Ninth Circuit Revives Antitrust Claims Over Invisalign–TRIOS Interoperability

Align Technology must again defend antitrust claims over its decision to end interoperability between Invisalign and rival intraoral scanners after the U.S. Court of Appeals for the Ninth Circuit reversed summary judgment in the company's favor.

The October 5, 2026, opinion sends consolidated class actions brought by dental practices and Invisalign patients back to federal district court. The appellate court did not find an antitrust violation. It held that factual disputes remained and that the plaintiffs' claims should not have been resolved at summary judgment.

The dispute centers on a 2015 agreement that allowed scans from 3Shape TRIOS systems to be submitted for Invisalign treatment. According to the opinion, the arrangement increased the scanner maker's U.S. sales and expanded the number of scanners that practices could use with Invisalign. The defendant announced in December 2017 that it would terminate interoperability in the United States, and TRIOS scans stopped being accepted in February 2018.

Dental practices later alleged that the termination helped preserve the defendant's position in intraoral scanners by forcing providers that wanted to offer Invisalign to purchase an iTero scanner. Patient plaintiffs separately alleged that the conduct protected market power in clear aligners. The consolidated cases also challenge exclusivity provisions and the company's Fusion discount program.

A federal district court granted summary judgment to the defendant in February 2024. The Ninth Circuit reversed, concluding that the plaintiffs had produced enough evidence to establish a prima facie refusal-to-deal case under the factors associated with the Supreme Court's Aspen Skiing precedent.

The defendant argued that patent litigation supplied a legitimate business reason for ending the arrangement. The appellate panel did not decide whether that explanation was valid or pretextual. Instead, it found factual disputes over the commercial rationale, the timing of the termination and evidence that the scanner relationship had been profitable.

That distinction matters: the opinion revives claims and permits further proceedings; it does not establish liability, damages or class-wide entitlement to recovery.

Why it matters

The ruling makes interoperability a competition issue, not only a technical purchasing question. In digital dentistry, a scanner's value can depend on which treatment systems, laboratories and practice-management workflows accept its files. A connection that disappears after a capital purchase can alter utilization, replacement timing and the economics of an entire clinical workflow.

Dental buyers already evaluate open versus closed formats, scanner compatibility and software dependencies when selecting equipment. Avized's dental clinical intelligence software buyer's guide explains why data access, integration depth and workflow fit should be tested before signing a long-term agreement.

For DSOs, the case also puts renewed attention on bundling and exclusivity. Multi-product discounts can lower near-term costs, but they may make it more expensive to introduce a rival scanner or aligner system across a network. Procurement teams should model the total effect of rebates, minimums, upgrade rights, termination terms and cross-product dependencies—not only the price of each device.

The broader 2026 dental technology market map shows how imaging, diagnostics, treatment planning and practice operations increasingly depend on shared data flows. As those categories converge, the commercial rules governing access can matter as much as hardware specifications.

The ruling also arrives as healthcare organizations are placing greater value on portable, usable data. Avized's analysis of dental and medical interoperability describes the operational and revenue-cycle consequences when information remains trapped between systems. The same principle applies within dentistry: a clinically capable device can lose economic value if it cannot participate in a practice's preferred downstream workflow.

What to watch next

District-court proceedings. The case returns to the Northern District of California. The next material developments may include renewed discovery, class-certification decisions, pretrial motions or a settlement. A remand does not guarantee that plaintiffs will ultimately prevail.

The business-justification defense. The appellate court said disputes remain over whether patent enforcement was the actual reason for ending interoperability. Evidence on internal decision-making, profitability and contemporaneous commercial strategy could be central.

Privilege and discovery. The opinion addressed the possibility that relying on executive testimony about legal advice could waive privilege. If that defense is used, the district court may need to determine whether additional discovery is appropriate.

Contract language. DSOs and large groups should watch whether scanner and aligner agreements become more explicit about interoperability duration, notice periods, file access, export rights and remedies when integrations end. A current integration list is not a substitute for contractual protection.

Product ecosystem changes. The most important commercial signal will be whether vendors expand, restrict or reprice connections between scanners, aligner platforms and planning software. Operators should verify capabilities in production and document dependencies before standardizing across locations.

The case is consequential because it tests how antitrust law applies when a platform owner withdraws compatibility from a rival device. Its practical impact will depend on what the district court finds and whether the litigation changes product, contracting or interoperability practices across dental technology.

Primary sources

• Ninth Circuit opinion — Simon and Snow v. Align Technology, October 5, 2026
• GovInfo case record — U.S. Court of Appeals for the Ninth Circuit, No. 24-1703