For much of the past three years, the orthodontic industry has been waiting. Waiting for patient demand to rebound. Waiting for referrals to return. Waiting for consumers to regain confidence.
Halfway through 2026, it’s becoming clear that waiting is no longer a strategy.
The latest Metrics That Matter webinar, featuring insights from Chris Bentson and Shannon Patterson or Bentson Copple Patterson & Associates, and Dave Ternan, CEO of OrthoFi, paints a remarkably consistent picture. While each brings a different perspective on industry benchmarking, consumer behavior, and decades of consulting experience, they all arrive at the same conclusion: the practices outperforming today’s market aren’t waiting for conditions to improve. They’re adapting to the market that exists today.
As Chris Bentson put it, “The practices that are doing plus 10, plus 15, plus 20… they’ve decided to not wait for the market to change. They’ve decided to change.”
Healthy Financials Are Masking Pressure at the Top of the Funnel
At first glance, the orthodontic market’s financial health appears encouraging. According to Gaidge’s mid-year benchmarking data, production is up slightly year over year, collections have increased 3.6%, and collection ratio has improved. Practices have remained financially disciplined despite a challenging operating environment.
A deeper look, however, reveals why many orthodontists still feel pressure. New patient adds have increased just 1.3%, while both new patient exams and starts are essentially flat. Even more concerning, only 71% of scheduled new patient exams are actually being kept, and add-to-exam conversion has slipped to well below the industry’s 90% benchmark.
The implication is significant. The challenge isn’t that practices have forgotten how to convert patients. It’s that fewer opportunities are making it into the consultation room, making every inquiry, appointment, and follow-up substantially more valuable.
“Protocols and systems matter most now when new patient calls and exams are sluggish,” said Shannon Patterson. “Right now, they are.”
Today’s Consumer Hasn’t Lost Interest. They’ve Changed How They Buy.
The data also challenges another common assumption, that consumers are simply saying “no” to treatment.
According to OrthoFi’s data, patients are still choosing orthodontic care. They’re simply taking longer to make the decision. Nearly 44% of treatment starts now come from pending patients, individuals who left their initial consultation without committing but ultimately began treatment after continued engagement.
That’s a remarkable shift in buying behavior.
Patients are shopping. They’re seeking second opinions. They’re discussing treatment at home with spouses and family members. In many cases, they’re delaying decisions rather than declining treatment altogether.
For practices with structured follow-up systems, those patients continue moving toward treatment. For practices without them, the opportunity often disappears.
The strongest practices have recognized that case acceptance no longer ends when a patient walks out the door. Increasingly, it begins there.
Affordability Is the New Competitive Advantage
Economic pressures are influencing nearly every purchasing decision consumers make today, and orthodontics is no exception.
According to OrthoFi’s consumer payment data, patients are choosing lower down payments and longer financing terms to keep monthly payments manageable. Despite those shifts, delinquency rates have remained stable, demonstrating that families are still willing to invest in treatment when payment options align with their budgets.
“Patients are putting less down and extending payments longer to keep their monthly payment down,” explained Dave Ternan. “The practices that are able to be affordable, with the right guardrails and financial discipline, are going to have a competitive advantage.”
That distinction matters. Making treatment more affordable isn’t the same as making it less expensive.
Gaidge’s benchmarking data shows discounts increased another 4% this year after rising 13% the year before, while case fees increased just 1.5%. Discounting may preserve volume in the short term, but it often comes at the expense of long-term profitability.
Leading practices are taking a different approach. Rather than competing on price, they’re competing on flexibility, offering payment structures that fit comfortably into a family’s monthly budget while protecting the value of the treatment itself.
Growth Is Coming From Better Operations, Not More Patients
One of the most encouraging findings from this quarter’s data is that production continues to outpace treatment starts.
According to OrthoFi, practices are increasing production through thoughtful fee management, insurance optimization, and value-added services like retention programs, all while maintaining strong case acceptance. At the same time, referral relationships, observation protocols, and pending patient management have become increasingly important drivers of sustainable growth.
As Patterson noted, “The pending bucket only converts if someone’s working it systematically.”
Operational excellence has become a competitive advantage.
The Practices Winning Today Aren’t Waiting
Every market eventually reaches a point where yesterday’s assumptions stop producing tomorrow’s results. Orthodontics appears to have reached that moment.
The practices outperforming the market aren’t hoping for patient volume to return to historical norms. They’re strengthening referral relationships, investing in systems that improve the patient experience, following up with greater consistency, and making treatment more attainable without compromising profitability.
The data doesn’t suggest an industry in decline. It suggests an industry in transition.
Chris Bentson summarized the challenge and the opportunity best: “Leave behind the idea that the market is going to improve or get back to normal. That means you’ve got to execute a new idea in your practice to make it better.”
For practices willing to embrace that mindset, the second half of 2026 isn’t about surviving a difficult market. It’s about building the capabilities that will define the next generation of growth.
Whether you’re evaluating your own performance or planning for the second half of 2026, the full conversation offers practical insights and actionable ideas that every orthodontic leader should hear.
Watch Metrics that Matter Q3 2026 to explore the data in greater depth and learn what today’s highest-performing practices are doing differently.
