Aso International Has Become a Leader in Orthodontic Solutions

In recent years, the Japanese healthcare industry has been the subject of criticism for falling behind its Western counterparts due to cumbersome regulatory procedures, price competitiveness and lack of internationalization, but since the late former Prime Minister Shinzo Abe took office, economic reforms by him have enabled companies to take global leadership in niche applications. Why do you think Japan has been successful in these niche medical fields?

I generally believe that the strength of Japanese companies lies in the “diligence of the Japanese”. People in this country are very serious and self-disciplined. I have visited many academic seminars in Europe and the USA and have found that working people in other countries have longer holiday periods than in Japan. Even when emails are sent to these countries, it often takes a long time to receive a reply. In Japan, the opposite is true: emails are replied to almost immediately. This basic idea of consideration for others permeates every aspect of life and is a core strength of Japanese companies. This way of thinking is best exemplified in large companies such as Toyota, for example.

We operate in a very niche sector, but in order to manufacture in this orthodontic field in Japan, staff need to obtain a national qualification as dental technicians and to be professionally registered. The barriers to entry are very high and stringent, limiting the number of entrants in this field. As a dental technology company, we want to make the most of our more than 40 years of experience and technology.

I recently spoke with the former president of Kuraray Noritake Dental Supply, a company with very unique materials, development capabilities and sensitive technology. We are allowed to use their materials and further develop products with our technology.

Similarly, companies such as Nakanishi have their own solutions. All of these technologies and solutions reflect the Japanese 'kaizen' philosophy of continuous improvement. With this in mind, we work together with Japanese material manufacturers to create unique solutions that improve the quality of our products and services.

As new technologies continue to emerge, medical practice needs to be transformed. There is concern that as robotics, AI and other technologies are incorporated into the medical field, the doctors and technicians who actually use them may not be able to keep up with the technology. This may require the constant provision of new education and other services. How does ASO International help medical professionals to keep up to date with the latest products?

Frequent seminars are organized by us to disseminate knowledge and improve the technical skills of doctors and dentists. The seminars are regularly attended by eminent professors who lecture on how to use the digital equipment developed by us.

In the past, dentists decided the position of the brackets themselves, which caused variations in treatment results depending on the skill level of the dentist. The development of robots and the commercialization of instruments using this technology has made it possible to provide standardized orthodontic treatment without treatment results being dependent on the skill level of the dentist.

We would like to continue organizing these seminars in different parts of the country. Fortunately, we live in a post-corona world, which allows us to organize these activities face-to-face.

We are also developing an AI to design the appliance and this AI technology will require further training. Traditionally, orthodontics has only focused on the teeth and tooth alignment, but recently it has been understood that the tooth roots within the bone and the shape of the jawbone are also very important. Our solution uses CT scans to determine the position of the tooth roots and also utilizes an intraoral scanner to align the tooth roots and jawbone. This is an excellent application of the AI software we are developing.

Japan is known to have an aging population, with experts predicting that by 2050 the population will fall below 100 million and one in three people will be aged 65 or older. Older people experience dental problems such as tooth decay, gum disease and teeth more frequently. As an orthodontic provider, what solutions do you offer to Japan's elderly population?

I founded this company 42 years ago, but at that time orthodontics was not that big in Japan, especially when compared to the prevalence of orthodontics in the USA. Looking back at the past, the first McDonald's restaurant in Japan opened in Ginza, but at the time, Japanese people did not have the habit of eating bread and hamburgers, and onigiri were the most common type of fast food, so I was half-convinced that McDonald's would do well in Japan. Today, when we think of hamburgers in Japan, we think of McDonald's. This has led me to believe that orthodontics, which is part of the same American culture, will be accepted by the Japanese in the future.

As Japan faces a super-aging society, it is important to prevent dental diseases from a young age. The number of children in Japan is decreasing year by year, and inversely, the amount spent per child on upbringing is increasing. This applies not only to education, but also to medical and dental care.

Globally, the size of the orthodontic market is growing, with the US alone projected to reach a valuation of USD 9.6 billion by 2029. There is huge potential in the US and this will spread to other regions, including Japan.

In Japan, there is a slogan known as the '80-20 movement'. In other words, "Let's leave 20 teeth at the age of 80". The recent trend in dentistry is to reduce the number of dentures and inserts, etc. We also refrain from pulling out your healthy teeth and instead focus on ways to keep as many of your own teeth as possible.

The keywords for the Japanese dental and medical industry as a whole are preventative dentistry and improvement of unwellness.

I am 63 years old now, and I believe that the orthodontic model will change dramatically in ten years' time. Orthodontics as prevention will become more and more important in the future, against the backdrop of the term aesthetics and unwellness.

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Most dental treatment is covered by national health insurance in Japan. However, orthodontic treatment is considered cosmetic and is not covered by insurance. Do you think this perception will change as the dental industry moves towards a business model based mainly on preventive dentistry?

Preventive medicine in dentistry has recently received particular attention in the industry. The Japanese Government has now set a goal of making dental check-ups mandatory for all citizens. This policy is highly anticipated as it will lead to a change in public awareness of the need for orthodontic care.

Speaking about my own experience, I had orthodontic treatment when I was 10 years old, but it was very expensive. I told my father that I wanted an audio system rather than braces for me, but he recommended that I get braces. Today, my teeth are still very beautiful, and that is thanks to the treatment I received as a child. It has made me more confident and more sociable. I believe that orthodontics has an important role to play in changing people's lives.

ASO International traces its roots back to 1982 and has since grown into a leading dental laboratory specializing in the manufacture of orthodontic appliances. Can you give us a brief overview of your company's core products?

The company's strength lies in the fusion of analogue technology of skilled dental technicians and digital technology in the manufacturing process. In December 2022, the company made an initial public offering (IPO) on the Standard Market of the Tokyo Stock Exchange. The aim was to raise the status of dental technicians and to develop our business more globally as a public company.

When I founded the company in 1982, the US was the clear leader in the global market for orthodontics, so one of my goals was to be able to compete with the US market. To achieve this competitive edge, we use digital tools. For example, traditionally, plaster casts of teeth after impressions were taken and used to produce dental work. Nowadays, the patient's mouth can be digitally scanned and a suitable mold can be created instantly using CAD software. This means that orders for dental laboratory work are now accessible anywhere in the world, regardless of location.

Currently, major aligner manufacturing companies in the USA are taking a high share of the global situation, but we are a laboratory founded mainly on analogue technology since 1982, and have developed a lot of technology using analogue technology and then moved to digital. This accumulation of analogue technology gives us a deeper understanding of methodology and a unique advantage in advancing digital technology.

A recent trend is the increasing popularity of bracketed orthodontics (wire orthodontics) among the various orthodontic treatments, including aligner orthodontics. This is because aligners can be removed at any time at the patient's will, while brackets are more likely to reflect the dentist's intentions as they cannot be removed freely by the patient.

While aligner orthodontics also has its advantages, disadvantages and limitations, an increasing number of dentists are using brackets in combination with aligners and are digitally developing aligner-bracket combination appliances.

Regardless of whether they choose aligner or bracket orthodontics, all patients use retainers to maintain the correct alignment of their teeth once orthodontic treatment is complete. While the major aligner companies specialize in the development of aligners, we have considerable expertise in this particular field due to over 40 years of accumulated technology since our inception. We aim to use this knowledge to further penetrate the global market.

Can you tell us more about the benefits of SYMPHONY and how it compares with competing products on the market?

Similar products are available worldwide from several manufacturers. To use these products, dentists need to be highly skilled and operate the software provided by the manufacturer to virtually design the dentition.

Our company, on the other hand, aims to provide high quality treatment to all dentists, so we have developed a business model in which all work is carried out in-house, leaving dentists to concentrate on treatment. All of our work is carried out by dedicated dental technicians.

ASO International has been involved in millions of orthodontic treatments and its extensive experience has given it a deeper understanding of the ideal tooth alignment.

SYMPHONY also has three important features. One is the jigs used when bonding the brackets to the teeth; if the jigs are of poor quality, the wire may apply force in an unintended direction and the teeth may not be aligned properly. We believe that the quality of these jigs gives us an advantage over other companies' products.

Another is that all manufacturing processes are digital and mechanized, so the quality of all treatment plans, fixtures and wires is consistent.

Finally, the ability to customize materials and brackets according to the dentist's preferences is also a major attraction. Other companies' products are limited to one type of material and bracket, which limits the number of dentists who can use them, whereas our SYMPHONY can be tailored to the preferences of all dentists.

Can you comment on how you develop your products to cater for different markets and whether you need to adapt your designs to suit specific ethnicities or body types?

Indeed, there are differences in skeletal structure and jaw shape, and different nationalities and races have different dental arrangements. Incorrect dentition in Asians is often more complicated than in the rest of the world, and the same is true for the Japanese, our main target group.

With our 42 years of experience in such markets, we believe we can easily adapt to the global market.

As we have provided our product Harmony to more than 65 countries over the past 15 years, we are aware of trends in malpresentation around the world and would like to utilize these in our AI teaching materials.

The US orthodontic market is expected to reach USD 9.6 billion by 2030. How will your company further expand its products and services to capture this growing demand?

We have been active in presenting ourselves within the academic community and this has been achieved through participation in various exhibitions and scientific seminars. In addition, we have invited many well-known dentists from abroad to speak at professional events here in Japan. This serves as an excellent network for our business.

The development of the Intra Oral Scanner (IOS) has been key to our development in the US market. We have had an office in Hawaii since 2005, but our business model was very analogue: we made plaster casts of patients' teeth at the clinic, had them transported to our Hawaii office and did dental work on the casts. It used to take a lot of time for the clinic to make the dental mold and transport it there and back, but with the increasing use of IOS, the lead time has been reduced. Because the scan data is in digital format, we can receive the data as soon as the imaging is complete, which saves a lot of time and transport costs. We envision a business model where we open a base in San Jose, which will act as a huge data center. To meet the demands of the expanded US market we aim to increase the number of employees at our manufacturing site, ASO Manila, to around 400.

Our initial targets in the US include the West Coast and California, but we hope to tackle the East Coast, including New York and Boston, as soon as we get going. We have a lot of dentist friends in those places, so we can work with them to expand our sales network.

Previously, the company had a base in Turkey, which was closed following the IPO. Our future focus is on the Asian market, particularly China, where the population is growing. We have been visiting China for the past ten years and have offered our technology through local seminars as well as to local doctors and technicians. We intend to continue to expand our network and strengthen our business in China.

Since opening a base in Hawaii in 2005, you have participated in numerous seminars and trade shows. This year you will be attending other major industry trade shows in New Orleans and Chicago. Can you describe some of the solutions you plan to demonstrate at these trade shows?

We want to ideally introduce digital tools to cover HARMONY and SYMPHONY services. At the same time, we are considering offering more conventional products such as retainers to the US market. We will utilize our nationwide network of technicians to provide orthodontic appliances tailored to each individual patient. We already have 55 partner laboratories in Japan that support our business. We are considering re-establishing a similar network in the USA.

Aligner orthodontics, which is currently the mainstream in the US market, uses approximately 100 aligners per patient by the end of treatment. Patients need to patiently replace the aligners over a long period of time.

In contrast, our aligner orthodontic business model is set up so that the number of aligners themselves can be significantly reduced and the treatment time shortened by selecting the right device for the patient from our vast range of offerings and using it in conjunction with the aligners.

Imagine coming back in six years' time and doing this interview again. What goals or dreams do you hope to achieve by the time you return for a new interview?

When I founded my company in 1982, I was 23 years old. As I mentioned earlier, orthodontics was not yet widespread in Japan. Many people told me I would never be successful. I first focused on improving my technical skills. Then I wanted to work on globalization and at the same time I changed the name of the company to ASO International. The first ten years of business were very difficult, but with the advent of digital technology I was able to find a niche where I could differentiate the company. This allowed us to increase our presence in the Japanese market as well as in the global market.

I can't stop believing that by the time you come back in 2032, ASO International will have grown to be the number one name in orthodontics in the world that you can trust.

For more information, visit: www.aso-manila.com