The Next Generation of Dental Value Creation

Lincoln International expects this evolution to drive greater valuation differentiation between platforms that primarily aggregate practices and those that demonstrate consistent organic growth and operational improvement. Standardized systems and workflows can reduce revenue leakage and administrative burden; technology and AI can improve patient access, revenue cycle management (RCM) and clinical productivity; and thoughtful investments in recruiting, mentorship and career development can strengthen dentist retention and alignment. For owners contemplating an eventual transaction, demonstrating these capabilities and their measurable contribution to organic same-store EBITDA, margin resilience and clinician retention will increasingly influence buyer confidence, valuation and the terms on which transactions can be completed.

The consolidation activity that defined U.S. dental over the past decade has created a growing number of scaled platforms, but the underlying market remains large and fragmented, with more than 200,000 dentists practicing across approximately 140,000 dental offices. The sector generates ~$190 billion in annual expenditures and has demonstrated steady long-term growth and resilience across economic cycles.

M&A remains an important growth lever, but the universe of scaled, acquisition-ready practices is smaller than headline fragmentation would suggest. At the same time, higher financing costs and greater buyer scrutiny have reduced the ability to rely on acquisition volume and multiple arbitrage alone to create value. The next phase of the dental consolidation story is therefore less about whether platforms continue to acquire and more about what they can do with the scale they have already created.

Importantly, M&A remains central to the growth strategy but increasingly requires disciplined capital allocation. Individual-practice affiliations, larger group acquisitions and de novo development offer complementary paths to expansion, with their relative attractiveness influenced by local market conditions, acquisition economics and expected returns. As discussions with Heartland Dental’s Affiliations & Corporate Development team indicate, successful platforms should have the flexibility to pursue opportunities selectively while remaining focused on creating long-term value through the resources and business support available following an affiliation. De novo development is also an important complement to acquisitions, particularly in high-growth markets where population inflows are outpacing existing dental capacity. In these markets, purpose-built practices allow DSOs to optimize site selection, facility design, technology and staffing from inception, while mature markets with established provider networks may favor affiliations. Heartland Dental offers an example of this dual strategy, having collaborated with practices to open 51 de novo offices through early October 2026 while continuing to pursue individual and group affiliations opportunities. As Chief Growth Officer Mark Greenstein has emphasized, the decision between building and acquiring should ultimately reflect the needs and characteristics of each local market.

In private equity diligence, the focus is shifting from the number of affiliated practices to the quality of the operating infrastructure supporting them. Common systems, standardized workflows, centralized RCM, disciplined scheduling and patient-access protocols, shared services and consistent performance reporting can enable platforms to operate more efficiently and systematically improve practice-level performance. These capabilities can also create a stronger foundation for integrating future acquisitions, allowing M&A and organic growth to reinforce one another rather than operate as separate value-creation strategies.

Increasingly, the integration process begins before closing. Leading dental support organizations (DSOs) are placing greater emphasis on developing multi-year growth plans during diligence, engaging selling dentists earlier and identifying opportunities across recruiting, specialty expansion and operational improvement. William (Bill) Higgins, Vice President of Corporate Development & Regional Director at The Smilist, highlights the organization’s increasing focus on developing multiyear growth plans and engaging selling dentists before closing, helping establish early alignment and accelerate the realization of growth opportunities.

Successful integration, however, does not necessarily require immediate technological uniformity. Reflecting on Heartland Dental’s affiliation with Foundation Dental Partners in a call with Lincoln International, Jeff Ungrund emphasized the importance of cultural cohesion and doctor alignment:

The implication is that operating standardization and clinical autonomy need not be competing priorities. Scaled platforms can build common infrastructure while preserving the local relationships and clinical cultures that underpin practice-level performance.

This evolution is also changing how buyers evaluate scaled dental platforms. Headline location count is increasingly less informative than the quality and consistency of the underlying practices. A 100-location platform is not necessarily more valuable than a 50-location platform if growth is concentrated in a handful of offices, acquired EBITDA masks deterioration elsewhere or operating performance varies materially across the network.

The distinction is evident in public company reporting. For example, Park Dental Partners (NASDAQ: PARK) reported 5.6% headline revenue growth in H1 2026, while same-practice revenue growth moderated to 2.3% in Q2 2026 from 5.8% a year earlier. The divergence illustrates why buyers must look beyond consolidated growth to understand underlying practice performance and the contribution of acquisitions. Ultimately, the question is whether the platform itself is making its affiliated practices more productive and profitable.

As a result, investors are placing greater emphasis on same-store performance and the underlying drivers of organic growth. That means separating acquired growth from improvements in patient volumes, provider productivity, schedule utilization, treatment completion, pricing and specialty mix, and understanding how consistently those improvements are occurring across the portfolio.

For owners contemplating an eventual transaction, this creates an important distinction between scale that has been accumulated and scale that has been operationalized. Platforms that can demonstrate how standardization has translated into sustained same-store growth, operating leverage and more consistent practice-level performance are better placed to differentiate themselves in a competitive transaction process and support stronger valuations. In that sense, organic growth is not the strategy itself, but it is one of the clearest measures of whether the operating model is delivering results.

“This is a critical transition point for the industry as we move from the ‘land grab’ phase into true institutional integration,” said Mandy Gast, Chief Development Officer at Lone Peak Dental. “Valuation in the next era won’t be dictated by how fast you acquire practices, but by how well you operate, integrate, and retain providers within the platform you’ve built.”

For many scaled dental platforms, a meaningful opportunity for value creation exists within the current practice base. While U.S. dental benefits from recurring patient demand and attractive cash-flow characteristics, meaningful operational whitespace remains across the average practice, including RCM, patient access and scheduling, treatment completion and hygiene.

RCM represents a particularly tangible opportunity: Even modest improvements in collections, claims management and patient accounts receivable can translate directly into incremental EBITDA, making revenue leakage an important area of focus for scaled operators.

Advances in administrative automation are beginning to demonstrate the magnitude of this opportunity. AI-enabled insurance verification, for example, can significantly reduce time spent on eligibility and benefits administration, allowing front-desk teams to focus more heavily on scheduling and patient engagement. The Smilist has reported time savings approaching one full-time employee equivalent in many offices through these applications, alongside reduced centralized RCM workloads. Importantly, the economic benefits extend beyond labor efficiency to include the potential for improved patient access and revenue capture.

Dental industry benchmarks show case acceptance rates of 61% but completion rates of just 49%, highlighting meaningful leakage between diagnosed treatment and realized production. Closing even a portion of this gap represents an opportunity to generate incremental growth from the existing patient base and clinical footprint.

Digital clinical workflows provide another opportunity to improve patient engagement and treatment conversion. Intraoral scanners, digital impressions and treatment-visualization tools can improve the patient experience while enabling more efficient restorative and orthodontic workflows. Heartland Dental’s investment on behalf of supported practices in iTero scanners and Invisalign capabilities illustrates how these technologies can support patient education and streamline treatment planning for supported doctors while improving communication between clinicians, patients and dental laboratories.

Asset owners also face challenges in workforce availability, which continues to constrain clinical capacity in certain markets. The most acute deficit is among dental hygienists, with only around 60% of dentists reporting that they have “adequate” levels of hygienists at their practices and 91% describing hiring hygienists as challenging. These constraints increase the importance of improving productivity and utilization of the existing workforce. Better scheduling reduced administrative burden, targeted training and greater treatment completion can improve productivity without requiring a commensurate increase in clinical headcount.

Scaled DSOs are particularly well positioned to address these opportunities by building capabilities that can be difficult for individual practices to replicate independently. Centralized RCM, standardized scheduling and patient-access protocols, shared services and common performance reporting can improve consistency and reduce administrative burden across the enterprise. When deployed effectively, these capabilities can translate scale into operating leverage while allowing clinicians to devote more time to patient care.

Beyond workforce capacity, the ability to attract, develop and retain dentists is becoming an increasingly important competitive differentiator. Expectations vary by career stage: Younger clinicians often prioritize mentorship, structured training and professional development, while established providers may place greater emphasis on earnings potential, autonomy and work-life flexibility.

According to projections highlighted by dental equipment manufacturer Coltene in its Q4 2025 results, structured group practice environments will become the primary career pathway for the profession, with DSO networks projected to employ 50% of practicing dentists by 2030, up from 30% today, as younger clinicians prioritize work-life balance, administrative insulation and modern clinical facilities over the capital burden of solo practice ownership. A platform that makes it easier for dentists to practice, develop professionally and build long-term careers improves clinician retention, supports patient continuity and provides a stronger foundation for sustainable growth.

For scaled DSOs, investments in mentorship, training, career development and thoughtful economic alignment can strengthen recruiting and retention while supporting more durable clinical capacity, patient continuity and same-store growth. The ability to offer compelling clinician experience is therefore becoming an important source of competitive differentiation, rather than simply a human-resources consideration.

Technology and AI are creating new opportunities to improve productivity across dental organizations, but their impact depends heavily on the operating infrastructure already in place. While AI is widely in use in areas such as dental diagnostics and periodontics, deploying individual technology solutions across a fragmented network of practices is unlikely to generate the same benefits as embedding them within standardized systems, workflows and data.

The opportunity is therefore not simply to adopt more technology but to build a common operating foundation that allows technology to be deployed consistently across the enterprise. Unified practice management systems, standardized workflows and a common data layer can enable automation, improve performance visibility and allow successful tools and processes to be replicated across locations.

Recent results from Henry Schein’s technology business reinforce growing interest in integrated practice management systems, with its global technology group reporting 9.1% like-for-like revenue growth in Q2 2026. However, the more consequential opportunity for DSOs is not simply technology adoption but the ability to deploy common systems and processes across an entire platform.

Technology adoption, however, is not solely an infrastructure question. Clinician engagement and demonstrated utility are equally important. AI tool adoption by supported offices provides an example of this dynamic. AI utilization has exceeded 80% across supported offices, with participating practices reporting higher gross production. Importantly, Heartland Dental’s approach focuses on making technology, training and implementation resources available to supported practices, while the supported practices retain responsibility for determining whether and how such tools are used in the delivery of patient care. Realizing the potential benefits of these tools requires more than an investment in technology; it also requires access to effective training and opportunities for thoughtful integration into a practice workflow. With that foundation in place, AI can increasingly serve as an operating multiplier. Clinical applications such as AI-assisted imaging and diagnostics are already gaining adoption, while administrative and workflow applications remain earlier in their development. Patient access, RCM, clinical documentation, diagnostic imaging and treatment planning all represent opportunities to reduce manual activity, improve consistency and expand capacity.

The benefits extend beyond cost reduction. Automation can expand the productive capacity of existing teams, improve patient follow-up and treatment completion, and provide clinicians with more time to focus on patient care. At the enterprise level, integrated data and technology can also enable more consistent benchmarking, faster identification of underperforming practices and more efficient integration of acquired locations.

Ultimately, technology should strengthen an effective operating model rather than compensate for weaknesses within it. Platforms that establish standardized infrastructure before deploying AI and automation should be better positioned to demonstrate tangible returns through clinical productivity, organic growth and more sustainable profitability.

While U.S. dental platforms are increasingly focused on extracting more value from established networks, Europe presents an additional opportunity: a renewed consolidation cycle across markets where national fragmentation and cross-border ambitions coexist.

Market fundamentals support renewed confidence.

Envista CEO Paul Keel in the Q1 2026 earnings call described dental demand as “remaining stable despite macroeconomic pressures.” Lifco CEO, Per Waldemarson, referred to dental as being essentially “non-cyclical”, while Henry Schein CEO Fred Lowery observed that the U.S. market was “not growing as fast…as it is in EMEA“. Straumann delivered 8.6% organic EMEA growth in Q2 2026, after delivering 15.3% in Q4 2025, while Align reported 7.4% global growth in aligner shipments despite a 10.8% decline in scanner and services revenue.

Institutional capital has seemingly noted this and is returning alongside strategic consolidation.

Bridgepoint’s mydentist and Ontario Teachers’ Donte investments in 2025 were followed by Metric Capital’s June 2026 investment in Spain’s 129-clinic Dental Company. Donte subsequently agreed to acquire Institutos Odontológicos, with more than 40 clinics. Cross-border groups are also building density: Nordic Capital-backed European Dental Group acquired Fresh Tandartsen in the Netherlands, while Axcel-backed Oral Care added De Tandartsengroep’s 31 clinics. Colosseum operates over 630 clinics across 11 markets and has successfully extended and expanded their financing to push faster on M&A as the business and market performance strengthens. The European opportunity is no longer confined to national roll-ups.

Regulation compared to the U.S. market is more of a patchwork quilt and is both a catalyst and an underwriting risk in Europe.

Sweden’s 2026 reform limits eligible over-67s’ contributions to 10% of reference prices for specified treatments, potentially supporting restorative volumes while constraining provider pricing. Denmark has agreed proposals for adult dental accounts and to allow dentists to own up to four clinics rather than two, subject to implementation. In contrast, Dutch maximum tariffs fell 1.12% for general dentistry and 11.18% for orthodontics in 2026. The UK Competition and Markets Authority (CMA) is also reviewing the £8 billion private dentistry market, examining competition, pricing transparency, consumer choice and patient outcomes, with findings expected by March 2027. Across Europe, national regulation, policy, payer mix and permitted pricing therefore have a direct bearing on sustainable EBITDA and investor appetite and valuations.

Management execution matters more than a single operating formula.

Germany’s mixed consolidation success illustrates this point. In contrast, AllDent’s de novo multi-specialty centers and Acura’s acquisition-led network of approximately 100 practices demonstrate successful routes to scale and how execution excellence is critical. European Dental Group emphasizes shared infrastructure, while Oral Care explicitly preserves local clinical decisions. Colosseum provides tangible performance evidence: S&P Global Ratings estimated its adjusted EBITDA margin rose from 11.6% in 2021 to approximately 16% in 2024, supported by pricing and integration. Newly appointed CEO Arjen Radder has prioritized “driving the digital transformation” to improve patient experience, connecting Europe’s operational agenda directly with the US focus on digital workflows and productivity.

The European outlook for 2027 is increasingly positive.

Lincoln’s proprietary research identifies over 15 potential European DSO transactions through 2028, with stronger activity expected in 2027. Renewed buyer competition should favor businesses that can demonstrate retained clinicians, organic growth and repeatable clinic-level improvements, not simply larger networks.