Building a dental practice from scratch gives DSOs control over the layout, the technology stack and the culture. But control can come with longer ramp-up and higher upfront costs.
For most DSO leaders, that tradeoff still favors acquisition, even as AI and shifting market dynamics begin to change the math. Organizations aren’t abandoning de novos, but they’re being selective. The ones gaining ground are the ones who know their model, know their markets and aren’t chasing growth for the sake of it.
Here is what six dental leaders said about how they’re thinking about the build-versus-buy decision over the next two years.
Note: Responses were lightly edited for clarity and length.
Question: Looking ahead two years, do you expect more DSOs and dentists to shift toward building their own locations, and what would drive that shift?
Andreas Augat. Founder and CEO of Viviscus Dental Partners (Switzerland): I believe we could see a growing shift toward building new dental clinics from scratch rather than acquiring and modernizing existing ones, with AI potentially becoming one of the key drivers behind this development.
Building a clinic from scratch allows dentists and DSOs to rethink the entire operating model. Instead of investing significant resources into modernizing legacy systems, adapting inefficient workflows and working around existing physical infrastructure, they can design a clinic around a connected technology stack, optimized clinical workflows and a modern patient experience from day one.
AI could become a real force multiplier, particularly for administrative and back-office functions. Tasks such as scheduling, patient communication, billing, insurance processing and operational management could become significantly more efficient, reducing overhead costs and allowing dental professionals to focus more on patient care.
Of course, the economics still need to work. Construction costs, access to capital, location and the challenge of building a patient base from zero remain significant considerations. Acquiring established practices will continue to make sense in many situations. However, in some cases, the real value of an acquisition might lie in the existing patient base rather than the physical clinic itself, making it more attractive to build a new, purpose-designed facility nearby.
Ultimately, I believe AI and modern technology could fundamentally change the economics of building versus acquiring dental clinics.
Rutulkumar Barot, DDS. CEO of Altius Dental (Arlington, Texas): Over the next two years, I expect the decision to build or acquire to remain closely tied to each organization’s business model, access to capital and long-term exit strategy. De novo growth can be attractive when an organization identifies an underserved market, has a strong recruiting pipeline and can support the practice through its ramp-up. More predictable construction costs and a clearer path to profitability could encourage greater investment in that model.
For us, the priority remains acquiring existing practices and strengthening their performance. Our core business is serving patients and operating successful dental practices. Where development also involves owning real estate, we view that as a separate investment decision requiring its own expertise and capital.
Building new locations can be a successful strategy when executed well, but we do not believe growth requires pursuing every available model. We intend to remain disciplined, build on what we do well and pursue acquisitions that fit our culture and operating approach. That consistency is part of our business’s DNA.
Phil Cassis. Co-founder and CEO of Providence Dental Partners (Atlanta): Some DSOs will keep focusing on de novo builds. Some have been very successful with that model and have the funding model to do it. There will also always be opportunity for entrepreneurial dentists to build and run successful practices of their own. The next few years could be challenging though, because of macro factors like interest rates, construction costs, student loan debt and labor rates. On top of that, the business side of a dentistry continues to rapidly evolve, which adds administrative and operating complexity that many dentists don’t want to spend their time focused on as practice owners.
Jay Glazer. Director, Business Development at DC Dental (Baltimore): Yes, a gradual shift toward more de novo building is likely over the next two years, but it will be selective rather than a full reversal of the current acquisition preference.
Sam Jenio. Vice President of Strategic Partnerships and Procurement at EPIC4 Specialty Partners (Scottsbluff, Neb.): I think you’ll see some of that, but I wouldn’t expect a wholesale shift toward de novos. Building from scratch can be attractive when you have a strong understanding of a market, confidence in the demand and the infrastructure to support a new location. It also gives you the opportunity to build the practice the way you want it from the beginning.
At EPIC4, we’re not trying to grow in every market just to add locations. We’re looking for the right partnerships and opportunities to build a sustainable business over the long term. I expect that discipline, rather than a move toward one growth model or the other, will be what separates the successful groups over the next couple of years.
Antonio Molina, DDS. Partner at Guardian Dentistry Partners (Miami): Only 50% of people use dental services in any given year. There is an untapped patient pool and anyone that can expand and reach these patients will have a tremendous opportunity. If a de novo can appeal to these patients, it will be a great success.
