Joe Hogan sees a lot of smiles. When people ask him where he works, he responds with “Align Technology,” which inevitably prompts the follow-up, “What’s that?” It’s the $12 billion company behind Invisalign, the discreet, clear plastic aligners worn approximately 22 hours a day that gradually shift teeth into better alignment. After months, sometimes years, this alternative to traditional braces promises to deliver smiles patients are eager to showcase. Hogan, the CEO of Align Technology, is at the forefront of a significant transformation within the company, aiming to expand access to these transformative treatments.
Align Technology is currently undertaking its most substantial manufacturing overhaul since its inception 29 years ago, founded by two Stanford Graduate School of Business classmates. The company is preparing to transition to directly 3D printing the aligners that form the core of its business. This move represents a departure from its previous, more time-consuming and potentially wasteful process that involved creating molds. Hogan anticipates that a successful transition could lead to reduced production costs and, consequently, more affordable treatment options for a wider patient base, thereby boosting Align Technology’s overall profitability.
This strategic shift is also poised to solidify Align Technology’s position as the world’s largest user of 3D printers. While Hogan himself is not a founder or a scientist, he brings a wealth of experience as a manufacturing veteran. His background includes over a decade at Align Technology, during which the company’s share price has tripled. This impressive growth trajectory has seen Align Technology successfully navigate market challenges and surpass competitors. Last year alone, the company managed a record 2.6 million cases, including a significant number of 936,000 pediatric and teenage patients. Globally, over 22 million patients have benefited from Align Technology’s expanding portfolio of aligners.
The company’s integrated approach encompasses nearly every stage of the treatment process. This includes the development of intraoral scanners used to map patients’ teeth, sophisticated AI-powered software that assists clinicians in treatment planning, and the advanced machinery that will soon be responsible for producing aligners and retainers. Hogan is confident that this foundational control over its ecosystem will pave the way for decades of continued growth.
In a recent interview with WIRED at Align Technology’s lab in Silicon Valley, Hogan elaborated on his vision for the future, offered advice to patients, and discussed his perspective on the evolution of orthodontic treatment.
The Evolution of Orthodontic Care
WIRED: Have you ever been an Invisalign user? What has your personal journey with dental alignment been like?
Joe Hogan: My understanding of dental alignment was minimal before joining Align Technology. I wasn’t even aware of how teeth moved throughout one’s life. To gain a comprehensive understanding, my first step was to undergo a dental scan and initiate treatment myself. This was a decade ago. I must admit, I’m not always as diligent with my retainers as my wife, Kate. She often reminds me, "You’re not a doctor, Joe. You just run the company." Despite my occasional lapses, the personal experience has been highly informative.
WIRED: Invisalign commands a significant portion of the clear aligner market globally, estimated between 60% and 70%. However, within the broader dental industry, where does Align Technology stand?
Joe Hogan: We position ourselves not as a general dental company, but rather as an orthodontic specialist. Last year, our revenue reached approximately $4 billion. When assessing our position within the orthodontics sector, our primary benchmark is traditional wire-and-bracket braces. In this comparison, there is no other company that comes close. To provide some financial context, we generate roughly $3 billion from aligner sales, $800 million from scanner sales, and about $3 million from retainers. This clearly indicates our substantial market leadership in orthodontics.
Pioneering Mass Customization Through 3D Printing
WIRED: What factors have contributed to Align Technology’s success where other companies have struggled to gain traction?
Joe Hogan: Time and innovation have been critical. We were pioneers in what I refer to as "mass customization," achieving the capability to 3D print a million distinct aligners daily. This was a multi-year endeavor to perfect. In the early days, companies in this space would celebrate if they managed to produce five cases a day. Our challenge was to significantly modify existing 3D printing equipment, as most 3D printing technology at that time was geared towards prototyping.
The team at Align Technology, even before my tenure, dedicated themselves to mastering the production of these aligners at an unprecedented scale. This first-mover advantage extends beyond clinical setup, material science, and the technical aspects of case management; it fundamentally lies in our ability to produce at scale.
WIRED: Your colleagues have suggested that Align Technology is likely the largest user of 3D printing machines globally.
Joe Hogan: It’s not a matter of probability; we are by far the largest user. This assertion is corroborated by two independent 3D printing industry experts who confirmed to WIRED that Align Technology prints more parts in-house than any other entity worldwide.
WIRED: It seems remarkable that a $4 billion business is the leading consumer of 3D printing technology, rather than a company with hundreds of billions in revenue.
Joe Hogan: That was my initial reaction as well when I joined the company. The broader 3D printing industry had not achieved significant scale, often catering to a niche market of hobbyists. Upon my arrival, I realized that we weren’t actually 3D printing the aligners themselves. Instead, we were 3D printing molds and then using vacuum forming to shape plastic over them.
Shifting Demographics and Evolving Treatment Goals
WIRED: Historically, straightening teeth was primarily driven by aesthetic concerns for a better smile. What percentage of cases today are for beauty versus functional health?
Joe Hogan: Over the past three to four years, we’ve observed a significant increase in cases driven by functional needs. When I first joined, our focus was predominantly on aesthetics, and our patient demographic was largely comprised of women within a specific age range.
However, there’s been a growing awareness within the industry regarding the long-term benefits of improved dental hygiene, such as easier teeth cleaning and better flossing access due to improved spacing. Looking ahead, I anticipate a 50-50 split between aesthetic and functional motivations. Younger patients will likely continue to prioritize aesthetics, while older patients will be more focused on maintaining their oral health for life.
WIRED: During my own Invisalign process, I sought out studies on its efficacy compared to traditional braces. It appeared that many of these studies were conducted on a narrow demographic. What steps is Align Technology taking to broaden its research, especially as it expands into new global markets?
Joe Hogan: As we expand into regions like the Middle East and Asia, we encounter diverse dental anatomies. For instance, China’s dental alignment patterns differ significantly from Japan’s. Consequently, we must adapt our technology accordingly. To effectively address these varied demographics and nationalities, we are investing heavily in expanding our product portfolio. While Hogan declined to cite specific public studies with broad racial demographics, the company’s commitment to adapting its technology highlights an awareness of diverse patient needs.
WIRED: You’ve recently placed a strong emphasis on products for teens and children. Was this a response to market demand?
Joe Hogan: I recall using an Essix device to expand my younger child’s palate in 1993. The process involved a daily manual adjustment with an Allen wrench, which was quite uncomfortable and often met with resistance from my child. I remember sending my wife in, saying, "You have a better way with him." I was, frankly, a bit of a coward about it.
Upon joining Align Technology, this memory resurfaced, and I discussed with the team innovative ways to achieve palate expansion. Our current focus is on developing solutions that can incrementally expand palates nightly, making the process significantly less arduous for both parents and children compared to the manual turning of a screw.
Navigating Pricing and Patient Experience
WIRED: One of the most significant frustrations, particularly in the North American market, revolves around pricing, exacerbated by the complexities of dental insurance. Invisalign treatments can range from $3,000 to $8,000, yet your average selling price to doctors is approximately $1,200. Could you clarify this pricing structure?
Joe Hogan: It’s important to understand that Invisalign is a medical device, and we do not set the final price for consumers. We charge doctors for each case, which is determined by factors such as the number of aligners required. The doctor then determines their pricing for the patient. Orthodontists often charge more for pediatric cases, perceiving them as more complex. General dentists, who primarily treat adults, have their own pricing structures. Ultimately, our product cost represents approximately 25% of the total price paid by the consumer.
While we may charge less for international markets, this is often due to the nature of the cases, which might involve fewer aligners for moderate corrections. This allows doctors to charge less as well. However, orthodontic treatment is inherently expensive and time-consuming, making it one of the more costly medical procedures.
One of our significant expenses is shipping. We are among the largest small-volume shippers globally, and as we’ve reduced our internal production costs, transportation expenses have become a more prominent factor. While our profit margins are healthy, they are not extravagant.
WIRED: During my treatment, I was advised to eat with my aligners in and cautioned about foods that could stain them. Is there potential to develop a plastic material that is stain-resistant, allowing for unrestricted eating?
Joe Hogan: My advice would be to refrain from eating with your aligners in. We cannot always control the precise communication that patients receive. However, eating with aligners can increase the risk of cavities, permanent tooth discoloration, and compromise the fit of the aligners. The outer layer of our aligners is made of polyurethane, a soft plastic designed to grip teeth effectively, while the inner layer is polyester, providing the rigidity needed for tooth movement. Achieving a material that is both highly effective for tooth movement and completely stain-resistant presents a significant material science challenge.
The Dawn of Direct 3D Printing for Aligners
WIRED: You’ve mentioned the goal of directly 3D printing aligners. This implies a breakthrough in material science for a resin that can be processed by these machines.
Joe Hogan: We believe we have achieved that breakthrough. This conviction led to our acquisition of Cubicure in Austria. The inability to directly 3D print aligners was a persistent challenge. We explored collaborations with various chemical companies, but none could meet our stringent requirements. We subsequently hired our own polymer chemists and, over time, developed a resin with the necessary properties to be 3D printed, mirroring the performance of our current vacuum-formed material.
Our research indicated that high-viscosity resins were essential to achieve the complex material properties and performance characteristics required for our applications. Watery resins were insufficient. This is precisely why we acquired Cubicure, as their machines are engineered to process high-viscosity, performance resins. We now possess a resin that is comparable to, or even superior to, our current SmartTrack material, along with a viable process for 3D printing aligners. The scale of this operation is immense, requiring the production of a million aligners per day, and we are currently implementing a completely new manufacturing process to achieve this.
WIRED: What are the primary scaling challenges associated with this direct 3D printing approach? Is it solely about machine capacity, or are there other factors at play?
Joe Hogan: The challenges are multifaceted. We must optimize the printing process to minimize resin usage. This involves determining the optimal printing orientation – vertically, horizontally, or even sideways. We also need to strategize the placement of sprues, the channels through which the material flows, whether on the exterior, interior, or label side. Furthermore, the method of removing excess material, such as laser cutting, needs to be refined.
In our previous vacuum-forming process, laser trimming of the gingival margin was relatively straightforward. Direct 3D printing introduces a fundamentally different set of complexities. It’s a dynamic and intricate engineering problem. Our aim is to ensure that this new process is not only efficient but also profitable at scale. While we anticipate that resin costs will decrease over time with increased volume, this is a long-term projection that will take years to fully realize.
Addressing Patient Concerns and Future Innovations
WIRED: Are patients who chew with their aligners in at risk of ingesting microplastics?
Joe Hogan: We have not received any complaints related to microplastics during my tenure. It’s important to differentiate between validated scientific concerns and unsubstantiated claims. Plastics are widely used in the medical field, and their composition varies significantly. When selecting materials for oral applications, we rigorously avoid any components with known toxicity. This ensures that our materials meet FDA and regulatory approval standards, confirming their safety.
WIRED: During the treatment plan, I often wished for a way to predict which aligner would cause the most discomfort. AI seems like a potential solution for this, given the wealth of data you collect.
Joe Hogan: That’s an interesting observation, as another individual recently shared a similar sentiment with me. My son, Tyler, also mentioned this. The correlation between specific aligners and periods of discomfort is something we’ve discussed. While my initial suggestion to our R&D team was met with skepticism, having two independent data points now makes it a more compelling area for investigation. We acknowledge that significant tooth movement can lead to discomfort, and we are exploring ways to better predict and manage this experience for patients.
WIRED: Regarding treatment efficacy, I noted that "touch-up cases" shipped last year increased by 36% to over 136,000. Shouldn’t this number be decreasing, indicating fewer necessary adjustments?
Joe Hogan: The "touch-up" designation typically refers to situations where a patient has not consistently worn their retainers. In such instances, a doctor may recommend a series of additional aligners, usually between five and fifteen, to address minor relapses, such as slight crowding. While an increase in this metric might seem concerning, it’s often a reflection of patient compliance and the need for minor correctional adjustments rather than a fundamental flaw in the treatment efficacy itself.
Re-shoring Manufacturing and the Future of Braces
WIRED: There’s a strong sentiment in the US currently advocating for the repatriation of manufacturing. Given your current operations in Mexico, Poland, and China, is it feasible to bring aligner production back to the United States?
Joe Hogan: It is a possibility. Labor costs are a significant factor in manufacturing. As our production processes become increasingly automated, manufacturing in the United States could become economically viable. We will certainly evaluate this option as it becomes more practical. The cost of shipping, which we’ve discussed, is also a factor that could influence this decision.
WIRED: Could you estimate the number of individuals involved in the current production of aligners in Juarez, Mexico?
Joe Hogan: Thousands of people are involved in our operations in Juarez.
WIRED: That seems substantial. Is it not primarily a machine-driven process?
Joe Hogan: At this scale, 3D printing is a complex operation that requires a significant human element. Beyond the printing itself, there are numerous post-processing steps. Aligners need to be bagged, and sometimes undergo specific treatments. It’s a highly labor-intensive environment, resembling the bustling activity of a large retail store.
WIRED: It seems counterintuitive, considering the relative simplicity of an aligner compared to a product like an iPhone with hundreds of components.
Joe Hogan: While the end product may appear simple, the manufacturing process is remarkably sophisticated. Our facilities utilize centrifuges for resin recovery and employ extensive washing stations. Even with the integration of 3D printing, there remains a substantial need for skilled labor and oversight. We also employ numerous software engineers to manage the complex digital workflows. As we transition to direct 3D printing, we anticipate a reduction in the labor component. As a US citizen, I am supportive of domestic manufacturing. However, trade agreements like NAFTA have historically benefited our operations, and our decisions are guided by what is most advantageous for the business.
WIRED: In the current political climate, and with discussions surrounding the FDA, do you perceive the FDA as a reliable benchmark for approval?
Joe Hogan: Generally, I view the FDA as a competent regulatory body. Much of the current debate surrounding the FDA often pertains to vaccines, which is beyond my area of expertise. Our interactions with the FDA concerning the testing and approval of our materials have remained consistent. I find their oversight to be robust and adequate. Throughout various administrations, I haven’t observed significant shifts in their approach, which I believe is beneficial. The complexities of vaccine policy are best left to those with specialized knowledge.
WIRED: Do you foresee a future where traditional metal braces become obsolete?
Joe Hogan: Predicting the complete disappearance of traditional braces is difficult. We are confident that our technology can achieve all the outcomes of wires and brackets, often more rapidly and with greater patient comfort. Ultimately, the decision rests with the patients. We are committed to demonstrating the advantages of our approach. However, I find it hard to imagine that in 20 years, people will still opt for metal and wires when the functionality is no longer essential. There may always be a segment of the population or a subset of practitioners who prefer traditional methods, and we fully support that freedom of choice.