The orthodontic industry has changed more in the last five years than it did in the previous twenty. The next two years are going to keep pushing the same direction. Faster consolidation. Smarter technology. Different patient expectations. A labor market that doesn't look anything like 2019.
Here are the seven trends I think every orthodontic practice owner needs to take seriously in 2027, and what to do about each one.
I'm Luke Infinger. I track these trends across my consulting work, my agency HIP Creative, and conversations with practice owners and industry leaders on the GrowOrtho podcast. The patterns below are not predictions. They are what's already happening.
Trend 1: AI Goes From Hype to Operating Tool
Through 2025 and most of 2026, AI in orthodontics was mostly marketing language. By 2027, it's becoming an operational tool with real impact. Three places it's actually working:
- AI-powered patient communication. Voice agents handling first-touch inbound calls and qualifying leads before human staff get involved.
- Imaging and diagnostic support. Tools that automate cephalometric tracing and treatment planning aids, freeing the doctor's time.
- Operational analytics. AI surfacing patterns in scheduling, conversion, and overhead that humans miss.
What to do: pick one AI use case and pilot it inside the next 90 days. Don't try to AI-everything. Start with the one that has the clearest ROI for your practice today, usually patient communication or diagnostics.
Trend 2: DSO Consolidation Continues, but the Premium Compresses
The wave of DSO acquisitions that defined 2020 to 2023 has slowed but not stopped. What's changed is the price. Multiples have come down from their peak. Earnouts have gotten more demanding. The gap between strong DSO offers and good private buyer offers has narrowed.
What to do: if you're considering a sale in the next two to three years, stop assuming the DSO will pay the highest number. Get a real valuation, talk to multiple potential buyers (DSO and private), and structure your pre-sale work to maximize optionality.
Trend 3: Gen Z Patients (and Parents) Behave Differently
By 2027, most teen orthodontic patients are Gen Z, and an increasing number of parents (specifically the parents of younger patients) are millennials with Gen Z communication patterns. This shifts how patients find your practice, what they expect from the experience, and how loyalty is earned.
- Search starts on Instagram and TikTok, not Google. Visual social proof matters more than ever.
- Reviews carry massive weight. A practice with 50 reviews loses to a practice with 500.
- Texting is the default. Phone calls are perceived as friction. If your front desk doesn't run a smooth texting workflow, you're losing leads.
- Convenience beats reputation early in the funnel. Patients will choose a less-known practice with online booking over a more-established practice that requires a phone call.
What to do: audit your patient experience from the perspective of a 17-year-old or a 32-year-old parent. Where's the friction? Fix the top three friction points before you do anything else.
Trend 4: Virtual Consults Become Standard, Not Optional
The early-pandemic experiments with virtual consults have settled into a new normal. By 2027, practices without a virtual consult option are leaving meaningful starts on the table, especially in rural markets and for second-opinion situations.
Done well, virtual consults convert at competitive rates and dramatically expand the practice's reachable area. Done poorly, they're a low-conversion channel that frustrates everyone.
What to do: pick a virtual consult software, document the workflow, and train one TC to own it. Aim to convert 50 percent of qualified virtual consults to in-office starts within 30 days.
Trend 5: Staffing Is Permanently Tighter
The labor market is not returning to pre-2020 conditions. The supply of strong TCs, OMs, and assistants in most markets is structurally tight. The practices that win in 2027 are the ones that have built recruiting pipelines, retention systems, and culture worth staying for.
What to do: stop hiring reactively. Build a recruiting pipeline that runs whether or not you have an open seat. Invest in retention. The single most expensive hiring you'll do in 2027 is the replacement hire you weren't expecting.
Trend 6: Insurance Landscape Continues to Shift
Insurance reimbursement pressure on orthodontics has been gradual but real. The carriers' efforts to reduce orthodontic benefit caps, push patients toward in-network providers, and slow claim payments are all continuing trends.
What to do: revisit your insurance strategy annually. Track your true cost-per-claim. Consider the math on dropping low-value insurance contracts. The practices that lean into a fee-for-service model with strong patient financing tend to outperform on margin.
Trend 7: The Patient-Owner Doctor Becomes a Differentiator
As DSO consolidation continues, the doctor-owned, doctor-treated practice becomes increasingly rare and increasingly valuable to patients who notice. The practices that lean into this positioning (continuity of care, the same orthodontist from start to finish, owner involvement in the community) are winning more of the long-treatment, high-value cases.
What to do: if you're staying private, lean into it. Your marketing, your patient experience, and your community presence should all communicate "the orthodontist who actually owns this place." That positioning gets stronger every year, not weaker.
What These Trends Mean Together
Take all seven trends together and a clear picture emerges. Practices that succeed in 2027 are practices that look more like operating businesses and less like clinical solo practices. They're investing in technology that pays for itself. They're recruiting and retaining strong teams. They're meeting Gen Z patients where they actually are. They're either positioning to compete with DSOs or positioning to be acquired by one on favorable terms.
The practices that ignore these trends and keep operating the way they did in 2018 will keep producing 2018 results. Some will sell out of frustration. A few will get bought at a discount. Most will simply stop growing.
The good news: every one of these trends rewards the practice owner who's willing to build operating sophistication on top of clinical excellence. That has always been the formula. It just matters more in 2027 than it ever has.
Frequently Asked Questions
Should I be worried about DSOs in my market?
Worried, no. Aware, absolutely. Have a clear strategy for either competing with them or partnering with them, and stop assuming the situation will resolve on its own.
Is AI going to replace TCs and front desk staff?
Not in the next two years. AI will assist them, handle some first-touch communication, and remove low-value tasks. The human relationship at the consult is still the conversion engine.
What's the single most important thing to focus on in 2027?
Honestly, building a stronger team. Every other trend on this list is easier to navigate with a strong team and harder to navigate without one.
Will the orthodontic industry keep growing overall?
Yes. Total industry revenue is projected to keep climbing through the rest of the decade. The growth will be uneven, with consolidating practices capturing a larger share of it.
Talk to Luke About Your Practice Strategy
Talk to Luke About Your Practice Strategy