Big Brands, Big Ambitions and Yet No Success: The Dilemma of Aligner Orthodontics

For years, aligner orthodontics has been regarded as one of the most exciting growth markets in the dental industry. Forecasts were and still are impressive, double-digit growth rates, driven by the demand for aesthetic, digital, and convenient treatment methods. The long-term potential undoubtedly remains.

However, reality shows that many of these promising expectations have not materialized in the speed and scale originally calculated in the business cases of large dental companies, the traditional incumbent. We have already seen in the past that even companies with excellent reputations and global reach have failed to translate their ambitions into real market success in this segment. Dentsply Sirona is a striking example. With the acquisition of Byte®, the step into the direct-to-consumer (D2C) market seemed logical and forward-looking.

The SureSmile aligners also appeared promising, embedded in the company’s strong clinical expertise. Yet neither the D2C model nor the clinically oriented product line was able to achieve the anticipated market share or revenue. Still, after years of limited recognition in the aligner space, SureSmile aligners are beginning to gain traction in selected markets like Italy. This may reflect a longer-than-expected learning curve for Dentsply Sirona, further complicated by structural changes and leadership transitions that negatively affected early progress.

A similar picture emerges with Straumann Group. In 2017, the company acquired the U.S.-based business-to-business (B2B) aligner brand ClearCorrect to participate in global revenue growth in this segment. In subsequent years, Straumann also invested in the direct-to-consumer channel: in 2020 by acquiring the Berlin-based provider DrSmile, and in 2022 with the acquisition of PlusDental, also founded in Berlin. The goal was to position itself not only in B2B but also in a promising, consumer-driven market. However, the expected successes failed to materialize. In August 2024, Straumann decided to transfer the consolidated structure of its two DTC brands to the Spanish Impress Group, a step that clearly underscores a strategic reassessment of this market segment.

Another discouraging piece of very recent news is that Straumann intends to discontinue actively offering the B2B brand ClearCorrect in certain markets during Q4 2025. Straumann believed for too long that excellence in implantology would automatically translate into success in the clear aligner market – a misconception that has cost valuable time, weakened trust and brand recognition, and limited potential market share. The differences in logic, technology, and business model were too often underestimated or overlooked. The withdrawal from smaller markets therefore appears less like a bold strategic move and more like a necessary correction. Whether a stricter focus on core markets will be sufficient to regain lost trust remains doubtful.

Market Dynamics

The aligner orthodontics market is strongly dominated by Align™ - a company that, through early scaling, globally anchored brand recognition, and a fully integrated ecosystem of intraoral scanners (IOS), software, clinical services, and system-specific education, has set standards for many providers over more than two decades. The user experience, within the context of the entire workflow, is exemplary and has shaped practitioners’ expectations in the long term.

New competitors therefore face not only high entry barriers but also have to invest enormous amounts in marketing and sales just to achieve visibility and relevance in the market. For publicly traded companies with a clear focus on returns, the unavoidable question arises as to whether such resource deployment is proportionate to the realistically achievable results.

In addition, there is another, often underestimated challenge, especially for already established global dental players: they tend to bring aligner products to market through existing marketing and sales structures, treating them as just another stock-keeping unit in the portfolio – sold transactionally rather than strategically. While this approach may have worked for decades with traditional product categories such as implants or brackets and wires, it inevitably leads to a dead end when applied to the go-to-market strategies for aligners.

At the same time, a new generation of B2B competitors is emerging in aligner orthodontics, pushing the boundaries of clear aligner therapy (CAT). These companies are fully dedicated and vertically focused on this modality alone, supported by private equity and characterized by their openness to new approaches in orthodontic treatment. With a strong customer-centric mindset, they act with agility and speed, setting themselves apart from traditional incumbents. Examples include uLab Systems™ and OrthoFX™, as well as Angel Aligners and Smartee, two manufacturers with over two decades of clinical and operational expertise in the domestic Chinese market. Both Angel Aligners and Smartee have built significant experience and credibility and are now expanding their presence into North America, EMEA, and APAC, marking a new wave of global B2B competition with huge clinical expertise and commitment in this field.Another new and interesting frontier is the fully vertically integrated direct-to-consumer (D2C) model pioneered by IMPRESS. Unlike many earlier D2C initiatives that operated with fragmented structures and limited clinical integration, IMPRESS has built a comprehensive model that combines consumer-focused accessibility with in-house clinical expertise, digital infrastructure, and vertically integrated operations. This approach aims to overcome the shortcomings of traditional D2C providers by offering a higher standard of treatment quality and continuity of care, positioning IMPRESS as a notable benchmark in the evolving D2C segment.

B2B - Beyond Transactional Sales

This transactional mindset highlights the fundamental challenge in the B2B channel. Many companies still approach aligners like a commodity, when in reality clear aligner therapy is not just a product line but a treatment modality requiring clinical expertise, digital integration, and long-term practitioner engagement.

To succeed in B2B, aligner providers must shift from selling units to building strategic partnerships with orthodontists and dentists. Practitioners expect far more than delivery of aligners; they demand:

• Clinical credibility grounded in evidence and predictable outcomes, 

• Educational and training support to integrate aligners confidently into daily practice, 

• Digital workflow solutions that connect diagnostics, treatment planning, and patient management, and 

• Trusted collaboration instead of transactional sales. 

Those who fail to deliver these elements risk becoming interchangeable suppliers, easily replaced and quickly forgotten. In contrast, companies that position themselves as partners in the digital transformation of orthodontics can create sustainable differentiation and loyalty.

The real challenge in B2B is balancing scale with specialization: building vertical expertise, nurturing relationships with key opinion leaders, and offering robust clinical and workflow services. These investments are resource-intensive, but without them, aligner ventures in B2B rarely gain long-term traction.

Unlike D2C, where clinicians act as gatekeepers limiting patient access, in B2B they hold the key to unlocking scale. Success in this channel depends entirely on whether companies treat practitioners as true partners in therapy, not as transactional buyers of another SKU.

Why this is the case, and the mistakes companies should avoid, will be the focus of one of ConCom Dental’s upcoming insights: The B2B Marketing Playbook.

Channel Strategy

 The focus on direct-to-consumer models has proven to be a double-edged sword. While D2C promised direct access to patients and new revenue potential beyond traditional practice structures, in reality the bond with the treating practitioner remained decisive. Dentists and orthodontists are and remain the gatekeepers for a long-term successful therapy. Without their acceptance, D2C models cannot be established at scale or with sustainable profitability. The consequences were high customer acquisition costs, intense price competition, and comparatively low patient retention.

At the same time, models such as IMPRESS demonstrate that with full vertical integration, holistic treatment concepts, and a consistent focus on customer centricity, significant growth is achievable. By combining strong consumer accessibility with in-house clinical expertise and seamless digital workflows, IMPRESS has established a unique and exemplary approach within the D2C space. This shows that, when executed with discipline and patient-focused integration, alternative channel strategies can create both clinical trust and commercial scalability. For the industry, IMPRESS stands as an encouraging proof point that innovation in channel design – if truly holistic – can open new growth opportunities beyond the conventional models.

Integration & Differentiation

Aligner systems that do not offer a clear clinical and workflow-oriented USP quickly lose attractiveness. Today, practitioners expect far more than a simple aligner treatment: 

• seamless integration into the digital practice workflow, 

• solid scientific evidence, clinical expertise and 

• options for hybrid treatment concepts (e.g., combining aligners with fixed appliances or digital diagnostic tools). 

Providers unable to convincingly deliver these added values become interchangeable – a serious disadvantage in such a competitive market.

Corporate Logic

Large dental manufacturers operate under the pressure of investors and capital markets that expect rapid, scalable results. Innovation fields such as aligner orthodontics, however, require: 

• time, 

• clinical validation, and 

• strategic patience – as well as the development of urgently needed vertical expertise in Clear Aligner Therapy. 

Without deep clinical understanding, continuous research, and a reliable network of key opinion leaders, engagement in this field often remains superficial. This is precisely where many companies fail: they underestimate the depth of know-how and clinical credibility required to build long-term trust among practitioners and patients.

Outlook

We are convinced that in the future we will see more examples of global dental manufacturers reassessing their involvement in the aligner segment. However, this should not be seen as a sign of lacking market potential, but rather as an indication that success in aligner orthodontics requires more than capital, a dental legacy and brand value.

For us, one thing remains decisive: long-term success arises where clinical evidence, digital integration, and genuine added value for practitioners and patients are aligned. Those who master this will not only survive in this market but grow. Positive examples such as IMPRESS, with its holistic, vertically integrated model and strong customer centricity, illustrate that when these elements come together, sustainable differentiation and significant growth are possible.

At ConCom Dental, we support companies and investors in building exactly these prerequisites for success. With deep market understanding, strategic expertise, and a clear focus on the future of digital orthodontics.