Three Trends Driving DSO Growth in 2026: De Novos, M&A, and AI Rollouts
Becker’s Dental Review identifies three primary drivers shaping DSO expansion in 2026. De novo development is gaining traction as an alternative to acquisitions — Smile Partners launched its first de novo as a strategic pivot, while PDS Health plans to open more than 100 new offices. M&A remains active, particularly in oral surgery, with 69% of DSOs expecting to increase acquisition activity despite a constrained supply of available practices. Technology is the third lever: AI rollouts across several networks are focused on patient care efficiency and staff support. The high-demand, low-supply environment is reshaping how DSOs weigh organic growth against deal-making velocity.
DSO leaders face a real trade-off: the acquisition pipeline is thinning while de novo builds require longer return horizons. The groups separating themselves in 2026 are layering technology onto physical expansion — and this piece gives a snapshot of where the category is actually moving.
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