Align Technology, Inc. (ALGN) Earnings Call Transcript & Summary

Good morning, everyone. My name is Brandon Vazquez. I am a research analyst here at William Blair, and I cover Align Technology, who we are very fortunate and excited to have with us today. We have John Morici, CFO; and Simon Beard, EVP and Managing Director of Americas and EMEA. And without further ado, I will hand it over to them, and they'll give us a little an overview of the company.

Great. Good morning, everybody. So walk through a few pages here. stop any time if you have questions or anything else, and we'll save some time at the end for a few questions, too. But I just wanted to walk through a few pages that we had just on the company. If we can get this to move, here we go. Look, we're a large medical device company. We make clear aligners to be able to move teeth. It's a digital orthodontic company, but we are the company that provides the aligners to doctors who then actually provide the care for patients. We've been around for 25 years over 26 years this year, and our model and what we believe in is transforming Smiles changing lives through the digital orthodontics that I'll get into more details here. So when you look at really where we've been going back to 1997, the technology was to be able to make clear aligners through the CAD/CAM type manufacturing to be able to move teeth once you set up a digital plan to be able to move teeth with clear aligners. A lot of technology that's gone into this, a lot of innovations, and I'll talk a little bit about as we go through. But it's really around the software that we've developed to be able to move teeth in a predictable and reliable way, a lot of innovations that we've gone through to be able to get it to this point. And then also the technology around the scanner. We bought a scanner company back in 2011, and that allows us to capture that digital image of the teeth and the dentition, be able to transform it in a way that we can then be able to understand kind of where your teeth are at, doctors work with our technicians to be able to find the final position. And through our software and a lot of technology that's gone in, being able to move those teeth to that final position and be able to move teeth in a predictable way to that. But a lot of technology that's gone into it, so our revenue growth over that time through last year growing at 23% a year. So when you think about the system that I was referring to, you've got the aligners. The liner actually takes the movements that we've now programmed in to be able to move teeth that aligner gets switched out every week to 2 weeks. New aligner comes in, moves teeth in that certain way to be able to get to that final position that, that orthodontist wants those teeth to be in. Like I said, the scanner that we have, what we've acquired in 2011, and it's really become an integral part of our digital process. That front end of the business is the scanner that we have, the iTero and that scan is really important to be able to take a digital impression essentially of where your teeth are at, we've loaded a lot of software on to be able to really give that doctor right their chair side, a lot of visual information to be able to give that doctor an understanding of what it's going to take to be able to move teeth a lot of visualization so that doctor will then be able to see right there chairside cures where your teeth are. Here's how they've changed over time to time lapse as they've had scans. We would be able to provide the doctor a digital view as to where the teeth will be with the work that they expect for the digital orthodontics and also give them a restorative view. Exocad is a company we acquired 3 years ago. They're very, very useful to be able to provide restorative information. So when we think about that scan that's done with that patient to be able to say, here's what that -- and we'll be able to show them with their teeth, with their smile, the digital picture of what they have to be able to understand what they're restored to, what their digital outcome would be for orthodontics and then what their outcome would be with restorative as well. So you'd be able to see both. So this integration is very, very useful for us to be able to provide whether it's orthodontists or general dentists a complete view as to what digital orthodontics will look like for that patient and what it would look like with restorative as well. And then just a few stats of just kind of looking at the last 12 months and $3.7 billion, being able to help doctors treat over 15 million patients. We've got about 24,000 employees worldwide, manufacturing in 3 different locations and a lot of trained doctors that we have to be able to utilize the system that I was talking about. So when you look at the growth opportunities that we have, we really looked at -- and really pushed for 4 pillars of growth opportunities that we have. One is international expansion, continued to expand out into regions where we can find opportunities. Our strategy has been that, I think early on, we had some distributors and companies that we had worked with. We've really taken the approach that we want to go direct. And our expansion really has that focus. So all the sales and marketing and all the go-to-market activities, we have our own sales force worldwide to be able to really take the technology that we bring to market in how to move teeth predictably and reliably and be able to explain these products through our direct sales force, and that's worked out well for us to be able to grow internationally. When you think of what we have to create in those markets, some of it is just around that patient demand and trying to drive that conversion. So remember, when we were early on, nobody knew about what Invisalign was. We had to explain what we were trying to do that providing digital orthodontics, be able to move teeth with this plastic appliance and many people didn't know. No one knew what this was. So we wanted to be able to advertise to potential patients, let them understand what we were doing and be able to come in and talk to the orthodontists or the general dentists directly and say, what about this product, can this will be something that we can have? And through that investments in our brand, by far, the #1 brand in digital orthodontics and people come in asking for our product by name. They have an understanding of what this is. And so a lot of investments that we've made around, you see it on TV or maybe we have social influencers or others that talk about our products, but it's really making sure people understand what our products can do and then going in and talking to their dentists or orthodontists about the potential of using Invisalign. But that's been a key part of our go-to-market strategy, and we've been able to build that brand up. And we look at the 2 parts that we want to grow within kind of our doctor base, one is orthodontic utilization. So we have orthodontists that are utilizing our products. I'll get into kind of the size of the market or so, but it's really about getting doctors to be trained so that they understand our products and the usefulness of it. And they -- we want them to not only get trained, but then also start working cases and being able to start with maybe more straightforward, easier cases and then work their way up to be able to do more complicated cases. And when we think about when we first started, as we started putting technology into the product, our capability of the product was maybe more minor movement, if you had a minor crowding or adjustment that you needed, our product would be able to provide that giving those doctors the ability to provide that. But as we invested more and more technology, our capability for the product really increased. And so now we're at a point where our ability or the doctor's ability to use our products, they can treat 90-plus percent of the cases that they see. Some doctors treat 100% of the cases that they see. And these are cases that go down to and I'll get into it a little bit in the presentation, but it goes down to 5 or 6 year olds who if you think about small children who have permanent teeth coming in or they lose the baby teeth and they need to be able to create space, a doctor needs to be able to create space. We have products that can really address some of the needs that 6- or 7-year-old would have and be able to provide that space with mixed dentition to be able to allow for some space for those permanent teeth to come in. And then obviously, as they go through their teenage years, they need to have their teeth straightened, they need to have their jaw adjusted, perhaps if it's not aligned properly, we have products to be able to help provide that. And then, of course, the overall adult cases that we have. When we think about the mix that we have, about 75% of our cases are adult and 25% are teen, and I'll talk a little bit more about that in the future. But the market in the orthodontic space is 75% is teen and 25% is adult. So there's a bit of a mix there. We were able to get more adults early as we started our product and so on. And now where we see the growth opportunity and it continues because it's the biggest part of the market is in teenage side. And then lastly, in terms of some of the priorities that we have, it's really around that general dentist. They about that general dentist is you and I go in to that dentist every a couple of times a year. And being able to provide that dentist with -- if they have a scanner, they can take a digital view of your teeth. They can be able to show you as part of their normal workflow that dentist comes in and checks on things and so on, he can show you over time how your teeth have changed with some of the technology that we have. That dentist now, right chairside, will be able to show you what your teeth would look like in your base with your teeth and so on, what your teeth would look like with orthodontic, digital orthodontic care. And that doctor will also be able to show you not only the orthodontic piece through exocad and some of the technology that we're integrating together, be able to show you with your smile, with your -- the view of your teeth, what it would look like with the restorative piece as well. So you'd be able to really get a comprehensive view. And then we think that drives a lot of opportunities. When we think about that market, that's 500 million potential patients that we think are out there where they have the means to afford some type of dental care, and they have the availability to do that. And we really want to get at those patients that are in those GP chairs on a daily basis. So when we look at the opportunity that we have, as I mentioned, you look at being able to provide care for kids as early as 5 or 6 years old. And again, this is some of the crowding that we have, a product that we have is called Invisalign First. It really gives arch expansion for kids and having this mix dentition. So the normal way that things are created from a space standpoint when there's a crowding like they have, there's a metal device that many orthodontists will use it kind of fits to the top of a child's mouth and that every night for some of your parents who have to go through this, you just adjust that every night, and it just slowly expands the upper palate for a child. We have a product that's coming out, where instead of that metal device, it will be a product -- it's -- we call it a Rapid Palate Expander, which will actually be a 3D printed, direct 3D printed product, which will be our first direct 3D printed product that will be able to be snap to the top of a child's mouth every day. And it slowly expands out. The parent just have to pop that out and put another one in slowly expands out and it creates space. And it allows space to come in so that the permanent teeth have a way to come in and they keep come in straighter. It essentially replaces this metal device that goes on top, much better for the child, much better for the patients and the parents to be able to provide this care. But these are products that we have that really gets down to the kind of the primary time, you've got mixed dentition, where we have products and then, of course, kind of the permanent dentition that is the traditional products that we have to be able to help treat teens. But this is really the frontier that we have to bear to provide more of a holistic view of children who need care all the way until they become almost adult in this teen space that we call. But it's a very vast and growing market. It's a market where we've had to invest a lot in new technology to be able to get us to this point. When I looked at -- and I talked about the 21 million orthodontic starts, this is worldwide, like I said, about 2/3 of them or so are teens and then 7 million adults. These are the patients that fall into the orthodontic care. So there mostly -- these are not the ones that are maybe going to your general dentists and so on. These are the ones that are traditionally we would call orthodontic case starts. When we look at these starts and broke in about 14 to 7, the vast majority of these, we've been around over 25 years and our competition has been and it still is wires and brackets. The vast majority of these cases, 80% of these cases, up to 21 million are done with wires and brackets. Even though our technology that we have, we can move teeth faster, less office visits, better care in the end. It's ultimately up to an orthodontist or a general dentist to be able to make a decision as to what care they're going to provide. So the vast majority of these cases say 17 million of these orthodontic cases are done with wires and brackets. And that's what we're trying to fight against with advertising, all other go-to-market strategies that we have to be able to help drive that conversion because ultimately, it's a doctor making the decision as to the care that they provide. Talked about the over 15 million patients treated and of that 4 million teens, this is since our inception, and that continues to grow. Looked at -- like I said, when we look at our technology as part of that 21 million ortho starts, about 10% or so of those starts are what we would use for Invisalign. There are some others that are other clear aligner companies in that space, but really the vast majority of what we have is wires and brackets as a standard of care right now. I spoke about the market opportunity from general dentist. This is the 500 million-plus potential patients. These are the patients that it's you and I that are in those general dentists, you're getting a cleaning, you're getting a filling or some other restorative work, they're in the chair. They need to be able to -- in our opinion, be able to talk to -- from a doctor to say, here's what care would provide. You're grinding your teeth, you're chipping your teeth, something's happened. and orthodontic care will help your -- help your teeth, will help your smile, help you keep healthy teeth. And we think combining the ortho piece of it, the digital orthodontic piece as well as restorative and being able to provide that view to that, it really gives the patient an informed view as to what they want to do and it's an easy way -- easier way for a doctor to be able to sell what type of treatment that they want to be able to provide. So we think a lot of the technology that we're bringing is really going to help drive the conversion while those potential patients are in the chair seeing their hygienist or dentist. We look at scanners that we have, we have -- there's 2 million overall doctors across the world between general dentists, orthodontists, other types of specialty in this orthodontic space, orthodontic dental space, 2 million doctors. And we looked at scanners that are available to be in a market. When we think about Invisalign being very underpenetrated in this vast market. It's the same way on the scanner side. Most doctors treat patients, most dentists or orthodontists, but stick to the dentists, they don't have a digital scanner. They don't digitize their practice, they will do physical impressions. You'll get an impression and then they may mock something up to show you what your teeth could look like kind of not your face, but just kind of an overall to show you with the model and so on, but it's all done kind of on an analog way, and we're trying to change that. We're trying to help them digitize their practice, get a scanner to their practice, help them really be the front end of the digital ecosystem that we're trying to create and ultimately, then if they have a scanner at the practice, it helps us from our overall Invisalign standpoint. A lot of innovations that we have, like the appliance itself, there's several million lines of code that go into those aligners. It's a digital process to be able to work with the doctor to find the final position of where he or she wants your teeth to be in the end, and we go through the process with the technology that we have to be able to have those aligners slowly move the teeth week after week until they get to that final position. But a lot of technology that's gone in looks simple from a plastic standpoint, millions of lines of code to be able to actually produce that product. Technology that's gone in around, being able to move teeth in a predictable way can control in it, so that you're moving roots. You're not tipping teeth. You're not doing things, something that's going to harm the patient. We have SmartTrack material specific type of plastic that's multilayer to be able to provide the right forces to be able to move teeth in a predictable and reliable way. And a lot of technology that's gone into how to stage, how to -- sometimes you have to rotate it to or do things where you have to make attachments on to torque things the right way, but a lot of technology that's gone in over this 25-plus years to be able to make provide predictable, reliable results for our doctors. So a lot of work that we said around being able to drive adoption, some of the technology from a scanner standpoint, making it very easy and user-friendly for our doctors to be able to use, integrated in some of the different software that we have, but being able to provide products to doctors no matter what stage they're at. It could be an experienced doctor who's doing almost all their cases with Invisalign. We have the technology for that. We've got the technology for maybe a new general dentist who doesn't have a lot of experience moving teeth, we can be able to help provide that as well. And ultimately, we want to be able to just work with the doctor to provide care for their patients, no matter what -- where they're at within. The other piece to this is after teeth are moved and you want to be able to retain all of us have teeth, they're moving every day. And we have what we call Vivera Retainers that actually hold teeth so that it moves. Once your teeth are moved, we can hold them and you wear your retainers at night and they'll stay where they're at. Various types of scanners that I've talked about, but that's, like I said, the front end of the digital ecosystem. It's really -- it's about 15% or so of our business. growing just like the rest of the Invisalign side. But again, it's an underpenetrated market in terms of many doctors don't have a scanner. They don't haven't digitized. This helps us get in and start that digital evolution. Talked a little bit about the GP adoption. We just want to make it our products, our system that we create, we want it to be part of the overall digital ecosystem that is great for a general dentist starting with scanner and being able to provide tools as we go through. When we think about the platform that we've created, it really is a digital platform where we're connecting to potential patients. That's the advertising I spoke about, being able to take the scan, that's the iTero that we spoke about, being able to plan the treatment, get to that right result. We're working with that doctor, being able to provide the software to be able to help move -- provide the software so that we can make the appliance to be able to move teeth in a predictable, reliable way. Monitoring the teeth. There's a lot of technology to even virtually monitor to make sure that the teeth are moving the right way, maybe that patient doesn't need to come into the office on a regular basis because they're doing some remote monitoring, it's a huge benefit in productivity savings on both sides. And then the retention that I spoke about with the retainers. There's a lot of the more details in terms of the workflow, but it really starts from connecting patients or potential patients at that time all the way through treatment and then ultimately retaining to the end. And then when you think about the competitive advantage of how we view the business, you can see all the different parts of it. But it's technology that's gone into the products to be able to help doctors move teeth predictably and reliable to digital experience that they have. You look at some of the statistics, we'll make over 1 million clear aligners in a day. We're the largest 3D printed product company in the world. Every one of those products that we make, every part that we make every day is unique. It's unique for that patient. It's unique for that stage that they're in, and we have manufacturing across the world to be able to do that. I talk about the direct sales force that we have, large sales force to be able to go direct to doctors, a large customer base with doctors that are trained, both on the ortho and GP side. And ultimately, we're creating that digital platform to make it more part of an orthodontic or general dentist workflow to be able to provide this care that they need. And we continue to invest in the business. We're investing in technology to grow the innovations that we have. We think that's very important. You also have that marketing and that awareness that we want to be able to provide to those potential patients. We want them to know our name, be able to talk to doctors directly. We want to be able to go to sales -- with our sales team, go to doctors directly and make sure that they understand our focus and the benefits that we bring and ultimately be the standard of care. Right now, the standard of care, the majority of cases are done with wires and brackets through what we're trying to bring to this market. We think that eventually, we will be the standard of care. We're growing. We grow 20-plus percent a year. And through our innovation and our go-to-market activities, we think we will be able to keep our competitive advantage that we have. So that kind of takes us through all of this. I don't know, Brandon, if there's any other questions that we have.

Thanks, John. So we have a couple of minutes here, and maybe we'll have a breakout session after this, so we can go in more detail, but we'll ask 1 or 2 now. Maybe one, I can't let you go the entire presentation without talking about AI in today's world. And I think it'd be a good background for everyone in the audience today. Can you just talk about -- because you guys have been using AI for some time now. What do you -- where do you guys use it? What are the benefits? And how hard is that for others to replicate as they look to compete with you?

It's a good question. I mean so in our digital technology, I know AI gets a lot of attention now. Really, when we look at what AI and machine learning has given us is, we've got 15 million-plus cases that we've been able to take information from understand how teeth are being moved in a predictable, reliable way. Being able to take that technology so that we can apply it down to the doctor level, where the doctor now can set preferences as to what he or she wants for moving teeth with some of the technology that we have in past cases and so on. So that -- as that doctor takes a scan, that scan then follows the preferences that, that doctor has set up with our AI technology. And now you're going to have a treatment plan that's very, very close to what that doctor want, and we've allowed them the 2D, 3D control so that doctor can kind of tweak things, maybe move teeth slightly to be able to give a view as to what he or she wants for that final position and then a live update. It essentially creates that digital plan. So what used to take weeks sometimes back and forth with our technicians and those doctors now takes minutes or hours to be able to give the view as to what that final position is going to be and then the digital treatment plan to be able to provide that. So it's a huge productivity savings for the doctor, not as much back and forth and a productivity benefit for us. So AI and machine learning, that's been something that we've been using for a long time kind of within our company, and it really applies to what we're seeing in the marketplace now.

Great. Two minutes. I'll try to sneak one last in before we go to the breakout. If we are here again next year, if we're honored to have you here next year, and you're participating? What are we going to be talking about that you think we'll be most excited about?

I think you'll see a lot of new innovation around some of the digital treatment planning. So really being able to make sure that we can help customize and make our product more effective for doctors. So they really experience and get the benefits of the digital workflow and the digital treatment planning and ultimately, the predictability and reliability of our products, you're going to see us continuing to innovate around direct fab, 3D printing. So this rapid palate expander that I spoke about, that goes on the top of the child's mouth and upper palate. That will be our first direct fab 3D printed product. And in a year from now, we hope to see great results, a good adoption for that. And then you're also going to see us continue to innovate in the scanner, the scanner technology to be able to make it faster, better field of view, easier to use, give a lot more capability so that the many doctors who don't use digital technology, they'll find that it's a great way to use in their practice. So -- but ultimately, in a year from now, you're going to see us making -- continue to innovate and come up with products around these 3 focus areas and ultimately growing adoption so that we can continue our journey to be the standard of care.

Perfect. Well, thank you, everyone, for joining. We'll go ahead to the [ Adler Room ] for a breakout session following this. Thank you.

Thank you.