Corporate Profile: Align Technology, Inc. By Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine

 
Clearly Moving Forward

In 1997 Align Technology, Inc. was born with one clear idea: provide an aesthetic alternative to moving teeth with braces and wires. The company grew exponentially and went public in 2001. Initially, this unique technology was only available to orthodontists. In 2001 general dentists were invited to learn this technique. In 2005, one of Align’s founders and a few former employees launched a competing product, OrthoClear. Most people in the dental profession know what happened next.

Recently, I interviewed three key members of Align Technology to learn more about the past, present and future of clear aligner therapy. I spoke with Tom Prescott, Align’s president and CEO, Dr. Lou Shuman, vice president of clinical strategic relations, and Kathy Farley, senior director of clinical education.

Initially, Invisalign was introduced to orthodontists only. Now it’s available to orthodontists and general dentists. How did orthodontists react to this strategy? What is your penetration in the specialty in orthodontics vs. general dentistry in terms of numbers of trained dentists?

Early on, there was a lot of push-back from the orthodontic community because there was a lack of understanding about why we were going out to GPs (general practitioners). They were worried that there was a plan to somehow remove orthodontists from the equation altogether. Nothing can be further from the truth. We look at what goes on in a GP’s office and it is totally complimentary to what goes on in a specialist’s office. In markets where we’ve helped strengthen the relationship between a GP’s practice and the orthodontist’s practice, both their businesses have boomed.

When it comes to our general base of trained orthodontists, we’ve trained about 8,000 practicing orthodontists. Of that, approximately 70 percent have submitted a case or two. In general, we do frequent business with about 4,000 of those orthodontists. That includes doctors who are doing several hundred cases a year to those who are doing five to 10 cases a quarter. On the GP side, we’ve certified approximately 22,000 of 140,000 general dentists. About two-thirds of those doctors have tried at least one Invisalign case.

What would be a good target for a dentist to have in terms of number of Invisalign cases?

As with any technique, there is a learning curve with Invisalign. If you’re only going to do one case every few months, then you’re just not going to get it. To hit their stride, most doctors need to start about one case per week.

When did you learn of OrthoClear’s infringement on your patents?

Officially, there was no finding of infringement since the settlement with OrthoClear stopped the litigation process, although we did believe there would be a finding of infringement by the Inter-national Trade Commission (ITC). We first learned about OrthoClear in late January 2005 and we fired our first shots across the bow in February of 2005 by filing suit against the company in California state court.

What would you say is the turning point in that whole case? Why did it get settled?

We think it was the right combination of product and pricing and legal strategy that brought about the settlement point. Early on in the litigation we decided to get focused about what we were doing for our customers and compete on quality and continue to improve the product, programs and pricing to give customers more of what they wanted. At the same time, we pursued a very hard-nosed legal strategy. We thought those things would intersect around now (Spring 2007) because we felt that we would have outcomes in state court and in the ITC case, and we felt that would lead towards an order to bar OrthoClear from importing its product. We were actually surprised that the settlement led to a resolution sooner than we expected.

When you were going through this settlement and you were considering what you’d do with the OrthoClear patients when this was resolved, did you consider finishing them with OrthoClear system rather than switching the patients over to Invisalign?

It is important to remember that Align did not acquire OrthoClear, its patients or their records. I asked the judge’s staff, “What happens to all these patients and doctors who were using OrthoClear?” Their answer was, “I don’t know. I guess they’ll just finish their cases.” Finishing patients with OrthoClear wasn’t an option – the company shut its doors. We didn’t want 30,000 patients and their doctors to have a bad experience with clear aligners and their orthodontic treatment because OrthoClear shut down – it would have given all of us a black eye. I called a couple board members, told them it would cost between $7 million and $12 million to do this, but I thought it was the right thing to do. We started hiring people right away to help us take on a potential additional 30,000 cases and within a few weeks we launched the Patients First program to provide free treatment to those patients.

Many dentists on Dentaltown were initially upset about the settlement because they liked some of the features of the OrthoClear aligners and now that intellectual property (IP) belongs to you. What are your plans for the IP you now own and how will you incorporate that into your current products?

The IP we gained through the settlement was not as deep as we’d hoped for and the value was very low. What we are working towards with our own product development is to be able to do two things: we want to take today’s Invisalign and Invisalign Express and separate those into GP and specialist platforms, and then once we’ve done that, we want to build out some really cool products. We’ve listened to the Townies and we’ve been out doing very detailed market research with patients and doctors. We have a very interesting product roadmap over the next couple of years that will continue to increase ease of use and allow your readers to provide better care and better outcomes.

What do you see as some of the advantages now that the OrthoClear chapter is behind you as you move forward?

We had to make some hard choices about programs and priorities when we were spending $20 million just on litigation with OrthoClear. We’ve actually increased our spending this year on technology and new product development and the expansion of clinical education. We’re spending millions more on research and development so we can make sure that what we put into the market really resonates with the doctors and helps them achieve success.

Who are your top two or three competitors in this area?

Our biggest competition for straightening teeth is still brackets and wires. There are between 2 million and 2.5 million orthodontic case starts each year. If you subtract children and very difficult cases such as surgical cases, you are left with approximately 1.1 million cases that could potentially be treated with Invisalign. But we are also targeting the patients who are already in your readers’ practices. Of the more than 117 million people in the U.S. who see their dentist regularly, around 77 million are older than age 15 and have Class I crowding – and that is Invisalign’s sweet spot. Our job is to continue to improve the value proposition for GPs and orthodontists so that doctors will choose and recommend Invisalign treatment for those patients.

How did you prepare for the integration of OrthoClear dentists with your current Invisalign dentists?As soon as we announced the settlement with OrthoClear, we started working on the Patients First Program, which would allow former OrthoClear patients and their doctors to start Invisalign treatment at no charge. More than 4,000 former OrthoClear customers were also Align customers, but we had to worry about the immediate training needs of non-certified doctors. Within weeks, we rolled out a free, provisional Web-based certification that would allow doctors to start their OrthoClear patients in Invisalign treatment. We also expanded the number and capacity of our regular two-day Certification I courses at the end of the year. If doctors wanted to continue treating cases with Invisalign beyond their OrthoClear cases, the doctors would have to complete and pay for full Invisalign certification. Not everyone was happy about that. At our first certification training, we had about 50 to 100 angry former OrthoClear doctors sitting in the front of the room and we said, “By 10 a.m. if you’re not satisfied with this, you can forego the training and we’ll refund your money.” By 10 a.m., they all found out that there was a lot more to Invisalign than they had originally perceived.

How many new staff have you hired to accommodate this increase in volume?

We’ve hired more than 100 dental technicians for our treat operations facility in Costa Rica, and they continue to come online and we continue to train more. We’ve said that we want to be finished with all Patients First program cases before the end of the second quarter. We’re tracking right along in that progress.

The Patients First program was created to handle the OrthoClear patients. How has the creation of that program and what you’ve implemented with it so far affected your overall handling of all your current customers? Has this project changed the way you’re going to do business on a daily basis?

It has pointed out that we’re not as good as we can be. It’s highlighted some areas where we can invest in systems and capabilities to even give better service and improve the overall user experience for customers. For example, we just launched an online e-pay capability that went off without a hitch and we already have a whole bunch of doctors moving quickly to pay on credit cards for their cases. The good news is that we’ve learned a lot about ourselves and there is a lot more we can do to be more responsive to our customers’ needs. They love what we’re doing with Invisalign, but they have a long list of things that we can do better.

You mentioned there are a couple levels of certification. What are the options available today to Invisalign dentists?

The educational approach is multifaceted. Align hosts more than 400 educational events each year, from certification courses to advanced workshops, study clubs and expert conference calls. Certification I is the first step to treating patients with Invisalign. From that point forward, we try to provide as many educational opportunities for growth for the practitioner as we can. There’s a formal program called Certification II which is for the more advanced practitioner to get into more advanced types of malocclusions or more difficult cases to treat. We also have ongoing clinical support programs. We have a significant number of clinical support mechanisms in place such as Ask the Expert calls. These are monthly two to three hour conference calls with a PowerPoint presentation by one of our clinical experts. Not only do doctors get to follow along with the presentation, but they actually get to ask questions and get experts answers, which everyone hears. Once the Ask the Expert call is completed then we archive it at the Invisalign CEC (Continuing Education Center), which is our online clinical compendium. Doctors can visit www.invisaligncec.com to access clinical articles, case studies, tips and techniques and other resources.

Many dentists are reluctant to learn Invisalign because they’ve not had any formal orthodontic training. How do you address that?

What we’re trying to do is create an awareness that we’re not just focusing on Invisalign for doing major orthodontics, but we’re also excited about what Invisalign can do to support the existing practice of the general practitioner. One of those options is the ability to do limited ortho to alleviate crowding issues in minor orthodontic cases and in restorative treatment. The opportunity for combining Invisalign with restorative procedures is huge.

Where does the Dentaltown community fit in both influencing potential Invisalign dentists as well as Invisalign dentists communicating with each other

We recognize that Dentaltown has created a unique, real-time approach to communication and interaction with an important part of our customer base. There is a tremendous opportunity to for us to gain knowledge about GPs and their needs – and for us to share knowledge with Townies.

What sort of new ideas are you bringing to clinical education at Align?

I’m looking at augmenting the instructor-led experience, and at how can we provide some additional user experiences directly to individuals. We’re revising and revamping the one-and-a-half day Certification I offering down to a one-day offering (which will launch at the end of June 2007); however, the plan is to provide an online pre-certification course so that the individual clinician can (for example) learn Invisalign terminology and be better prepared prior to going to the instructor-led program. There’s also opportunity for self-paced learning and new high-tech offerings like pod casting.

How do you evaluate the effectiveness of the courses?

We’re interested in everything from the content to the speaker who delivered the information. Our plan is to figure out how to boost the confidence of the clinician so that when they walk out of the certification, they’re ready on Monday morning to start submitting cases and offering Invisalign to their patients. We do look at case submissions and find out if they’re calling in for assistance as well.

For the dentist who is considering becoming an Invisalign provider, where’s the appropriate place for them to start?

I would suggest contacting the local Invisalign sales representatives. They are a wealth of knowledge. They can really present the product to the doctors and staff in a really good way and help them understand how Invisalign can fit into their practice.

There is no doubt that this technology is here to stay and more innovation will attract new users. Now that the OrthoClear chapter is finished, Align Technology, Inc. is poised to own this market with new technology, effective training and excellent service. Pay close attention to this company and consider orthodontics in your practice.