愛齊科技 (ALGN) 2020 Q3 法說會逐字稿

Greetings, and welcome to Align Technology's Third Quarter 2020 Earnings Call. (Operator Instructions) As a reminder, this conference is being recorded.

It is now my pleasure to introduce your host Shirley Stacy, Vice President, Corporate and Investor Communications. Thank you. You may begin.

Thank you for joining us, everyone. Joining me on today's call is Joe Hogan, President and CEO; and John Morici, CFO. We issued third quarter 2020 financial results today via Globe Newswire, which is available on our website at investor.aligntech.com.

Today's conference call is being audio webcast and will be archived on our website for approximately 1 month. A telephone replay will be available today by approximately 5:30 p.m. Eastern Time through 5:30 p.m. Eastern Time on November 4. To access the telephone replay, domestic dialers should dial (877) 660-6853 with conference number 13710706 followed by pound. International callers should dial (201) 612-7415 with the same conference number.

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, including the corresponding reconciliations, including our GAAP and non-GAAP reconciliation, if applicable. And our third quarter 2020 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 thanks for joining us. I'm pleased to report stronger-than-expected results with record third quarter revenues up 21% year-over-year, reflecting strong momentum across all regions and customer channels for both Invisalign clear aligners and iTero scanners and services.

During the quarter, we continued to support doctor recovery efforts with products, programs and virtual tools and training that help more docs transition their practices to digital technologies and drove record utilization across the Invisalign portfolio. Capping off a record quarter is an achievement of our ninth million Invisalign patient milestone.

We also saw a strong response to our new teen-and-mom-focused consumer campaign with 118% year-over-year increase in total leads, garnered 3.3 billion impressions, an uptick in consumer engagement from new social media influencers like Charli D' Amelio and Marsai Martin, and 26% increase year-over-year in teenagers using Invisalign clear aligners.

Our overall revenue momentum has continued into October, and we are encouraged by positive feedback from Invisalign practices regarding the benefits of digital orthodontics, starting with an iTero scanner for Invisalign treatment especially in this COVID environment.

For Q3, total revenues were $733 million, up 108% sequentially and up 21% year-over-year, reflecting a sharp rebound in sales for both Invisalign clear aligners and iTero imaging systems as practices around the world reopened and got back to work treating existing and new patients.

Q3 revenues for clear aligners were $621 million, up 20% year-over-year, and Imaging Systems & and CAD/CAM Services were $113.4 million, up 24.5% year-over-year. Q3 and Invisalign shipments were a record of 496,000 cases, up 28.7% versus prior year and up 124% versus prior quarter, reflecting strong recovery across all regions.

During the quarter, we saw increased demand for new cases as restrictions eased and doctors ramped up their practices. This is in contrast to Q2 where doctors' primary focus was to maintain continuity of patient care for their existing patients through additional aligner shipments and replacement aligners. John mentioned this in his comments last quarter and we'll touch on it again today.

For the quarter, we shipped Invisalign cases to a record 70,000 doctors, of which 5,800 were first-time customers, reflecting increased doctor activity as practices have reopened. We have also trained approximately 6,500 new doctors in Q3, including 3,200 international doctors, reflecting increased doctor engagement through our online virtual education courses, summits and forums.

Across the business, we believe there are several factors contributing to our strong performance, starting with pent-up demand. Many of our doctors indicate that they are making good progress in working the backlog of patients from office shutdowns. Pent-up disposable income remains a key factor as consumers focus on feel-good investments, while many other quality of life options are low.

In our new normal, there are far fewer trips abroad, fewer flights, less money spent on gas, dry cleaning, et cetera. More people can afford to allocate that spending to Invisalign treatment, especially when they're working remotely and critiquing themselves on camera, so much of the time. That's the Zoom effect we've heard about across multiple sectors.

As we look at our customer channels, we feel the strategy to dedicate sales representatives by specialty alignment is bearing fruit, particularly in the GP dental segment. Sales reps were able to partner with a wider range of providers within their designated specialty during the downturn and assess mindset and specific needs during the recovery and tailor plans to thrive beyond COVID.

A digital mindset has been key, and we believe this is the largest influence in the ortho market and the one we've been laying the foundation for over the last several years. For many doctors, they are still down from normal years in terms of overall production and weekly patient flow. But they have prioritized Invisalign clear aligners as their preferred modality expanded to the first age group and leverage programs that help to make the transition from analog to digital treatment. We see this both in teen and adult treatment growing with the same provider, increased use of iTero scanners, our virtual care, our high overlap of bracket buyback switch.

As part of our recovery programs, we offer doctors 2 programs, either switch their braces in patients into Invisalign treatment by buying their wires and brackets or just buy back their existing inventory. We took out the equivalent of 10,000 cases. Providers actively reduced their analog footprints by proactively switching their patients to sustainable digital care with Invisalign. And for GPs who already demonstrated momentum with digital, an active choice was made to position Invisalign as a priority. Scanning every patient with iTero is generating more opportunity from recall patients even if overall practice capacity is still down. Because doctors in both channels are trying to anticipate what may come in terms of additional waves and office shutdowns, they are hyper-focused on ensuring that they have the best plan for continuity of care and business continuity, which is digital.

To support them in this digital journey, we've rolled out My Invisalign app in virtual care to 40-plus countries. These tools have been received very positively by our doctors and are quickly becoming part of their practice workflow.

Our commitment to continuous innovation is key. We've recently announced our treatment planning evolution and global availability of our next-generation ClinCheck Pro 6.0 proprietary treatment planning software. ClinCheck Pro 6.0 moves Invisalign digital treatment planning to the cloud, making its robust treatment planning tools and features available to doctors anytime, anywhere, on any laptop, personal computer, tablet or phone. The release includes a new ClinCheck in-face visualization tool, an enhanced doctor facing digital clinical tool that combines a photo of their patients face with their 3D Invisalign treatment plan, creating a personalized view of how their new smile will look.

In addition, we also announced today Invisalign G8 predictability improvement with SmartForce Aligner Activation for both orthodontists and general dentists starting in Q1 2021. The Invisalign G8 with SmartForce Aligner Activation is our newest biomechanical innovation and the latest in our long history of Invisalign predictability improvements.

We continue to focus on building partnership with doctors. Our data shows the providers who have or quickly developed momentum around digital orthodontics, leaned into our comprehensive platform in a variety of our programs and resources to accelerate a digital shift. It's a compelling story of how engagement may be the first step, but transformation is achieved through the breadth of product and services only Align can provide.

Transformation and support programs like ADAPT, virtual tools, development of teen awesomeness centers, GP accelerator, teen conversion, aligner intensive fellowship, iPro and doctor-led coaching programs that support GP growth. Building on the teen market in Q3, 163,000 teens and preteens started treatment with Invisalign clear aligners, representing 33% of total cases shipped, reflecting growth predominantly from North American orthos and EMEA regions.

In parts of the market, we saw an initial rush for teen treatments earlier in the quarter with a slight change in demand profile compared to what we normally see in a typical season, which may be the result of a different type of back-to-school season as most kids return to school late or through virtual learning. Invisalign First continues to accelerate among young patients as well.

In terms of product performance, we saw strong growth across the portfolio and noncomprehensive outpace comprehensive, even with the record adult shipments for the quarter. Growth of the Invisalign Go product also increased among GPs driven by North America and EMEA, and there was an increase in our Express package shipments with North America contributing to the majority of that growth. Overall, both noncomprehensive and comprehensive shipments were up, with continued increased adoption of our Moderate product among the ortho and GP channels.

Now let's turn to the specifics around our third quarter results, starting with the Americas. For the Americas region, Q3 Invisalign case volume was up 166% sequentially and 25% year-over-year, reflecting an increase in shipments due in large part to the digital programs and tools implemented during the pandemic to help our doctors as well as our continued investments in targeted marketing and sales efforts.

The Q3 utilization was up for North American orthos and GPs both quarter-over-quarter and year-over-year. We saw a continued utilization increases during the quarter, especially among our orthodontic customers in the teen segment, the strongest teen quarter in the last 6 quarters. As we mentioned previously, in Q2, we started a bracket buyback program to enable doctors to switch their braces patients into Invisalign treatment by buying back their wires and brackets inventory.

We also saw stronger growth in the adult segment. We believe that some of the increase in adult shipments is reflective of how circumstances have changed today, with adults in our target demographic having more disposable, direct -- more disposable income directed at getting their smiles fixed.

In Latin America, volume was also up year-over-year, led by strong growth in Mexico and Brazil. When you consider the timing of the pandemic and the shutdowns occurring later in Q2 for Lat Am, we were encouraged by the growth this quarter. We also saw increased utilization in the GP channel with Invisalign Go and adoption of Moderate. DSO utilization also increased and continues to be strong growth driven by Heartland and also Aspen.

For our international business, Q3 Invisalign case volume was up a sequential 88%, led by a significant increase in EMEA. On a year-over-year basis, international shipments were up 34%, reflecting increases through both EMEA and APAC.

For EMEA, Q3 volumes were up sequentially 104% and up 38% on a year-over-year basis across all markets with strong performances from the ortho channel as well as the GP channel as many doctors kept their offices open during their typical summer holiday season. Both core and expansion markets accelerated, with growth in our core markets, led by Iberia, the U.K., Germany and growth in our expansion markets led by Central and Eastern Europe and the Benelux.

We introduced the Ortho Recovery 360 Program in EMEA last quarter to support our orthodontists as they started reopening their businesses. As of Q3, over 4,000 orthodontists have enrolled in the program, with over 13,000 touch points with sales team members providing a dedicated support in July and August alone. As a result, we continue to see an increase in Net Promoter Score, or NPS, with qualitative feedback from doctors showing that they appreciate Align for the support during this difficult time.

We also rolled out your billing -- Your Brilliance Enhanced marketing campaign to selected EMEA markets that highlights the skills of our orthodontists and illustrates how partnering with Align in using Invisalign clear aligners and iTero systems and services can help further enhance the brilliance of these specialists.

To support our GP doctors, we also launched our GP Recovery 360 program during the quarter with over 2,900 GPs enrolled so far. At the beginning of the quarter, we also launched an Invisalign Go Plus system in the U.K. and Benelux and had 2,500 GPs attend the event. During the quarter, we continue to offer virtual and hybrid education events for our doctors with online and on-demand education events, which reached over 2,000 GPs cumulatively.

For APAC, in Q3, volumes were up sequentially, 74%, reflecting continued improvement within the region. On a year-over-year basis, APAC was up 30% compared to the prior year.

During the quarter, we're pleased to see a record number of unique doctors submitting cases and positive growth in the adult segment with growth in GP channels and noncomprehensive cases with Moderate product. In the teen segment, shipments were at an all-time high as doctors' offices continue to recover. We also saw acceleration from Japan and ANZ.

During the quarter, we celebrated the grand opening of our China manufacturing facility in Ziyang. The event was attended by key partners and doctors in China. The state of the art facility replaces our original temporary facility, further establishing our commitment and capacity to manufacture Invisalign aligners and iTero imaging systems in China.

Align was also one of the sponsors of APACMed Virtual Forum 2020, which attracted over 1,000 attendees from the medtech industry. The forum consisted of panel discussions in live video chat sessions at the Align virtual booth as we continue to establish Align as a global medical company that aims to transform smiles and change lives in the APAC region.

Last week, we also hosted the Align APAC Virtual Symposium, a fully digital event that showcased a digital treatment technologies and featured practitioners from across the Asia Pacific region with over 800 participants. Our consumer marketing is focused on building the clear aligner category and driving demand for Invisalign treatment through a doctor's office.

In Q3, we saw strong digital engagement globally with more than 78% increase in unique visitors as well as on leads traded driven by our new campaign, revamped social media strategy and our new invisalign.com website that was rolled out to 15-plus countries. Several key metrics show increased activity engagement with the Invisalign brand and are included in our Q3 quarterly presentation slides available on our website. We're pleased with the strong engagement and activity we've seen on our consumer platforms over the last few months and believe it speaks to the strength of the brand and consumer interest in treatment even during the challenges of the last few months.

As you recall from last quarter, we launched our Mom multitouch campaign with incremental support to drive reach, awareness and foot traffic to practices during the key teen season. We also launched a new multimillion-dollar TV campaign designed to reach mom and teens across a broad range of networks nationwide, including cable and connected TV networks.

Align is always looking for new opportunities to reach consumers and be relevant to potential patients wherever they work, live and play.

During the quarter, we announced that the Invisalign brand is the official clear aligner sponsor of the NFL Football League. With 11 NFL teams working with great sports brands like the NFL is another way to connect with consumers by leveraging the power of the NFL brand in its existing brand platforms. The NFL League partnership will help build awareness of Invisalign clear aligner treatment at a national level, while the team agreement will help us engage with key markets and connect consumers with doctors in those markets.

During the quarter, we also extended our innovation to drive engagement with new Invisalign Stickables designed to personalize Invisalign clear aligners, especially for younger patients. The innovative sticker accessories designed exclusively for use with SmartTrack material are available in a variety of designs, colors, shapes and themes and reflect patients' desire to show their personal flair during Invisalign treatment.

For our Systems and Services business, Q3 revenues were up 110% sequentially due to higher shipments and service revenues. We continue to see momentum with Element 5D imaging system, gaining traction in North America and APAC region.

On a year-over-year basis, System and Services revenues were up 24.5% due to higher shipments and service. Cumulatively, over 27.4 million orthodontic scans and 6 million restorative scans have been performed with iTero scanners.

For Q3, total Invisalign cases submitted with a digital scanner in the Americas increased to 83% from 79% in Q3 last year. International scans increased to 72%, up from 63% in the same quarter last year. We're pleased to see that within the Americas, 95% of cases submitted by North American orthodontists were submitted digitally.

Our Q3 Systems and Services revenue also includes exocad CAD/CAM products and services. exocad's expertise in restorative dentistry, implantology, guided surgery and smile design extends our digital dental solutions and broadens Align's digital platform toward a fully integrated interdisciplinary end-to-end workflows, and we're excited about our continued integration progress and product plans.

In September, exocad celebrated its tenth anniversary in conjunction with exocad Insights 2020, an annual event for manufacturers and users of dental CAD/CAM technologies entitled, A Decade of Digital Innovation. The event attracted over 300 dental technicians, dentists and over 40 partner companies as well as 1,600 users of digital technologies and laboratories and practices from 55 countries.

With that, I'll turn the call over to John.

Thanks, Joe. Now for our Q3 financial results. Total revenues for the third quarter were $734.1 million, up 108.4% from the prior quarter and up 20.9% from the corresponding quarter a year ago. For clear aligners, Q3 revenues of $620.8 million were up 108.1% sequentially and up 20.2% year-over-year due to Invisalign volume growth in all regions driven by North America, EMEA, APAC and Lat Am partially offset by lower ASPs.

Historically, we have raised prices by approximately $50 per case in the third quarter. Given our continued commitment to helping our customers in their recovery efforts, we did not implement a price increase this year.

Q3 Invisalign ASPs were down sequentially $75 primarily due to higher mix of new cases versus additional aligner shipments, as Joe mentioned earlier. Recall, Q2 ASPs benefited from more additional aligner shipments as doctors were focused on maintaining treatment progress for existing Invisalign patients. This trend reversed itself after practices reopened in Q3 and demand for new cases ramped up significantly. As a result, our deferred revenue balance increased $93 million from Q2, of which the majority of this increase is related to clear aligner and will be recognized with future additional aligner shipments.

On a year-over-year basis, Q3 Invisalign ASPs decreased approximately $80 primarily reflecting higher promotional discounts and increased deferrals related to additional aligners. In addition, we provided doctors with incentives designed to specifically aid them in the recovery during the pandemic.

Q3 total Invisalign shipments of 496,100 cases were up 123.6% sequentially and up 28.7% year-over-year. Our System and Services revenues for the third quarter was $113.4 million, up 110.1% sequentially due to an increase in scanner sales and increased services revenue from higher installed base.

Year-over-year Systems and Services revenue was up 24.5% due to higher scanner sales services revenue and the inclusion of exocad's CAD/CAM services partially offset by lower scanner ASPs.

Imaging Systems & CAD/CAM Services deferred revenue also increased 28% primarily due to the increase in scanner sales and the deferral of service revenues, which we recognize ratably over the service period.

Moving on to gross margin. Third quarter overall gross margin was 72.7%, up 9.1 points sequentially and up 0.7 points year-over-year. On a non-GAAP basis, excluding stock-based compensation expense and amortization of intangibles related to exocad, overall gross margin was 73.3% for the third quarter, up 8.9 points sequentially and up 1 point year-over-year.

Clear aligner gross margin for the third quarter was 74.7%, up 10.2 points sequentially due to increased volumes driving favorable manufacturing absorption of fixed costs, coupled with lower freight costs from increased domestic shipments partially offset by lower ASPs. Clear aligner gross margin was up 1.2 points year-over-year due to increased manufacturing volumes, driving favorable absorption and lower doctor training partially offset by lower ASPs.

Systems and Services gross margin for the third quarter was 62%, up 2.8 points sequentially primarily due to favorable product mix to higher-margin scanners, higher services revenue partially offset by freight and training costs. Systems and Services gross margin was down 2.1 points year-over-year due to lower ASPs and higher freight and training costs offset by higher services revenue and product mix shift.

Q3 operating expenses were $357 million, up sequentially 20.1% and up 15% year-over-year. The sequential increase in operating expense is due to increased compensation, marketing and media spend and favorable foreign exchange. Year-over-year operating expenses increased by $46.6 million, reflecting our continued investment in sales and marketing and R&D activities. Additionally, prior year included a benefit of $6.8 million from the early termination of our discontinued Invisalign store leases.

On a non-GAAP basis, operating expenses were $332.1 million, up sequentially 25% and up 12.8% year-over-year due to the reasons as described above. Our third quarter operating income of $177.1 million resulted in an operating margin of 24.1%, up 44.8 points sequentially and up 3.2 points year-over-year. The sequential increase in operating income and operating margin are primarily attributed to higher gross margin and operating leverage. On a year-over-year basis, the increases in operating income and operating margin reflect higher gross margin and operating leverage partially offset by our continued investment in R&D, geographic expansion and go-to-market activities.

On a non-GAAP basis, which excludes stock-based compensation, acquisition-related costs and amortization of intangibles related to exocad, operating margin for the third quarter was 28%, up 39 points sequentially and up 4.2 points year-over-year.

Interest and other income expense net for the third quarter was a gain of $7.5 million primarily driven by favorable foreign exchange. With regards to the third quarter tax provision, our GAAP tax rate was 24.5%, which includes tax benefits of approximately $8 million related to the release of certain previously unrecognized tax benefits as a result of the closure of an income tax audit.

The third quarter tax rate on a non-GAAP basis was 16.6% compared to 27.8% in the prior quarter and 18.8% in the same quarter a year ago. The third quarter non-GAAP tax rate was lower than the second quarter's rate primarily due to reduction in tax benefits resulting from considerable profits recorded in Q3 as opposed to losses incurred in Q2.

Third quarter net income per diluted share was $1.76, up $2.28 sequentially and up $0.48 compared to prior year. On a non-GAAP basis, net income per diluted share was $2.25 for the third quarter, up $2.60 sequentially and up $0.77 year-over-year.

Moving on to the balance sheet. As of September 30, 2020, cash and cash equivalents were $615.5 million, an increase of approximately $211 million from the prior quarter, which is primarily due to higher cash flow from operations. Of our $615.5 million of cash and cash equivalents, $298.8 million was held in the U.S. and $316.7 million was held by our international entities. Q3 accounts receivable balance was $626 million, up approximately 32.3% sequentially.

Our overall days sales outstanding was 76.5 days, down 44 days sequentially and down 2 days as compared to Q3 last year due to strong cash collections as doctors' offices reopened from Q2 shutdowns.

Cash flow from operations for the third quarter was $211 million. Capital expenditures for the third quarter were $21.3 million primarily related to our continued investment in increasing aligner capacity and facilities. Free cash flow defined as cash flow from operations less capital expenditures amounted to $189.8 million. Under our May 2018 repurchase program, we have $100 million still available for repurchase of our common stock.

Now let me turn to our outlook. Overall, we're pleased with our Q3 performance and the strong momentum in our business. We made investment decisions that help drive and capture demand across all regions and all customer channels. We see good return on our investments and strong revenue growth, which has contributed -- has continued into October. We are confident in the huge market opportunity, our industry leadership and our ability to execute. At the same time, there continues to be uncertainty around the pandemic and global environment. Therefore, we aren't providing specific guidance.

With that, I'll turn it back over to Joe for final comments. Joe?

Thanks, John. In summary, we're certainly pleased with our progress in the third quarter. We have taken a very thoughtful approach to recovery, and we've persevered in a large part by living the values that are important to us as an organization: agility, customers and accountability.

In a time of great uncertainty when swift actions have been required, we've responded like no other company in our industry. Most importantly, we have followed our guiding principles and supported our employees and customers, protecting employee jobs and salaries and working to support the needs of our teams globally. And supporting our customers with PPE, extended payment terms, postponed subscription fees for iTero and numerous programs to help them through this crisis.

We also applied our manufacturing experience and resources to making testing swaps for hospitals and PPE for our own terms, teams and also customers. Instead of going quiet or holding on a planned spend, we accelerated our investments in marketing to drive consumer demand to our doctors' offices and stay top of mind with consumers.

We accelerated new technology to market so that we could provide virtual tools to our doctors that enable them to stay connected with their patients and keep their treatment moving forward. We supported doctors and their teams with online education and digital forums that went beyond product and clinical education to help to navigate the PPE shortages and recovery planning. And we continue to grow the business, not just protecting jobs but adding headcount, continuing our investments in R&D and product innovation, as you saw in our Invisalign G8 announcement today and developing our plans for manufacturing expansion.

Our actions are a result of the convictions that we have in our business model, supported by the strength of our balance sheet to drive results that exhibit our accountability to our employees, customers and shareholders. Even in a time that required us to change and adapt, we maintained our long-term focus. I feel this is what good companies do. And it's proof of being a good company and delivering on the types of results we've seen this quarter can go hand in hand.

We have remained a growth business, driving programs in anticipation of recovery, but we acknowledge that there still remains uncertainty due to COVID-19. Our plan is to counter future uncertainty by staying focused on our long-term strategy, living our values, supporting our employees and customers and keeping the demand drivers we've identified over the last few months in mind: the redirection of disposable income for many consumers; channel focus that allows us to reach and support a wider range of customers within each channel; and most importantly, the digital mindset that is really taking hold with more and more of our customers and that we are supporting through innovative products and programs that can help support their digital transformation.

We are not ignoring the reality of COVID-19 and how long it may be part of our lives. But we're also not going to stop driving the business forward for the good of customers, their patients, our employees and stakeholders.

With that, I want to thank you again for joining our call. I look forward to updating you on our progress as the year continues to unfold. On November 20 to 21, Align will be hosting the Invisalign Ortho Summit, Virtual Edition with the theme, Digital is the Answer.

The Invisalign Summit is the ultimate learning experience for orthodontic practices. From digital practice transformation to great patient experience, there's never been a more exciting time to learn about digital orthodontics. Align will also host a Virtual Investor Day on November 23, where I also look forward to sharing our views on the incredible market opportunity that we have combined with the unmatched power of Align's digital platform, technology innovation, global reach and brand equity.

Now with that, I'll turn it over to the operator for questions. Operator?

(Operator Instructions)

Our first question comes from the line of Nathan Rich with Goldman Sachs.

Joe and John, obviously, great to see the volumes come back so nicely. Sounds like the momentum continued in October. Could you maybe just, kind of, help us understand, kind of, the cadence of growth that you saw over the quarter? And any comments on how October has fared so far maybe relative to the type of case growth that you saw in 3Q?

Yes. Nathan, thanks for the question. Look, we just built through the quarter. Every month we saw, actually, continue to enhance momentum. And the short answer to your question is, we've seen that build in October also.

That's great. And Joe, obviously, you talked through in detail about what has driven the stronger utilization that you've seen in the value of digital treatment. When you take a step back and think longer term, how is that kind of change your outlook or influence your multiyear outlook for what you could see from this business over the next several years going forward?

Nathan, you've known John and me, and Shirley really long enough. I mean we're incredibly enthusiastic about this business and bullish about this business. And you can see we're even more so as, obviously, we delivered the kind of results we have in 3Q. I think you always have to keep in mind 2 things here.

One is we're in a very volatile environment. We understand that, and we've done some things we feel that's really helped our doctors through this and made the company stronger coming out at the other end.

But always remember, we're completely under-penetrated in this marketplace, right? We're still less than 10% penetrated from an orthodontic procedure standpoint, let alone those 300 million patients we talk about there, that should receive orthodontic treatment that aren't receiving orthodontic treatment. So let me -- we remain incredibly bullish with a digital format to be able to go after those patients and be able to continue to drive the growth of this business.

Our next question comes from the line of Erin Wright with Credit Suisse.

So can you speak to some of the contributions from the recovery efforts in switching brackets and wires in patients? Are you continuing to see those contributions and efforts into the fourth quarter? And do you think that will drive a more longer term shift here? Do you have any indication based on the responses, I guess, you've seen from practitioners, how sticky that is?

Well, it's -- overall -- hey, it's Joe. I mean overall, it's pretty sticky when we buy their wires and brackets inventory back. And then we introduced in the programs like ADAPT and different things. It will really allow them to begin a digital transformation within their practices. So I feel that part is very sticky.

I can't sit here and naively say that everyone who starts to move digital in this crisis is going to stay digital. But I can tell you that we have the tools, being able to drive consumer demand and the consumer awareness and all those things helps us to maintain that stickiness. And I think over time, we'll just have to see how sticky it is as we come out of this COVID crisis.

Okay. Great. And then on ASPs in the quarter, I guess, is that the run rate we should be thinking about? I know you didn't take the price hike, but any other mix dynamics then as we think about the next quarter and beyond?

Yes. Erin, this is John. Yes, the mix that we saw, we talked about some of the dynamics of all those new cases coming in. And we saw that. We also talked about not having a price increase given the conditions that we're in. We'll evaluate going forward as to any changes we might make in pricing and so on. But I think from a run rate standpoint, this is a good starting point for going forward.

Our next question comes from the line of Stephen Beuchaw with Wolfe Research.

I wonder if you could expound a little bit on some of the numbers that you've given here this quarter, and I believe you did in the prior quarter as well, around not just the training numbers, but some of the data that you gave on people who are not just getting trained, but who are new to Invisalign. I'm sorry, I don't know it. Maybe some do, but what were those numbers a year ago? And do you have visibility into what those training numbers look like out into 4Q or even beyond?

Yes. Steve, this is John. I think when you look at being able to train like we can now, doing much more virtual, be able to have that remote training as well as where you can in person, gives us a lot of flexibility going forward to be able to expand out our training. So there's a lot of new capabilities, a lot of new tools that we've introduced this quarter to be able to help our customers and train new customers as well as our sales team be able to reach those.

So it's a key part, as you know, to our growth, and we're going to continue to find ways to be able to connect with new doctors to be able to get them to understand the benefits of Invisalign and ultimately have them use it more and more to grow.

Okay. And then, Joe, one for you. So I'll let you carry the burden of being the CEO of the first big dental company here in the U.S. to report. Just give a little bit of perspective on how you imagine policy evolve.

As you talk to folks around the CDC, AAO, the ADA, any of their counterpart organizations in Europe, do you see any sign that there might be a move toward practice closures? Or are we really past that now that we've got PPE in place? I ask because I think there are just a lot of folks who are looking at the growth, not just at Align, but at some other companies, and it's really attractive growth, but people are just worried about the possibility that we see lockdowns again. So any perspective you could offer there would be really helpful.

Yes. Steve, I'd tell you, talking to, obviously, doctors all around the world or whatever. I don't see that there's any imminent a lot of closures in the industry. I mean there's frustration with the closures. And obviously, a lot of disagreement in the sense of when they're told to close. Fortunately, what we've seen with the COVID coming back here in the fall, we haven't seen the institution of going back and closing these doctors' offices, which help.

I can tell you, Steve, since I've been here 5 years, there's always a certain segment of the dental industry that is looking to sell or looking to change and get out, but not close down. So I honestly think that there's still optimism out there. I've seen the doctors do a great job in a sense of being able to protect their employees, make sure that they protect their patients and do the things that are needed.

I know by reading your material and other materials that we've all picked up that most of the doctors are running at 70%, 75% kind of the capacity, but they're finding a way to make it work. So I'm not looking at any imminent demise in the business in the sense of close downs or anything like that. And I think the offices are getting better and better in being able to drive volume through their offices.

And again, you know that this is the digital format that we feel that sets a foundation for them to have a much better patient flow through and much fewer touches in this COVID world, which we hope -- hopefully will carry over as we move out of this next year.

Our next question comes from the line of Jon Block with Stifel.

Joe, actually, first one for you. Sort of qualitatively, can you give us a beat or a signal on teen share of chair? And do you see it broadening out within your ortho customer base? I think that's the key sort of the broadening out. In other words, are you seeing the one from orthos that were always, I don't know, call it, less than 5% Invisalign share of chair? Are they stepping up to the play because the clear aligner workflow advantages? And if so, how do you sort of ensure that you capitalize on that longer term?

Yes. Well, I think there's a couple of things. John, obviously, COVID has been an additive incentive to move people out of analog and into digital because of fewer touches and being able to maintain continuity of treatment even if things were shut down. So there's no question, we saw a share of chair increase in that sense.

I think also when you see new products like Invisalign First and those things we've introduced in the last few years, that's -- as you know well, that's extended our reach from an age standpoint within that specific demographic. That's helped us also.

And I think there's a combination here of further and further realization of how digital processes in orthodontics really can help, can help be more efficient. But also a realization from consumers that it is an offering here that is better than wires and brackets and more efficient, certainly in this COVID, kind of, environment.

So how do we -- how are we certain that we maintain that? So when you look at programs like ADAPT and things, those -- let's switch over. Let's back up for a second, John. 5 years ago, we were fighting for a clinical, I'd say, relevancy in this industry. That's not a question anymore. Most of the docs out there understand very clearly, we can do 80%, 90% of the cases out there. It becomes a business formula. Can we really make money with a digital kind of a system?

And those are the programs that we've been putting together with doctors, with outside experts that can really train doctors as to how digital can work, how it can expand their practices and how that actually can be more profitable in a digital processing. I'm confident with what we're building up in that area, we'll be able to extend that going forward.

Got it. Fair enough. And I'll shift over to GP side for the other question, the utilization number 4, I think I've been waiting for 10 or so years for that. And I get it. Some of it's probably pent-up demand. You talked to that a little bit on the call, but what about the other components? Is it some scanner, digitizing the front end, the bifurcating of the sales force?

I mean essentially, Joe, have you given the tools that you needed to the GP to finally sort of step function that utilization rate higher? That was always sort of stuck right around that mid-3s for a number of years.

Yes. Jon, I feel the answer your question is, yes, we have. I mean everything from iTero and really the insides of iTero and the software programs and all, in conjunction with iGo, is that make it much simpler for doctors that haven't been associated with digital orthodontics before.

Our segmented sales force, for sure. I mean we piloted this in Europe first and somewhat in APAC. So we knew what to expect. We are just fortunate enough to launch it ahead of this issue -- ahead of the COVID issue and to have the salespeople ready to have that touch with customers to make it work.

What I'm excited about this, Jon, we have so much more that we can do to make that work also. And I think with the confidence that GPs are having in this kind of a system, it's a light touch system. It's a high revenue, kind of, a product, and it's gaining more attention in that channel. So yes, I'm really -- we're all thrilled here to see the utilization rates. But it is on the back of those kind of innovations in distribution and also product that we think we've been able to drive it.

Okay. And if I could just quickly slip in one more. Just for a clarification, I think it was all the way back to Nathan's first question. Just to be clear, when you say momentum building, I mean, do we take that your October year-over-year growth rate was north of your worldwide 3Q growth rate that you posted?

Jon, we -- you're right, we are -- we see momentum building. And that continues -- it continues that growth from a revenue and a volume standpoint into October.

Our next question comes from the line of Elizabeth Anderson with Evercore.

As we think about the outlook for 4Q and as we come out of COVID more broadly, are there any -- I know you guys were obviously didn't cut costs, kept the sales force because you maybe foresaw some of this growth coming back. Is there anything in terms of investments of the ramp back that we should be considering?

Well, there's a bit -- I think we're just -- there's continuity of investments is the way I'd answer your question. They're not new investments. We'll continue to invest in the consumer side pretty dramatically. You'll see that we're doing that all around the world. It's not just in the United States or Canada. We're also -- you'll see investments in Europe and also Asia to a degree that we haven't made before.

We have a series of new products that we're investing in that we kept that momentum in the third quarter and where we hired engineers to keep that moving. And then these specific programs for doctors like ADAPT that we're talking about, an AIF and different things, they're really an important part of this because you have to make sure that these workflow changes and the way ClinCheck works, like ClinCheck Pro, whatever, they have to be introduced to docs. And you got to have a high-touch kind of a system to give them the confidence in those programs.

So it's a long answer to your question, but I'd say we maintain and enhance what we have been doing is what you'll see in the fourth quarter and as we go into the first quarter, too.

The added piece, Elizabeth, from an investment standpoint is investing in operations to stay ahead of the volume and making those investments. We did so in Q3, we'll continue to make those investments in Q4.

Okay. But it doesn't sound like there's anything totally different that the sort of -- because we could consider catch up for something on that front?

Okay. I guess, and then...

No. I don't think... go ahead, Elizabeth.

No. I was just wondering, just -- you talked about some of your continued spend on social channels in terms of marketing, and that seemed also a continuation plus, obviously, the back program in the quarter. Is there anything else that you guys see changing in terms of your marketing spend going forward? Or do you see it's sort of like a continuation of the types of programs that you were doing in the third quarter?

Well, I think obviously, Raj and our marketing team are very innovative. And it's not that we'll just keep with the same themes. We'll -- we obviously -- we run trials, we do different things. We'll change them up or whatever, based on what we're experiencing in the marketplace. So our investments will continue to be very aggressive. We'll continue to be innovative in the sense of how we do these things. But we certainly won't let off the gas in the sense of the focus that we've had over the last few quarters.

Our next question comes from the line of Steve Valiquette with Barclays.

This is Jonathan Yong on for Steve. So just in relation to the backlog that you were talking about and the pent-up demand, I guess from your perspective, how much backlog do you think is, kind of, still out there with the docs before kind of normal -- before it normalizes that as we kind of move forward?

You asked a big question. I mean from a backlog standpoint, we really don't know. When you talk -- from an empirical standpoint, when you talk to any of our docs, they cleared out their backlog in July and August from -- this is a global business. It's hard to talk about all over the world where it stands, but -- and when things came out of lockdown and when they didn't. So we've struggled to be able to quantify a number for you in that sense.

Okay. And just going back to the comment about the utilization of docs being at about 70%, 75% capacity. I guess from -- that's from the capacity standpoint. But from your customer base, are they all largely open at this point? Or is there still 10%, 20% that still remains closed due to random shutdowns globally or locally in certain areas?

No, they're largely open.

Our next question comes from the line of John Kreger with William Blair.

Can you just talk a little bit more about, again, the uncertainties that prompted you to not guide to Q4 after a very, very good third quarter? And one thing I was thinking about, given the rebound in cases in Europe, are you seeing any sign of, maybe, just patient traffic slowing down even if practices aren't closing per se?

Yes. I think, John, when you think about what we've seen in terms of the momentum we see, we try to lay that out. Obviously, there are still unknowns in the world. I would say, COVID and the global economy and so on. But for the things that we can control and what we tried to lay out around the R&D investments in manufacturing and marketing and sales, we feel really good about our momentum and what we can drive in the future.

We just have unknowns that are outside of our control. And so that's the reason from a guidance standpoint that we didn't give specific guidance. And -- but we wanted to highlight that we saw continued momentum as we went through the quarter, both for revenue and volume and that continued past the quarter end.

Great. Joe, a question for you about sort of the strategy to get the attention more of GPs. Can you just talk about how exocad is going? And what else you -- what other levers you're pulling to sort of become more of that daily thought process for the typical general dentist?

Yes. John, it's a good question. Look, I feel great about exocad. And obviously, what I talked about in my -- in the highlights that we just went over is, I mean it's digital dentistry on the GP side. And you have to go around the world to understand how exocad is. exocad is very embedded in Europe, also in various parts of the Far East and in some parts of the United States. But the key is just a digital workflow. And it's between -- iTero fronts this. It's in a -- obviously, a GP's office, and that CAD/CAM piece is either extended in office or primarily it goes to labs.

It's given us -- I think it's given us the initial boost that we wanted to in the sense of our relevancy in the GP's office, in the sense of an iTero scanner can do these kind of restorative scans and this kind of restorative workflow.

What's really exciting is when you look at how you can integrate what exocad does in a seamless workflow way with iTero and also Invisalign, it just gives us a lot of degrees of freedom to really change that kind of restorative dentistry and I'm really excited about the progress even in a short amount of time.

Our next question comes from the line of Brandon Couillard with Jefferies.

Joe, I think you said leads were up something like 120% year-over-year. How do we think about the relevancy of that metric as a leading indicator of revenue growth? It's not a metric I can recall you really discussing before.

Well, it's a good question. I mean we do -- I don't know how we we've communicated that before, but it certainly is a term we use internally here at Align all the time. And a lead is just what you would guess it is, Brandon. It's a strong lead in a sense of a customer wanting to turn into a patient. And we have several ways of touching that customer.

They can come through our Invisalign app. They could be contacted by a concierge service. Concierge service can take the information and move it on to a doctor's office. But it's a lead and it's a great leading indicator of the interest of patients out there. And it's, again, one of the major attributes of Align and what we bring to the marketplace is to be able to excite consumers and move them into our doctor partner groups.

Okay. And then John, any chance you could specifically speak to China growth in the third quarter? And then secondly, the financial impact of opening the new permanent manufacturing facility as opposed to the temporary site you have been operating, be it in terms of revenue growth or profitability expenses, anything you can share there?

In China, we saw a good sequential growth, continues to grow. I mean, obviously, they were the first ones, kind of, in the pandemic to start in Q1. We saw some growth in Q2 and significantly more growth in Q3.

The manufacturing, like you said, has gone live. It's now a greenfield facility where everything is up and running. We're adding more capacity there to meet our demands, but it was a very smooth transition. We learned a lot from having that temporary facility and learning kind of the manufacturing, the scale-up that we needed and that transitioned very well into the new facility.

Our next question comes from the line of Jeff Johnson with Baird.

So Joe, I wanted to start with you and the same thing Jon Block is trying to feel out here. But on -- was there anything different in your North American ortho customer mix? Did the Diamond and double diamond guys come back much faster than the lower end guys, anything at all like that?

And I guess what I'm trying to get at the same thing, like I said, John, is sustainability of that 24% North American ortho utilization number, a fantastic number, is that our evidence? Is that our proof point there of this move from analog to digital as you keep talking about it? Is that the number to focus in on there, and obviously, the GP number as well?

Yes. I think if you're -- Jeff, if your real question is about utilization being a key metric, I mean, it certainly is. Now who led that? Our Diamond, Diamond Plus docs already have a big digital aspect of what they were doing. We're able to function extremely well in this environment.

Remember, our virtual care tool that we wrote out really 6 months before we wanted to do it. It wasn't the best tool in the world, but we've made it better over time, really given that digital interface with their patient base that allow them to be able to track their patients without having to come back to the office that was closed or (inaudible) at the time.

So -- but to say that it was only those practices would be wrong. We saw -- no matter what tier they were in our advantage program, we saw them reaching for training, wanting to work from a digital standpoint, the orthodontist to recognize the advantages of digital doing this whole sequence. And again, that's why the program and the things that we've had in place, the investments we made or whatever, they were very timely to help to support that interest.

Yes. Understood. And then maybe just a follow-up for John. So John, you seem to imply that maybe ASPs here at this level are a good way to think about the next few quarters. Does that mean some of the incentives, kind of, sustain here? Do you leave them in place and I just want to understand the accounting. Does the bracket buybacks, does that go against ASPs in any way? Or is that a cost buried somewhere else in the P&L?

No. That is a cost against the -- as a promotion. So it goes against revenue for the bracket buyback. And we'll evaluate as we do on a normal basis with promotions, what promotions are working, what's driving that right level of utilization and engagement, whether you're a new doctor to a doctor that does a lot of volume.

We did mention that we didn't increase price. And that was something that's a reflection of what's happening in the marketplace. And look, we were very pleased with -- when you look at Invisalign ASPs, it's at 74.7%. We haven't seen that in several quarters. So we're very aware of the dynamics around promotions and what that drives. But ultimately, it's driving profitability and we saw great gross margin growth.

Our next question comes from the line of Glen Santangelo with Guggenheim.

Glen are you there? Maybe we're not hearing your line clearly.

Hello, can you hear me now?

Yes.

Yes, we can.

Joe, I just want to take a step back. I mean a lot of the questions were already asked, but I wanted to follow-up to a response you said to an earlier question. What's your sense going on with the organic growth rate of this business? I mean are you seeing the organic growth rate or just in ortho business in general, accelerate through the pandemic?

And then as you think about sort of the penetration of clear aligners versus total cases, you sort of cited that you still think were less than 10% penetrated. Can you maybe talk about the penetration in North America and international, and maybe how you see those sort of penetration rates evolving over the next couple of years?

Well, I mean, we -- obviously, we measure ourselves from a penetration rate standpoint overall. And we split the market up, obviously, in teens and adults, ortho versus the general segment with GPs. But if I'm answering your question right, Glen, I mean we have increasing penetration and utilization we call in different parts of the marketplace. The digital platforms and things that we've put in place are really enhancement to doctors to get on these digital platforms and use the tools and things that we have.

So Glen, I think, again, as I mentioned in the other question on -- like this is that, remember, we're so underpenetrated. It really is. Digital orthodontics has such a long runway. But it is a different workflow for doctors, and it's a different expectation from a patient base, understanding you really can use digital plastic in order to move teeth as efficiently or better than wires and brackets.

And so, it's so important that we have a strong digital platform that unites the workflow between us and doctors and doctors and patients that you have a breadth of product. Everything from Invisalign First all the way to Express and comprehensive products and retainers and things in between. Sales forces are incredibly important for that penetration in the sense of how you touch docs and how you move things forward.

So there's -- I would say, Glen, to answer your question here, there's no magic on this penetration piece. It's a lot of work. It's a lot of work and a lot of friction you have to overcome. There's no escaping it. But it's inevitable. Digital is better than analog in a COVID environment or not in the COVID environment. That's our position and that's what we'll continue to drive.

And Joe, it seems like you maybe expanded your sort of technology lead again with sort of this latest development on the G8 side. Could you maybe just give us a quick update on the competitive landscape? Are you seeing anything else in the market that that is starting to get any traction? Or is it still kind of really just an execution issue for you?

This is all about execution with us. It's a -- from a -- I have nothing from an update from a competitive standpoint, really to report. Remember, our competition is about expanding the marketplace. That is what it's all about.

This is not a scrum of a bunch of people making plastic aligners. This is the scrum about what can you do to reduce the friction of getting dentists and orthodontists to move forward in the digital process. It's the growth of this marketplace that is really the material difference here. It's not individual competition and the trenches that we're focused on or concerned about how do we expand the marketplace, Glen.

Our next question comes from the line of Richard Newitter with SVB Leerink.

I wanted to just start off, just looking back over the 20-year journey that you had or longer than that now. Well, you're not specifically, but just in aligners and what you've seen in your tenure and what you know before you. Can you -- there have probably been inflection point moments. And I'm just curious where and how kind of this COVID opportunity, which is clearly, on some level, creating an inflection point on some level. Where this stacks up?

A year or 2 years from now, do you think we're going to be saying this was probably the -- one of the defining periods for you guys to capitalize on converting the team segment and getting that accelerated kind of digital boost that you needed to really kind of move this market conversion opportunity in a set function fashion? I'm just trying to put it in perspective. Are we kind of at the demarcation here, in your view, where this is kind of defining period for the company?

Well, Rich, it's always really -- it's hard to always call -- you're asking about the tipping point. And John has a great saying, you never know the tipping point until it's there, right? So but I would tell you that, obviously, in the current environment that we have right now where infection is a concern, digital becomes predominant in that sense of doctors looking at it.

But I think another good signal that you can say that this can become more permanent is what's really unusual here is take a look at iTero growing 25%, right? You see capital goods in a situation like this are going to lag because doctors aren't going to make that kind of a capital outlay when their businesses are under pressure. And what we saw in this case is iTero grew phenomenally.

And what we know, and you see that 93% of the cases in the United States right now for orthos are coming through digitally is, when you get an iTero scanner into an office, whether it's a GP or ortho, they've become really committed on the digital piece and want to learn.

So I think that kind of demand for iTero scanner, and what I call a hurricane right now from a doctor's cash flow standpoint, really shows that they're interested in the sense of this digital transformation and want to stick with it.

That's helpful. And maybe just one follow up on the competitive commencing question from the prior. I was just curious, your ability to train virtually and remotely and your customer base and your advantage together, are your competitors able to kind of get into the channel even as effectively as they might have otherwise been? Or are you basically kind of converting on your own right now?

I'm just curious if there's just an inherent structural advantage that you have there during this period, and if competitor sales reps are allowed to engage as actively as you are.

Yes. It's -- forgive me if I don't answer your question properly, but what I derive from that is the importance of a sales force versus competition and the importance of training. And there's no company in the world that can provide digital training, whether it's virtual or if it's allowed in the future, which it will be obviously face-to-face across a number of platforms that Align can provide.

ADAPT is another kind of training. ADAPT is Align digital and practice transformation program, that kind of -- there are experts that we put in place that understand doctors' office workflow and economics and how we can work through them. Our sales force is -- since I've been in this business 5 years now, and I've run sales forces and businesses pretty much my entire adult life, I have never seen such a high-touch sales force in my life. The importance of touch with the sales team with those doctors is incredibly important because of how different digital is from a workflow standpoint and a clinical standpoint than what an analog procedure is. So there's no way around that.

And then the last part is, maybe we're taking advantage of our competitors or something. And I don't say this in any arrogance or whatever, the competition's competition. I actually welcome it to a certain extent because it helps legitimize the digital space. Our job broadly is how do we go and get dentists and orthodontists to move from analog to digital, not so much what the next competitor's product is out there and that we're fighting for that extra ounce of share. That's not where we are right now. This is about an expansive marketplace.

Our next question comes from the line of Ravi Misra with Berenberg Capital Markets.

Hope everyone's well. Just a -- to take a pivot to the GA for a second. And remembering correctly, prior versions of the systems have been seen as these step function advancements that have opened the door to more cases and more comfort with doing the system. But G8, just curious in terms of, number one, how do you see it kind of increasing the addressable market for the number of cases you can treat? I mean is this opening up doors that couldn't be done before by the sort of average dentist?

And number two, do we have any sort of IP protection around this? I mean looking at the press release, it seems like a pretty powerful set of innovations and the way you're staging it? Or is this kind of a function or a development on top of existing technologies in that sense from an IP perspective?

Yes. Ravi, good question. First of all, when you think of how we got the G8 is we've done 9 million patients, right? And probably deep bite cases are 30% of those cases and G8 is around deep bite. And when you do deep bite, there's a lot of extrusion in deep bite. Now I want to get too clinically into this thing, but extrusion just means you're pulling the tooth down or pushing a tooth up. And those are the most difficult movements that we make. They are the hardest movements to do.

When you talk about IP, it has to be with the specific kind of attachment. It's where you place that attachment. It's that interface of that attachment with the aligner and how the aligner -- actually, that's what we call it the activated part of this thing. And I'd say, do we have IP around that? Sure, we do. Do we have IP around doing a deep bite case? No. But our products are specifically geared to be able to do that.

And so we use a lot of AI and machine learning to mine that database to figure out where these deep bite cases weren't finishing as fast as they could be at times. And the new G8 is supposed to make this better. It's been tried in different areas. And in the end, what it does, it gives doctors more confidence to be able to get into those cases and know they can finish in the way they want to finish. And that's the purpose of the product.

Great. And then maybe if I can build on that. So prepandemic, you guys were on a kind of case growth basis, somewhere in the 30s, high 20s range. I appreciate that it's very difficult to look past what's going on in the world right now. But today, we do kind of normalize at some point in the future postpandemic. With these innovations and the sales force touch points that you mentioned, is that 20% to 30% are kind of reasonable proxy for where this market can go?

Ravi, this is John. Good question. When we think about the investments that we make in the -- as we've described, the vastly underpenetrated market that we're in, we look at our investments to say, look, we can grow revenue in the 20% to 30%. And that's how we think of things, and that's what we think that we can control, the investments that we're making to be able to grow in this market to that. We didn't guide to that because there's unknowns outside of what we can control and we've kept it at that.

But certainly, when we look at investments in this market and the opportunities that we have, we look at those investments with the long-term growth model from a revenue standpoint of 20% to 30%.

Our next question comes from the line of Michael Ryskin with Bank of America.

I realized it's late, so I'll just keep it to one. Obviously, you see the strong -- really strong utilization numbers in the Americas for the orthos and GPs. But obviously, that's only half of the equation because you also got the number of docs actually receiving those.

So I was just wondering if you could provide any additional color on the split between ortho and GP, which really drove the volume in the quarter in the Americas. And what I'm getting at is, with the rebound you commented on from that pent-up demand, was there one part of your customer base that really accelerated better than the others? Or was it pretty broad-based?

Yes. I can take that, Michael. This is John. Really, when we look at the utilization and the growth that we saw was very broad. It was across GP and ortho. It was across multiple tiers. We just saw a good adoption of our technology as these practices opened. Patients ask for it by name, doctors use our product. There are many doctors that were higher up on the tiers, accelerated their cases. And then even new doctors or doctors that are at lower tiers, were able to increase the utilization.

So we're very happy with the results that we saw from newer doctors to more experienced doctors and felt really good about how they were in that recovery mode. As we said, it's tough to understand and break out the piece of how much is pent-up demand versus run rate. But as we went through the quarter, as we said, we got stronger and stronger. So we feel good about the situation that we left Q3 with.

Our next question comes from the line of Jason Badner with Piper Sandler.

Great. This is [Guzman] here. Congrats on a nice quarter, everyone. Have a clarification question just real quick and then another I'll ask upfront here. Just that enhanced momentum building comment that you made for October, Joe, can you just confirm that, that holds for all major reporting channels you have with GPs and orthodontists?

And then I know it's early days for iGo Plus, but curious if you could just talk about initial feedback on the system in the first markets you entered in Europe, any learnings you can draw on the early days of that launch before you look to take that system into additional markets?

Yes, Jason. First of all, I can confirm that it's across all channels, all markets. There's nothing really that I can cite that's -- it's not with that momentum that we -- on iPro Plus. iPro Plus is about just enhancing the ability of doctors that are on iPro to be able to do more enhanced cases. And the feedback is great.

We started in Europe because that's where iPro really started from in a big way. And those are the first doctors that really asked for that. And then as -- and we've rolled that out in general. And it's really on the back of like the ClinCheck 6.0, the cloud-type-based product that we've done. It's one of the great things about digital platforms is you can expand them to be able to fit specifically in different markets at different times. And that's what iPro Plus really represents. So I hope that helps, Jason.

There are no other questions in the queue. I'd like to hand it back to management.

Thanks, everyone. We appreciate your time today. If you have any follow-up questions, please contact Investor Relations, and we look forward to speaking to you at our Investor Day, November 23. Have a great night.

Ladies and gentlemen, this does conclude today's teleconference. Thank you for your participation. You may disconnect your lines at this time and have a wonderful day.