If you’re thinking about selling your orthodontic practice in the next one to three years, the most expensive mistake you can make is starting the conversation with a buyer too early.
Practice valuation is not what your numbers say today. It is what your numbers say after 12 to 24 months of focused, intentional preparation. Done right, that preparation can add 25 to 50 percent to your final sale price. Done poorly (or not at all) you leave that money on the table forever.
Here’s how I think about practice valuation, and what every owner should be doing 12 to 36 months before they sell.
I’m Luke Infinger. Through HIP Creative I’ve worked with practice owners across the full spectrum, from owners scaling toward an eventual sale to owners walking away from a DSO offer because the underlying business wasn’t ready. Both decisions cost real money. Both can be planned for.
What Drives Orthodontic Practice Valuation
EBITDA Is the Headline Number
Almost every meaningful orthodontic practice transaction is priced as a multiple of EBITDA: earnings before interest, taxes, depreciation, and amortization. The multiple varies based on the buyer (DSO, private equity, individual orthodontist) and the size of the practice, but EBITDA is the foundation.
Most practices I evaluate have understated EBITDA when we first start working together. Not because anyone is hiding anything, but because owners run the practice for tax efficiency, not for valuation. Discretionary expenses, family payroll, vehicle leases, and personal expenses run through the P&L blur the picture. The first job in pre-sale prep is normalizing the EBITDA so a buyer can see what the practice actually generates.
Top-Line Growth Trajectory
Two practices with the same EBITDA can sell at very different multiples. The one growing 15 percent year-over-year sells higher than the one that’s been flat for three years. Buyers are not paying for last year. They are paying for the next five.
If you’re 18 to 24 months from sale and growth has stalled, the most valuable thing you can do is restart it. Even modest renewed growth in the trailing 12 months before sale shifts the multiple meaningfully.
Concentration Risk
Buyers worry about concentration. If 70 percent of your production comes from one provider (you), the practice is worth less than a practice with the same revenue spread across three providers. Same logic for referral concentration. If half your new patients come from two referring dentists, that’s a risk.
Diversifying provider production and referral sources before sale is one of the highest-impact things you can do. It is also one of the slowest, which is why this work has to start years out.
Operational Maturity
Buyers pay more for practices that run on systems instead of personalities. SOPs, KPI dashboards, a leadership team, documented training, financial agreements that don’t depend on the owner being in the room. All of that translates into a higher multiple because it lowers the buyer’s transition risk.
DSO Buyers vs. Private Buyers
Most practice sales today fall into one of two buckets, and the playbook is different for each.
Selling to a DSO
DSO buyouts typically combine an upfront cash payment with rolled equity in the parent company. The structure can be lucrative, but the details matter. The earnout terms, the post-sale operating model, the equity vesting, and the seller’s continued obligations vary widely between DSOs.
If you’re considering this path, do not negotiate alone. Hire a transaction advisor who has closed multiple DSO deals on the orthodontic side. The difference between a well-structured DSO deal and a poorly-structured one is often more than seven figures.
Selling to a Private Buyer
A private sale (typically to a younger orthodontist or a small group) tends to clear a lower headline number but offers more flexibility on terms. Owner financing, transition periods, and earnouts can all be structured in ways that fit your goals.
Private buyers often pay full price for operational maturity. A practice with strong systems and a documented growth trajectory is much easier for an individual orthodontist to step into and run.
How to Compete Against DSOs as a Private Practice
Even if you don’t plan to sell to a DSO, you compete with them. They market harder, they hire faster, and they price more aggressively. The way to win is not to copy them. It is to position around what they cannot offer: continuity of care, community presence, and the patient experience that comes from a doctor who actually owns the place.
The 12-Month Pre-Sale Optimization Checklist
Twelve months before you start a sale conversation, run through this list.
- Normalize EBITDA. Pull discretionary expenses out of the P&L so a buyer sees the real earnings power.
- Restart top-line growth. A trailing-twelve-months growth trend is more valuable than any other single metric.
- Diversify provider production. Add an associate or rebalance the schedule so revenue is not all attached to you.
- Diversify referrals. Add at least two new dentist referral relationships and document the cadence of how each gets nurtured.
- Document SOPs. New patient flow, consult flow, financial presentation, recall, recare. All written down.
- Build a leadership team. Office manager or COO who runs operations, ideally with at least two years in the role by close.
- Clean up the books. Three years of audited or reviewed financials. Sale conversations move much faster when this is ready.
- Lock in your team. Key hires should be contracted with non-competes that survive the transition.
- Get a real valuation. Hire a transaction advisor 12 to 18 months out to tell you where you actually stand.
- Decide what you actually want. Cash, lifestyle, role post-sale, geographic flexibility. The structure of the deal is built around these decisions, not around the buyer’s preference.
Real Numbers and Real Choices
Dr. Ben Fishbein scaled from a $2.4 million single location to over $26 million across eight offices over seven years. At every stage, the practice was sale-ready in a way that gave him optionality. He could have sold at $5M, $10M, or $20M. He chose to keep building. The point isn’t that everyone should keep building. The point is that having a sale-ready practice is the same work as having a great practice. You don’t have to choose.
Frequently Asked Questions
How early should I start preparing for a sale?
Three years out is ideal. Two years out is workable. One year out is better than nothing. Less than that and you’ll leave money on the table.
What multiple should I expect on EBITDA?
It depends on size, growth, buyer type, and market. As of 2026, healthy single-location practices commonly trade in the 4x to 6x range. Larger multi-location groups command higher multiples. Get a real valuation rather than trusting any rule of thumb.
Should I take a DSO offer?
Maybe. The headline number is rarely the right way to evaluate a DSO offer. The structure (rollover equity, earnout, post-sale role) is often more important than the cash at close.
Can you help with the sale itself?
I help with the pre-sale work: building the practice that earns the right multiple. The transaction itself is best run by a specialized M&A advisor. We coordinate.