Glenn Coleman
Executive Vice President, Chief Financial Officer at DENTSPLY SIRONA
Thanks, Simon. Good morning, and thank you all for joining us. Today, I'll provide more detail on our second quarter results and an update on our 2023 outlook. As Simon mentioned, we delivered top and bottom-line results above expectations. The second quarter performance was highlighted by organic growth in all four segments, which coupled with favorable margins and a lower tax rate drove better-than-expected adjusted EPS. Notably, the second quarter represents another quarter of delivering on our commitments.
Let's begin on Slide five. Our second quarter revenue was $1.028 billion, representing reported sales growth of 0.5%. Foreign currency negatively impacted sales by $18 million and was larger than expected due to the strengthening of the U.S. dollar versus the Japanese yen and Russian ruble. On a constant currency basis, sales grew 2.3%, led by continued double-digit growth in our aligners business and broad-based strength in Asia Pacific, led by China, which grew 25%. EBITDA margins were 17.7% and were better than expected, driven by leverage from higher sales and effective cost management.
Year-over-year, EBITDA margins were lower due to continued inflationary headwinds impacting our cost of goods sold and higher commercial and infrastructure investments, partially offset by price increases and cost reductions from our restructuring program. Adjusted EPS in the second quarter was $0.51 and was well above expectations despite a $0.02 FX headwind. On a year-over-year basis, adjusted EPS declined by $0.18, largely due to lower operating margins.
Operating cash flow was $104 million as compared to $173 million in the prior year quarter. The decline was primarily due to changes in working capital, which was impacted by the timing of AR and AP compared to the prior year and higher operating expenses associated with commercial and infrastructure investments. In the second quarter, we returned $30 million to shareholders through dividends with a total of $207 million returned year-to-date through a combination of dividends and share repurchases.
Let me now turn to our second quarter segment performance on Slide six. Starting with the Connected Technology Solutions segment or CTS. Organic sales grew 2.8%, primarily due to improvements in the supply chain and shorter lead times for a certain high-tech equipment, partially offset by softer demand in Europe. Within CTS, our CAD/CAM business declined by mid-single digits, driven by lower demand in Europe, particularly in Germany, along with broader macroeconomic challenges across the region. That said, underlying retail demand in the U.S. improved sequentially.
The Equipment & Instruments business grew high single digits, driven by improvements in treatment centers and imaging in Europe as well as solid demand across all product categories in Asia Pacific. Organic sales in the Essential Dental Solutions segment, which includes Endo, Resto and Preventive products grew 0.7%, driven by stable patient traffic in the U.S., partially offset by softer demand in Europe. We attribute a portion of the softness in Europe to pre-buying activity in the first quarter. Moving to the Orthodontic and Implant Solutions segment, organic sales grew 3.7%. Aligners grew double digits for the fourth consecutive quarter, driven by growth in both SureSmile and Byte. SureSmile grew over 20% and continues to benefit from market share gains, regional expansion, new product offerings and differentiated outcomes.
Our direct-to-consumer aligner brand, Byte, grew high single digits, driven by improved customer conversion rates and lower customer acquisition costs, which not only drove higher revenues but also better profitability. On a full year basis, we continue to expect our aligners business to grow double digits. Implants returned to growth in the quarter, highlighted by demand for value implants as well as growth in China due to VBP volumes and a recovery from COVID-related shutdowns. Our U.S. implants declined in the quarter, but we expect to see gradual improvement for the remainder of the year. And wrapping up with the Wellspect HealthCare segment, organic sales grew 3.1%, with growth across all three regions.
For Wellspect, we expect to see faster growth in the second half of the year which will include recent and planned new product launches. Now let's turn to Slide seven to discuss second quarter financial performance by region. U.S. organic sales grew 1.1%, driven by stable demand in essential Dental Solutions and double-digit growth in aligners, partially offset by lower sales of imaging equipment and implants. U.S. CAD/CAM distributor inventory levels declined approximately $20 million sequentially in the quarter, driven by solid underlying retail demand. Distributor inventory levels for CAD/CAM products remained low at the end of the second quarter relative to historical averages.
Because of this, for Q3, we expect to see a sequential increase in U.S. distributor inventory levels in advance of DS World in September. Turning to Europe. Organic sales declined 2% due to lower implants and CAD/CAM sales which we attribute to macroeconomic headwinds in the market and unfavorable timing of orders for essential dental solutions. These declines were partially offset by continued SureSmile growth in the region. We also saw a more pronounced demand softness in Germany, which is a key market for our business due to recessionary pressures in the country.
Rest of World organic sales grew 11% in the quarter, driven by growth in all four segments. China and Australia posted solid growth, and we also saw strong equipment demand across the region. With that, let's move to Slide eight to discuss our updated outlook for 2023. We've updated our full year outlook to reflect our performance in the first half of the year as well as our increased confidence for the remainder of 2023. While we recognize macro uncertainties cloud the economic outlook in the second half, we are seeing stable to improving patient traffic in most key markets and our execution is improving.
We are increasing our outlook for the full year net sales to a new range of $3.98 billion to $4.02 billion. This represents a $75 million increase at the midpoint of the range, which is now at $4 billion. We expect organic sales to grow approximately 3%, which is an increase compared to our prior range of flat to 2% growth, and we expect to show growth in all four of our segments. We estimate full year EBITDA margin to be greater than 18%, unchanged from prior outlook. While we continue to face cost headwinds impacting gross margin, we're seeing these headwinds stabilize and expect gross margins in the second half of the year to be consistent with the first half.
Given the better-than-expected top-line performance, we're also raising our full year adjusted EPS outlook by $0.05 at the midpoint to a new range of $1.92 to $2.02. Keep in mind that the improved outlook also includes a $0.03 FX translation headwind. Overall, we're pleased to be raising our adjusted EPS outlook for the second consecutive quarter. Our first half performance gives us even more confidence that we're on the right path towards achieving our target of $3 adjusted EPS in 2026. For the second half of the year, we expect organic sales growth to be approximately 3%, with Q3 growth below 3% and Q4 growth above 3%. For the third quarter, we expect adjusted EPS to grow mid-teens year-over-year, but be lower sequentially due to seasonality. A return to earnings growth in the third quarter would mark an important milestone in our turnaround story.
And with that, I'll turn the call back over to Simon.