Guys, let's get started. I think we have a full 30 minutes and a bunch of different topics to get to. Next up, we have Align Technology, the leader in clear aligners, and joining us is John Morici, Chief Financial Officer, as well as Simon Beard, Executive Vice President and Head of Americas and now EMEA. A bunch of different topics, guys. If you have questions, please throw up your hand. I wanna start, John, with the LRP and maybe just long term, and then we'll sort of funnel and get a little bit more specific. The LRP hasn't been addressed in a period of time. Your revenue base is what? It's 2x'd. Competition's coming to the market. You guys would talk about being a 20%-30% grower and OM's 25%-30%. Maybe just help us out. Is that still, you know, Align's intention and thought, that that's the right growth profile for the company long term? Yes, it is. When we think of the market opportunity that we have with the products and services that we have to better go to market, that 20% plus 20%-30% of revenue growth, 25% plus of margin, is how we think of our investments, how we think of when we're expanding, when we're adding new products, when we're innovating. That's how we think of that market opportunity. Prior to COVID, that was very consistent in growing in the marketplace. Obviously, you have some impact from COVID, 2021, even stronger than that. When we think of on a more stable market that hopefully we're gonna be in soon, that's the long-range plan that we think about. Okay. I guess the 20%-30% top line is pretty clear. It would be, you know, innovation, new markets in areas all over the globe. There's a teen market that's, you know, wildly underpenetrated. We can get into that. Help us out with the OMs, 'cause I think where I struggle there is you were well in that band, the 25-30, and then this year you're gonna be, you know, around the $4 billion, but 20% OMs. Next year, I have you scratching 22%. What are the main levels to get back to 25% plus? Where does that come from? Yeah, I think, you know, the benefits that we'll see as you make these investments, some of these products come to market. As you start to see some of the revenue benefits of the various products, you get some of that benefit. We've been able to add price this year. We see that benefit coming through from a gross margin standpoint down to op margin. You look at facilities like Poland. We went about a year ago. That was about a point impact to us on an op margin basis. You start to anniversary that, and you start to see some of that productivity. It broadly comes from being able to leverage the investments that we have, whether they're innovations that we have, manufacturing, or some of the go-to-market activities, and we should see that improvement. Even if you looked at this year, really what we've implied is, you know, when you have the first quarter of 18.5% op margin, we guided to 19.5% in the second quarter. When we talk to the 20% plus, for total year, it really talks to some of that acceleration and op margin as you go out of this year, and we expect that into next year. It's a good point. I'm actually cheating and looking at the model right now. I mean, I don't have your top line wildly dissimilar. It's higher, but 2H versus 1H, yet I have you exiting at 21.6 versus starting the year at 18. Right Maybe there's some of those factors that start to more normalize exiting 2023 that we can more extrapolate going forward. That's what we expect, yeah. Okay. Simon, I'm gonna pull you in. You know, maybe just talk to us. You started running EMEA. You did a lot of great things in EMEA, bifurcating the sales force. You went over to Americas, and now it looks like you're running EMEA again. Maybe talk to us on why the company, you know, recently made that change and what it's hoping to accomplish with the leadership? Sure. Like you said, I ran EMEA for four in a half years, I've now been four years here. I think, you know, there's a lot of synergies. One thing that I suppose has surprised me a little bit is a lot of similarities about how we approach channel, how we approach customer. I think there's a great opportunity to kind of double down on where there are those similarities and share best practice and programs that we run across the different regions. I think it's gonna be great as well to have, you know, we're essentially going from, I suppose, two regions to five. That's the way I view it. I don't see it as one big kind of region. That's just gonna enable us to continue to be agile and customer-focused, et cetera, and, you know, push those kind of decisions and actions down to kinda local leadership. Is that something that you feel like you're able to make, you know, immediately, or does that take some time to take hold? Some things, I think we're doing immediately, which is where we're really synergizing around best practice. Then maybe some of the pieces around decision-making take a little bit longer. I wouldn't see those taking a long time. Okay. Helpful. I'll probably circle back on EMEA in a little bit. You know, John, we started high level, and I wanna get a little bit more near-term or trends. You know, at the beginning of the year, you mentioned growing cases Q over Q throughout the year, post 1 Q 2023 results, and you guided up for cases in 2 Q. Sort of when you do the implied math, I think I land around 3% up sequentially, 1 Q to 2 Q. Where I struggle is, if I go back to your normal historical seasonality, you're usually up closer to high single digits, right? 1 Q to 2 Q. You've guided again, 3%-4%. For the third quarter, because you sort of said at the beginning of the year, "We're gonna grow," you know, sequentially, the sell side sort of said, "Okay," and we went ahead and just plugged in the numbers. We all have you growing 2Q to 3Q, and your normal historical seasonality is up 1% because it's a very seasonal quarter with EMEA, a lot of them not working too hard over that period of time. I guess where I'm trying to go with this is, help us why. You know, give us the confidence on why you recapture your historical sequential seasonality, 2Q to 3Q, when you were below it, 4Q to 1Q. You expect to be below it, 1Q to 2Q. How do you get there, 2Q to 3Q, if some of these indicators around consumer confidence have softened a little bit of late? Well, I think it starts with making sure that the consumer confidence doesn't get worse. I mean, ideally, it's stable to up. If we see that continue. I think when you get into the third quarter, it's the biggest quarter for China. As long as China does, you know, COVID and some of the other concerns that have been out there don't materialize, and you see that China is still open, should be a very big quarter. It's teen season for China, and we should see the volume come through there. It does offset the EMEA, where there's holidays and vacations and so on. It's also a strong season in the U.S. We should see a lot of teen cases in the U.S. and North America as well. We think when you take all that together, keep the stability in the overall economy, nothing gets worse, and you see some of the benefits in China and North America from a teen season standpoint, we expect that overall seasonality to hold. That's helpful. Then you mentioned China, I wanna, you know, ask a follow-up question there. Every single company, dental company at this conference has gotten this question because I think on the 1Q earnings calls, everyone was talking about China. "Hey, look, January and February was really rocky, right? Got better in March, and then we saw an acceleration in April." Then some random day, we get this headline of what's going on in China and, you know, peak infection rates not occurring till June. On the ground, what are you seeing? Well, you see areas where you have improvement. We saw, you know, in the fourth quarter, a lot of people and, you know, things opened up in China. People got sick and had COVID and it kinda played itself out into the first quarter. We talked about it last earnings, that we saw improvement as we went through the quarter. February, better than January, March, better than February within China. You know, we looked at it from an overall quarter standpoint. 1 Q was better than 4 Q in terms of shipments. We're seeing this within China. We need to have, you know, that stability applied to China as well. We think that, you know, it will help us as we go into the second quarter and certainly into third quarter, as I discussed. Couple clarifications there. 1Q better than 4 Q. Sorry for the silly question. Cases in China were up sequentially, 4 Q? Up sequentially. Okay, they were. I'll get you to hopefully to split, you know, me and something else later. China cases were up 4Q to 1Q. It seems like the demand slope that you saw exiting the quarter, despite some of the headlines, that hasn't changed all too much. Is that a fair conclusion when we think about the headlines that we've seen? It certainly. You know, when we talked about at earnings, we saw that improvement as we've gone through. You know, don't wanna talk kinda within the quarter, but we certainly saw that as we progressed. Like I said, China is an important market for us, great opportunity for us, and especially as it heads into third quarter, where it's the biggest quarter for China. Yep. Okay. Maybe just a couple more around near term, and it'll be for John and Simon. You know, I think one of the themes that you were consistently touching on late in 2022 and into early 2023 was this theme of stability, right? Like, a lot of this that was going on, exiting 2021 and then 2022 had stabilized. Is that still the theme that we should be latching on to of late across your markets? That's what we see when we look at, you know, the consumer confidence indices. In most countries, they're either, you know, stable. Some have improved, we've seen some improvement in certain countries. U.S. has been largely stable. Comes down to the economics that people feel, inflation, concern about interest rates, concern about a lot of their own personal finances, that impacts their decisions. We hear a lot from doctors, is that patients aren't saying no to treatment. They'll say, "Wait and see." They'll say, "I need to see if I, you know, as I fit this into my budget," and so on. That impacts us from an adult standpoint, less so on the teen side. We can get into whatever, you want to discuss on the teens, but teens, a little bit less discretionary. As they get to a certain time of the year, they're on, you know, break or holiday, or maybe their jaw and the alignment needs to happen at a certain age, less discretionary from a teen standpoint. Okay, just to continue down the road of international, I'm going back to some of the metrics coming out of 1Q. International cases were down 4%, Q over Q. You mentioned China being up, it seems like EMEA was down obviously more than four, just doing sort of the implied math. You know, that seemed like a pretty big reversal. EMEA was a big outperformer in 4Q. Seems like it rolled in 1Q. Simon, can we still use stability in EMEA? I think what, you know, spooks me a little bit is the underperformance through my, you know, view in 1Q, the leadership changes that took place. Are we still seeing stability in EMEA currently? Well, leadership changes have nothing to do with the results. Yeah, I think, I think stability, I think, across the globe. I think when we look across the different regions, different markets, that's what we're seeing. I think we talk about unpredictability in the numbers. You know, that's kind of coming out of COVID, but definitely I'd say stability is still the word. Yeah. Okay, fair enough. Again, guys, if you have any questions, let me know. Otherwise, I can keep these guys up here for a couple of hours, so I'll just move forward. One of the things I wanted to talk about was the R&D deleverage, and I think one of the things that I truly value about Align, and makes you guys a lot of fun to cover, is the R&D and the investment. You know, you're 2x the industry, some of the big players, in terms of the R&D investments. The other guys are floating around 4% of revenue. You're closer to 8%, 9%. That said, I'd love to see you get back to down to 6% or 7% to go ahead and hit those goals of 25% plus op margin. A couple metrics for you. R&D was 6% of revenue in 2018, 2019, and 2021. In 2018, you were a $2 billion revenue company. This year, you're gonna do $4 billion in revs, and in 1Q 2023, R&D was 8.5% of sales. For that LRP to get back on track, John, how do we think about R&D as a percent of sales longer term? Well, I don't target a percentage when we make our investments. We look at products that, you know, sometimes they're more in the R stage versus the D stage. When you're in the R stage, you're doing a lot of research, you're developing products, and your, you know, your timeline to get them to actually be a product to sell, sometimes takes some time. You do see some fluctuations in some of that overall percentage. I would say on a long-term basis, it's around 7%, is how I would say the net of it all coming together, and therefore, compared to now, you'd see some leverage on that. It really comes down to the investments that you make. A lot of the technology that we're talking about, whether it's treatment planning around the software or the innovation that we think will bring to market around the direct fabrication printing, and then the innovation that we also give to our iTero business, that takes a certain amount of investment over time, and then how quickly those investments can turn into actually seeing the revenue, that's the cycle time that you're in. Longer term, I would say 7% is more the range. Okay, maybe let's talk about, you know, the payoff or what's on the come. We discussed this a little bit at the dinner last night, but, you know, Joe mentioned on, I think it was the fourth quarter call of, you know, we're on the cusp of one of the biggest innovation cycles of the company. What's on the come? We think palatal expansion is being trialed in Canada, awaiting FDA approval. Yeah. Rollout. Simon, maybe if you want to talk about it. I think there's some things that might be underappreciated from the street in terms of workflow tools. Yeah. How do we walk that back to the model and utilization and securing market share, if you want to go down that road a little bit? Well, I think, you know, as John says, we have invested heavily in the last few years. Particularly around software. We know that's the major interface for our doctors. They don't tend to play with the plastic, it's the ClinCheck. That's where they spend a lot of their time, and in some cases, too much time. What we've been trying to do is build a lot of kind of AI into that process. Really taking their treatment preferences, their treatment protocols, and automating them in a way that they're still gonna get the kind of the treatment plan that they want, but in a more efficient and effective way. We're now kind of commercializing. You know, there are two elements to it. There's what we call IPP, which is the individual, the Invisalign Personalized Plan, where well, we're able to code the doctor's preferences. Instead of it going to a technician to do all the kind of changes, et cetera, the code actually understands what the doctor wants from the scan. That, that takes a kind of a, what historically was a kind of a four-to-six-week process of you know, submitting the case and then the backwards and forwards with the technician down to literally hours. What we also added on the back end was the 3D Controls Live Update, where if there are just minor tweaks that the doctor wants to make, they make those, and then they push Go. Got it. I think the efficiencies there are, for doctors, you know, doing something in the moment is so much more efficient than having to go back over a number of weeks and remember the patient and remember what they're trying to achieve. Yep. That's the IPP, and then we've also introduced templates, for, you know, some larger groups of general dentists. These are efforts to really scale up that initiative more broadly. Yeah, who, you know, tend to follow the kind of the philosophy of some of the preeminent general dentists out there. They follow the template, works in exactly the same way, so they're getting the treatment plan back in a couple of hours. Yeah. To walk that back to the model, I mean, I see sort of, like, three different impacts coming out of that. Yeah. One, you know, one is maybe it aids utilization, 'cause now I'm a doc, it's much more streamlined. I'm not gonna spend six hours on a Saturday doing my ClinCheck. Correct. I've got a greater likelihood to do more cases. Yeah. I would think it's stickier in terms of potentially losing someone to competition, right? Like, if I go and I get an aligner and source it for $100 or $150 less, what am I getting back. Yeah In terms of inefficiencies? Yeah. Around treatment planning. Fair, all three of those variables? John, is there any way to quantify one, two, three of those variables? No. I think it's difficult to quantify. Okay. I think all three of those things are potentials. There are other elements as well on the software. We talk about IPP, we talk about templates. We've bolted on Smile Architect, which is a kind of a multidisciplinary ClinCheck now, where you can plan pre-restorative before you do ortho. We've got CBCT integration. We've got the ClinCheck now that we do In-Face Visualization, where you can take the ClinCheck and show a before and after in the patient's face. As you know, you've seen, we've got the video coming as well, so that'll not be a 2D, it'll now be a video. Conversion tool. You know, it's not just about IPP and templates. I know we talked about a lot about that last night, but there's a [audio distortion] The 8.5% has been going on just the full suite of software, creating efficiencies, visualization, and making the whole process more impactful. Fair to say, we will see a much greater return from those initiatives, 2024 versus. That's the key, John, because not only once those products come to market, and some of them are to market, you don't have the OpEx spend there. On many of these, we're also seeing productivity benefits as well. When we don't have to go back and forth with our technicians, I can either have technicians working on other things to drive volume and help with, you know, the kind of the treatment planning and so on, or I can just have less technicians. Yep. That'll drive productivity for us. Okay. I'm gonna try to, you know, go a little bit further down some of these roads. Palatal expansion mentioned it's out in Canada. If you get FDA approval tomorrow, can you go? I mean, We will. Can you move from a manufacturing standpoint? It's a ramp-up. I mean, it will be our first commercial direct printed product. Yep That we'll have. It is a ramp-up that you have. As soon as we get approval in the U.S., we will go. I was thinking back on the bus tour in December. I believe you had submitted at that time. How long has that been sitting with the FDA in terms of palatal? Has there been an active dialogue with the agency? Yeah, there's, you know, a process to go through, but ideally, you know, we've seen it released now and on a trial basis within Canada, great results. We're getting the movement. It's doing what doctors have expected to be able to move those young child's upper palate in the right way to create space for those permanent teeth to come in. In the U.S., we need the FDA approval. Largely incremental market opportunity for you guys expanding the palate. I went back and I looked at one of the other markets that you went into that I thought was largely incremental, being Invisalign First, right? And I pulled some stats that you guys gave to the street. You started 32,000 Invisalign First cases in the first 18 months. Is that a good analog? Is that a good benchmark? I know the ASP is different. I'm thinking for your Invisalign Palatal Expander, it might be around $500, but is that 32,000 in the first 18 months where we should look toward? Can you run faster than that? Look, I would like to run faster than that because I think when you start to think of the opportunity, if you think that there's 21 million orthodontic case starts worldwide, 16 million of them are teen, we hear that, you know, 10%- 10% plus of those teenagers, or in this case, pre-teens, need some type of palatal expansion. Some of it's handled in Invisalign First. Yep. It does do some of that. Really, if you need that palatal expansion, that's a, it's a huge opportunity. You're talking about, you know, 1.5 million kids who need something like this. The product that we have, which is, you know, for 30 days, the mom pops in that aligner, that palatal expander at the top, it's in for one day, pop the next one in another day, it goes 30 days, creates that space. It's a much less torturous device than the metal, palatal expander that we have now. Yeah. You think about from a compassion standpoint, you think about from kids actually wearing it and creating that space and so on, when you have over 1.5 million potential customers kind of within there, patients within this, I look at that as a huge opportunity for us, and that's incremental revenue that we don't have. That's a development coming from the research that it took to now we're kind of in a development phase. That's a benefit for us. Maybe just to run that R&D, because then I want to go after gross margins. You know, we talked palatal expander, we talked a lot of initiatives around software and workflow. To go over to the scanner and services division, it seems like there's initiatives there, a faster scanner, better workflow, and usually what accompanies that is hardware in order to make those changes. Is that fair? It's fair. When you think about the cycle that we're on in terms of some of these devices, you're in a three to five-year range, and you know. A 5D. 5D is like three years ago or so. You start to think, you know, you wanna have a scanner that, you know, meets these requirements, that you can build off of, and then supplement it with software and so on. That's the mindset that we have there. I wanna go to gross margin because I feel like to get back to the 25% plus, we need to see a different trajectory in gross margin. I feel like the building blocks are there, and so I'm gonna start in the less obvious place. We did some work in one of our most recent reports, sort of bifurcating systems and services, 'cause there's two very different businesses in there. There's the capital and the services, and you've given enough pieces to the puzzle where services is right around 50%, and that's a services business. I think, John, 80% gross margin-ish, fair? On the equipment side? Yeah. I mean. On the services part. Yeah Within there. Yeah. Okay. The service part. You've had this massive positive mix shift to services, yet overall, systems and services GM has been flat to modestly down. The implied math on the actual scanner is down pretty hard. Look, scanners went through the roof coming out of COVID, and then they've come back down. Talk to us, and now it seems like the number of scanners going out is starting to stabilize. Can you get stability on the equipment side of things, so the mix shift comes back more into your favor, and we get overall margin expansion within S&S? I think you have two things that have impacted, kind of on the scanner side. You have, you know, the volume that you need. You need volume leverage there. That helps. That helps your absorption, helps you know, generate some of the margin improvement. I think it's also been some of the raw material input into the product. Inflation costs. We've seen some of the inflationary where, you know, not long ago, we were talking about chip shortages and some of these other things that were impacting where, you know, you incur the price for that, some of the freight and other costs that have kind of gone into that. I think as we see some stabilization there, not as much inflation on some of those inputs, as well as some of the volume that we have, you start to get some of that gross margin leverage there. Okay, that might be, you know, call it a driver for systems and services going forward. Going forward. The other one, it's funny, sometimes I think I just get lazy at times with the analysts being, you know, looking at the gross margin percentages. One of the things I was like, Hey, Align's ASP is going up, but the gross margin is going down. I turned around into COGS dollars. When you actually turn it around into COGS dollars, you see a pretty big move higher over the past three to four quarters. Is it as simple as saying, let's tie that to Poland, and that should normalize? Well, that's a part of it. I mean, you think about when you have a facility, I mean, we're putting out, you know, a million aligners in a day. When you're trying to get that right mix of those facilities, and in Poland's case, that's a new facility for us. You put in the equipment, you've got labor, you've got overhead to support that plant, and then you're adding production to that. As that production and utilize that plant more and more, you start to see that productivity, and that shows up in reducing our costs and so on. We're aware of that. We know how to scale things there. It's just a matter of putting that in and then seeing the benefit. To maybe a more hidden extent, you saw this, I mean, it was kind of forgotten during COVID, but we put China as a greenfield in June of 2020. Right. It was lost in everything else going on in the world. Right. That's a good point. It experienced kind of the similar things. Was the same thing. It was lost during the fact that you had, you know, COVID and the volumes and everything else. We know how to scale this. It's a matter of doing that within Poland, and we'll see that cost improvement. Simon, quick question for you, and I'm gonna see what I can get through in five minutes. If the consumer weakens, how do you alter your approach? Let's just pick a market like EMEA, and consumer confidence starts to roll over. You know, what are sort of the marching orders that you give to the organization or your sales force in terms of what they can do or what's within your control to try to maximize the opportunity? Well, I think the good news about the business is there's a lot of levers we can pull. Whether that's from a channel perspective, so the how do we approach an orthodontist, for example, in Europe? How do we approach a general dentist, right? In that scenario is, you know, I always view the general dentist is about converting the patients that are already coming in, to your practice, maybe for other things, into clear aligners. On the ortho side, you know, teen is the big play, right? As John said, that's tends to be the less discretionary purchase that happens. I think we've got a lot we can do from a channel perspective, and then we've also got geographic, the geographic side. These are greenfield. Yeah, yeah. You know, we, as we were talking about last night, you know, the kind of the Eastern Europe into Middle East and into Africa, a lot of that is kind of virgin territory for us. Whilst, you know, we're, you know, they're investments, we, you know, that's, that's new business for us. Okay. Like I say, there's options for us, but, you know, the marching orders are, you drive the adoption of the technology. We can share insights with customers that shows when you adopt the platform, when you use the technology, when you use these tools that we've introduced around In-Face Visualization, the simulation. Helps with conversion. Yeah, helps with conversion, yeah. Okay. You know, we see some great results from that across multiple markets where we do that. One of the things that I wanted to hit on, you know, with the platform that we have this morning is DSP. You know, I'll try to be quick here, but what should be a positive, I don't want to say it was a negative in the quarter, I just think there was some confusion. John, we have your DSP run rating at around $80 million or $85 million. It's within non-case revenue. Most of that is retention. If I try to throw a case volume number in there embedded in the 1Q results, I land 8,000, 9,000. Am I in the right zip code within some of those numbers? Maybe you could talk to that. Well, okay. On DSP, which is Doctor Subscription Program, it's really a program that the commercial team thought through of saying: "Look, you've got a typically a lot of high-volume orthodontists who do comprehensive cases." What we found with those orthodontists, they weren't really giving us any retention or some of these minor touch-up cases that we have. The DSP program allows those doctors to buy aligners over a period of time, typically a year, and they commit to a certain amount of aligners that they're going to use for cases like touch-up or retention, and that doctor gets them at a price over a period of time. As you rightly said, you know, if they do a touch-up case, they do a case where they need some minor adjustments, maybe the person didn't wear their retainers, or maybe they had some other movement, and so on. Those cases that they do, they just put it under their subscription. Yeah. It doesn't fall as a case. Typically, it might have been a five-set aligner case, and we would have counted that as volume. Your eight to 10 is probably it's in the right, but it's north of that, you know, in terms of the volume. The cases that are being pulled out. The cases that are being pulled. Are north of 8-10. Yeah, out of the first quarter, it would be north of that. It's a way that doctors want to buy. What it's helped us is, it keeps that high-volume doctor able to support those, y ou know, they still want to do those comprehensive cases, they buy them from us, but now they're not making aligners themselves, they're not doing other lab work for retention or so on. They're using us. We're getting that volume that they were either using themselves or going somewhere else. We're getting that volume to us. Might not show up as case volume, but it shows up as revenue. Got it. Very helpful. Maybe just, you know, to conclude, and I know we're sort of at time, but DSP, in my eyes, has been wildly successful. Simon, I think last night you talked about maybe rolling that out to additional markets. Yeah Going forward. Teen Case Pack was another initiative around the same time that we had done a lot of diligence on, I think the feedback was a little bit more muted. I think Joe has always talked about, you run some plays, some initiatives, you see what the outcome is, then you might make some modifications. Is that something where we could see some sort of like a TCP reboot, or what didn't resonate maybe in the field the way that you initially expected in and around TCP? Well, first and foremost, we launched Teen Packs in a number of markets. I think, you know, I agree, DSP's probably been more successful, but we've had some success in other countries. I think in the U.S., I think when we launched it was right when the kind of the macro situation shifted. Mm. That commitment to a volume. Hit the dock a little bit. Yeah, kind of timing. We've learned a lot from that, and so we're doing a lot of work looking at, you know, slight tweaks around business model and how we can make it, 'cause there's still an appetite out there for almost like this concept of digital inventory and trading kind of commitment. For the last thing. Certainty around price, et cetera. It's not the, I wouldn't say it's dead. We've learned a lot. We've still got doctors out there using those packs. I think the other thing as well is the kind of the two refinements, maybe that was too little, particularly around teen. Teen. You know, we, as kind of Joe said before, we'll try things out. They're not always successful, but we learn, and then we can tweak and implement and keep going, because we definitely believe that kind of subscription pack type of approach for certain doctors is really appealing. Get them on TCP and then get them on DSP as well. Yeah, yeah. Yeah, Yeah, yeah, absolutely. Fair enough. It's great. We're gonna have to stop there. Okay. I appreciate the time, guys. Thanks. Simon and John, thank you very much.