Earlier this year, Europe’s largest clear aligner OEM K Line Europe launched its new innovative product line ClearX™, based on advanced thermoplastic materials and shape-shifting technology. The technology holds the potential to elevate orthodontic treatment efficiency by reducing the overall number of clear aligners by at least 50 percent, improving treatment outcomes, and providing a unique patient experience. The shape-shifting characteristic promises to significantly reduce the carbon footprint as well as the overall plastic burden of clear aligner treatments. In other words, ClearX tech enables the same set of clear aligner trays to be reprocessed, and used for further corrections – reducing the total number of trays required to achieve the same clinical outcome, while also decreasing the environmental footprint.
The proprietary technology, powered by advanced thermoplastic materials, is available currently under the brand name ClearX. However, K Line Europe is currently raising awareness of this disruptive technology and aims to include it in its OEM portfolio of services, offering the exciting new technology to anyone who wants to get his or her hands on it. Not mentioning that this comes at an advantage for treatment providers and consumers - enabling to cut down massively on the costs incurred for a clear aligner treatment. This may have even an effect on ASPs that have been turbulent throughout 2022 and 2023.
Looking at the bigger picture
In this edition of our research, insightsZ focuses solely on the global environmental impact of ClearX. The shape shifting aligner technology promises multiple advantages, and we will break it down in our research, in more than one edition, to cover what may be the next technological breakthrough in orthodontics.
The global healthcare industry uses a considerable amount of plastic each year. It was recently estimated that globally, the annual use of plastics in healthcare is around 15 million tonnes, a figure that represents a significant portion of overall plastic consumption. In the United States alone, healthcare facilities generate approximately 14,000 tons of waste per day, with an estimated 20-25% of this volume attributed to plastic products and packaging. This means that up to a quarter of the waste from healthcare facilities is plastics, amounting to about 3,500 tons every day.
In contrast to this, the estimated plastic waste in global clear aligner industry in FY 2023E is approximately 15,000 tons, a figure that’s roughly equivalent to the weight of approximately 600 blue whales – clearly signifying an opportunity for value creation.
The resultant carbon footprint of single aligner to be produced is around 4 Kg of CO2, whereas that of a ClearX™ aligner is only 1.8 Kg of CO2.
What’s even worse is that much of the clear aligner plastics, which could be partially recycled, ends up in landfill. This is often due to the fact that they are made up of a combination of different plastics that can't be easily split apart in a downstream recycling process.
HBR reports that >8.3 billion metric tons of plastics have been produced in the last 70 years. The total combined volume of a grocery bag weighing that amount will be sufficient to hold the entire planet. What’s even worse is that based on the current manufacturing (& recycling) levels, we will have produced enough plastics to double-bag the Earth by the year 2060.
Trying to counter the balance, GenZ & Millennials have clearly expressed their desire & preference for brands that align with their environmental protection values. Like expected, brands too understand the risks associated with sitting on the wrong side of the fence – and possible value creation pertaining the reduction of plastic waste & improvement of ESG related metrics. To summarize: Leading global clear aligner manufacturers are increasingly focusing their attention on plastic waste.
But plastic pollution is more than an environmental problem. It’s also a business problem.
There is clearly a lack of data and insights available about the lifecycle of clear aligner plastics post their intended use – creating additional challenges for any measures targeted at reducing footprint. However, the status quo is evolving fast as manufacturers start to analyse their value chains more closely, even possibly collaborating across both their upstream and downstream supply chains.
The advent of Direct 3DP aligners and environmental-friendly aligner plastics are creating additional tailwinds that may enable higher addressable volume, and even improve the business cases for recycling of clear aligners.
Other factors driving the green-revolution in the clear aligner category may include higher price premiums for recyclable clear aligners, increasing carbon prices, introduction of recycling regulations by governments, and even newer models for clear aligner collection- backed by ESG metrics.
Evolution of Material Science
Over the years, clear aligner materials have evolved from being single-layered materials to currently used multilayered materials, which often comprise hard and soft layers. The soft layer of the multilayer material is crucial for clear aligners to be elastic enough to enable smooth seating, whereas the hard layer ensures strength and durability - both of which are required to deliver the necessary forces.
PET, PETG (polyethylene terephthalate glycol) and TPU (Thermoplastic polyurethane) are among the most widely used materials used in clear aligner manufacturing. FY 2013 Invisalign aligners transitioned from a single-layer of polyurethane, Exceed-30 (EX30) to a new polymer, SmartTrack™ (LD30)- a multilayer thermoplastic polyurethane.
Emerging manufacturing technologies incl. Direct 3D Printing hold significant promises pertaining to reduction in plastic waste and overall carbon footprint. However, the technology still appears to be in its infancy, both in terms of processes and research. A recent insightsZ focus group interview revealed that the leading Direct 3D printing provider’s software was challenging to use and required significant time in digital planning. Not just that, even though production was much quicker than conventional aligner production, it was a much more technique-sensitive process. There are also speculations surrounding around dimensional stability of the aligner through wear, an issue with current aligners as they degrade with time. It still remains unclear whether is this better, same or worse with direct-to-print resin aligners.
To summarize: Multilayer clear aligner plastic materials are very difficult to be recycled.
Rationale: The multilayer material comprises of layers with different materials – each of which require a different recycling process – creating the need that the different material layers need to be separated before being recycled. This raises the barriers for post processing or recycling – disincentivizing the process. Outcome: With the exception of a small quantity of clear aligners, upwards of 99% end up in waste processing centres as residual waste → often decomposing into microplastics. More often than not, clear aligners find their way in domestic waste before eventually leading to landfill sites, or even being illegally dumped, sometimes evencarried by the wind or washed into rivers by the rain, ending up in the ocean.
ClearX tackles the plastic waste through a different angle. It approaches the plastic problem through decreasing the production of plastic in the first place, rather than producing much plastic and trying to deal with it downstream – that is, collecting, recycling, or generating clean energy out of it. The approach promises to cut down massively on the operational costs as well as COGS for aligner manufacturers. At the IDS in Cologne, March 2023, K Line Europe has mentioned that this technology might be made available for aligner manufacturers in 2025 to use it in their own production sites. If this happens, we might witness a great shift in aligner manufacturing methods, costs, ASP, as well as a change in the consumer experience.
The new eco-friendly approaches in clear aligners would significantly boost the consumer confidence and options for more eco-friendly choices like the ClearX technology.
According to Nielsen, a significant 75% of Millennials show eco-consciousness to the extent of altering their buying habits in favor of environmentally friendly products. This demographic has also indicated a willingness to pay more for such products compared to their cheaper, less sustainable counterparts, positioning them as the most willing among all age groups to invest more in environmentally sustainable products.
Another study, reported by Business Wire, supports this trend, highlighting that 75% of Millennials are willing to pay more for an environmentally sustainable product. This preference surpasses that of other generations like Gen Z, Gen X, and Boomers, marking a distinctive inclination towards eco-friendly products within the Millennial demographic.
Further emphasizing this point, a global study revealed that on average, more than one third of the population is ready to pay more for sustainable products or services. Particularly, Millennials stand out with 42% willing to pay more for sustainability, a rate higher than Gen Z, Gen X, and Baby Boomers. In terms of the premium that they are willing to pay, Millennials (31% premium) and Gen Z (32% premium) are prepared to pay considerably more than Baby Boomers (14% premium) and Gen X (21% premium).
Packaging & Sustainability
Unlike leading consumer brands, which have recently been seriously looking at packaging reduction, clear aligner brands are still moving in an opposite direction. That is, leading clear aligner brands still haven’t delivered on any brand promise about sustainable packaging whatsoever.
Patients want simple packaging that can easily be recycled. By the time a patient’s clear aligner arrives, the patient has already committed to the product - obviating the fancy packaging, even making it pointless.
Packaging and sustainability need to go hand in hand, without adding further burden on the environment.
ClearX: The market opportunity
Speaking in terms of the market sizing perspective, ClearX has the potential to disrupt the category and contribute significantly to reduction in plastic waste. Like mentioned previously, ClearX treatment has the potential to reduce the total number of aligners by up to 50 percent, without any significant loss in the clinical outcome.
Not just that, brand ClearX cooperates closely with Ocean Blue Project, an ocean cleanup organization that has removed +240,000 pounds of microplastics from oceans till this day. Closely mimicking the carbon-credits trade, the non-profit organization, Ocean Blue Project removes a pound of plastics for every dollar invested. Unlike in-house sustainability initiatives, such open partnerships encourage better transparency and accountability when it comes to monitoring sustainability KPIs.