Joseph M. Hogan
President and Chief Executive Officer at Align Technology
Thanks, Shirley. Good afternoon, and thanks for joining us. On our call today, I'll provide some highlights in the third quarter, then briefly discuss the performance of our two operating segments, Systems Services and Clear Aligners. John will provide more detail on our financial results and discuss our outlook. Following that, I'll come back and summarize a few key points and open the call to questions. I'm pleased to report strong third quarter results with revenue growth of 38.4% year-over-year on top of a record third quarter last year, driven by the strength across all regions, customer channels and products. For Q3, we shipped to a record 85,500 doctors in the quarter and reached 11.6 million Invisalign patients cumulatively. On a sequential basis, Q3 results reflect continued adoption of iTero scanners and increased utilization of Invisalign Clear Aligners in the Americas and APAC regions as well as the growth in Teen segment, especially in the North American orthodontics channel.
Our third quarter revenues reflect a growing confidence of doctors and patients with Invisalign treatment, iTero scanners and exocad software as more doctors discover the benefits of digital treatment and transform their practices with the Align Digital Platform. For Q3, Systems and Services revenues were up 57.3% year-over-year with strong revenue growth across all regions and up 5% sequentially primarily in North America. Q3 results reflect the continued adoption of iTero Element 5D Plus Series, our next-generation scanners and imaging system, which launched earlier this year and feature innovative technology like near-infrared technology, we call NIRI, which aids and detection and monitoring of interproximal caries lesions or cavities above the gingiva without harmful radiation. For Q3, Clear Aligner revenues were up 34.9% year-over-year with strong revenue growth across all regions and across the portfolio, including comprehensive and non-comprehensive products as well as Invisalign Moderate and Invisalign Go.
On a sequential basis, Q3 Clear Aligner revenues were down very slightly from record Q2, reflecting more pronounced summer seasonality than last year, especially in EMEA where practices and patients appear to have taken extended holidays and where offices were impacted due to resurgence of COVID-19 cases and restrictions, especially in some markets in Asia Pacific. In the Teen segment, Q3 '21 Invisalign Clear Aligner volumes for teens were strong, up 13.8% sequentially and 26.6% year-over-year to a record 206,000 teens, representing approximately 1/3 of total cases shipped, with strong shipment growth from North American orthodontists and a record quarter for Teen in APAC. Our third quarter revenues also include non-case revenue for clinical training and education and doctor-prescribed retainer products. Retention is a critical part of creating and maintaining a beautiful new smile. Retainers prevent teeth from gradually shifting back to their initial positions after treatment ends. Studies show that without retention, even perfectly aligned teeth can gradually revert to their pre-treatment state and that dentition continues to change as patients age, often requiring limited treatment, also known as touch-up treatment if not properly retained. Our retention products are designed to maintain teeth that have been aligned by Invisalign aligners, braces or other aligners.
These retainer products can accommodate lingual bars, wires, also known as a permanent retainer, missing teeth that require an artificial tooth and bite ramps, also known as turbos or blocks. While our retainer business continues to deliver solid revenue growth, our share of retention market is significantly underpenetrated, even more so than in our share of the orthodontic case starts. We have been developing a robust retainer strategy, including a separate marketing team focused solely on driving adoption and increasing market share in the United States. Our objective is to build brand awareness for Vivera retainers and drive engagement with doctors through clinical education and sales initiatives, while connecting consumers to doctors through demand creation programs and our concierge service. We've also recently implemented social media campaigns featuring the benefits of Vivera from the makers of Invisalign Clear Aligners.
We believe that incremental investments will provide increased value for Invisalign practices and drive growth consistent with our long-term financial model target. In addition, we successfully rolled out a limited pilot program to participating Invisalign providers in the United States and Canada that offers a monthly targeted subscription program to address the unmet patient demand for retention or touch-up cases. Our goal is to encourage experienced high volume in Invisalign practices who regularly treat patients with our comprehensive products to offer premium retention or entry-level products for the long-term health of their patients and to grow their businesses. Practices in this pilot program can purchase a monthly subscription at a fixed price based on their monthly needs for retention or limited treatment. The program allows doctors the flexibility to order both touch-up or retention aligners with their tiered subscription. The program is designed for a segment of experienced Invisalign doctors who are not regularly using our retainers or low-stage aligners. The positive feedback from our doctors have been encouraging.
For instance, the doctors at Bray and Tarby told us the program is very straightforward and easy to understand, and they've been hoping Align will do something like this. Dr. Jonathan Nicozisis at Princeton Orthodontics called the program a home run. We went -- he went on to predict it should replace the idea that doctors invest in 3D printing and the additional complications and expenses it requires, including the need for a full-time employee and additional overhead costs, particularly because he believes his treatment outcomes are always better with Align. Q3 non-case revenues also included accessories and consumables such as aligner cases called clam shells, cleaning crystals and other oral health products that are available on our e-commerce channels in the U.S. only, including the Invisalign accessory store, Walmart and Amazon.
In Q3, we announced an exclusive supply distribution agreement with Ultradent Products Inc., a leading developer and manufacturer of high-tech dental materials, devices and instruments worldwide. The Invisalign Professional Whitening program powered by Opalescence is optimized for Invisalign aligners and Vivera retainers and is available only through Invisalign-trained doctors. Also in Q3, we launched the Invisalign Whitening Pen through an e-commerce channels in the U.S. only. The Whitening Pen is an over-the-counter retail product for consumers seeking quick tooth whitening at a lower price and is not intended to be used with aligners. The Whitening Pen complements the other accessory products that Align already markets to consumers through its existing e-commerce channels and is a key addition to our consumable product portfolio. Now let's turn to the specifics around our third quarter results, starting with the Americas. For the Americas, Q3 results reflected strong performance, including record revenues for Latin America as well as summer seasonality for adult case starts in North America that primarily impacted GP practices, strong ortho performance, especially in the teen market that included increased utilization from the orthodontic channel.
Invisalign case volume was up 0.7% sequentially and up 36.4% year-over-year, reflecting growth across the region, especially in LatAm. DSO utilization continued to be a strong growth driver as well, led by Heartland and Smile Docs. For our international business, Q3 Invisalign case volume was up 27% year-over-year on top of record growth in the same quarter last year. On a sequential basis, international shipments were down sequentially 4.3%, primarily as a result of greater seasonality and COVID-related shutdowns in APAC markets. For EMEA, Q3 Invisalign case volumes were up 49.6% year-over-year, with broad-based growth across all markets led by the U.K. and Iberia, along with continued growth in our expansion markets in Central and Eastern Europe and the Benelux. For Q3, year-over-year Invisalign volume in EMEA was driven by increased submitters from both orthodontists and GPs and increased utilization primarily from orthos. On a sequential basis, EMEA was down sequentially 16.5% following a record Q2, primarily as a result of the extended seasonality we had anticipated primarily from summer holidays and vacations across the region.
For APAC, Q3 volumes were up 4.2% compared to a record Q3 last year in APAC. On a year-over-year basis, growth was uneven. The market as APAC, the first region to emerge from the depths of the COVID lockdown in 2020. Additionally, we saw COVID resurgences and lockdowns sporadically impact various APAC countries in Q3. On a sequential basis, Q3 Invisalign volumes were up 21.2% reflecting growth across the region, led by a record quarter in China, especially from teen cases as well as strong growth in Japan and ANZ. And Q3, growth from both channels was strong, with ortho growth driven by increased Invisalign utilization and GP growth -- channel growth driven by increased Invisalign submitters. APAC teen shipments reached an all-time high in Q3. At the recent 10th China Finance Summit Awards, Align was recognized as the 2021 most innovative enterprise for its advancements and outstanding contributions in the field of digital orthodontics. This award builds on our prior recognition of Align's leadership in the digital orthodontics industry and its efforts to promote the modernization of orthodontics. Our consumer marketing focuses on educating consumers about the Invisalign system to drive demand to Invisalign doctor's offices, ultimately capitalizing on the massive market opportunity to transform 500 million smiles.
In Q3, we expanded the next generation of the "Invis is" media campaign across EMEA, APAC and Brazil to increase awareness with adult, mom and teen consumers. Globally, we delivered 6.45 billion impressions, growing 42% year-over-year, resulting in a 70% year-over-year increase in unique visitors to our websites. In the U.S., we connected with teens on Snapchat, YouTube and Twitch with our "Invis is Not Your Parents Braces" campaign. These campaigns continue to feature some of the largest teen influencers from our Invisalign Smile Squad, like Charli D'Amelio, Marsai Martin, Michael Lynn Collins and Devon Key. These influencers share their personal experience with Invisalign treatment, including why they chose Invisalign treatment to shape their smiles. As part of our focus on teens, with our Invisalign ChangeMakers program, we held a recognition event hosted by Marsai Martin, with teens across the country to celebrate and recognize 100 teens across the country who drove positive change within their communities.
To continue growing for our young adult businesses, we expanded the "Invis is a Powerful Thing" campaign, which highlights how powerful the smile transformation with Invisalign treatment can be for their self-confidence. In the U.S., we expanded our Invisalign Smile Squad to include young adult influencers such as Cody Rigsby, Lana Condor and Emily Hampshire, will help to deliver over 405 million impressions. Additionally, our influencer partnerships with TikTok creators helped increase traffic to our sites with a 127% increase in click-through rates. In Brazil, we launched the "Invis is a Powerful Thing" campaign and teamed up with mega-influencer, [Indecipherable] to increase website traffic by 30%. In the EMEA region, we expanded into new media channels such as TikTok and Snapchat across the U.K., Germany and France to drive engagement. These efforts led to more than 153% increase in unique visitors. We also started consumer advertising in Russia, which resulted in more of a 1,000 increase in unique visitors to our website. In Q3, we continue to expand our consumer advertising across the APAC region, experienced a 132% increase in unique visitors to our websites.
In Australia, we expanded our media mix to include partners such as TikTok and Snapchat, which resulted in a 250% growth year-over-year in unique visitors to our website. In Japan, we continue to see a strong response from consumers to our "Invis is" campaign, resulting to more than an 800% increase year-over-year in unique visitors to our website. Adoption of our consumer and patient app, My Invisalign, continued to increase in Q3 with 1.2 million downloads to date. Usage of our four digital tools also continue to increase. For example, our Invisalign Virtual Appointment tool was used over 15,000 times and our insurance verification feature was used 14,000 times in Q3. Furthermore, we received more than 1.5 million patient photos in our Virtual Care feature to date globally, which continues to provide us with rich data to leverage our AI capabilities and improve our services for doctors that is used to enhance their patient's care. For our Systems and Services business, Q3 revenues grew 57.3% year-over-year reflecting strong scanner shipments and services and was up 5% sequentially. This is the fifth consecutive quarter of sequential revenue growth for our Systems and Services business.
The iTero Element 5D Plus imaging system continued gaining traction across all regions, with the most recent launch in Japan in Q3. The iTero Element 5D Plus imaging system will be available in China in Q4 of this year. Additionally, the iTero Element Plus Series was launched in Korea in Q3. The series expands the portfolio of iTero Element scanners and imaging systems to include new solutions that serve the needs of a broader range of doctors and patients in the dental market. Moreover, I'm proud to say that in a recent clinical study, the iTero Element 5D intraoral scanner was found to be more sensitive than bitewing radiology in detecting early enamel lesions, providing further evidence of the benefits of iTero 5D scanner in detection and monitoring of interproximal caries lesions or cavities above the gingiva without exposing patients to harmful ionizing radiation. This is great news for our iTero business as the study further supports the diagnostic validity of near-infrared imaging technology offered by the iTero 5D scanner for early proximal caries detection.
The findings also underscore the valuable role that NIRI technology can have in dental health assessment and early detection of cavities, which is important to the overall oral health care treatment options and a comfortable safe experience for a broad population of patients. A strong indicator of the digital acceleration with dental offices is a number of intraoral digital scans used for Invisalign case submissions. Total worldwide intraoral digital scans used to start in Invisalign case in Q3 increased 84.2% from 78.3% in Q3 last year. International intraoral digital scans for Invisalign case submissions increased 79.3%, up from 72.1% in the same last year. For the Americas, 88% of cases were submitted using an intraoral digital scan compared to 83.2% a year ago. Cumulatively, over 44.9 million orthodontic scans and 9.3 million restorative scans have been performed with iTero scanners. Our Q3 Systems and Services revenues 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 towards fully integrated interdisciplinary and workflows.
We remain excited about our continued integration progress and product plans with exocad. During the quarter, exocad launched ChairsideCAD3.0 Galway, the next generation of exocad's easy-to-use CAD software for single-visit dentistry. The software has improved automation for fast crown design and enables users to integrate open hardware and materials of choice. exocad's ChairsideCAD received 2021 Cellerant's Best of Class Technology Award for the third consecutive year. Also during the quarter, exocad had its largest ever presence at IDS, the International Dental Show, where they showcased their seamless digital workflows and the simplicity of the use of exocad's Galway software release. exocad was the only company at IDS to showcase live patient treatment with a smile creator experience station, featuring iTero's scans, instant smile makeovers and production of clip-on smiles. With that, I'll now turn it over to John.