Align Technology Inc (ALGN) — Q3 2025 Earnings Call Transcript

Good afternoon, and thank you for joining us. I'm Shirley Stacy, Vice President of Corporate Communications and Investor Relations. Joining me for today's call is Joe Hogan, President and CEO; and John Morici, CFO. We issued third quarter 2025 financial results today via Business Wire, which is available on our investor website at investor.aligntech.com. Today's conference call is being audio webcast and will be archived on our website for approximately one month. As a reminder, the information provided and discussed today will include forward-looking statements, including statements about Align's future events and product outlook. These forward-looking statements are only predictions and involve risks and uncertainties that are described in more detail in our most recent periodic reports filed with the Securities and Exchange Commission available on our website and at sec.gov. Actual results may vary significantly, and Align expressly assumes no obligation to update any forward-looking statements. We have posted historical financial statements with corresponding reconciliations, including our GAAP to non-GAAP reconciliation, if applicable, and our third quarter 2025 conference call slides on our website under Quarterly Results. Please refer to these files for more detailed information. With that, I'll turn the call over to Align Technology's President and CEO, Joe Hogan. Joe?

Thanks, Shirley. Good afternoon, and thank you for joining us. I'll start by giving an overview of our third quarter results and discuss performance from our two operational segments, Systems and Services and Clear Aligners. John will follow with more detailed insights on our Q3 financial performance and our outlook for the rest of the year. After that, I'll summarize a few key points and open the call for questions. I'm pleased to report our third quarter revenues, Clear Aligner volumes, and non-GAAP operating margins are all ahead of our expectations. Our Q3 results show year-over-year growth in Clear Aligner volumes, largely due to strong performance in the EMEA, APAC, and Latin American regions, particularly in the teens and kids category. Meanwhile, our Q3 Systems and Services revenues declined as anticipated due to seasonal factors affecting capital equipment. Our Q3 non-GAAP operating margin of 23.9% surpassed our estimate of around 22%. While the orthodontic and dental markets display mixed activity, especially in North America, our initiatives to boost consumer demand and patient conversion, especially through DSO partners, are yielding positive outcomes. Our extensive global business and product portfolio, along with unique consumer preferences for the Align brand, are advantages that help us navigate a dynamic global market. Notably, the year-over-year growth rate for Clear Aligner volumes improved from Q2 to Q3 across our top 10 countries, except in Canada. In Q3, total revenues reached $996 million, marking a 1.8% increase year-over-year and a 1.7% decline sequentially. Clear Aligner revenues of $806 million rose 2.4% year-over-year and saw a slight sequential increase. The number of Clear Aligner cases in Q3 reached 648,000, which is about a 5% year-over-year increase and a slight sequential rise. Imaging Systems and CAD/CAM services revenues stood at $190 million, with a minor year-over-year decrease and an 8.6% sequential decline. As expected, Sequentially decreased Systems and Services revenues reflected seasonal influences. Year-over-year, these revenues also saw a slight dip, primarily due to lower volumes, though increased scanner services and exocad CAD/CAM sales provided some offset. Furthermore, revenues benefited from strong iTero scanner lease growth, which allows doctors better access to our cutting-edge digital technology. By the end of Q3, active installations of iTero systems, including both sales and leases, exceeded 120,000 units globally, representing a 12% year-over-year increase. Regionally, Q3 scanner sales increased sequentially in North America among general practitioners, as well as in Latin America and APAC. Year-over-year, scanner sales grew in EMEA and Latin America. The iTero Lumina, featuring iTero multi-direct capture technology, establishes a new standard by offering effortless scanning and enhanced visualizations, enabling doctors to transition more smoothly to our advanced imaging systems. In Q3, over 90% of our full system units consisted of the iTero Lumina, and we're actively promoting adoption and utilization through wand upgrades and new system installations. Today, we unveiled several new product innovations for iTero Digital Solutions, which encompass a comprehensive ecosystem of intraoral scanners and integrated software tools aimed at modernizing dental consultations into comprehensive oral health assessments that enhance the patient experience and support Invisalign treatment conversions. These innovations cover essential practice workflows that reflect the Align digital workflow, incorporating AI-enabled X-ray assessments, personalized visualizations, and patient engagement tools, while expanding compatibility with 3D printers and milling machines. These advancements streamline workflows, boost communication between doctors and patients, increase patient acceptance rates, and foster practice growth. More details on these innovations can be found in today’s press release and webcast slides. In terms of exocad, revenues in Q3 experienced both sequential and year-over-year growth. During the quarter, we initiated pilots for exocad ART in several European countries, with plans to expand further in 2026 based on initial feedback. Exocad ART integrates orthodontics and restorative dentistry, enabling a smoother interface for orthodontists, dentists, and dental labs in their procedures, ultimately enhancing treatment outcomes. For Clear Aligners, Q3 worldwide volumes rose slightly sequentially and increased by 4.9% year-over-year. A record 88,000 doctors globally submitted Invisalign cases in Q3, primarily driven by general practitioners. Additionally, we achieved a new high in submissions for teens and kids. Sequentially, volumes reflect strong performance among international adults and teens, as well as adult patients linked to North American DSOs, offset slightly by the retail doctor channel in North America. Year-over-year growth was robust across the APAC and EMEA regions, despite challenges in North America. Q3 volume growth for Clear Aligners occurred among both orthodontists and GPs, with significant contributions from adults, teens, and kids, and strong support from DSOs. Product-wise, we noted substantial year-over-year growth from offerings like Invisalign First, DSP touch-up cases, and retention products, alongside a sustained shift towards non-comprehensive options. In the Americas, Q3 volumes were down year-over-year mainly due to North America, yet Latin America continued to exhibit growth. Despite lower overall volumes, we saw increased adoption of products such as Invisalign First for teens and kids and Invisalign DSP cases. Additionally, North American DSOs achieved double-digit growth, utilizing economies of scale and optimizing cost structures to enhance their Invisalign offerings. To address financial barriers for potential Invisalign patients, Align has partnered with Healthcare Finance Direct to improve treatment affordability. Enrollment among DSOs and doctors using HFD has risen, resulting in an uptick in Invisalign treatments, a trend we expect to see continue. In the EMEA region, Q3 Clear Aligner volumes grew by double digits year-over-year, driven by higher engagement and usage within the orthodontic channel, especially among teens, kids, and adults. This growth reflects the ongoing uptake of non-comprehensive products, including moderate DSP cases and Invisalign Comprehensive Three offerings. We also observed significant double-digit DSO growth in EMEA year-over-year. In APAC, Q3 volumes saw double-digit growth compared to last year, thanks to increased submitters and utilization across both GPs and orthodontists, particularly among teens and growing kids, with notable contributions from China. Q3 marked a strong retention performance year-over-year, revealing increasing engagement from both GPs and orthodontists. More than 256,000 teens and kids started treatment with Invisalign Clear Aligners in Q3, representing a 14.7% sequential increase, largely due to strong performance in APAC, North America, and Latin America, though partially dampened by seasonal softening in EMEA. On a year-over-year basis, case starts increased by 8.3%, with growth in APAC, EMEA, and Latin America, and some softening in North America. From a product perspective, we saw continued growth in Invisalign First and the Palatal Expander across all regions. This quarter, we achieved a record number of teen and kid cases shipped, accounting for 40% of total Clear Aligner cases. In Q3, the number of doctors submitting starts for teens and kids rose by 3.8% year-over-year, largely owing to strong demand for Invisalign First and the Palatal Expander. We also progressed with the rollout of the Invisalign Palatal Expander system and the mandibular advancement system featuring occlusal blocks. The IPE offers a more hygienic, comfortable alternative to traditional metal expanders that effectively achieve desired expansions. The MAOB system is constructed to align teeth and create Class II skeletal malocclusions in young patients, combining innovative design and material for reliable tooth movement. Today, we introduced ClinCheck Live Plan, a feature in Invisalign digital treatment planning that simplifies the generation of initial treatment plans in around 15 minutes. This represents a significant technological advancement for the Align Digital platform, reducing planning cycles from days to minutes. ClinCheck Live Plan leverages Align's proprietary data and algorithms drawn from years of research and the expertise of doctors who have treated over 21 million Invisalign patients globally. This tool allows doctors to treatment plan in real-time, with the ability to review and approve plans while patients are still in the office. The ability to expedite treatment planning can lead to quicker Invisalign starts, ultimately enhancing office efficiency and the patient experience. Over recent years, Align has rolled out a variety of new treatment planning tools designed to improve consistency, control, speed, and overall planning processes. We are making substantial progress in automation and AI-driven technologies that will underpin our next-generation treatment planning solutions. The uptake of Invisalign Flex Rx has doubled annually, with over 1 million Invisalign cases submitted through Flex Rx for personalized treatment plans. Furthermore, we now have more than 100 clinical cases for the Invisalign Palatal Expander on display in the Align Global Gallery, both of which are unprecedented milestones in new product offerings within the orthodontic sector. With that, I'll hand the call over to John.

Thank you, Joe. Now I will discuss our Q3 financial results. Total revenues for the third quarter were $995.7 million, which is a decrease of 1.7% from the previous quarter and an increase of 1.8% compared to the same quarter last year. When considering constant currency, Q3 revenues benefitted by about $11.7 million or 1.2% sequentially and by approximately $15.6 million or 1.6% year-over-year. Clear Aligner revenues for Q3 were $805.8 million, showing a slight increase mainly due to favorable foreign exchange and a price hike in the U.K. effective August 1, although this was slightly offset by a shift in product mix to lower-priced countries and products. Foreign exchange had a positive effect on Q3 Clear Aligner revenues by around $9.8 million or 1.2% sequentially. The average per case shipment price for Clear Aligners was $1,245, reflecting a $5 decrease sequentially, largely due to a more significant mix shift to lower-priced products and countries, countered somewhat by favorable foreign exchange and a price increase in the U.K. On a like-for-like basis, Q3 Clear Aligner average selling prices for the U.S. and EMEA saw a sequential rise. Year-over-year, Q3 Clear Aligner revenues increased by 2.4%, driven mainly by higher volume, price increases, favorable foreign exchange, and decreased net deferrals, though this was partially offset by increased discounts and a shift in product mix to lower-priced regions. Foreign exchange contributed approximately $13 million or 1.6% to Q3 Clear Aligner revenues year-over-year. The average per case shipment price for Clear Aligners was $1,245, which is down $30 compared to the previous year, primarily due to discounts and shifts to lower-priced regions, somewhat mitigated by price increases and favorable foreign exchange. The deferred revenues for Clear Aligners as of September 30, 2025, fell by $19.5 million or 1.6% sequentially and by $78.7 million or 6.2% year-over-year, which will be recognized as more aligners are shipped under the sales contracts. Meanwhile, Q3 Systems and Services revenues totaled $189.9 million, down 8.6% sequentially, mainly due to reduced sales of scanner wands and systems, despite some offset from favorable foreign exchange and increased nonsystem sales. On a year-over-year basis, Systems and Services revenues declined by 0.6%, mainly due to lower scanner system sales, although offset by higher scanner wand sales, increased nonsystem sales, and favorable foreign exchange. Foreign exchange positively affected Q3 Systems and Services revenues by approximately $1.8 million or 1% sequentially. Year-over-year, these revenues were boosted by foreign exchange by about $2.6 million or 1.4%. Deferred revenues for Systems and Services decreased by $7.9 million or 4% sequentially and by $30.9 million or 13.9% when compared year-over-year, partly because customers opted for shorter duration service contracts with new scanner system purchases. In terms of gross margin, our overall gross margin for the third quarter was 64.2%, down 5.7 points from the previous quarter and down 5.5 points from the same quarter last year, primarily due to restructuring and other noncash charges, asset impairments, depreciation on assets designated for disposal other than sale, and excess inventory write-offs, although partially offset by operational efficiencies. Overall gross margin benefited from favorable foreign exchange by 0.4 points sequentially and 0.6 points year-over-year. On a non-GAAP basis, excluding the aforementioned restructuring and other noncash charges, our third quarter gross margin was 70.4%, down 0.1 points sequentially and flat year-over-year. Clear Aligner gross margin for the third quarter was 64.9%, down 5.2 points sequentially, mainly because of the restructuring and other noncash charges. The gross margin for Clear Aligners was positively affected by foreign exchange by approximately 0.4 points sequentially. Year-over-year, the Clear Aligner gross margin saw a decline of 5.4 points, primarily due to restructuring and noncash charges, although some operational efficiencies provided a slight offset. Foreign exchange positively impacted this margin by around 0.6 points year-over-year. The Systems and Services gross margin for the third quarter was 61.3%, down 8.2 points sequentially, chiefly due to excess inventory write-offs, while foreign exchange positively influenced this margin by roughly 0.4 points sequentially and by approximately 0.5 points year-over-year. Q3 operating expenses were $542.9 million, representing a 0.4% decrease sequentially and a 4.5% increase year-over-year. Sequentially, operating expenses were $2.2 million lower, mainly from reduced consumer marketing expenditures but offset somewhat by restructuring costs. On a year-over-year basis, operating expenses rose by $23.4 million due to restructuring costs, although this was partially countered by lower consumer marketing spend. Excluding stock-based compensation, restructuring and other charges, and amortization of acquired intangibles, our non-GAAP operating expenses for the third quarter were $463.3 million, reflecting a 6.9% decrease sequentially and a 2% decline year-over-year. Our operating income for the third quarter was $96.3 million, leading to an operating margin of 9.7%. This signifies a decrease of about 6.4 points sequentially and approximately 6.9 points year-over-year, primarily because of Q3 restructuring and other charges totaling $36.3 million, mostly related to post-employment benefits and other noncash items. The aggregate of these charges came to $88.3 million. The operating margin was positively influenced by foreign exchange by about 0.4 points sequentially and 0.5 points from a year ago. On a non-GAAP basis, excluding the impact of restructuring and noncash items, the operating margin for the third quarter was 23.9%, an increase of 2.6 points sequentially and 1.8 points year-over-year. For interest and other income and expenses, the net expense for the third quarter was $1.6 million, compared to an income of $10.5 million in Q2 2025, primarily due to foreign exchange fluctuations on open assets and liabilities. Year-over-year, Q3 interest and other income and expense presented an unfavorable comparison to an income of $3.6 million in Q3 2024, driven largely by adverse foreign exchange movements and reduced interest income. Our GAAP effective tax rate for the third quarter stood at 40.1%, compared to 28.2% in the previous quarter and 30.1% from the same quarter a year ago. The higher effective tax rate for Q3 reflects changes in our jurisdictional income mix due to restructuring, partially offset by lower U.S. minimum tax on foreign earnings and updates from tax law. On a non-GAAP basis, our effective tax rate for the third quarter was 20%, aligning with our long-term forecast. Our third quarter net income per share was $0.78, which is down $0.93 sequentially and down $0.77 from the previous year. Foreign exchange positively impacted our EPS by $0.02 sequentially and $0.03 year-over-year. On a non-GAAP basis, the diluted net income per share for the third quarter was $2.61, up $0.11 sequentially and $0.26 year-over-year. Regarding the balance sheet, as of September 30, 2025, cash and cash equivalents totaled $1.0046 billion, an increase of $103.4 million sequentially and a decrease of $37.3 million year-over-year. Of this total, $190.8 million was held in the U.S. while $813.8 million was held internationally. In Q3, we repurchased around 0.5 million shares of our common stock at an average price of $136.77. This was part of the $200 million open market repurchase plan announced on August 5, 2025, which we expect to complete by January 2026. As of September 30, 2025, there was still $928.4 million available for stock repurchase under our previously mentioned program from April 2025. Q3 accounts receivable balance was $1.0994 billion, which was down sequentially. Our overall days sales outstanding were 101 days, up by about 2 days sequentially and 8 days compared to Q3 2024, reflecting our flexible payment terms aimed at aiding Invisalign practices. Cash flow from operations in Q3 was $188.7 million, while capital expenditures were $19.8 million, primarily for our manufacturing capacity and facilities. Free cash flow, calculated as cash flow from operations minus capital expenditures, was $169 million. I would also like to address the U.K. VAT and U.S. tariffs as of September 30. As noted in our Q3 earnings release and conference call on July 30, 2025, we have ceased charging VAT for affected customers in the U.K. as of August 1, 2025, with our invoices no longer including the U.K. VAT rate of 20% for all approved Invisalign treatment packages from that date forward. Simultaneously, we adjusted the prices of our Clear Aligners and retainers to maintain overall pricing consistency. Currently, we do not anticipate a significant impact on our operations due to the latest U.S. tariff actions, and we recommend reviewing our Q1 2025 press release and earnings materials as well as our Q2 2025 webcast slides for specifics on potential tariff impacts. Assuming no unforeseen circumstances such as foreign exchange fluctuations, macroeconomic changes, or alterations to our duties including tariffs and fees, we anticipate the following for Q4: We expect Q4 2025 worldwide revenues to fall between $1.025 billion and $1.045 billion, an increase from Q3 2025. We are predicting Q4 Clear Aligner volume and average selling price to rise sequentially due to favorable geographic mix. We expect Q4 2025 Systems and Services revenues to increase sequentially in line with usual Q4 seasonal trends. Our expectation for Q4 2025 worldwide GAAP gross margins is between 65.5% and 66%, an increase attributed to higher revenues and lower restructuring charges, as well as reduced noncash items like asset impairments, despite higher depreciation on assets scheduled for disposal. We foresee the non-GAAP gross margin being around 71%. For Q4 2025, we expect our GAAP operating margin to be between 15.3% and 15.8%, reflecting a sequential rise influenced primarily by lower restructuring and noncash charges, although this will be partially offset by increased depreciation on disposals. We anticipate a non-GAAP operating margin of about 26%. Looking ahead to fiscal 2025, we expect mid-single-digit growth in Clear Aligner volume, with revenue growth remaining flat to slightly up from 2024, assuming foreign exchange rates stay consistent with current levels. We estimate fiscal 2025 GAAP operating margins to be around 13.6% to 13.8%, a year-over-year decrease due to higher restructuring costs and anticipated noncash charges of about $145 million to $155 million, mainly for asset impairments, depreciation, and inventory losses, although partially balanced by lower legal settlement expenses. Most of these one-time charges will be noncash, with a cash outlay for 2025 likely around $45 million. We project the 2025 non-GAAP operating margin to be slightly above 22.5%. Our planned capital expenditures for fiscal 2025 are around $100 million, mainly for technology enhancements. We are nearing the end of our restructuring actions aimed at enhancing operational focus, minimizing ongoing costs, and improving capital efficiency. For fiscal 2026, we expect these restructuring efforts and other initiatives to improve our GAAP and non-GAAP operating margins by at least 100 basis points year-over-year. With that, I'll turn it back over to Joe for his closing remarks.

Thanks, John. In summary, I'm pleased with our third quarter results and encouraged by the sequential and year-over-year growth in the Clear Aligner segment as well as the continued expansion of our digital scanning solutions and footprint. While the North American retail doctor channel remains mixed, we continue to see strength in our other key geographies and areas of our portfolio, including teens and kids, and digital workflow innovation as demonstrated by continued strong double-digit year-over-year growth by our DSOs. Our investment in AI-powered treatment planning software, direct 3D printing of aligners, and next-generation iTero Lumina scanning technology are key to helping doctors deliver better outcomes more effectively and efficiently, while enhancing the patient experience. Looking ahead, we intend to remain flexible in navigating headwinds in the U.S. dental market and are committed to supporting our doctor customers with localized marketing, education, and clinical support across all regions. We're making good progress against our strategic initiatives to drive long-term growth across our business, and we're excited about the opportunities to further expand our reach, deepen engagement with consumers and providers, and deliver value to our shareholders. Before we wrap up, I want to take a moment to express my sincere gratitude to the doctors around the world who continue to trust the Align team and our technology to transform smiles and change lives. Your partnership and commitment to patient care inspire us every day. We appreciate your continued support and confidence. I also want to thank our employees who continue to demonstrate agility, innovation, and resilience in everything they do to deliver and extend our leadership in digital orthodontics and restorative dentistry. With that, I thank you for your time today, and I'll turn it over to the operator.

Congratulations on a strong quarter. It was great to see the increase in cases during the quarter. Could you share any early insights for the fourth quarter regarding the end market? Additionally, I would appreciate it if you could provide more details about the new ClinCheck launch and its anticipated effect on gross margins.

Yes, Elizabeth, we are pleased with how the third quarter went and are looking forward to future progress. The technology we're integrating is a comprehensive solution we've developed over several years. Our two main goals are to streamline the process for our doctors to convert cases and grasp the complexities of each case while providing the right structure for those cases. Additionally, this will enhance our efficiency, allowing us to spend more time with customers on challenging matters. It's encouraging to see everything coming together. This is not merely a productivity tool; it also improves doctor-patient communication. The ability to provide a live update within 15 minutes significantly increases the chances of closing a case since the doctors will have a clear understanding of the case's details and duration. We're excited about this progress, Elizabeth.

Look, not many blemishes, but I'll try to find one. So ASP was supposed to be up a smidge Q-over-Q. It was down a bit. John, I think I heard you right, you mentioned country mix. So I think like-for-like was still maybe what you expected. But for Q4, you do expect it to be up sequentially. Just help me out with that. So I'm guessing a full quarter of that probably helps with that. What else gets it up sequentially? And then just more big picture, Joe, for you, if you want to comment on the pricing environment and really any thoughts on the timing about the potential rollout of what we're at least referring to as no refinement plan? And then I'll ask a follow-up.

Yes, Jon, I'll address the first question about the ASP. The growth we experienced in markets such as China, which has a lower ASP compared to Europe, was a key factor. In Q4, Europe accounted for a larger share of our total as they came out of their holiday season, while China's contribution decreased during the same period. Therefore, these two regions significantly influenced the ASP changes.

And Jon, regarding the no refinement plan, we've been developing that concept for some time. We transitioned from a 5 x 5 system to a 3 x 3 system, and typically, our moderate products had only one aligner. I view this not as a significant shift but as a continuous evolution in how we serve our doctors. Additionally, over the years, we've enhanced our technology so doctors can understand these malocclusions better. In most cases, they don't require five additional aligners to address these issues, and they appreciate having options like, "I believe I can resolve this without refinements," or "I can purchase one if needed," or "I'll get an insurance policy because I'm uncertain." This represents both a technological advancement and a boost in confidence for us in developing our cases, as well as for the doctors.

Okay. That was helpful. And I'll pivot for the second one. Maybe this falls to both of you guys again. You've certainly given some 2026 margin thoughts and the 100 bps is good to see. Just any high-level discussion on the top line next year. It seems like, Joe, like half the Clear Aligner business is growing double digits. The other half is flat to down, being North America. Systems and Services, at least in my view, is maybe a little bit longer in the tooth regarding the Lumina product cycle. John, you talked about ASPs being down low single digits. And when I roll that up, I land up LSD when you think about all those moving parts, but anything directionally for us to think about to sort of pair with the margin commentary?

Jon, I'll attempt to address that, though it's a significant question. We provided projections for the fourth quarter, and we feel optimistic about them overall. If you compare the third quarter to the second quarter, we saw that nine of our top ten countries experienced growth. Therefore, we're witnessing strong growth. However, our primary challenge lies in North America retail. In North America, the DSO is a frequent topic of discussion, and growth in some areas exceeds 20%. We're aiming to solidify that as we approach the fourth quarter. We believe we'll maintain a strong global presence, but I am not making any predictions for 2026.

Maybe, Joe, if I can just follow up on that last comment you made, at least in terms of the markets in North America. As you think about that retail customer, I'm trying to wrap in a lot of comments we already had, but what do you think is the biggest gating factor that gets them back to some level of, I don't want to call it, normalized demand, new normal demand, whatever it might be? And what can Align proactively do relative to waiting out the macro in order to help them get there?

Michael, that's a great question. If we look at the retail side in North America, Canada has faced more challenges than the U.S. Overall, we're focusing on improving DSO because it benefits both general practice and orthodontics. Additionally, we believe that by enhancing our marketing efforts and targeting specific ZIP codes, we can better connect patients with doctors. These challenges seem to affect retail customers more than the business-focused DSOs. By leveraging our brand and strong portfolio, we can help improve the marketplace. Ultimately, the solution lies in fostering a more confident U.S. consumer, but we can't afford to wait for that. We'll utilize our brand and technology, and our field team will engage more closely with retail customers and doctors to support them as best as we can.

Joe, I promised you when I saw you last time in Vegas that I would try to get you to provide a bit more detail by geography than your high-level comments. So for EMEA and APAC, I think I heard you say both markets are up double digits year-over-year in Clear Aligner volumes. I want to confirm that was the case on a year-over-year basis, and are we talking around 10% or 11%? I'm trying to use those numbers to understand how much North America would have been down, whether it was a few points or more in the mid-single-digit range from a North American case volume standpoint.

Jeff, overall, to confirm that double-digit year-over-year growth that we talked about. Again, it was widespread. We talked about our top 10 countries. India being one that's growing well, Turkey in different areas, really strong performance in EMEA overall. So Jeff, I'm not ready to give any kind of broad specific numbers on the double-digit piece, but it's robust in a lot of different parts of the world, which gives us a lot of confidence in the sense that we can keep that kind of momentum, but also to make sure from a resource standpoint and a focus standpoint, we start to move our retail doctors in the United States more towards positive growth.

Yes. All right. And then just on the U.S. side, I mean, obviously, that's where the biggest headwind remains. You talked last quarter about kind of the gross receipts looking good, but then the case is not closing. Any change in behavior? Did any of that clear itself up a little bit? Did it get a little worse? And I think more importantly, on that front, just as Q3 itself played out in that retail channel, just again any kind of incremental improvements or degradations throughout the period. We did see consumer confidence come off in September and then again in October. So would just love to hear kind of what the exit rate might have looked like on 3Q as we head into 4Q here as well from a U.S. standpoint.

Yes, Jeff, we analyzed gross receipts and CCAs last quarter to understand what had happened. I can confirm that there hasn't been any significant change in that data. It varies across different countries, and we monitor each of them closely. There's really nothing new to report in that regard. I understand that you are closely observing the North American market, particularly consumer confidence and other factors. However, from an overall sales perspective, our DSOs continue to grow, and our retail accounts remain under pressure. To clarify, the situation hasn't worsened; it's consistent.

Can I first start on the orthodontic side, or more specifically, the teens? That seemed to be a nice highlight of the quarter. Last quarter, we were talking about this kind of shift back towards wires and brackets in kind of difficult macro times. I didn't hear any of that this quarter encouragingly. So maybe just spend a minute on teens, what was driving kind of the growth there? And do you think we're moving past this kind of shift back to wires and brackets again, and we're a little bit back on the offensive there?

Yes. I think overall, when you look at that teen increase, I mean, it was pretty phenomenal when you look at the growth. Remember, it's a big China growth period for us from a teen standpoint. That's their season. And we saw really substantial growth there, which is tremendous. What's helping to drive the growth also are our new products like IPE and mandibular advancement with occlusal blocks. It just gives us more leverage to be able to start those patients earlier. And often, as we mentioned before, Brandon, Invisalign First, goes along with those products one way or another to be able to address different types of expansions or different kinds of malocclusion. So what I like about the teens is it had good breadth to it all over the world. We saw the same thing in Europe also and in some of the emerging economies that we're doing. Again, I think it's the penetration that we're getting in those areas, but also our technology, the breadth of our technology, particularly for early interventions in kids.

Okay. As a follow-up, I've been hearing a common theme among many in the dental industry, including you, that dental service organizations seem to have an effective strategy in place that is driving growth in various segments within dentistry. I'm curious if you can share what percentage of your business currently comes from DSOs. Additionally, could you elaborate on why they are performing particularly well and if you believe this growth will continue into next year?

Yes. Overall, Brandon, it's about in the 25% or so. It varies by country, as you know, but that's probably a good ballpark to be in.

So I guess from my side, I was just curious to hear more color around the evolution of the HFD patient financing partnership. Just curious if that has helped in any notable way to help get patients across the finish line in the third quarter? Or is that still maybe going to be just a bigger factor for the fourth quarter and into 2026, where that stands right now?

Yes, I would say it's healthy, and we're observing an increasing number of doctors adopting it. You can see it among some of the DSOs who have taken advantage of the situation. However, when potential patients are deciding whether to proceed with treatment, it often comes down to pricing and the overall cost. Additionally, it ultimately hinges on the monthly payment if they choose not to pay in full. Thus, HFD becomes more critical in that context. We're pleased with the partnership we're seeing, and more doctors are utilizing it. So, I would say it's unfolding as we anticipated in the third quarter, and I expect to see more of this in Q4 and beyond.

I wanted to start on the China market. It sounds like a pretty good third quarter you had there. Just wondering, any updated perspective on the competitive landscape and anticipated VBP in that market as well as how or whether you plan to adjust your go-to-market and pricing strategy in light of VBP.

Jason, I mean, we're aware of what's going on from the VBP standpoint. It's still not clear exactly what provinces at all will be included in that and exactly when it will be implemented. But we're positioning ourselves because we know, ultimately, that's probably going to happen one way or another. But I don't have any new news to report versus what we had in the second quarter.

Okay. Joe, when you mention you're positioning yourself, could you clarify what you mean by that? I'll also ask my follow-up now. I wanted to focus on the current U.S. retail discussions you’re having. The DSOs are performing well with strong double-digit growth. They are more sophisticated, but this indicates that it may not just be a consumer spending issue in the U.S. I'm curious if it’s not an economic or consumer spending issue, and perhaps the business that is more sensitive right now is the lower volume, lower ROI accounts that have more incentive to switch to cheaper alternatives. How much effort do you dedicate to defending that business, especially when you are focused on meeting your margin expansion goals for next year?

Yes. The first part of your second question was about China again. It's important to remember that there are many Tier 3 and Tier 4 cities. We needed to ensure that our portfolio is properly structured to reach those types of patients, as we have primarily focused on private patients in the larger areas of China. When discussing defense, I believe we have the opportunity to expand markets with our new technology and initiatives. While we need to defend certain territories, I see this market as one ripe for expansion. We had a challenging second quarter, but as we continue to advance our technology, it's worth noting that 75% of people still have a malocclusion, presenting numerous opportunities to address this issue. Therefore, our strategy is not solely about defense; it's also about proactively growing the market. This approach extends beyond the United States and North America to encompass global opportunities, and we demonstrated the strength of our business in the third quarter.

To wrap up on your DSO comment, I believe some DSOs are performing exceptionally well. They are aware of market trends and noticing that consumers are visiting for services like cleanings. In response, many DSOs are scanning most patients and providing extensive before-and-after visualizations. They remain competitive in terms of pricing and offer various financing options similar to HFD. This indicates active engagement, although not every provider is aligned, as some retail doctors are also participating. However, DSOs as a whole are adopting a digital orthodontic strategy while being attentive to patient needs regarding treatment enrollment. This exemplifies the market opportunities available, approached in a manner that seeks to generate excitement among potential patients.

I just want to confirm that you're still confident in your 5% to 15% growth targets that you laid out in your LRP. And if so, is mid-single-digit top line growth on the table for next year?

Vik, we're sticking with our 5% to 15% plan for the future. That hasn't changed, and we really believe the business can do it.

You mentioned the shift in geographic mix affecting ASP throughout the year in the Americas, China, and EMEA. There was also a favorable FX impact that started as a challenge in the first quarter, became neutral in the second, and offered support in the third. Looking at the reported ASPs, they have remained relatively stable in the $1,240 to $1,250 range. If we consider the increasingly favorable FX as the year progressed, it appears the underlying ASPs might be somewhat weaker. Can this be solely attributed to geographic and product mix, or is there something else influencing this trend?

Yes, Michael, this is John. When you compare the results in Europe or the U.S. on a like-for-like basis, our average selling prices have increased from one quarter to the next. We are pleased with the volume growth in some emerging markets like China, but unfortunately, the average selling price there is lower, which impacts our overall average. If we excluded China, our average selling prices would have seen significant improvement from Q2 to Q3. It's mainly the country mix that brings the average selling price down. Looking ahead to Q4, with a lower contribution from China and a higher one from Europe, we expect the average selling price to improve as we transition from Q3 to Q4.

Erin, sorry, we can't hear anything.

Yes, happy to circle back.

Okay. Thank you, operator. I think we'll go ahead and close off the conference call. So thank you, everyone, for joining us today. We appreciate it and look forward to the opportunity to meet with you at upcoming investor conferences and industry events. If you have any follow-up questions, please contact Align Investor Relations. And I hope you have a great day. Thanks.