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  "documentTitle": "Align Technology, Inc. (ALGN)",
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  "authorName": "Ben Axler",
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  "presentationDate": "2020-04-09 00:00:00",
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  "notes": "Uses a combination of qualitative expert testimony and a quantitative 'materiality' table to build a bearish thesis.",
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      "kind": "callout",
      "text": "Could 11.5% of Align's orthodontic case starts in the Americas be at risk to the loss of a single DSO customer?",
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      "text": "DSO Group Share of Invisalign Orthodontist Cases: 11.5%",
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      "text": "Spruce Point emphasizes that, while 3D printing centers are relatively new to the clear aligner space, the threat which they pose is not merely hypothetical...",
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      "kind": "quote",
      "text": "There is a 50% chance that we move away from Invisalign when our contract comes up in 2020...",
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      "kind": "quote",
      "text": "Invisalign case volume at DSOs is the biggest risk in the dentist channel. One big one that launches in house aligners... could have 50,000 annual cases at risk.",
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      "text": "You can setup a clear aligner FDA approved lab in less than a year. Your capital equipment costs... will be less than $200K.",
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      "kind": "quote",
      "text": "\"You can setup a clear aligner FDA approved lab in less than a year. Your capital equipment costs between buying three [high-volume] 3D printers and thermoforming machines can be less than $100K to get started. If you add in labor, your total costs in your first year will be less than $200K.\" — Senior Employee, Major Dental Equipment Supplier; \"There is a 50% chance that we move away from Invisalign when our contract comes up in 2020 and for me to say that is a big deal. It's a really big deal. I personally have not been happy with the service for the last year and half.\" — Dentist, Top 10 DSO; \"Invisalign case volume at DSOs is the biggest risk in the dentist channel. One big one that launches in house aligners and it is going to be a huge loss. If you have 1,000 practices in your DSO, each dentist could easily be doing 50 Invisalign cases a year, so with just one DSO, you could have 50,000 annual cases at risk.\" — Dentist, Top 10 DSO; \"Our group has a committee looking to get a relationship with one of these [third-party labs] as our own print farm. They seem keen on one or two affiliated with carbon printers.\" — Orthodontist, Large DSO",
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      "text": "Large DSO: Materiality to Align Case Volume table showing 11.5% share calculation.",
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      "text": "Not Just Hypothetical: Major DSOs Considering 3D Printing Centers, Both In-Sourced And Outsourced",
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