In our previous blog post, we discussed the impact of the economic downturn on the clear aligner market and why Align Technology (ALGN) is its leading manufacturer. Another aspect of how ALGN has maintained a stronghold in the market is through its exclusivity with iTero scanners which locks in dentists into using their products. ALGN refuses to accept third party scans which has pressured providers who offer Invisalign to invest large sums of money into iTero scanners. Some dentists have begun shifting towards in-house aligner printing and other manufacturers to cut costs.  

Below are various expert orthodontists and dentists who explain how iTero scanners are not meeting up to their expectations and why some are moving to in-house printing. You can gain access to these expert call transcripts for a free 14 day trial at Stream by AlphaSense.

Invisalign’s iTero Scanners are Binding

Invisalign refuses to receive scans from third parties and can get away with it

“There’s an interesting element that unless you have their scanner, you can’t use the scanner with Invisalign. It’s an interesting play because they always know that they’re the best aligner, clear Aligner Technology out there. If they didn’t feel confident that they had cornered the market, I don’t think that they would be pushing so hard.

If you have another scanner, [Invisalign] will not allow you to send them scans from those other scanners, even though they have the technology [to] receive them. They’re just refusing to because they want you to go on and buy their scanner. The only way they’re able to get away with that.”

-Dentist, Aesthetic & Implant Dentistry of Atlanta

Even though ALGN has the capability to receive them, like at the start of COVID-19

“The only time that [Invisalign] has allowed scans from other [parties] that I remember was right at the beginning of COVID. They made an exception because they were having issues. They obviously were freaked out about receiving impressions through the mail in the COVID risk potential, that they allowed for scans from other third-parties, but then they stopped again.”

-Dentist, Aesthetic & Implant Dentistry of Atlanta

According to one orthodontist, Invisalign is very annoying

“I have an iTero scanner in both of my practices. Invisalign is very annoying. They used to accept scans from other scanners that general dentists can use too. General dentists can use iTero scanners as well, but iTeros are more expensive and they’re more clunky. It’s definitely an investment to get an iTero, and it does obviously make you somewhat bound to Invisalign because you’ve made that investment. Now if the other companies start accepting iTero scans as well, then that’s an incentive to work with those brands.”

–Orthodontist, Madison Dental Group

iTero Scanners are Losing Value

Various orthodontists feel that while iTero scanners are a good option, they are not significantly superior to other scanners especially from a file management standpoint.

iTero Scanners do not provide enough value to one orthodontist’s practice

“The animations of their teeth moving, there was no real significant difference in the percentage of people accepting my treatment options versus my own office where I was not using an iTero. I never found the real value of using an iTero for case conversions, which I think is one of the biggest selling points…

There’s still some incremental costs for the bits of the scanners and other things, and it just didn’t seem for me to provide enough value. I have definitely thought about some of the less expensive scanners, but they don’t integrate quite as well with the Invisalign aligner company. I haven’t quite seen the full value and potential of iTero.”

–Orthodontist and Owner, Salt River Orthodontics

Another orthodontist believes that file management for scanners are laborious and is open to other options

“[Itero Scanners are] easier now to use with anything than it used to be. There’s been some workarounds of the original headache of having to download a scan, upload a scan. EasyRx has come around, acting as a middle man to make life easier there…

You used to have to get your scan, physically download it, and then physically upload it to whatever software you’re using. If you’re using 3M, you have to download the scan, drag it over, and upload the scan, and the files that are not small.

My scanner is about four years old, obviously, it’s the iTero. At the time I looked at a lot of scanners and I felt like it was the easiest to use… It was a good scanner, it was easy and yes, it was expensive, but so are all scanners. If I get to the point of having to buy another scanner, I would be open to the different scanners, user-friendly, and work with what we were doing.”

–Orthodontist, Vac Orthodontics

Cloud file connectivity is valuable which Invisalign is missing

“The probability of me acquiring an iTero specifically, I would say, is probably fairly low-ish, maybe 10%-20%. That’s different than any scanner. I think any scanner I would go much higher than that, maybe 80% or 90%, but the iTero, it does certainly have its benefits working with Align. Align has substantially higher fees than say 3M or in-house printing or some of the other Henry Schein aligners or something like that. The benefits of sticking with an iTero don’t seem that big to me.

I’ve looked at, I can’t remember all the names for everything, I think it’s AirStreams. The way that they do their incremental cost structure and the way that you can save the patient files on your own server instead of uploading it to the cloud. I don’t know with Align. That to me is a valuable thing. An iTero specifically, I’d say it’s very low, although it does have some unique features. It wouldn’t be probably my number one choice because of the costs and the seemingly less flexible nature of the iTero versus some of the other scanners.”

–Orthodontist and Owner, Salt River Orthodontics

Shifting towards In-House Printing

Cost pressures and the pandemic have led some orthodontists to consider in-house printing options to cut out the middleman entirely.

COVID led one orthodontist to move entirely to in-house printing

“During the closures of everything in 2020 is when I was always interested in 3D printing more for retainers… To make it in the office, you either take a scan with your iTero or you take an impression with the goopy stuff, alginate, and then you take the goopy impression you can pour it up into a model and then you make a retainer.

With the 3D scan, you either had to send it to someone else to make a retainer or you had to have it printed and made. You had to have a middleman to make the retainer, unless you wanted to do the impression. That’s the old way. During the pandemic, I bought a cheap 3D printer because actually the thing that pushed me over was I had people lose retainers during the closure and they were freaking out that their teeth were going to move.

I started it that way, and since then, now I have three cheap printers and we print all retainers. I can go from a scan to a print to a retainer all in-house. I cut out the middleman, and now they don’t have to have the impressions, the goopy stuff, like that.”

–Orthodontist, Vac Orthodontics

In-house printing is laborious but feasible for smaller practices

“You train a dedicated team member to make sure everything’s printed well. Printing is pretty laborious too because you have to load the STL files and then the 3D printer prints them, and then you have to take it off, you have to cure it, you have to wash it.

You have to make the suck-down mold and then cut that mold, which is really frustrating sometimes, and then you have to polish that. It is a lot of work just for one tray. A lot of these patients, they don’t have just one tray, they have 18. It’s a lot of work.

Usually, I remember the threshold amount, this is arbitrary depending on what resin you use and what materials, and the price point at which you get your materials. If there was a private practice with one clinician and two assistants, it does not make sense to do more than 18 trays. I would say if it’s somewhere below 12-18 trays, then that might be worth it.”

–Associate Orthodontist, Private Practice

Although one orthodontist doesn’t have any desire to move to in-house printing

“For the transition to [3M], just not a huge push for me right now. I definitely like 3M. I haven’t heard many people talking about it recently, but I definitely had a good time with [3M] and I would like to be moving back in that direction, if not in the future doing in-house aligners. Where I am right now, I don’t have any desire to move to in-house [printing], but I wouldn’t mind going back to the 3M.”

–Orthodontist and Owner, Salt River Orthodontics

ALGN may not be able to maintain its lead in the clear aligner market as product gaps close and dental practitioners seek other cost effective solutions. We have seen a slight waiver in ALGN’s strict first-party policy during the COVID pandemic, so it may be possible for it to open again in desperate times. Especially given ALGN’s Q2 earnings recently posted in July, they may have to become more flexible.

Keep your finger on the pulse with us here on Stream for more posts about the healthcare sector!

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