How Process Debt and Disconnected Software Hinder Multi-Location Orthodontic Growth. 

Alison Werner (00:05)
Managing a growing orthodontic practice or specialty group has never been more complex, especially when the rapid acquisition strategies of the past decade start colliding with the realities of today’s economic reset. But what happens when disconnected software, front office bottlenecks, and compounding process debt start eating into your clinical efficiency and organic growth? Sometimes the key to building a sustainable, high-performing practice and a more streamlined workflow isn’t about adding more locations, but about building a unified modern operational.

Foundation. Welcome to the Orthodonic Products Podcast. I’m your host, Alison Warner. In this episode, I’m speaking with Kevin Simmons, Enterprise Sales Director for Cloud 9 at Planet DDS, to discuss the key findings from their newly released 2026 mid-year dental industry outlook. Drawing from an analysis of more than 8,000 practices, including 2,500 orthodontic clinics, we dive deep into why specialty and orthodontic groups are currently outperforming general dentistry, growing at a rapid 5.5% rate.

We discuss the hidden revenue leakages occurring between case acceptance and actual case completion, how practices can leverage automation to combat structural labor shortages, and how to draw the line between clinical autonomy and business standardization. Here’s our conversation.

Alison Werner (01:21)
Well Kevin, thank you for joining me. I appreciate it.

Kevin (01:25)
happy to be here. good to see you again.

Alison Werner (01:27)
Yeah. Okay, so we’re talking about the 2026 mid-year dental industry outlook report from Planet DDS. So you’ve published these reports before, but this mid-year report is framed around a transition in what you call the era of the dental enterprise. So what specific operational blind spots or questions were you looking to uncover with this deeper dive that previous industry and al analyses have missed?

Kevin (01:57)
I think it’s just looking to take things deeper, but specifically into a multi-specialty type of view. you know, Planet DDS has been very focused on the dental industry, but in recent years the orthodontic industry since the acquisition of Cloud 9, and we’re working towards a platform that handles all specialties in one pane of glass, as we say. and so I think this analysis is just bridging off of that focus and direction.

that we’ve been headed here in recent times.

Alison Werner (02:29)
Okay, and then the scale of this data of the data in this report is kind of significant ’cause you’re drawing from more than eight thousand practices and from what I understand it’s including 5,200 on Denicon and then 2,800 on Cloud 9. So for an audience of clinicians and group leaders, how is this data compiled and what makes the data set uniquely uniquely qualified to reflect the actual state of the industry?

Kevin (02:58)
I think it being based on actual organizations and actual data is is part of what makes it powerful and unique. and so for what I like about the data is it’s looking not only across specialties with Dennacon and Cloud 9 data married together, but selfishly as an ortho guy, there are parts that are carving out orthodontic focus and numbers. and of course there’s some that are geared towards the the dental side as well.

but I think just having the actual data and being able to rely on it and normalize it and analyze it is is just what makes it unique.

Alison Werner (03:34)
Yeah. Okay, so let’s kind of dive into some of the data. So the report highlights kind of this striking contrast in growth. So general dentistry DSO practice counts grew by just 1.8 percent over the past year, while specialty DSOs, so including ortho, grew by 5.5 percent. So what

In looking at that data, what macroeconomic or clinical factors you do th do you guys think are driving this disproportionate growth in the specialty and orthodontic sectors? And what does that trend tell us?

Kevin (04:08)
With a spin towards orthodontics, I think orthodontics has just always been able to weather the storm of trying times financially. and

Alison Werner (04:15)
Mm-hmm.

Kevin (04:16)
of course, all dental industries need patients that are willing to come in and hear about the treatments that they may be candidates for, and of course, be able to make it work financially. and I think that orthodontics just traditionally being a cosmetic, not necessarily required driven treatment in industry.

I think it’s it’s better able to to weather some of the challenges that we’ve seen here in recent times that this most recent report is is really reflecting.

Alison Werner (04:45)
Yeah, okay. And then, you know, another data point is the data the data data data point the the data showed that ortho practices average 368.3 new patient consultations over a six month period. So in a mature, kinda highly competitive market, how should an orthodontic practice interpret that benchmark?

Kevin (05:08)
in general that you can never have too many patients. and I think that, you know, one of the things I’ve enjoyed observing in orthodontics over the years, and I’ve visited over a dozen practices in my time, is that it’s not necessarily the size of the practice. It is, you know, the effectiveness of the practice. And I’ve seen a situation with one doctor and three chairs, you know, doing

Alison Werner (05:31)
Mm-hmm.

Kevin (05:32)
over two million dollars a year.

and you know, just back to that new patient figure, obviously the more opportunities you’re drawing into your business and hopefully the more successfully you’re converting them into treatment starts, the the more you’re going to thrive. And then of course the data and the analysis gets into the efficiencies and the effectiveness of treating the patients that I’m sure we’ll touch on. but I think getting as many opportunities in the door and having skilled members of your team ready to maximize those opportunities.

I think those are the most direct way to fuel a practice.

Alison Werner (06:07)
Yeah. Okay. Okay. And then, you know, the pr the report speaks a lo extensively about this idea of process debt. kind of that as I understood it, that compounding operational cost of running an enterprise on disconnected legacy infrastructure. So orthodontics has historically relied on highly specialized, standardized, standalone software. What does process debt look like

specifically for an expanding ortho group and what are the risks of deferring a transition to kind of a unified cloud native system.

Kevin (06:44)
I think there’s a couple layers to the answer. Certainly being on a cloud platform maximizes your ability to access the software and it should be reducing your overall tech spend and tech stack. so that is certainly a direction that is worthwhile for groups looking to grow and and be more efficient. but I also think it goes back to standardization of operations.

And let me be clear because I think that’s nuanced. I think the way that the clinicians and the doctors operate inside of the clinic and are treating the patients and recording the records and everything like that. I think that even in a standardized environment, there’s still a lot of room for that clinical autonomy. I think the most impactful ways to standardize go back to the new patients and drawing as many opportunities as you can.

But also standardizing. How are we presenting our treatments to these patients and how are we making these large, complex financial decisions as easy and enticing to them as possible? And then in terms of the overhead and you know not spending too much chair time treating a patient and getting their teeth straightened, that’s actually been one of the focuses I’ve been hearing in recent years. Is traditionally as somebody who had braces in the 90s, I’ll admit.

you

Alison Werner (08:01)
What is

Kevin (08:02)
know, the the pattern was you come in every single month until you’re done. what has been trending is a more optimized schedule on a per patient basis. And there may be times in my 18-month treatment that I only need to come in every six weeks or eight weeks. So I’m seeing people invest in tools and operate operational procedures that help make that treatment as effective and efficient as possible. because I’ve always heard every minute a patient sends

sits in your chair is is money that you are spending. and so the less often you are having to consume that chair time and the more efficiently you’re completing your treatments, I think that overhead is impacted for the better.

Alison Werner (08:44)
Yeah. One of the you know, one of the data points I found interesting is that this case completion was reported out at 49 percent and this was across the dental industry.

Kevin (08:56)
It was.

Alison Werner (08:56)
And it was much larger than this, I guess, a bottleneck than case it was it was a bottleneck compared to case acceptance, which was 61 percent. So

First talk to me about that that overall number set data point, but then because orthodontic treatment is inherently it’s multi year, it’s long term commitment, how does that completion gap manifest in ortho practice practices?

Kevin (09:21)
I spent a lot of time thinking about that figure because, as you said,

Alison Werner (09:25)
Well.

Kevin (09:26)
it is across all specialties. It is not ortho specific.

Alison Werner (09:30)
Mm-hmm.

Kevin (09:30)
I myself wonder what the number would like would look like in an ortho specific situation. my guess would be it’s higher than the 49% in an ortho situation. I think

Alison Werner (09:41)
Yeah, we think so.

Kevin (09:43)
what brings it down often is on the dental side, you have a treatment plan of crowns and

implants and complex, not attractive work that needs to be done. And I may accept that treatment plan, but I have anxiety and hesitancies before I complete it. Or maybe I did the you know, the the cavity fill, but I didn’t do the crown. so

Alison Werner (10:05)
Mm-hmm.

Kevin (10:06)
I just yeah, personally I would love to know more about where the number comes from and and dig into it deeper.

Alison Werner (10:10)
Yeah. Yeah.

Kevin (10:12)
but I do think that in an ortho situation when they have accepted that, you know,

Several thousand dollar orthodontic treatment. They’ve done it for the right reasons and they’ve done it with the ability to pay for it financially. And I think they are much more likely to come in for that treatment. And I wonder too how much of that number is did I finish in the 18 months they expected me to, or did you know I go over or under? That’s where again I would love to know more.

but I would say that tracking of treatment efficiency in an ortho practice to me is one of those very impactful success measures. and I’ve observed practices that don’t necessarily pay attention to it at all and don’t always put in the data point of we think this is gonna take 18 months versus 12 months or you know what the data is gonna rely on to tell that story.

but I do find that highly effective practices are tracking every data point that they can accurately and especially when it comes to the treatment timelines and are we over our expected goal, you know, the well-oiled practices are definitely tracking those and paying attention to them on a regular basis.

Alison Werner (11:24)
Yeah. One of the other data points is related to staffing and i the report showed that with 70 percent it’s 70 to 90 percent of dental offices reporting they cannot fill clinical roles. What did you take away from that data point?

Kevin (11:42)
I hate to bring up COVID again, but it kind of reminded me of, you know, the story after COVID when, you know, staffing and, you know, the ability to hire and main and and keep staff, you know, started to be impacted. so that’s not one I have man managed to uncover anything too insightful about quite yet. but I do think it just goes back to, you know, the the workforce force and, you know, our society are changing in some ways that

are impacting the ability to, you know, find and keep good staff.

Alison Werner (12:13)
Yeah. So what d what would your advice then from that data point be for how practices can manage that?

Kevin (12:23)
I and this kind of goes back to the way I have built teams in my own career, is you know, find some good people and then leverage their networks of people they’ve worked with in the past or people that they’ve, you know, met over their journeys. and you know, especially with orthodontics, a lot of these are localized to communities. And so it’s, you know, probably a legitimate constraint that there’s only so many trained orthodontic assistants in my area.

So, you know, maybe an out-of-the-box answer too is to continue to grow the awareness of the orthodontic industry and be getting more people to pursue those educations and those those things that help them, you know, get into this industry. one s over sharing side note is I have three teenagers and I

Alison Werner (13:07)
Mm-hmm.

Kevin (13:07)
have influ encouraged all of them to, you know, at least look into this industry. And so far they’ve all said, no, I don’t want to work in people’s mouths.

but at the same time, I think that people that know this industry and know that being a dental assistant or an orthodontic assistant or veterinary assistant, like those are good good careers to be part of a, you know, company that becomes your family for a long time. And I think traditionally that’s what orthodontic and dental practices have been built on are those long-term family-like relationships within their teams.

Alison Werner (13:40)
Yeah. I’m curious to kind of look at the technical side with, you know, Cloud 9, what are some of the tools within that kind of software or platform that can help get through this staff shortage or staff, you know whatever lack of staff.

Kevin (14:03)
I won’t use the latest A-word in technology AI yet, but I will use a different one, automation. So I

Alison Werner (14:08)
Okay. Mm. Okay.

Kevin (14:10)
think automation has definitely been growing within our tools and our industry in recent years, and for something like appointment reminders. Traditionally you had to go through a list at the end of each day for the appointments coming up. You had to manually cue those up and then manually watch them and follow up.

so part of what has been introduced not only in Cloud 9 but in other tools is the ability to set and forget. And these reminders are gonna send the right messages to the right people at the right time. It’s gonna give them an option to reschedule or cancel their appointment, and we’re gonna have other r related tools that allow them to do that. and you know, one of the traps in orthodontics is active patients go too long without coming in for an appointment.

so trying to make sure that they stay on track while also making things easier for the staff.

Alison Werner (14:59)
Mm-hmm.

Kevin (15:00)
and if I may, I would extend that automation to the RCM side, and that’s probably a bigger source of stress for a lot of people, is

Alison Werner (15:08)
Yeah.

Kevin (15:08)
making sure that you’re running all the payments at the exact day that they’re supposed to. that if somebody’s payment declines, you are automatically messaging them, hey, there is a problem, we need to talk about it, and things like that. So

RCM is a problem that can compound very quickly and it’ll continue to be a challenge in our industry. but that is another way where our automation and the tools we’ve been focused on developing are are trying to make staffs more efficient.

Alison Werner (15:36)
Yeah. One of the big messages in the report is this fa you know, you kinda talk about this idea that DSOs and large practices have kinda hit a wall in a way of, you know, they’ve done so much to grow, but now they’re kinda hitting an infrastructure gap. Can you kinda talk about that point?

Kevin (15:56)
And to me, it’s kind of depends on well, for one thing, every DSO is different. And as an

Alison Werner (16:00)
Mm-hmm.

Kevin (16:01)
ortho guy, I get to add, well, what are the diamond dynamics of your orthodontics as another variable? but

Alison Werner (16:05)
Right. Yeah.

Kevin (16:07)
I think that the biggest struggles are in that mid-size, the 20 to 50 locations. So they’ve got a plan to grow. They have had success growing and got to 20 or 50 locations, but most often at that size, there has not been a PMS standardization effort yet.

Or looking across the tech stack. I find groups in that size are typically most focused on the doctor autonomy and the clinical autonomy, which again

Alison Werner (16:35)
Mm-hmm.

Kevin (16:36)
does still have a place even when you’re standardized. But

Alison Werner (16:39)
Right.

Kevin (16:39)
I think that desire for doctor autonomy stems to don’t make me change software or tools at all. You know, I’m doing just fine, let me keep rolling with that. And so

Alison Werner (16:49)
Yeah.

Kevin (16:50)
I don’t deny that that can be successful.

But I think the best way to be successful is to have that standardization and that consistency and you get everybody from the top down paying attention to the same metrics with the same plans on how to address things and improve things. and that I think is the best way to drive growth across an entire organization.

Alison Werner (17:14)
I’m curious,

what are maybe two of the points or data points in the the report that surprised you?

Kevin (17:22)
one I just touched on to cheat and use that answer is that mid-size segment had the lowest growth rate, which did surprise me. I had to

Alison Werner (17:23)
Yeah. Look. Mm. Okay.

Kevin (17:29)
spend a few seconds wondering why that was. And, you know, I think we’ve offered you know, logical reasons as to why that would be. And quick call out there, they can always, you know, make the changes and address the things and get, you know, to the point that they need to be most profitable and grow beyond that, you know, ten to twenty to fifty range. and

I would say the other one was the multi-specialty. And I think I may have confused the the number I referred to with the the 1%, but

Alison Werner (17:59)
Yeah.

Kevin (17:59)
you know, the multi-specialty groups growing the lowest two. That very much surprised me, especially knowing our focus and the industry’s focused on multi-specialty.

Alison Werner (18:10)
Yeah.

Kevin (18:11)
so with the case completion, I mentioned I want to know more. This is another one because

I would imagine the pediatric and orthodontic multi-specialty grouping might be

Alison Werner (18:23)
Yeah.

Kevin (18:23)
an exception where there is a little bit more ability to drive growth on both sides.

Alison Werner (18:29)
Mm-hmm.

Kevin (18:30)
but just to highlight the I think one of the reasons given for that smallest growth in multi-specialty is that you’re not you’re not the best of either or best of any of them. You know, you’re

Alison Werner (18:41)
Mm.

Kevin (18:41)
you’re kind of making sacrifices on a per specialty basis.

Whereas I think the the perfect harmony would be that each specialty gets the special considerations and and approaches that they need, but you’re still focused on, you know, driving growth in the appropriate way within each specialty, if that makes sense.

Alison Werner (19:01)
Yeah.

Okay.

I wanna talk you know, the t the report talks about the future as well and it kind of warns that groups building a connected data foundation today will hold, quote, an intelligence advantage in 2030 that a late mover cannot close. So for an orthodontic group looking at building this long term, I guess, enterprise value, what are the immediate or practical data decisions that they make right now to ensure that their clinical and operational data begins compounding for the future?

Sure.

Kevin (19:35)
I think it goes back to some of the things we’ve talked about. So for new patients and case acceptance, to me, that drives production. We need to focus on increasing production. and then also the efficiency within there. So treatment efficiency, but also on the RCM side. It is great to get those starts and have that money on the books, but the blessing and the curse of the in-house financing we offer without interest is usually a challenge that we must

manage through to make sure that we are earning and collecting every one of those production dollars.

Alison Werner (20:08)
Yeah. What are you what kind of data do you wanna see would you like are you interested in seeing in the next few years with these reports? Like what are what are the data points you’re gonna be paying attention to?

Kevin (20:20)
As an ortho guy, you know, certainly clarification on ortho case completion and maybe getting a little more detailed into that. I am curious, AI is the buzzword, and there are a lot of different companies out there. I

Alison Werner (20:35)
Mm-hmm.

Kevin (20:36)
am curious in the specific ways that AI implementation in the dental and orthodontic world has the most impact.

Alison Werner (20:42)
Yeah.

Mm-hmm.

Kevin (20:44)
I think it it can improve all of the individual pieces and and things to focus on that we talked about, but I am really curious to see how that plays out. I’m also curious in the the trend of enterprise growth versus independent practices.

Alison Werner (21:01)
Mm.

Kevin (21:02)
you know, I am an enterprise salesperson. I have spent most of my recent years focused on the enterprise organizations.

but Cloud 9 and orthodontics in general were also founded on independent practices. and one of my favorite things about orthodontics is the ability for somebody to go through all of the education and the the internships and everything that it takes to to stand on their own as a business owner. and I want to be confident that there’s still room for that and room for, you know, orthodonics to kind of maintain that that character that it has.

Now tying those two things together, I once worked for a financial institution and I view this the way that they viewed their approach too. I would love to see that there is always the big bank benefits of a DSO or an OSO and all the advantages for staff members and patients that can come from that, but

Alison Werner (21:58)
Mm-hmm.

Kevin (21:59)
that there is also still the community focus and the community roots.

And I think that that’s largely inevitable because an orthodontist established in an area is still a person to know when you know. and so but at the same time, I think growth and organizations and the standardization and everything that can come, I think they both have benefits. and I think there’s gonna be a harmony between the two. But I’m curious to see how that plays out.

Alison Werner (22:24)
Yeah. Yeah.

Well one funny question is, what should the small independent orthodontic practice take away from this report? Because this is so focused on the DSO level and the multi specialty, but what would you say to that group?

Kevin (22:43)
I say the same three keys to success main t are are applicable at the independent practice level too. Build your brand, build your reputation and it and attract as many new patients as you can. And then put the best case presentation in front of you and convert as many of them as you can and then treat them and collect their financials as effectively as you can.

I think those four pieces are the the key to success at any level of any size when it comes to orthodontics or even dental practices.

Alison Werner (23:15)
Well, Kevin, thank you so much for joining me. I really appreciate you breaking down some of the data in this report.

Kevin (23:21)
Yes, it

was great to see you again. Thanks for having me.

Alison Werner (23:23)
Thanks.