How Invisalign Became the World’s Biggest User of 3D Printers

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 hellish and expensive pieces of clear plastic worn about 22 hours a day that brute force teeth into better alignment. After months, sometimes years, the discrete rival to braces promises to give people smiles they will want to show off. Hogan gets a look at them all. And he’s eager to see more.

Align is embarking on its biggest manufacturing overhaul since it was founded by two Stanford Graduate School of Business classmates 29 years ago. The company is preparing to begin directly 3D printing the aligners at the core of its business, ditching what Hogan describes as a longer, more wasteful process that involves making molds. A successful transition could lower costs and make treatment more affordable in the long run, bringing Invisalign to more customers and boosting Align’s profits.

It also, according to Hogan, would entrench Align as the world’s biggest user of 3D printers. Hogan isn’t a founder or a scientist, though he has raised honeybees for over 25 years. He also doesn’t have a Wikipedia page, despite having run three multibillion-dollar international companies. But he’s a manufacturing veteran who knows about plastics and 3D printing, especially after over a decade at Align.

Shares of the company have tripled in price during his tenure as it outlasted failed upstarts and surged past other competition. Align handled a record 2.6 million cases last year, including a high of 936,000 kids and teenagers. Altogether, 22 million patients globally have worn Align’s growing portfolio of aligners.

The company controls nearly every step of the process. It develops the scanners that map patients’ teeth, the AI-powered software that helps doctors plan their treatment, and the boxy machines that will soon drip out aligners and retainers. On that foundation alone Hogan expects decades of growth ahead.

Last month, Hogan spoke with WIRED at Align’s lab in Silicon Valley about his predictions for the future, his tips for patients, and why he believes my recent Invisalign experience was an anomaly.

This interview has been edited for clarity and length.

WIRED: Have you ever been an Invisalign user? What's your journey with teeth been like?

Joe Hogan: I didn't know anything about teeth before I came here. I didn't even know how teeth moved your entire life. The first thing I did is I got my teeth scanned and started a treatment so I could really learn. So that was 10 years ago. I can't tell you that I always wear my retainers. My wife always wears hers. I tell my wife sometimes and I say, “Kate, you don't have to wear them every night, like every other night.” She goes, “You're not a doctor, Joe. You just run the company.” But the journey was good.

In the clear aligner market globally, Invisalign represents 60 percent to 70 percent of the market share, but within all of dentistry, where do you sit?

We're not a dental company. We're an orthodontic company. We did roughly $4 billion in revenue last year. If you look at what we measure on orthodontics, you have to measure against wires and brackets. There's no one even close. I don't want to be overly business to you, but we sell roughly $3 billion of aligners and $800 million of scanners. Then we sell roughly $3 million of retainers. So there's no other company in orthodontics that large.

What allowed you to succeed where other companies have not taken off?

It's time. We were the first ones to what I call mass customization, to be able to 3D print a million different aligners a day. It took us years to figure out how to do that. When these guys started, if they did five cases a day, they were excited. We had to take 3D printing equipment and modify it massively because most 3D printing was a prototype business at that point in time.

This team—this was before I got here—had to learn how to make these things at mass and at a scale that has never been done. I'd say we have a massive first mover advantage of not just the clinical setups, the material science, and the technical part of how you set up cases, but also the raw how you produce this at scale.

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Your colleague was saying that you're probably the largest user of 3D printing machines.

Not probably. By far. [Two 3D printing industry experts tell WIRED they agree that Align prints more parts in house than anyone in the world.]

That seems crazy to me that a $4 billion business is the biggest consumer, not one of the businesses that have hundreds of billions of dollars in revenue.

That seemed crazy to me when I walked in too. That whole industry got lost because it really wasn't scaling. It was trying to appeal to a whole number of hobbyists. When I came in here, I realized that we really didn't 3D print those aligners—that we were 3D printing molds and vacuum-forming a plastic over them.

When I was growing up, people were trying to straighten their teeth to have better smiles, not necessarily resolve a medical issue. How many cases these days are for beauty versus health?

Over the last three or four years, I'd say we have many more that have to do with functionality. When I walked in, we primarily were about aesthetics, and our demographic would've been women within a certain age group.

But the industry became more aware about the long-term viability of your ability to clean teeth and having spaces between them, so you can floss on a regular basis. As you go forward, I think it'll end up being 50-50 where the younger patients will probably be worried more about aesthetics and the older patient is going to be worried about how do I maintain my teeth for life?

When I was going through the Invisalign process, I was looking at studies on the efficacy of Invisalign to understand if it is as good as braces, and it seemed like a lot of those studies were done on a narrow demographic group. What are you doing to expand the research, especially as you go into new markets around the world?

As you move into areas in the Middle East, in Asia, you see China is completely different from Japan in the sense of the way their teeth align or don't align. We had to adopt our technology around those things. What we do about being able to address these other demographics or other nationalities is we have to put a ton of money into expanding our portfolio of products. [Hogan later declined to point to specific public studies with broad racial demographics.]

You've spent a considerable time talking about teens and kids products recently. Was someone asking for these things?

If you ever saw an Essix device that they used to expand kids’ palates, I had that in 1993 with my younger kid. I remember refusing to go into his bedroom at night and turn that crank. I'd send my wife in. “You have a better way with him.” That's what a coward I am.

You walk in there with this Allen wrench, and you have to turn that thing 360 degrees. It hurts. When I came here I remember thinking about that and talking to the team. We had ideas that we could put in a palate expander every night and make that move. And so I thought what we were addressing with that is a way to … have it much easier on parents and kids than turning that screw every night.

One of the biggest frustrations, at least in the North American market, is the pricing, especially with the way dental insurance works, or doesn't work. Like the price ranges, I saw, anywhere from $3,000 to $8,000. Your average selling price to doctors is about $1,200. But help me understand the pricing.

Remember, this is a medical device that in the end, we don't s