Markus, welcome once again to Dubai, UAE. How has Align Technology performed so far this year in 2021, both globally and in the EMEA region?

Markus: Looking at our Q1-3 2021 performance, we have done well in the EMEA region, with the growth being driven by markets, such as Spain, France, the Netherlands and Germany. A few countries did very well in the first part of the year compared to last year and we can attribute this to the acceleration of the digital treatments during the pandemic - for obvious reasons. Globally, we have announced numbers for the third quarter - and we did very well as an organization. For the Q3 2021, total company revenues were up 38.4%, year-over-year. It has been a strong quarter for the company, with 11.6 million patients treated to date. We couldn’t have achieved it without over 200,000 Invisalign trained doctors globally – dentists and orthodontists - their passion and commitment for transforming smiles and changing lives of their patients. 

What is remarkable is how we did on the scaling side: digitalisation really moved up significantly on everyone’s agenda. That’s one of the reasons why iTero scanners were in high demand during the first three quarters of the year - everywhere globally, but especially in Europe. With this continued trend towards digitalisation, it is becoming more important for dentists to consider digitalisation for the future of their practices, and patients – also in the Middle East. 

You recently announced the development of Align’s first manufacturing facility in the EMEA region - how will this impact business and how do you envisage it providing additional support for Drs in this region? 

Markus: This is another attempt by Align to get closer to dentists and orthodotnists here, in the EMEA region – as part of our global operational expansion efforts. Three years ago, we moved three operational centres, where ClinCheck treatment planning is done from Costa Rica to Europe—Germany, Spain and Poland. This year, we also added a treatment planning facility in France. We are continuing this trend of regionalisation, so that we can be present in all the major markets in the future with dedicated centres. 

Aligner fabrication also plays a major role for us in order to be much closer to dentists, which obviously has a number of advantages. We plan to open the manufacturing facility in Wroclaw, Poland in 2022, and over time, manufacture all our aligners for EMEA doctors from the new facility. It`s a major investment for Align Technology, with our plans to add over 2,500 jobs over the next few years. 

“The affect of the pandemic on dental practices has demonstrated the importance of digitalisation in practices.”

Has the pandemic hindered these plans? 

Markus: The pandemic actually did not hinder the process as such - we were lucky to be able to continue with the original planning and preparations, despite the lockdown. 

We started the construction earlier this year, after we announced that we are going into Poland with clear aligner fabrication, and we plan to be ready in early 2022. I’m confident that we will be up and operating from Poland in the first half of the year – according to the progress the team is making. 

Here, I would like to recognise our operations team, our vendors and officials for their support and commitment to make this project happen. 

During the pandemic, what measures did you take to help doctors and patients navigate the challenges they were facing? 

Markus: First of all, we introduced an immediate recovery programme for dentists and orthodontists. We also introduced a couple of educational activities to help keep businesses running. In some markets, dental practices were closed for several months, so we introduced the Invisalign Virtual Appointment tool through a platform called Smile Consult, in order to give them the opportunity to connect with their patients virtually, during a time when access to the practice was limited or not allowed. We also put a lot of emphasis on the education  and used this time to enlarge our footprint in education in order to help build doctors` confidence in handling and using our products in their day-to-day practice.

We increased our investments significantly during this time, because we knew that this was needed by dentists and orthodontists. Honestly, we focused and listened very carefully to our customers to show empathy in this new situation, as well as understand what they needed the most - and the need was obviously different from country to country. 

Also, the measures in place and the impact of the COVID-19 pandemic were very different across the regions, however we have taken the necessary measures to be able to provide the best service for our dentists across the board, and I think the relationship has become even closer in the last year.

We analysed the feedback from Invisalign trained dentists, and we are very happy with the feedback we have received, but we always know we have to do better each time. There is never a point where I would say we have reached all our objectives, because we still have a lot of opportunities to train more dental professionals, make clear aligner therapy available to more consumers -  and to help dental practices operate better. Doctors are at the centre of everything that Align does, and doctor-led therapy is essential to treating patients with great outcomes and in a safe way. 

Concerning risks, the direct-to-consumer segment poses a considerable risk, and therefore we want to strengthen the dentist in order to cope with the situation and to give clear arguments that the quality and outcome of the treatment of a dentist-led process are the best ones possible. Our aim is to support them in the best possible way.

Align Technology is known for accelerating new technology innovations. Can you tell us about some of the key innovations that distinguish within the industry?

Markus: I was at IDS (Dental industry and Dental trade fair) in late September, and our approach was different this time, which is probably the future of the way Align will be present during these kinds of meetings. 

We did a hybrid model: we had a big booth of over 600m2 there and a live studio, where we had a lot of interviews, meetings, educational sessions, and presentations by dentists and by internal staff. We had over 20,000 dentists sign into our digital broadcast, and up to 8,000–10,000 dentists watched the sessions live every day. This international meeting, as you know, is the biggest dental conference in the world, and many dentists from Asia and from America joined the sessions—that’s our future! 

Everything at IDS was focused mainly on two products: iTero intraoral scanners, especially our new series, the iTero Element Plus series, which we launched in the beginning of the year, and the Align Digital Platform. We connected all the dots, all the different opportunities with exocad and with the restorative element as well as the orthodontic element and the possibility of even combining both. That’s really the opportunity for us in the future. We are concentrating a lot on the digital platform to explore the opportunity of the digital practice more in the future for our dentists. 

The next question is for Angelo. Align recently released a white paper in the Middle East around digitisation and patient care during the pandemic, why was this developed and what were the key findings?  

Angelo: The story behind it is that we really wanted to understand how the behaviour and how the attitude of the public and of dentists has shifted because of the pandemic. Teledentistry has always been here, but what happened with COVID-19 was that it accelerated the adoption of teledentistry because it had become necessary and no longer optional.

We wanted to understand more, so we did two things. We ran a YouGov survey for 1,000 respondents, half from the UAE and half from Saudi Arabia, from different walks of life, with different demographics and in different geographical places. We also ran round-table discussions with some of the biggest key stakeholders in the region, such as Dr Mubarak Al-Saeed from Kuwait and Drs Reem al-Ansari and Suliman Shahin from Saudi Arabia. We asked how their attitudes had changed towards teledentistry, digital, and remote care. These individuals formed the Align Technology Advisory Council, upon which the whitepaper we developed was centred. 

When it came to the research, we found that, even though only a third of prospective patients used digital tools to connect with their dentist during the pandemic, 78% of them said that they found it convenient - and even more convenient than before. Almost all of them said that they would like to keep using it also after the COVID-19 pandemic. On the dentists’ side, it was not only because they found it convenient; it was also because they found it more efficient, because it meant that they could see more patients in less time. 

One of the things that we spoke about as part of the Advisory Council was the value of a face-to-face interaction between the dentist and patient. The dentists advised that we keep pursuing digitalisation of tools, but without completely doing away with the importance of physical interaction. They have appreciated our digital interaction tools that Markus mentioned, the virtual tools and visualisation tools on the scanner and so on. Another key topic that arose was the call for more agility among peers to be robust in the face of change, and in order to be robust in the face of change, it is fundamental to implement a digital workflow in the practice, because of the repeatability of the treatment, the quality of the treatment, the ability to communicate better with the patient and visualise the outcome for the patient. They found that to be very important. In conclusion, the dentists all agreed that there is a need to strike a balance between the important dentist-led treatment and face-to-face interaction, as well as the use of digital tools in order to be more efficient and more convenient; at the end of the day it is a win-win situation for both doctor and patient.

Our next question is for Markus. As tele dentistry has become an increasingly accepted form of patient doctor interaction, what role do you think tele dentistry can play in the future of the dental sector? 

Markus: I think the outcome of the white paper answers this question. A hybrid model of the latest digital tools and face-to-face interaction represent the future of dentistry. Dentists will use the opportunity to choose the capacity in their practice for those patient cases who must attend in person and to do all consulting virtually and digitally in the future. That’s something that is highly likely in the years to come. The question is who will be doing this first and who will be exploring the opportunities best. It is all about the capacities and the drive of individual dentists to make that change. Once they do, things will become more efficient for both dentists and patients. We also must not forget the human and logistical elements of this: patients have to travel to get to their dentist’s practice, they have to find parking space - it takes some time. Doing this from home or from where you are, even at work, is so much easier and more convenient for patients and the outcome of efficiency for dentists is even better.

Do you think patients will still be inclined to continue opting for teledentistry in the post-COVID era? 

Markus: Well, it depends on what we all learn from the entire pandemic. If we go back to square one, to where we were in February 2020, then obviously not -  but I don’t think this will be the case. The pandemic has taught us a couple of lessons. It has taught us that we don’t have to travel like we did in the past, for everything we need; it is possible to stay connected in other ways. The same is true for treatment. Of course, there are many treatments that have to be done in the practice—there is no doubt about it—so we are not talking about 100% teledentistry, but there is a certain amount which can be shifted, which can be done also at a time when practices are not open. Many people who are working, who are busy, can’t come during normal practice times, and it is just more convenient for everybody involved.

Going back to Angelo, what are your plans for the region in the coming years?

Angelo: Like Markus explained, the affect of the pandemic on dental practices has demonstrated the importance of digitalisation in practices. In a nutshell, this is the same objective that we will have in the region like we have globally. We will keep driving towards that kind of digital shift that we know will continue to benefit patients and dentists. To talk specifically about the region, there is a huge drive towards the 2030 visions that are common in the UAE, Saudi Arabia and other countries in the Gulf Cooperation Council region. A key objective of these visions is the advancement of digital and artificial intelligence, and this of course applies in healthcare as well. This is where Align Technology can play a role. We will keep working in unison towards these visions to help dental practices move towards digitalisation and keep educating practices on the importance of treating malocclusion as the basis of oral health. We will also continue expanding the reach of our treatment, especially concerning growing patients, and expanding to adjacent restorative opportunities. This is going to be our direction for years to come, as we continue our geographical expansion.

Markus: The Middle Eastern region is still very young for us, yet it is one of our most important areas of focus and growth. Our investment will continue and will increase in the future because we are just at the starting point in the Middle Eastern region.

Can we expect any new products to come out soon?

Markus: We are investing a lot in research and development. We are working on a number of improvements of our products and services which will help our dentists use ClinCheck software in their every day practice, and to speed up the process from the moment the patient has the initial visit with their dentist - to the moment they receive their aligners. Regarding aligner fabrication, it is all about reducing the time from the first scan to when the dentist gives the patient the full aligner set. We are working hard to achieve this. On the iTero side, we will continue to improve our offerings to make sure we continue to offer high scanning accuracy, including in 5D. 

Thank you both Markus and Angelo for your valuable inputs and timings.