INDUSTRY

DSOs are buying DSOs

When the supply of solo practices to buy dries up, what's a DSO in growth mode to do? Opening de novos is one option, but some buyers are finding that scooping up smaller groups is an appealing alternative.

Driving the news: Deals where one dental group absorbs another are stacking up.

• In a widely shared LinkedIn post, Dental365's Joshua Gish called his company a "consolidator of consolidators," saying it has absorbed four or five smaller groups of six to ten offices each across New Jersey, Massachusetts, Pennsylvania, and Ohio.
  

• Heartland Dental bought Smile Design Dentistry last year, a roughly 60-office Florida group, in a deal reportedly priced at a low double-digit EBITDA multiple.
  

• Earlier this month, Thurston Group folded three of its platforms—SGA, Gen4, and Modis—into one organization under the SGA Dental Partners banner, a network of more than 250 locations and over 500 dentists across 26 states.

Zoom out: This isn't a run of one-offs. LevinPro has logged 110 dental transactions so far in 2026, and industry observers note a growing split between DSOs that expand by opening de novos and those that grow by acquiring smaller groups.

Why it's happening: Attractive solo practices are getting scarce and expensive, while smaller DSOs that never hit maturity—some carrying debt troubles—are starting to hit the market. Restructurings and shelved sale processes are leaving a growing pool of stranded and orphaned groups hunting for, in Gish's words, "a stronger home."

• Buying a group also comes with other benefits, like instant density in a regional market and, often, redundant overhead you can trim by folding its back office into shared services.

Yes, but: Buying existing groups isn't all sunshine and rainbows. There are real challenges to buying DSOs that, for one reason or another, never lived up to their owners' ambitions.

• That can mean half-built integrations, antiquated systems, and broken revenue cycles—all the usual problems of DSOs that aren't firing on all cylinders.
  

• Culture clash, low morale, and staff turnover are common too, and industry experts flag them among the top reasons DSO deals underperform.

Why it matters: Still, group acquisition is becoming a real lever for scale—and one well suited to a market where good small deals are scarce. But it raises the stakes on integration, putting a premium on operators with a proven ability to absorb what they buy.

Bottom line: Earlier cycles rewarded whoever bought fastest. This one will reward whoever absorbs and integrates best—and in 2026, the best deals may go to the larger groups with the proven ability to do exactly that, scooping up the groups that couldn't quite achieve lift-off.