Shownotes
Digital orthodontics is transforming the specialty, and in this episode of the Golden Age of Orthodontics, hosts Dr. Leon Klempner and Amy Epstein sit down with Align Technology CEO Joe Hogan to explore what's next for orthodontics. Joe Hogan discusses 3D printed aligners, AI in orthodontics, and how clear aligner technology continues to evolve. He addresses pricing concerns and competitive positioning, and reveals Align's roadmap for direct printing, promising greater design flexibility and efficiency. Learn how AI technology enhances orthodontic treatment planning and discover why Hogan believes technology will expand—not replace—the orthodontic profession.
What you will Learn in this Episode:
✅ How digital orthodontics and 3D printing technology are revolutionizing aligner manufacturing, with Align's development of variable wall thickness aligners that mimic the orthodontic digital workflow advantages of traditional brackets while reducing waste by 95%.
✅ The strategic reasons behind Invisalign cost comparison with competitors, including how comprehensive aligner treatment pricing differs globally.
✅ Why orthodontic IP protection matters for innovation, and how Align's billion-dollar investment in ClinCheck software and iTero scanner technology creates efficiency tools that reduce weekend treatment planning time for practitioners.
✅ Joe Hogan's perspective on AI in orthodontics and whether technology will replace orthodontists—plus how orthodontic practice efficiency improvements will actually expand the marketplace and enhance the profession rather than diminish it.
Subscribe to the Golden Age of Orthodontics and our sister podcast, Practice Talk, hosted by Lacie Ellis, wherever you listen to stay updated on orthodontic innovation and real-world practice strategies. Visit People in Practice for more insights and to connect with our team for practice growth solutions.
TIMESTAMPS:
00:00 Joe Hogan, Align Technology CEO, discussing the future of digital orthodontics and clear aligner technology innovation
07:18 Align's strategic focus on clear aligner therapy versus custom digital braces, and addressing the resurgence of brackets among younger patients
10:25 Joe defends Align’s IP, noting decades of innovation and significant R&D investment
13:36 Invisalign cost comparison explained: why US pricing differs from international markets, new flexible comprehensive aligner treatment options and marketing questions
22:56 Direct 3D printed aligners roadmap: CubiCure acquisition, bio-based resin development, variable wall thickness advantages, and orthodontic practice efficiency gains
28:58 AI in orthodontics and the future of the profession: why technology enhances rather than replaces orthodontists and expands the adult patient marketplace
KEY TAKEAWAYS:
💎 Align Technology is pioneering 3D printed aligners with variable wall thickness capabilities through their CubiCure acquisition, enabling customized force application—40 mils on molars versus 10 mils on incisors—that mimics orthodontic digital workflow advantages of traditional brackets while eliminating 95% manufacturing waste and promising future cost efficiencies for practitioners.
💎 Invisalign treatment planning efficiency has dramatically improved with 20-25% of cases now "touchless" requiring minimal orthodontist input at the end, thanks to ClinCheck software, iTero scanner technology, and cloud-based systems that free doctors from weekend treatment planning sessions and enable better remote orthodontic monitoring capabilities.
💎 AI in orthodontics will enhance rather than replace the profession according to Hogan, who emphasizes that clear aligner technology expanded the marketplace by bringing adult patients to orthodontics at unprecedented levels—top practices now see 50% adult patients versus the wire-and-bracket era when adults rarely sought treatment.
ABOUT THE GUEST:
RESOURCES MENTIONED:
QUOTES:
"I hope the orthodontic community can see it's not us telling them how to practice, but giving them tools to allow them to practice more efficiently and in a better way with their patients." - Joe Hogan
"If you go back to the complete analog data set and look at wires and brackets by nature, that process is constraining. You don't have a number of people who want to go through that process with wires and brackets. What did Invisalign bring to the market? It brought an adult population to the marketplace that never existed before." - Joe Hogan
SEO KEYWORDS: Golden Age of Orthodontics, Dr. Leon Klempner, Amy Epstein, Orthodontics, AAO, Joe Hogan, Align Technology, Digital orthodontics, 3D printed aligners, AI in orthodontics, clear aligner technology, how AI technology enhances orthodontic treatment planning, Orthodontic Digital Workflow, 3D Printing Technology, Invisalign Cost Comparison, ClinCheck Software, iTero Scanner Technology, Orthodontic Practice Efficiency, Analog Brackets and Wires
Transcripts
[00:00:17] Joe Hogan: Our Golden Age of Orthodontics podcast
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[:[00:01:56] How will digital orthodontics, artificial intelligence, clear [00:02:00] aligner therapy, remote monitoring, in-house printing, and other innovations change the way you practice? Join your host, Dr. Leon Klempner and Amy Epstein each month as they bring you insights, tips, and guest interviews focused on helping you capitalize on the opportunities for practice growth.
[:[00:02:28] Dr. Leon Klempner: Welcome to the Golden Age of Orthodontics. If you don't already know me, I'm Leon Klempner. I am the really tall guy you see at the uh, exhibit halls running around, interviewing, looking for new stuff. But I'm a retired board certified orthodontist. I also am the director of orthodontics at Mount Sinai Hospital here in New York, part-time faculty at Harvard and Montefiore Ortho Programs and the CEO of people in practice and the newly president elect.
[:[00:03:19] Amy Epstein: Thank you. Good to be here as always. I am Amy Epstein.
[:[00:03:42] This is like our 75th or 76th episode. So we've been doing this for some time. And my favorite part about what I do is the podcast, but also through people in practice, is. Being able to bring more information and more resources and more insight to [00:04:00] orthodontists about what sorts of technologies and what sorts of relationships and what sorts of understanding are impacting their business.
[:[00:04:41] He has 25 years of executive leadership across healthcare, industrial technology, global operations. Um, and he's also a very nice person when you talk to him and is very gracious to join us on the show multiple times. Uh, and so today we're gonna talk about Align's role in serving orthodontic [00:05:00] practices, what the next wave of innovations mean for your practice.
[:[00:05:08] Joe Hogan: Oh, thanks Sammy. Thanks Leon. Great to see you both again.
[:[00:05:29] Yep. But you've also, I've seen, been posting on the Facebook groups. Is that, so what was the, you you got some good? Yeah. Interaction there.
[:[00:05:54] And I got a flood of different topics. So there's a lot. A lot on orthodontist mine. And, [00:06:00] uh, before we, we started, I asked Joe, um, you know, if, is there anything off limits that you don't want me to talk about? And as usual, he said, no, you ask me anything you want. So this guy is, um, uh, a, you know, whether you like a line or you don't like a line, you gotta, like Joe Hogan, he's a straight shooter and he's honest.
[:[00:06:53] That's the way kind of, we see it unfolding as time goes by. So, um, I wanna [00:07:00] know, first of all, do you see it that way? And if so, does Align have any plans at all? To maybe move into the custom digital braces world, maybe acquire some of the leading brands that are out there now. So that's the first question.
[:[00:07:18] Joe Hogan: Well, my first answer to that question is I do see a future that when you look at orthodontics, it's gonna be digitally based for sure. And I think when we see it add, you know, the advances in our technology and what we do and how far we've come, even in the last five years, I'm even more sure that the future of orthodontists in general and orthodontics.
[:[00:07:53] Um, we're focused on clear aligner therapy. We really believe the clear aligners and particularly, uh, the advent [00:08:00] of 3D printed aligners are really gonna make a, a big difference in the world in the sense of how fast you can treat the specificity, the flexibility you'll have to treat too. So I see a digital future, the digital future for Align, you know, as I'm CEOI see around clear aligners and not, uh, a hybrid of some type.
[:[00:08:43] So have you noticed that, and, and do you have, how do you plan on addressing that trend?
[:[00:09:04] Uh, you know, there are certain demographics in the us. From a cultural standpoint that, uh, moved in that direction. And we've been very aware of that over the years, and I feel it's a trend. Um, I understand. Look, I'm, I'm a big personal preference person. I think a, a patient should ask what and have a kind of therapy and be able to apply that kind of therapy in the way that they want it done.
[:[00:09:40] 'cause I think when you look at the science, when you look at the comfort, uh, when you look at the hygiene and all those different things, it's, you know, for sure. I think the future is around digital aligners.
[:[00:10:00] Talking about behind the scenes they're paying close attention to align's legal actions against Stroman and Angel Align. What's the context now that we have you, that you would like? Orthodontists to understand about these cases, how it relates to align's long-term plan that that protects ip, but also allows for innovation that can help orthodontists Where, what's your perspective that you want them to understand?
[:[00:10:49] It's just not there. No. To, to do that journey for 28 years to where we are today, we had to spend a lot of money and develop technology that we know promotes orthodontics, the movement of [00:11:00] teeth, uh, the scanning of teeth, how fast you can move these things, what direction, all those algorithms and different things.
[:[00:11:27] They, they produce certain products. Those products can be good or whatever aligns. We're kind of a unicorn. We're a technology company. We're founded on technology. It's at, you know, there's Silicon Valley, is where, you know, it was born and majority of our engineering team is still there today. And so the, the short and long answer to your question is we'll defend that it's the right of our shareholders, the right of this business.
[:[00:12:07] And that's predominantly, you know, the basis of, of the lawsuits that we have out there today.
[:[00:12:14] Joe Hogan: I hope that makes sense because I mean that's Yeah. If you're, if you're in tech, uh, IP and that, that is such a precious asset and commodity. Yeah. And you earn that with money and sweat and people's, and, you know, people's ambitions and what they wanted to do, and it's, it's emotional and it's important to us.
[:[00:12:49] The customer and also the supplier at the same time. And understand maybe,
[:[00:12:56] Amy Epstein: too, know. Oh no, not you. I'm saying as an orthodontist, it's hard to see the, [00:13:00] the perspective of align as well as seeing the, you know, on the ground potential challenges that could, that could come out of it.
[:[00:13:25] There's just a certain amount of, and this is the way our society works, is that you have to earn where you go. And in these cases we think that's our technology and we brought that to the marketplace.
[:[00:13:49] You know, I, I get to look up. Sure. Some of the, the, the p and ls and, you know, the line items for, for lab costs are high. Uh, it's a digital [00:14:00] world as you stated before, so orthos need to, uh, you know, adapt to some new technology that costs money. Invisalign is priced higher than its competitors. Um, and my understanding, and correct me if I'm wrong, but that, um, internationally, um.
[:[00:14:29] Joe Hogan: Yeah, I would say that, um, it's true and it's not Leon and not like I'm a politician or something. Okay. Is if you take a, a country like India, uh, we've vet substantial growth in, or Turkey recently too, or different parts of the world.
[:[00:14:55] It's just the us We have broadly a comprehensive business around the orthodontic community overall, [00:15:00] and that happens to be our high, most highest price product as it should be. 'cause there's, you know, more aligners and more technology associated with it. Um. Yeah. I'd also say too that we've changed our, our positioning on comprehensive.
[:[00:15:27] We'll give you a price for comprehensive that can be very competitive. If you're confident that, you know, and we'll allow you to, you know, buy aas, uh, additional aligners at a certain period of time. So we're gonna be as flexible as we possibly can to reach out to the orthodontic community to give them choice in that situation.
[:[00:16:08] But you know, if we're gonna translate. Invisalign's, uh, higher cost or, you know, more investment in that. How does that translate into a more beneficial technology or service and technology to patients?
[:[00:16:28] Amy Epstein: Yeah. I mean, what is the, what is the competitive edge that you would say orthodontists should communicate to patients now?
[:[00:16:35] Joe Hogan: that's, that's a good que but first of all, I'd say that, um, when you look at our product line, overall, the brand is really important. It's well known. We spend. Literally hundreds of millions of dollars is supporting that brand. So, and that's so that person will walk into that doctor's office and ask for Invisalign in one way or another.
[:[00:17:12] And, we'll, we want to make sure that people that are using Invisalign brand, that we keep moving those patients through. Secondly, I'd say, why would you use Invisalign in general? Uh, hey, look, I think we still, when you, we tried to make this as efficient as possible for orthodontists. Our scans with an iTero scan is how fast those scans are today, how much work, if you use our IPP, our personalized plan with claim check live and different things.
[:[00:17:56] Working constantly to try to do new cases of different things. And [00:18:00] we really moved into their personal time and, and again, we spent hundreds of millions of dollars to be able to make ClinCheck easier. We moved it to the cloud, obviously away from servers several years ago, uh, with ClinCheck live or signature experience that I can go through.
[:[00:18:33] And so I hope the orthodontic community can see it that way, that it's not us telling them how to practice, but giving 'em tools to allow 'em to practice more efficiently and, and maybe in a better way with their patients too. Mm-hmm.
[:[00:18:56] I think that being able to show them and, and use some of the tools you have [00:19:00] as sales tools as well Yeah. To the patient is, would be super important. Um, a question for you that comes up, um. With our clients and because we develop websites and we manage content on websites and we're involved in search engine optimization.
[:[00:19:37] They'd be able to make a decision about
[:[00:19:52] But I would say it's not draconian in any way. Like if you happen to use other aligners at some point in time where it's gonna, you know, kick you to the [00:20:00] curb, that's not. Our intent here at all.
[:[00:20:02] Joe Hogan: Uh, but we certainly want to make sure that we're, when we, you know, obviously invest in our brand to such a degree, uh, that the patient ends up getting what they want.
[:[00:20:28] Joe Hogan: I'm saying that there's guidelines around that, Leon, if they talk to their, um, they talk to their their salesperson, then we'll get the information to 'em to support that.
[:[00:20:57] Uh, our salespeople wrestle with it all the [00:21:00] time. When I say it's not draconian, I mean dock lock in the end is the facilitator of that kind of interest, right? The more cases you do in Invisalign, the higher you're gonna be on the dock lock profile, and that's important and it's, it's one of the things that work out.
[:[00:21:29] And so I think just for the doctors to have concerns about this, really contact your salesperson, we're very, you can be very descriptive in the sense of what's allowed and what's not allowed.
[:[00:21:44] Sure. Yeah. And so being in con, you know, close con communication about what the guidelines are will be important. So we'll have our, our, uh, clients reach out to reps and have those conversations.
[:[00:21:57] Dr. Leon Klempner: Okay. Let's talk about my favorite subject, [00:22:00] ai.
[:[00:22:01] Dr. Leon Klempner: So, um, couple of things come up for me. Uh, one of them is, um, I know that, uh, align purchased a direct printing company in Europe Yes.
[:[00:22:15] Joe Hogan: That's right.
[:[00:22:40] And if there are, uh, uh, efficiencies using ai, which it seems that they will clearly be, um, can orthodontists expect to maybe, you know, get a little bit of break on costs again? Mm-hmm.
[:[00:23:03] And we can, we can verify that. Um, we, the resin, we've had to develop the resin, uh, simultaneously with a process too. And so we had a. Uh, an agreement with the University of Vienna, uh, real experts in certain types of 3D printing, um, that we move forward with. Over a period of years, we identified a resin and qualified a resin that, uh, that we know works today that we 3D print aligners with today also.
[:[00:23:46] And that's where Cubi Court came in because they were founded, uh, through the University of of Vienna originally to be able to print high viscosity resins. And so as it stands today, we have a formulation and we're not at scale, but we know how to print those on the cubicle machines. And [00:24:00] now. We have to do something that really no other company in the world's ever done, like we've done before, is learn how to print, you know, a million of these a day is, you know, basically what, what what we do.
[:[00:24:24] It's al it's bothered me from the time I've been here that we haven't been able to vary wall thickness because, uh, in a, in a vacuum form process. So, look, I, let me back up. So, so that the audience understands this directly. So we're the biggest 3D printing company in the world. It's ever existed, but we don't 3D print anything.
[:[00:24:59] Uh, the waste [00:25:00] in that process is 95%, meaning you end up with the molds mm-hmm. That are basically scrapped, that you can thermally recycle some way, or we found some other tech things you could do. But it's a, it's a brutal kind of recycling. Uh, and, and so that 95% of that waste is, is kind of crazy. So you're, you're one, you're sacrificing a lot of productivity that you're losing from that waste.
[:[00:25:38] But if you could put 40 mils on molars or different things, you can change the whole scope of how fast you can move teeth and the accuracy, you can move those teeth. And I'll bring AI into that equation too and how we'll use that overall. And then plus we're using it with a material base that's gonna be a lot less scrap.
[:[00:26:07] Dr. Leon Klempner: Well, did I hear you say that there'd be some cost benefit to the end user?
[:[00:26:16] Joe Hogan: No. There has to. At some point in time, this will be a more efficient product in the sense of how we manufacture it, but this is gonna be much more efficient for orthodontists too, uh, in the fact, in the way the material behaves. And I don't want to go into too much detail. I bother you all day.
[:[00:26:48] The other question you had is, what, what will we see first? Our first product will be an Invisalign first retainer. So, you know, how do you retain the dentition, uh, and the morphology is when you, you know, obviously [00:27:00] you do a palate expansion of some type. Um. In, in some ways splitting the suture or not, like with IPE or not, or using Invisalign first.
[:[00:27:24] And they're singular units. It's not like trying to, you know, print a hundred aligners. Or
[:[00:27:28] Joe Hogan: Uh, you know, a, a case, you're gonna do these singularly and it'll allow us to be able to ramp up in those applications as we, we have to scale resin, which has never been scaled, uh, to thousands of metric tons like this.
[:[00:27:47] Dr. Leon Klempner: Yeah. Yeah, for sure. So I'm
[:[00:27:49] Dr. Leon Klempner: at the clock.
[:[00:27:57] And hopefully that translates well, that if you can [00:28:00] vary, you remember. We can also add attachments. Uh, we can do cut lines. Uh, when you think about occlusal box like man, advance with occlusal box, we can vary, uh, the size of those occlusal box throughout the case. It's just the design flexibility is so exciting for everybody involved in the, in the, in the project overall, and we hope to trans be able to translate that excitement to the marketplace here soon too.
[:[00:28:22] Dr. Leon Klempner: I get it?
[:[00:28:23] Dr. Leon Klempner: so I'm looking at the clock and. I wish we had you for much longer period of time, and, and we'll certainly always be inviting you back, but I just wanna get this last question into you and, and it relates to something you said earlier about, uh, making it easier for orthodontists. So they have to spend less time and, and, um.
[:[00:29:10] Joe Hogan: Hmm.
[:[00:29:37] I want to hear what you have to say about this particular topic.
[:[00:29:56] It'll continue to be a great profession. I feel this technology grows [00:30:00] your marketplace. I think with, if you go back to the complete analog data set and you look at wires and brackets by nature, that process is constraining. You just don't have a number of people that want to go through that process with wires and brackets.
[:[00:30:34] And I see this technology in so many dimensions enhancing the marketplace. I don't see it as a direct to consumer market. That market blew itself apart through Smile Drug Club obviously, and other pro other companies all around the world to try that. It's not, you need a doctor in this process. Moving teeth through bone is critical.
[:[00:31:09] And the way that we'll set this up will really add productivity to the profession. I hope. I hope that makes sense.
[:[00:31:20] Amy Epstein: also the name of the podcast is The Golden Age of Orthodontic.
[:[00:31:25] Joe Hogan: No, I think it's, it's such an exciting time to be an orthodontic, so please tell 'em that they went into the right profession and it's gonna be great.
[:[00:31:33] Amy Epstein: Well, that's how we feel. That's why the podcast has its title. And that's why when we talk to technology providers and systems providers, we, um, you know, we, we do believe that this will enhance the, both the patient experience. Also the doctor's experience in delivering the care. So, um, thank you for, uh, providing us with an excellent end to this [00:32:00] episode of the Golden Page of Orthodontic Podcast.
[:[00:32:04] Amy Epstein: right on brand. We appreciate you being here. As always, happy Thanksgiving to you and your family if we don't talk to you beforehand, and we hope to have you. Back on the show again next year.
[:[00:32:26] And Amy, it's, uh, pat, really pleasure to see you again too. So
[:[00:32:51] Uh, we have a team across the uni, the US and Canada, and we, uh, would be happy to talk to you about any of the challenges that you might be facing. Thing [00:33:00] you can visit our website@pplpractice.com to, uh, reach out. It. There's a little thing that will pop up that says, you know, talk to Leon. It's, I'm really here.
[:[00:33:25] Dr. Leon Klempner: Thank you Joe. We really appreciate Thanks you coming on and taking all these questions and um, you know, to your credit, um, you know, uh, you've always given us car blanche to ask you anything and, uh, we sincerely on behalf of the profession, we appreciate it.
[:[00:33:44] Joe Hogan: Thanks Dion.
[:[00:34:04] if
[:[00:34:04] Amy Epstein: wondering how AI search is going to impact your SEO or your website or your visibility, all of these things.
[:[00:34:37] Narrator: Thank you for tuning in to the Golden Age of Orthodontics. Subscribe now on Apple Podcasts, Spotify, or visit our website at the golden age of orthodontics.com for direct links to both the audio and video versions of this episode.
