Planet DDS 2026 Dental Industry Deep Dive Report Reveals a Widening Performance Gap Across the DSO Industry

Analysis of 8,500+ practices across 497 DSOs reveals six performance drivers, and a $545M opportunity that requires no new patients to capture.

IRVINE, Calif.--(BUSINESS WIRE)--Planet DDS, the leading provider of cloud-based enterprise dental software, today released its 2026 Dental Industry Outlook: Deep Dive, a comprehensive performance analysis drawn from more than 8,500 dental practices operating on the Planet DDS platform throughout 2024 and 2025 consecutively. The report debuted yesterday evening at the Dental Capital Forum, a private, invitation-only gathering at the Union Club of New York City, before being released publicly today.

The Deep Dive is the most extensive group practice same-store dental performance dataset ever analyzed and published, covering $6.79 billion in gross production across 497 DSOs, 3,294 same-store year-over-year comparisons, and more than 2,500 Cloud 9 orthodontic practices. It goes significantly further than the industry outlook published at Orbit in March, surfacing the specific operational patterns and gaps that separate the industry's fastest-growing practices from the rest of the field.

Six DSO Benchmarking Findings That Challenge Industry Assumptions

1. New patient acquisition is the single strongest growth predictor. Practices with 75 or more new patients per month grow at 9.0%, nearly double the rate of mid-volume practices. Growth rates accelerate meaningfully around 35 new patients per month, below which practices are essentially treading water.
2. Operational consistency compounds. The most volatile 10% of practices are shrinking by 3.4% while the most consistent practices are growing by 6.1%—a 9.5 percentage point gap. Consistent practices also produce 28% more revenue per day, signaling that schedule stability directly drives both top-line and operational performance.
3. Efficiency beats size. Small, efficient practices outperform large, inefficient ones every time. Nearly 1,050 practices average 44 chairs but generate only $56K in annual revenue per chair—underutilized capacity representing the largest addressable opportunity in the dataset. More chairs without maximizing existing ones is a capital mistake.
4. The 26–50 office danger zone is real. DSOs in this size range grow at just 2.8%—less than one-third the rate of their smaller peers. Only 55% of their offices are growing, the lowest of any tier. The message is clear: either stay lean and nimble, or build the infrastructure to push through to enterprise scale.
5. Case completion, not acceptance, is the bottleneck. The industry's average case completion rate is 47%. Practices with a moderate 10–30 point gap between acceptance and completion grow the fastest because they have strong scheduling discipline. Practices with a 50+ point gap have 77.2% acceptance but only 19.7% completion.
6. Revenue cycle efficiency is the silent EBITDA lever. Revenue cycle efficiency is the silent EBITDA lever. Growing practices are not necessarily collecting practices. Unlike the five growth drivers above, fixing this does not require new patients, new providers, or new locations. It requires collecting what is already owed. For a DSO generating $10M in gross production, closing the average operational billing gap adds approximately $890K in annual EBITDA — without touching the top line.

"The industry is splitting. One-third of practices grew by more than 10% last year. Nearly 14% declined by more than 10%. The middle is getting squeezed. The practices that are winning figured out the fundamentals. That is what is making the difference,” said Eric Giesecke, CEO of Planet DDS

Unveiled at the Dental Capital Forum

The Deep Dive was presented for the first time on May 12, 2026, at the inaugural Dental Capital Forum, a private, invitation-only gathering held at the Union Club of New York City. The forum was co-hosted by Planet DDS, Aquiline Capital Partners, Dykema, and West Monroe, and is intended to become an annual gathering.

The forum brought together DSO CEOs operating more than 8,000 dental locations across North America alongside institutional investors and private equity professionals overseeing more than $1 trillion in assets under management. The Planet DDS data presentation, drawn from the same proprietary dataset behind this report, closed the formal program.

Access the Report

The 2026 Dental Industry Outlook: Deep Dive is available now at planetdds.com. It includes 16 sections covering same-store growth, the DSO size paradox, production benchmarks by specialty, appointment operations, the revenue cycle waterfall, AR aging benchmarks, and a complete set of warning, target, and elite zone metrics for DSO operators to benchmark their own performance.

The original 2026 Dental Industry Outlook, released in March at Orbit, provided a top-line view of industry performance. The Deep Dive goes further, with findings on production volatility, the Friday production opportunity, specialist portfolio strategy, case acceptance as a credit quality signal, and a $300–400M annual recovery opportunity sitting inside the existing platform.

To download the Deep Dive report, visit planetdds.com.

About Planet DDS

Dental software is broken. We aim to fix it. As a partner in growth for DSOs and dental groups outgrowing legacy systems and fragmented tools, Planet DDS delivers a cloud-based AI platform designed to scale alongside growing organizations. Powered by DentalOS™ with AI, Planet DDS is built on connection—connecting people, partners, and technology across an open ecosystem that includes Denticon Practice Management, Cloud 9 Ortho Practice Management, and Apteryx Cloud Imaging. Trusted by leading DSOs and emerging dental groups nationwide, Planet DDS supports more 100+ location DSOs than any other cloud-based dental practice management provider, enabling 14,500 practices and 175,000 users to move beyond outdated legacy software with seamless integrations, optimized workflows, and scalable technology built for growth.