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Game Changers: 4 Trends Defining the Future of Orthodontics by Dr. Roger P. Levin

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Game Changers: 4 Trends Defining the Future of Orthodontics 

Navigating how orthodontic practices can thrive in an increasingly competitive market

by Dr. Roger P. Levin

Since founding Levin Group in 1985, I have been fortunate to observe many of the best orthodontic practices and support them with proven success strategies. I sincerely hope these innovative and effective ideas will be beneficial to you and your practice.

Orthodontics has a great future. The American public is highly committed to orthodontic treatment for their children, and in many families, it is simply seen as a rite of passage. However, there are some challenges ahead. Understanding the following four trends will help any practice proactively improve performance and be better positioned to grow.


1. Orthodontic competition
Although competition is never a pleasant challenge to discuss, it is a reality. Thirty years ago, the orthodontic specialty was insulated. Most general dentists stated that they learned very little about orthodontics in dental school and had no desire to provide orthodontic treatment to patients. However, the advent of aligners has changed the dental landscape, and many general dentists now provide some level of orthodontic services. In a recent national survey, Levin Group identified that 37% of general dentists are providing some level of aligner treatment, and that number is increasing slightly each year.

Even with this shift, the reality is that general dentists are also a major referral source for orthodontic practices. Orthodontists need to understand that in the business world, it is not unusual for a large customer to also be a competitor. It is no longer an “all-or-none” world where you only want to work with general dentists who refer all their orthodontic cases. It is just as important to include general dentists who provide aligner treatment but also refer more complex cases, or those cases they do not feel comfortable completing themselves. This is becoming the new normal.

There is compelling evidence that general dentists remain an excellent referral source. Last year’s Levin Group survey revealed that general dentists refer more than $3.6 billion per year in orthodontic treatment to orthodontic practices. As a result, it will become increasingly important for orthodontic practices to secure their slice of that pie by using a robust referral marketing program.

Another avenue of competition is the dental service organization (DSO). One type of DSO is orthodontic-only, and some orthodontists have sold their practices into these models. They have collective marketing and greater negotiating power with insurance companies, among other advantages, but do not necessarily achieve equal levels of success. Other DSOs, which are not orthodontic-only, are also entering the orthodontic arena by directly hiring orthodontists or purchasing other DSOs that own orthodontic practices. You can expect this trend to continue, as DSOs have recognized that orthodontics is a highly profitable area that adds value to their overall service offerings.

Action item: The solution to increased competition is better marketing. Orthodontists should market to what Levin Group calls the five focus areas: patients, parents, referring doctors, social media, and the community. However, the selection of the right strategies and the right mix of those strategies in the five focus areas will determine the overall effectiveness of the marketing program. Other ways to overcome competition that I will discuss in future articles include advancements in technology, customer service, and new methodologies for providing orthodontic treatment, such as remote monitoring.


2. The orthodontic practice staffing crisis
If you speak to any orthodontic practice, you will find there is more than a 60% chance that they are currently seeking at least one additional staff member. This trend began during the pandemic and has continued. This is not strictly an orthodontic specialty problem but one that is pervasive in many industries. I recently attended a national CEO conference of various industries, and it was highlighted repeatedly that there is a shortage of “talent,” which refers to the ability to hire people with the right skills.

A key factor affecting the orthodontic staffing shortage is advancements in orthodontic technology, techniques, digitalization, and software. In other words, orthodontics has become more complicated, requiring practices to have more experienced and highly skilled individuals to perform at top levels.

Furthermore, staff turnover has accelerated at an unprecedented pace. Unlike years ago, when many staff members stayed for extensive periods, it is now common for orthodontic staff to change jobs every three or four years—or even less. The shock waves began during the pandemic, when the typically stable, long-term staff with occasional turnover became the less typical short-term staff with frequent turnover. In 2024, the staffing shortage improved slightly, but we will not see stability for seven to ten years.

Action item: Many steps need to be put in place today. These include advancing doctor leadership skills, implementing policies that support staff well-being beyond the practice, creating strong recognition and appreciation, understanding the right compensation methods (see more discussion in the next trend below), developing a team-based process for onboarding and training new staff members, implementing development plans for new and current staff members, and even offering longevity bonuses. You may have a fantastic and stable staff today, but that can change, and you want to be well-positioned to manage it.


3. Increasing overhead
Every orthodontist is aware that overhead has increased significantly since 2020. The reasons are relatively simple to understand. First, there was a significant change in staffing patterns, leading to an overall staff shortage that resulted in higher compensation for new hires and existing team members. Anytime there is a shortage of labor in any industry, compensation must increase for a business to be competitive and have the ability to hire the right people for those jobs. Orthodontics is no different. Compensation in orthodontics rose approximately 10% starting in 2022. It then went up another 2% to 3% in 2023, according to Levin Group national surveys. In addition, supply chain issues and inflation also contributed to a general overhead increase of approximately 8% to 9%. The only real way to effectively offset this expense is by increasing orthodontic practice production.

Unfortunately, overhead will not be coming down. Once costs rise, they typically remain high, even if supply chain issues, inflation, and other factors subside. We also know that staff compensation will not decrease, and practices that do not meet the average or above-average labor demands to hire the right orthodontic staff will find themselves with employees who are less skilled, experienced, and competent, resulting in a less efficient practice.

Although this is not good news, the overhead challenge is not insurmountable. Many orthodontic practices continue to grow as they implement excellent referral marketing programs, step-by-step documented operational systems, and effective customer service strategies. These practices are typically proactive in implementing the right strategies to continue to grow and increase production to help offset overhead increases.

Action items: These three strategies can be used immediately to combat the negative effects of rising overhead and expenses:
  • Review all practice systems to eliminate waste, unnecessary steps, and excess expenses. When necessary, eliminate an entire system and rebuild it from the ground up to prevent waste and inefficiencies. However, do not reduce marketing efforts, as they are key to building production.
  • Implement a powerful referral marketing program. Levin Group has been involved in referral marketing for orthodontic practices since 1985, and we have excellent data showing that the right referral marketing almost always increases referrals and production. Increasing referrals is the fastest and easiest way to boost production and offset rising overhead as described above.
  • Train the orthodontic team to be as efficient as possible. Implementing concepts like procedural time studies to determine how long each type of patient needs for each procedure can save chair time. A practice that saves 10 minutes per hour increases the orthodontist’s production time by two months per year—that is the equivalent of six years in a 36-year career. This is one of the biggest gains that practices can achieve relatively quickly, offering one of the highest returns on investment in an orthodontic career.

4. The economy
Although there is some debate, there is also broad agreement that many day-to-day consumer goods are still affected by inflation and that those inflated prices may not return to lower levels. Those goods include groceries, clothing, gasoline, car repairs, etc. The price increases that occurred in the later stages of the pandemic and beyond may, in many cases, be permanent. This means the American public may not see enough of a compensation increase to offset inflation, which could become the new normal for the economy. Orthodontics has weathered the storm relatively well so far and should remain a highly successful specialty. However, there is some concern that price competition in orthodontics may be increasing. At least one large DSO now offers aligners for just under $2,000. Although those aligners are not typically provided by an orthodontist, there may be a slight shift toward accessing orthodontic treatment at a lower cost than in the past. This means practices must be prepared to compete effectively and demonstrate the value of standard orthodontic fees.

Action items: Overhaul the orthodontic treatment coordinator (TC) presentation and program. The TC must adopt a new approach to demonstrate the value of orthodontic treatment and should not assume that every parent or patient will follow through with treatment. Competing with shoppers or other orthodontic practices is different from competing on significant, well-advertised prices. We expect DSOs to bring more orthodontists and orthodontic treatment into their practices and to advertise lower fees as a competitive strategy. We suggest that every orthodontic practice strengthen its TC process now by understanding current trends.


Summary
These four trends will reshape the orthodontic specialty moving forward. Although it is always easier to avoid competition, the reality is that the best orthodontic practices are preparing today for upcoming trends. Even if some of the scenarios posed in this article never occur, orthodontic practices that prepare as if they will can only benefit. For example, if orthodontic price competition continues to accelerate, orthodontic practices will need to evaluate strategies such as offering different financial options and patient financing. All of this will be critical to the long-term success of practices, even if they are thriving today. Furthermore, better systems, referral marketing, a strong orthodontic team, and excellent customer service are at the heart of having an excellent and successful practice.

Author Bio
Roger P. Levin, DDS Roger P. Levin, DDS, is the CEO and founder of Levin Group, a leading orthodontic practice management consulting firm that has worked with more than 30,000 practices to increase production. A recognized expert on orthodontic practice management and marketing, he has written 67 books and more than 4,000 articles, and regularly presents seminars in the U.S. and around the world.
To contact Levin or to join the 40,000 dental professionals who receive his Practice Production Tip of the Day, visit levingroup.com or email rlevin@levingroup.com.
Orthotown Magazine
September 2025
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