system because it served me well in the past. But you know what? As a clinician, I owe it to my patients to just look around and see what's available. And I'll be lying to you if I didn't tell you.
I've I've I've tried a dozen cases from other let's call them competitors because I don't wanna mention any. So give me sort of an an insight into what else is available out there. And if anything, it it reassured me that my partnership with online is is on the right path. Other companies are are sort of late to join the game. They have they have their heart in the right place.
They're moving forward. But, you know, by the time you catch up to the to the quality of the plastic, the SmartForce feature, the smart technology, the software, the the digital platform as a whole, by this time they catch up, it's gonna be years and years. So it it is nice to know that we're we're on the right path. The other thing is other companies, way and that's from from me observing and myself. The best way to grow was to actually try to imitate what Allied has done in the past, and that's, I think, the biggest compliment.
But then again, I don't think they have the history, the resources, or the patient or the data mining that Align has. So it's nice to see we're certainly, rocketing ahead of, other companies. I know my my patients are getting the best results.
All right. Thanks, Sam. Thanks for your honesty.
I would just add to that too that I've gotten transfer patients with other aligner systems as well as done some different things through the university with different systems. The best analogy I can give you, it's like an Atari. Remember Atari? Yeah. First video games?
Versus a PS5.
So
far behind that it's I don't want to say it's a joke, but when I pulled up the software system that's like their version of ClinCheck
Yeah.
That's all I can say. It's just not even in the same ballpark.
Okay. Thanks, Regina. Just anything else, Regina? Obviously, you've been really close to our innovation over the last kind of five to ten years. What kind of stands out for you?
Well, orthodontists have always tried to move teeth with plastic retainers. I mean, we've done that if you look in the literature. But it was such a cumbersome process to make a plaster mold, or make a mold, make a plaster model and cut the tooth off and then either make these plastic with wire retainers or these vacuum formed retainers. And it was just so cumbersome. The whole act of automating these processes hedged.
It was revolutionary, really revolutionary. And I think we're seeing that now. But Align has taken that to a whole another level of sophistication, where at the summit, Doctor. Garfunkel I can't pronounce his last name, but he presented how you can get ABO board results with aligners now. And I think that going forward, that is the quality level that we're going to see with Invisalign.
So Regina, what would you say you can't treat with Invisalign?
What you can't?
Yeah.
Now I'm going qualify that. Am I allowed to use a bracket or wire or something as an auxiliary if I need a little help but not the main appliance?
I'll give you some auxiliaries. Yeah.
Then I can treat it all.
Okay.
And what I think in the future is brackets and wires are going to be the auxiliary to aligners, not kind of the other way around. To give you a more serious answer to that, I have not treated a split palate surgery case with aligners alone. But that is an incredibly small percentage of patients that we treat.
Okay. That makes sense. And Sam, what about you? If I was to ask you the same question.
Don't think we can do laser eye surgery with Invisalign, but other than that, you're asking the wrong person. I I've I've treated everything even even surgically assisted rapid palatal expansion, which Regina Regina was talking about. I actually showed a case at the AO, if I'm not mistaken, in 02/2016. Even that, I've treated with, with a line with Invisalign, impacted canines as well. So, honestly, I've treated it all just thinking a little bit outside the box.
I didn't use brackets, but I used buttons and elastics and other auxiliaries.
Yeah.
So I I I treated it all. But, again, I I'm you know, I I don't wanna be biased, but but I have and decided the simple truth. Yeah.
So look. Both of you are very future looking, you know, to get got involved in the technology and in many ways pioneer, you know, the approaches to it. So when you look at, you know, orthodontics, you know, orthodontic treatment, how do you see that evolving in the future? And then when you think about aligning our products, you know, what are we going to have to do to really meet your needs, but also the needs of patients in the future?
Well, one thing I think Align is farther ahead than what the orthodontists even know they need, the majority of them. When you say that's true, Sam, mean, they have a virtual appointment platform. If I hadn't been versed in that when COVID hit, my practice would have floundered. But we were already doing that. We didn't miss a beat with our aligner patients.
They have that. Just from a patient hygiene standpoint, hygiene and keeping the gum tissue and teeth healthy is by far easier with aligners than with brackets and wires. And I think when the orthodontist or the dentist start putting their toe in the deep end of the water and find out what they really can, align has just hit the tip of the iceberg with this. It's just going to go crazy. I kind of like being elite, Sam, don't you?
And people go, wow, you could do that with aligners. But that's going to change because I think eventually they're going
to Catch up. Speed. They're going to
catch up, right?
Yeah, they are.
They are. And the residents that we're teaching, guys like Sam and me, We're teaching residents that now. So they're walking out of school with the expectation that they can treat patients with aligners, not like when we went to school and it was like this completely laborious process that we had to do all by analog, you know, by hand.
Regina, let me add something. I I I taught I was an associate professor at the University of Pacific, and now I'm teaching at the University of Montreal because they need French speaking doctors. It's funny when when and I teach as well aligners and then and obviously Invisalign. It's funny. It's not that the residents, it's the other teachers that come around you and each job.
Some of them, you know, will actually come in and ask as many questions as the residents do. I find that interesting because some of these doctors were my teachers twenty, twenty five years ago. Right? So
it the same.
It's exactly the same. It's like you're the the the mama goose and all the little, you know, babies are following you around because they can't believe what you're doing.
But it is a it is a
good sign. That means their their their minds are opening up, and then these, you know, these are usually the the older guys, in their in their seventies finished their careers that wanna teach them. It's nice to see their interest, and they ask intelligent questions, which is nice to see.
So so we we talk now a lot about a digital platform. And really interested to get your thoughts on really the iTero. That's a big part of the whole enabling technology that we have there. So what role does iTero play for you in your practice, but also in the overall treatment kind of journey for a patient? Sam, do you want to kick off with that?
Yes. I so I'm I'm early on, when when I first opened up my office in in the early two thousand, I was paperless. And back then, was green and I was paperless. So when the this digital platform, what Align started this digital platform, and as it grew, it fit perfectly well with my philosophy. So from a to z, everything is digitized.
Even when when you wanna send an STL file to a lab for whatever reason, now it goes outside of the world of Invisalign and and align technology, which is amazing. It will allow us to interfere. But let me tell you, the iTero element, the near the near infrared imaging, I almost fell off the chair when I got introduced to it in in in March. Because now you're looking you're looking at the health of the teeth and the and and and the the tissue. You're looking at potential crack lines and insipient cavities and and decay early on without any radiation.
You know how revolutionary that is? That's above and beyond everything it does. So it's this platform is certainly something that has supported me, my vision, and my practice quite a bit from the iTero to the to the innovation and the ClinCheck in face visualization. But, you know, there's a couple of things that are overlooked, Simon, that I'd like to touch upon. The the the doctor, vocator, and the concierge service, for instance, and these are again, we they're they're taken for granted, but those have helped me grow my practice so much.
And it's a well kept secret that nobody talks about, but we shouldn't overlook it either. The direct to consumer that Align does, you notice that it's less marketing and more educational. And, again, now patients come in and ask me intelligent questions. So the platform from a to z just fit into my practice beautifully well. And, again, like Regina said, now when you have multiple practices, they're all duplicates of each other because you have a system in place, And it is based on this full and complete digital platform that not only is limited to the, Invisalign, but it sort of goes beyond that into the rest of dentistry, sharing knowledge with the general dentist, other specialists, even labs.
So it is interactive, and it's not inclusive. And I love that aspect about it, and I want to thank you all for that, actually.
Thanks, Sam. Now Regina, you've got a few IT reps. You've obviously invested heavily.
I think we have probably 30 to So do the math. There are multiple scanners at locations. Because it has such a wide breadth of use in the consultation room. It allows us to get a complete record accurately to the point now where I take minimal actual photos with the camera because the images are so striking and so clear and usable. So it's helped with that.
Sam touched on the Neri technology where before we might see a dark spot on a tooth and wonder if it was stain, wonder if it was decay. Is it safe to keep going? Should we check with the dentist? Now we know whether it's decay or not. And it opens that dialogue with the general dentist that's referring to us.
An educational tool for the family, I can explain to them what consequences of, say, a deep bite are and where the wear facets are on the teeth or where the teeth don't mesh together correctly and what kind of long term consequences that can have. And even showing them what their teeth are going to look like when we're finished. There's that whole wow factor. And then you move into the clinic. So I want one in the clinic where I can do progress assessments, and I can take scans for additional aligners.
And gee whiz, it's just a seamless workflow all the way to virtually removing attachments and getting a Vabera retainer, it's just from beginning to end. I use my iTero for all those steps.
That's great to hear. Look, just kind of building on that, this is a question for both of you. I don't think I could kind of let a session go by without asking you about the pandemic. I think it links a little bit to iTero, but Regina, from a pandemic perspective, what did you learn during the pandemic, and maybe how did it kind of
crystallize Well, the you know, one big thing, and, you know, Sam can probably nod his head on this, and he's probably even farther down the path than I am on this one. I found out that the patients want to connect with me, but they don't necessarily want to come into the office to see me. So one of the we had already started doing virtual assessments, but there was this little nagging part of me that was, are the patients are the parents are they Okay with it? Or do they feel like I'm pushing them off? And people would say, wow, this was cool.
But with the pandemic, the overwhelming pouring out of, I'm so glad you could do this for me this way. I feel like you're really taking my safety into account because we're able to connect while I'm at home and I'm safe. It just it really drove home the fact that patients appreciate this.
Yeah, there's a value attached, right, to the
Yeah, huge.
So how do you think that will affect you in the future as far as how you will shape this?
Well, it's already changed what we're doing because, you know, we opened up a little bit more here, and we were allowed to have patients come in the office. But after our initial delivery, the next appointment is a virtual appointment, and we're offering that as a that's our standard of care. And the patients are, yeah. Okay. You know, we need to see you in office for the third appointment because we have IPR to do.
Okay. I'll see you in twenty eight weeks. But we are checking in with them probably a couple of times between now and then.
That's a big change. What about you, Sam?
Well, it's funny because, Regina did a good job articulating this. The only thing I want to add is as doctors and then as clinicians, we knew that teledentistry or teleroorthodontics is the future. But what unfortunately, it's there's a silver lining to COVID. And the one thing I wanna add is it made our patients and their parents aware now, and they had a chance to test, that tele orthodontics, and now they believe it. So it it made our life easier.
This is something that we've already been open to as doctors, especially those of us that are sort of ahead and and watch Invisalign. So and treat with Invisalign. So those patients and their parents are open to it right now. And, maybe just you'll see the floodgates open. And I agree with Regina.
This is here to stay, and it's only gonna get better both for us and for our patients. It certainly is the future, no doubt in my mind.
Great. Thanks, Sam. So just a final question. You know, there's a lot of what I would describe as maybe cheaper alternatives now flooding the market. How do you look at that, and how do you kind of almost reconvince yourself that you're paying a little bit more is is worth it to yourself, but also to your business?
If well, the thing is, when I first bought my first practice, I I bought it from an older gentleman, and and he used to say, I don't know if it's politically correct or not, he says, you pay penis, you get monkey. So the thing is, what the the it's it's the value. People look at the price, and what we should look at is the value. And there's a huge difference between price and value. With the value of what we provide, what Alive provides us with is tremendous.
It's it's it's it's decades ahead. The the the overall, patient based experience and the, the diagnostic tools that we have as orthodontists are tremendous. So I'm not chasing the dollar. I believe, money follows success. I mean, I believe money follows good work and good quality, and I've always subscribed to that theory theory and haven't skipped a beat.
I don't wanna be bragging, but I have to tell you the month of July, August, September, and October have been the best four months in my practice. And in that one particular practice in Toronto is forty two years old. So this is just to give you an idea. In '42, those four months have been the absolute record breakers of my office. So I I ain't missing a beat.
Yeah. My father used to have a saying that if you can't afford to do it right the first time, you certainly can't afford to have to do it over. So I look at some of these cheaper alternatives as inviting having to do it over if I can't trust that technology to do it correctly the first time. And I believe in the long run, it would end up costing me more money. You have to figure in the appointments are very valuable overhead for a doctor.
And even one extra appointment affects your profitability in really tangible way. But yeah, I agree with Sam on that. This technology has allowed our practice to grow. And Sam, I don't know about you, but it's almost embarrassing when you're out even just conversing on Facebook forums and things with your other colleagues on how their practices are hurting and what's going on. Man, I just don't say anything because like you, we had record months right after the pandemic and really didn't miss much of a beat during the pandemic.
And you're you're almost wanna apologize for doing so well.
It's funny you say that, Regina. I'm here. I keep my mouth shut when when some of them say they're suffering all that stuff. And I'm thinking, literally, month after month, we broke every single record, and we have the numbers to prove it. So you sort of be quiet because you don't wanna rub it in their faces.
But you know what? The truth is the truth.
Yep. Hey, guys. I think I think you I think you both deserve our success because I think you know when you started this in the early days, took a lot of kind of criticism from colleagues, so I think sometimes it's sweet to see that you were right, that you had the right vision, and that you committed yourself to that. Look, I think we've reached the end of our time here. I'd just like to, first of all, thank you both.
Whilst you're both great clinicians and great customers, you're also very challenging to us at Align, which we really do appreciate. It makes us better as a company. So, you know, love the partnership, love the relationship, and as I say, thanks for taking the time to speak to the audience today.
Yeah. I just want to say one thing and ending as a thank you for everyone at the top. I've never in thirty years worked with a company where I had direct email and text message access to the people at the very top for any concerns, questions, or thoughts that I have. And I I thank you, like, from the bottom of my my heart for being so open to that.
And I know we're overtime. Thank you again. You guys have been an amazing partner, and you are part of my success. So thank you. Keep doing what you're doing because the innovation and the service have been impeccable.
And I tell you, if you ever miss a step, I'm gonna give you a piece of my mind. But so far, you've been doing well. Thank you all. And he will. I can tell you.
Already
does, Regina. So we signify
when I do it, Sam.
Thank you, guys. Ciao. Bye.
Thank you. I'll hand back to you early. Thank you.
Thanks. Thank you, Simon. Thank you, Doctor. Blevins and Doctor. Dahr.
That was fantastic. Now I'd like to invite the entire EMC to open their cameras, and we're going to turn it over to the Q and A session. We'll just give you one minute to get on camera. And we've got a fair amount of questions, and I want to try and get to as many as possible. So we will be fairly succinct.
And I'm going to kick it off with there's a fair amount of questions, I think, just around the investments and the comments that both Joe and John made about significant investments and you really kind of really driving the growth and continuing to support the business. So Joe and John, could you comment on that a little bit more, please?
Yes. Shelly, I'll kick it off. First of all, we made a comment because we continue to invest in this business to drive demand and to create the kind of digital platform and capability that was just described by I thought Regina and Sam did a great job. But we'll always be responsible. We know we'll halt our 25%, 30% operating profit piece that we've been reiterating over the years, and we keep that in our mind also.
But I'll let John give you some more specifics. Yes.
To add to that, and like you said, we're respectable of the of our model. We have to invest in advance with manufacturing. There's long lead times, R and D, marketing and sales, and it's a reflection of volume and demand that we see. So just like we've done in the past, we make those investments because we see good return on those investments. But it's not a difference in terms of our long term model.
Still that same model, just a reflection of the demand that we see.
Thanks. Next question. There is lots of questions around the brand investments. And how does this compare to prior years when you think about how much you're spending now versus prior years? Is it a significant difference?
Can you give any additional color?
Yes. I just start to answer that question by look, when we make investments, we look at returns. We just don't invest because we think it's good to have our name on TV. We look at the investment of those kind of communications to drive consumer demand versus technology versus other aspects of the business. Again, John and I are always together on that.
And John, any comments you have, I appreciate.
Yeah. And I think what you see us doing is finding different ways to be able to invest. So partnership with the NFL, investments that we make with influencers, media investments that we have online and so on. So not a change in terms of percent, in terms of how we're how much we're spending. It's just differences in terms of how we see those investments and ultimately comes back to getting those return on investments.
Yes. I think it'd be good
to hear from Raj, too, because Raj really has a good conceptual understanding of the strategy that we have right now and how we've been spreading that around the world. Raj, any comments you have would be appreciated.
Just one part to add to what you and John said, Joe. I think the important concept here is that of ROI. Right? You know, when we go above a certain threshold and we have really reach based and science based media plans, then we're able to achieve the ROI that we that we need to achieve to deliver business results. So, you know, kinda even as we kinda go ahead with media investments, country by country, we are looking at is there sufficiency on reach?
Is there sufficiency on media? And hence, can we actually prove ROI? Right? You know, John is pretty tough on that. Can we prove ROI before we can actually go invest, and that's how we can go ahead
and do it.
All
right. Next question. If you look at what The Street's modeling, looks like they're using a two year CAGR of off of 29 revenues of about 18%. So almost as if COVID had never happened. Do you think it's fair conceptually to think about 2021 revenues being at or nearly the same levels as if COVID had not happened in 2020?
I think that's a pretty intelligent question to have us predict what 2021 will be. And we're not we necessarily want to do that. But, John, I'll I'll let you handle that question.
Yes. What I would say and what we talk about internally a lot is investments that we're making to continue momentum that we have. So everything about COVID was an impact to that time. And then what you saw us do in the third quarter and what we're expecting is that we're going to continue that momentum, continue those investments that are driving that return. So everything we talk about internally is exit speed, the investments that we're making to be able to drive volume.
And that's how we're looking at things, just to really make sure that we come out of this in a very healthy way and drive as much demand as we can.
Couple of questions on Asia Pacific. One, can you talk about the tremendous turnaround in Japan that drove that MPS performance? And then question on China. Can you talk about having gone through the COVID exposure first there and obviously through the recovery efforts, what are the kind of the key learnings? And are we on a trajectory in China where things are starting to normalize?
Julie is on. She can handle those questions. Julie, take.
Hi. So with Japan, the NPS turnaround, I think there's a combination of factors. One is, I mentioned a couple of years ago, we have a segmented sales team. So we're very targeted. We're able to offer specific programs for each of those segments, whether you're auto or GP.
When we launched iTero, we're able to really help doctors to bring the digital workflow into their clinics. And that made a huge difference. The third piece is when we launched Treat, now we're able to speak a language at the same time in the same time zone. And I think the Japanese doctors really appreciate that. So I think a combination of all these factors, not necessarily these three that I mentioned, there are other factors as well, but this would be the top three factors that made the turnaround for Japan's NPS.
Thanks, Joon.
And then with respect to China, having gone through COVID, any learnings, any feedback there from a competitive perspective and market dynamics?
Shirley, Yes, I know COVID, it's kind of an episode that we went through. But if we look at China, I think the basic fundamentals of what we need to do remains. One is the case complexity is complex. And Invisalign has all the innovations to be able to help the doctors. We've COVID and when we launched iTero, we really were able to help the doctors to digitalize their practice more.
And you heard Professor and Lai talking about that. I think the other point is we continue to put feet on the street in China and really to support the organization and the business there. So we're very well positioned in that sense to go after those opportunities.
Julie.
Regarding exocad and enabling digital dentistry, especially with a focus on GPs and DSOs, is there a strategic shift in all moving away from your core competency in clear aligners and orthodontics to dental therapies? Or are you planning to stay purely a digital tool based company focused on clear aligners?
That's a good question. You remember, Exocad, and Jumbo can articulate this better than me. But obviously, Exocad with iTero and Invisalign, we just work on that incredibly important workflow between what you have as labs and what you have with GPs and really all around the world. And you can see from Zelko's presentation today just how intricate that is and how important Exocad is to us. We are a digital company.
We're focused on aligners. And that's what exocad was about. That's what Itero is about, and that's our portfolio. And we feel comfortable with it, and we'll continue to invest in driving that. But Jelco, anything you'd add to that?
Or your thoughts?
I would just add that this is really about interdisciplinary. So it's not shifting away or two, it's really bringing all disciplines together. And as we said, three out of four people, seventy five percent need ortho with benefit. So every patient should get the best outcome that they get, and it's going to be a combination. So our platform is to bring all the disciplines so that doctors can work together, and we believe that ortho will be a big part
of the majority of that. Thanks, Gianco. The last thing I'll just mention in the whole series of questions is, remember, this market, we're so underpenetrated in this marketplace. And that's how we started, obviously, our investors' discussion and how we ended it, too, and then plus our digital platform and the complexity of it. And we just have so much room to grow in what we do.
So the idea of becoming a diversified dental company, the way I think your question is framed, it's just something that's not in our mind and something we feel we don't need. We feel we have a huge runway here for growth, and we'll continue to focus on that.
Yes. What are your views on three d printing? And how far away are we from office technology capable of producing it for doctors' offices?
I have to be careful because I could talk about that one all day. But, you know, right now, there are, you know, some docs that do, you know, three d print molds. You know, no one's three d printing a liner, but three d prints molding and vacuum forms in their office. But I often have to say like, Why in the world would you ever want to do that? I mean, Emery is on the line, and he can tell you exactly how hard this is to do.
And every business has resource constraints. And when you're in a business, think of orthodontics. These are 60%, 65% gross margin businesses. Backward integration and putting real estate and time and people and money into printing aligners and often substandard at times versus out in the marketplace, advertising and pulling in patients with that kind of gross margin. It's just no comparison.
So I know people get excited about three d printing and offices and things like that. I just don't think it makes sense. And it sounds kind of self serving. I mean, we certainly can ship STL files to doctors and have them work through that or whatever. But I just think I think it's just a holdover from being in more control with wires and brackets and not really embracing the partnerships that a digital era really presents.
Simon, I
know you face this in
The United States more than Marcus does and Julie does. Any thoughts on that and what you're seeing out there?
Well, I'd agree with Jarvis. I'd agree with what you said. I think the one area where we do see an opportunity around the STL side is with same day starts. Think sometimes for a doctor, the patient's in the office and they can put them into some kind of appliance, it prevents them from disappearing into the Orthodontic Desert. So I think that's one area, but I completely agree with you.
I think it's down to us to really partner with doctors to see that they don't really need to put in this massive infrastructure to support printing of their own aligners. As far as the long term, I
think I'll leave it to the experts to say how long that's going
to take before maybe that happens.
Thanks. Shifting gears a little bit, how should we be thinking about the iTero business and growth going forward? Can placements grow at similar rates of clear aligners? Or should we be thinking about overall scanner plus CADCAM growing similar to clear aligners?
Well, I think we've said that we frame this between 2030% revenue growth within the business in both iTero and Invisalign and Exocad included in that. And so I think long term, you can continue to model iTero and Exocad within the framework. Yuval, any thoughts on that?
No. I think we are excited about the growth we see moving forward. I talked about the key drivers. And yes, we should see it in the 20% to 30%.
And John, you John, anything from your end?
Yes. Think noted it. I mean, look, both on the scanner side and with exocad as well and on the Invisalign side, they're both underpenetrated markets. Huge opportunities to continue to digitize. And really, they go hand in hand together as part of our digital ecosystem.
So when we think about the growth in both on the scanner and services side as well as on the Invisalign side, we look to them to be within our long term growth model. And that's how we're investing.
So a few follow-up questions on the comments around strong momentum continuing into November. Most of the questions are looking for characterization between October and November. And if there's any additional color by region, by product, particularly as COVID cases have increased week after week, how do you think about the momentum you're seeing relative to COVID cases increasing?
Well, I'll just start off by saying we're seeing what's great about this is we're seeing consistent momentum around the globe. We can't just specifically point out one region. But John, do you you're more optimistic?
That's exactly it. We see consistent growth on a global basis, similar to what we saw in Q3. We see it with GP and orthos, and we see it across tiers. So a lot of that growth that we saw, the broad growth that we saw in Q3 has continued, and that's the momentum that we spoke about. And that's why we're making the investments that we continue to make to reflect that demand that we're seeing.
So on the DSO side, the market's created significant growth opportunity, but it's also attracted a fair amount of competition. How do you continue to make Invisalign preferred partner in that channel? And for a DSO customer like Heartland, who's almost nearly all Invisalign, how does their utilization compare to average?
It's a tough question, utilization versus average. I'll let Simon really address that. But from a DSO standpoint, remember, they have to educate and have a number of doctors, hundreds of thousands of doctors, to really understand how to do clear aligner treatment, and it's not something they were taught in dental school. And so having a digital platform like we have, a product like iGo and product like the Galler templates and things that we use, it just helps to fit this in a GP workflow in a way that's very difficult from a competitive standpoint. So I know there's a lot of questions in the sense of the challenges and tough stuff that are out there, but I think Sam and Regina's comments that you just heard apply just as well from a GP standpoint.
But Simon, you work with those relationships every day. What do you think?
I think if you look at it kind of comparing utilization, I think the profile is probably well, it's not probably it is. It's very similar to what we see across the rest of the GP business, which is exciting in a way because there's still room to grow within those DSOs and also increase the number of doctors who are actually submitting cases. So, you know, people like Aspen and Harland's and Smile Doctors, they're work in progress for us, key partners, and, you know, we continue to support them. But I think one thing I'd pick up on, Shirley, about all the noise that's going on in DSOs, I think I made it pretty clear in my presentation this morning, which is there are very different types of DSOs out there. And as a company, we're really focused on working with organizations who see the value of a digital platform, and they see the value and consistency that it brings to what they can deliver from a consumer experience and patient experience side.
So where we're at at the moment is, you know, we focus our resources around those DSOs. We see that value and the partnership really works out great when we can work together and really drive value for them as organizations. Thanks, Sam. Thanks.
A couple of questions for Emory. Emory, your operation model is changing with respect to treatment planning. It sounds like you're adding tremendous amount of AI and ability to faster treatment plan, how will that change your operations, especially from a centralized perspective in Costa Rica and elsewhere? And then the second follow-up on operations is, as you continue to decentralize your planning and fabrication facilities, will that make the company more or less efficient from a gross margin perspective?
So on the first on the treatment planning side, our strategy is actually to is to no longer centralize on purpose, and that's to get our resources closer to the customer. We'll have three hubs that will support the regions, and then we'll have smaller satellite offices in our major markets. It's kind of what I mentioned in the presentation this morning. The AI that goes into this and a lot of the automation we have will essentially allow us to to continue to support more customers and more volume from those customers without having to add a bunch of additional headcount. We're already seeing some efficiencies out of that today.
And so that will help not only in general, but it will help in our expansion. Our people will start to become less involved with doing, you know, the busy work of putting a treatment plan together and more time supporting doctors and helping to solve clinical problems. That will be the transition that our employees will make over time. On the aligner fab side, we're getting to a point now in the regions where the volume is sufficient that freight becomes one of the largest one of our largest cost drivers. And so as we put factories closer to those in those regions, for instance, in EMEA, we can reduce a substantial amount of freight costs.
We'll pick up a little bit of labor costs. But when you net that out, it's actually positive for us. So over the long haul, we see these moves as being will add efficiency.
Thanks, Sam.
Thanks, Sam. Joe, you've talked about the sales process being a high touch model, and that's driven ongoing investments in the business and, to some extent, help keep out competitors. How do you how should The Street think about sales and marketing investments longer term? Is this always going to be a high touch model? Or are there certain penetration rates where the move is to a medium, low touch?
I think we're always this is a high touch model. I mean when you think about programs like Adapt to Align Digital and Practice Transformation and those things, they're not just salespeople. They're actually experts on business workflows and different things. So again, I'll just take us take us back to our penetration rates. Remember, we're less than 10% penetrated in the orthodontic community.
As we work with orthodontists that aren't familiar with our kind of process, there's a lot of friction in that. And we need to spend money with salespeople and training and advisers and those kind of things to work through this. So I think that that question is why I can't say forever that we're going to do that. But right now, since we're so underpenetrated and the friction still exists in the marketplace, we still have to spend at a certain level, to make sure that we have adequate sales support, we have adequate kinds of teaming capabilities with doctors on both sides, GPs and orthos, to make this work. But again, I'd just reemphasize, we're concentrating that 25% to 30% operating profit side in our gross margins to make sure that we have the kind of gross margin that can deliver that over time.
Joe, and on the restorative side, Perjelco's comments, it seems like there will be an increasing focus on restorative in coming years. How does Align monetize that? Is it from increased clear aligner utilization, increased exocad users, or another source?
I think it's another way of asking if we're going to expand our portfolio. And again, how we monetize that? We monetize that through iTero, iTero sales, exocad sales and more sales of Invisalign. That's the way we look at it. That's the way we model those investments.
And remember, we keep that in mind, but we're not looking for a broad dental platform that we think we're going to need to compete in that marketplace. We feel you compete on that in technology, compete on that in workflow, compete on that in the entire digital platform that we talked about.
Joe, this entire weekend and your presentations are all about digital. And clearly, we've seen the benefit of that in your business more recently. But what gives you confidence that this move to digital will persist once the vaccine's distributed and COVID's gone?
Well, I think the the movement to digital has persisted. It's just at a different plane right now than what we had before. But, you know, if you I know we had a lot to do in orthodontic conference that we just put together at the summit. But if you could see that digital always wins. We talk about disruptive technologies and different things.
Digital is our air. It's what works. And the idea that wires and brackets are going to hang around for a long time, I think, somewhat naive given what we see in other industries and the incredible advantages that you have for clear aligners in a digital kind of a format. So what gives us the confidence? Confidence within our progress and momentum so far, Analogies to other kinds of digital processes have been disruptive out there and the uptake that we're seeing from doctors on both the general dentistry side and also the orthodontic side.
Two questions for Simon. Simon, can you talk a little bit more about the opportunity? You talked about Brazil being the second largest or third largest opportunity. Can you talk about the size and growth of the Brazil market? And then is there anything from a key takeaway perspective from the Ortho Summit that you just wrapped up this weekend?
Let's start with Brazil. So yes, look, I think we're all incredibly excited about Brazil. I think you have to take a step back and think about the culture and the focus of the people there. People, if you've ever visited Brazil, they look after themselves, and they want
to look the best they absolutely want
to be. So you add to that the size of the population, and we've got over 32,000 orthodontists in Brazil. It's a market, and when we talk about being less than 10% penetrated, we're less than 1% penetrated there. So it is an absolutely stunning opportunity. The other great thing as well is we've a fantastic team down there, really intelligent, passionate, and they've built incredible relationship.
Our NPS in Brazil is 60 plus. So they're doing a great job down there. So very excited about Brazil. When you talk about the Ortho Summit, look, suppose I'm looking at it from an aligned perspective. It was the first time we did something on this scale.
We're all, I think, very disappointed that we couldn't do that event face to face. It's kind of the high point for us as a business every couple of years. We build up to that. But I think what I've heard, well, I've heard great reviews from our customers, which I think is more important, but I just think the timing of it was just perfect because we had a number of customers who've learned so much as well as as an organization over the last few months. And I think the theme of digital is the answer.
I think people have really started to see that it is the answer. And there are so many benefits to their business, to their patients. But the one thing we probably don't talk about is the benefit to the doctor. And you heard it a few times from doctors talking about their quality of life, how they get to spend more time with their families, they're more flexible. And I just think that's a great thing as a company.
Not only can we bring them excitement from the technology point of view, but we can help them with their kind of quality of life and how they choose to live their life, which is fantastic. So really strong message, we're looking forward to following up with the content.
Thanks, Simon. Can you talk about how you measure the ROI on influencer marketing? That is, what kind of impact has TikTok campaign had on teen starts in Q3?
I'll let Jon and Raj
I can start with that, and then Raj can add. So when we look at our returns on investments like this, ultimately, it comes down it's going to come down to volume. But it's a matter of how it gets to that volume. So you look at some of the investments, are we getting the reach that we expect, the frequency? Are people coming to our website?
Are we getting people that come to the concierge team and ask questions about things? So do you get that awareness? Do get that top of that funnel and then ultimately driving it to volume? And is that an effective way for us to be able to grow our business, create this awareness? As you know, we've invested and continued to invest even during the crisis because we knew people would be on their phones, on their computer, at home, looking for things to be able to consume from a media standpoint.
So we were very targeted in terms of how we wanted to invest and but ultimately, it comes down to the volume that we see. Raj, I'll turn it turn it to you.
Thanks, John. I'd say in quarter three, know, teen starts grew, teen cases grew by 2625.6%, and you saw that. There are two or three different ways in which we look at, you know, what's the impact of marketing, especially influencer marketing. Right? So at a very simple level, if you take an influencer like Charli D'Amelio, right, who's got about 95,000,000 followers on TikTok, 35,000,000 followers on Insta.
So when she posts a video that's actually liked, you know, you you kinda get to a 100,000,000 impressions very, very quickly. So in terms of total impressions that our campaign was able to kinda hit in quarter three, we hit about 3,300,000,000 impressions. Right? You start there and then say, okay. Out of all the people who saw our marketing, how many went to our website?
Out of the folks who went to our website, how many actually, you know, searched for a doctor, and how many set up an appointment with the concierge? Right? So the concierge leads data that you saw in quarter three. It more than doubled versus a year ago, and that was an indication of the level of interest that that teams had, right, from the campaign.
The second thing I tell you, the second way
we measure it is we have a multivariate model that we use. It's a regression model. We put all the inputs in, and we look at, okay, you know, how much of each of these inputs is driving sales. And based on that, we figure out what the ROI is. It's kind of an industry standard.
So if you go back to packaged goods industry, you know, which has got much larger marketing budgets, the industry standard is really, you know, kinda like market mix modeling. So that's one tool that we have in our mix as well. And the last thing I tell you that we also know is the feedback that we get from our social and community channels. Right? So if you look at community management and the comments that teams and adults are leaving for us, They've been incredibly positive, you know, in terms of what we've heard back from them, specifically the idea.
It's not your parents' braces. Teens seem to love that, and I have to say even moms and especially our authors love it.
Yeah. Thanks, Joce.
We're going to probably need to start to wrap up, but I want to try and get to just maybe a couple more questions. For iTero, what is scanner adoption right now? And where are you in terms of global market penetration?
Yuval?
Yes. As I mentioned in my presentation, overall, when you look at the Invisalign customers, we still see that more than 50% do not submit with iTero. We also have a lot of opportunity with the second scanner. So I think we still have a lot of opportunity in front of us. Obviously, we see markets like in North America that is we have higher penetration in the ortho and then we have an opportunity for a second scanner with them and still have opportunity with GPs and other markets that we started.
So we have a deeper opportunity there.
Thanks. And looks like we've got a couple more follow ups. I'm going to try and just net it out with this question. Multiple questions on, is November consistent with Q3? Or has the October momentum continued into November?
John has said both, but I think each statement denotes a different growth rate, especially when October was had the momentum. So can you clarify that, John?
Yes. I'll go to the our momentum continues into November. So we saw momentum coming out of the third quarter into October. We talked about that at earnings. And then the latest statements are, that momentum continuing into November.
Great. Thanks. I think with that, I'm going to turn it back to Joe for his closing comments.
Look, I'd like to thank you for your interest. I see you have one hundred and fifty six fifty seven participants, which is terrific. I just I guess I'll close with how I opened when we did the video is that two biggest thing in this business is to consider is, one, is the incredible demand profile in front of us in the sense of the 500,000,000 patients that
we talk about that are
out there that can be reached mostly through general dentistry and then our just incredible low penetration in the overall orthodontics segment, given our technology and capability, and we know what we can do. And obviously, Sam and Gina really helped to reinforce that well. Then secondly is the digital platform, the operations piece, all the things that we've been working at for almost a quarter of a century, really hard to mimic. And we continue to spend a lot of rights to improve this because we get excited about the returns we see on those investments and what we can really help with our customer base out there. So look, thanks for your interest.
Really appreciate your participation. We look forward to engaging with you when we report the fourth quarter. Thank you.