The short answer
Dentrix and Open Dental can both support a successful dental practice. The right choice depends less on which interface your team prefers and more on which deployment model your organization can support. A locally installed system gives the practice more direct control but also makes the practice responsible for the server, backups, security and recovery. A vendor-hosted cloud system reduces that infrastructure burden but makes internet reliability, vendor terms and data-export rights more important.
For a single practice that wants local control and already runs the Dentrix ecosystem, classic Dentrix may remain a practical fit. Dentrix Ascend is the clearer Dentrix option for practices and groups that want a cloud-native platform. Dentrix Enterprise is designed for multilocation and integrated health organizations. Open Dental is strongest for practices and groups that value transparent published pricing, direct database access and the freedom to choose how the system is hosted. Open Dental Cloud offers a vendor-hosted path, but it is in limited release and has integration requirements that must be verified before purchase.
For a wider product shortlist, use our broader dental practice management software selection guide.
The most important step is to compare the exact products and deployment plans. Asking whether Dentrix or Open Dental is better without identifying the Dentrix edition and Open Dental hosting model can produce the wrong answer.
Dentrix is a product family
The name Dentrix can refer to three materially different products. Each places data and infrastructure responsibility in a different location.
Classic Dentrix
Classic Dentrix is installed locally and normally depends on a server inside the practice. Henry Schein One describes it as an on-premises product for practices that want local access and control. Its own comparison page says classic Dentrix has limited multi-location support and assigns the practice responsibility for IT and backups.[1]
Dentrix Ascend
Dentrix Ascend is cloud-native and accessed through a browser. Henry Schein One positions it for growth-focused practices and DSOs, with centralized access and reporting across locations. Because the platform is hosted, the practice does not maintain the PMS database server. Local computers, networks, identity controls, imaging connections and internet redundancy still require planning.[1]
Dentrix Enterprise
Dentrix Enterprise is a separate platform for multilocation practices, integrated health centers and public health organizations. Its product materials emphasize centralized provider and patient data across locations.[2] A buyer should confirm hosting, integration, migration, support and pricing terms for the proposed environment instead of assuming they match classic Dentrix or Ascend.
Open Dental has two main hosting paths
Self-hosted Open Dental
Open Dental is self-hosted by default. The practice can host it on a local server or manage remote hosting. Open Dental documents several multi-location architectures, including separate databases, a single central database, terminal services, middle-tier configurations and clustered designs. The vendor also states that its support team does not configure the underlying network, so capable dental IT support is part of the deployment requirement.[3]
Open Dental Cloud
Open Dental now offers its own hosted service. Open Dental Cloud is managed by Open Dental Software and includes automatic nightly backups, updates and remote access. As of September 2026, the service is limited to U.S. customers, accepts a limited number of customers and has stated interoperability limitations with some third-party products.[4] Practices that depend on separate imaging, patient communication, revenue-cycle or analytics tools should verify every integration before committing.
The five deployment choices at a glance
| Product | Deployment | Primary responsibility | Strongest fit |
|---|---|---|---|
| Classic Dentrix | Local installation and server | Practice and its IT provider manage the server, backups and local environment | Single practices and smaller groups that want local control |
| Dentrix Ascend | Cloud-native browser platform | Vendor runs the application platform; practice manages endpoints, network, access and integrations | Practices and groups that want less server management |
| Dentrix Enterprise | Centralized enterprise platform | Responsibilities depend on the quoted implementation | Large groups, public health and integrated health organizations |
| Open Dental self-hosted | Local or customer-managed remote hosting | Practice and its IT provider own architecture, security, backup and recovery | Practices and groups that want control and direct data access |
| Open Dental Cloud | Hosted by Open Dental | Vendor manages hosting and PMS backups; practice manages local technology and connectivity | U.S. practices that want Open Dental without maintaining a database server |
Where the data lives changes the risk
A local database can keep the practice working when the internet fails, but only if the server and local network remain healthy. Without redundancy, a failed server can interrupt scheduling, charting and access to clinical information. The effect depends on whether the practice has a current backup, a tested recovery process and replacement infrastructure ready.
A cloud-hosted database removes the local PMS server from the office, but it makes the internet connection operationally critical. A practice considering Dentrix Ascend or Open Dental Cloud should evaluate its primary circuit, expected repair times and an automatic failover connection. Failover should be tested with the actual software, imaging workflow, phones and authentication process. Buying a second connection does not prove that clinical work will continue when the primary connection fails.
Multi-location groups face an additional choice. Separate databases can isolate an outage, but they complicate centralized reporting and cross-location access. A shared database improves centralization, but the network path to that database becomes a shared dependency. Open Dental documents both approaches and several variations, which is useful flexibility but also means the architecture must be designed rather than assumed.[3]
What the software actually costs
License price is only one part of the cost. A useful comparison includes the software, hosting, backups, cybersecurity, server replacement, implementation, data conversion, imaging integration, training and downtime during migration.
Henry Schein One does not display license pricing for classic Dentrix, Dentrix Ascend or Dentrix Enterprise on the product pages reviewed for this article. Practices need written quotes that identify the exact product, tier, locations, providers, integrations, conversion services, training, support and renewal terms.
Open Dental publishes a detailed fee schedule. As of September 2026, its U.S. self-hosted license and support rate is $199 per month per location for the first 12 months, covering up to three providers. The current reduced rate after 12 consecutive months is $149 per month per location. Additional providers beyond three are $20 per month each, excluding hygienists. The published four-to-nine-office rate is $169 per month per office during the first year and the vendor asks groups with 10 or more offices to contact management.[5]
Open Dental Cloud starts at $430 per month per location for one provider, 15 concurrent sessions and 50 GB of OpenDentImages storage. Additional providers are $150 per month each, and the listed one-time migration charge is $400. Open Dental says discounts may be available when multiple locations share one database.[4]
| Cost category | What to obtain in writing | Why it matters |
|---|---|---|
| Software and hosting | Product, tier, providers, locations, storage, sessions and renewal terms | Headline prices rarely describe the full environment |
| Conversion | Each database, images, attachments, test conversion and final conversion | Images and documents may sit outside the primary database |
| Infrastructure | Servers, cloud resources, firewalls, circuits, failover and endpoint upgrades | Hosting choices shift cost rather than eliminating it |
| Support | Vendor support, dental IT support, after-hours coverage and escalation ownership | The software vendor and IT provider solve different problems |
| Exit | Export formats, fees, timing and assistance after cancellation | Switching cost becomes leverage only before the contract is signed |
Data access and integrations
Open Dental changed from an open-source GPL license to a proprietary license in version 24.4. The vendor states that this change did not alter customer pricing, use or database access. It continues to provide database documentation and read access.[6] This distinction matters because some comparisons still describe the current product as open source. Direct access to the database can be valuable for reporting, data warehousing and custom integrations, but access must be secured and governed.
Dentrix integrations use Henry Schein One's supported integration routes, including its API ecosystem. A practice should identify each integration it requires and confirm that the exact Dentrix product supports it. Classic Dentrix, Ascend and Enterprise should not be treated as interchangeable simply because they share the Dentrix name.
Integration review should cover more than the practice management system. Confirm imaging bridges, sensors, CBCT systems, patient forms, communications, payment processing, insurance tools, analytics, revenue-cycle services, accounting exports and identity management. Ask the vendor to demonstrate the proposed workflow in the product and tier you will actually purchase.
Backup and recovery responsibility
For classic Dentrix and self-hosted Open Dental, the practice and its IT provider carry most of the infrastructure responsibility. A backup is not sufficient until the practice can restore it. Before selecting either platform, document how often the database and images are backed up, where copies are stored, how backup failures are monitored and when a full restoration was last tested.
For Dentrix Ascend and Open Dental Cloud, the vendor handles the hosted application and its platform backups. That does not eliminate the need for a continuity plan. The practice still needs a documented response for internet failure, unavailable workstations, compromised accounts, imaging-system outages and vendor-side service disruption. Buyers should request the vendor's backup scope, retention, recovery objectives and data-export process in writing.
Dentrix Enterprise buyers should establish the same responsibilities during solution design. The product name alone does not tell the practice who will host each component, who will test recovery or how quickly service can be restored.
Imaging can decide whether the migration succeeds
Practice management data and dental images are often stored or handled differently. A migration plan should identify the imaging database, image files, bridges, acquisition software and device drivers before the PMS conversion begins. Confirm whether historical images will remain searchable from the new patient record and whether new images can still be captured from every operatory.
A cloud PMS does not automatically place every imaging system in the cloud. Open Dental's published cloud guidance says separate imaging software may remain outside its hosted environment, and some integrations that do not use the Open Dental API may not be compatible.[4] Dentrix buyers should confirm the exact imaging package and integration included in their quote. The safest approach is a documented compatibility matrix built from the equipment and applications the practice already owns.
Plan the migration as a clinical project
Switching practice management systems affects scheduling, charting, billing, insurance workflows, patient communication and imaging. Treat it as a clinical operations project with an IT workstream, not as a software installation scheduled for a convenient weekend.
- Inventory every database, imaging repository, document store, integration, workstation and device that depends on the current PMS.
- Obtain a written conversion scope that identifies what will transfer, what will not transfer and how exceptions will be handled.
- Run a test conversion early enough for clinical and billing teams to validate patient records, balances, insurance data, clinical notes and images.
- Define the final data-freeze period, rollback decision, support contacts and authority to delay go-live if validation fails.
- Test every operatory workflow, including imaging acquisition, prescriptions, payments, claims, printing and patient communications.
- Keep the legacy system accessible for the agreed retention period and confirm licensing before the old server is decommissioned.
Recommendations by practice type
| Practice profile | Best starting shortlist | Condition to verify |
|---|---|---|
| Single established practice | Classic Dentrix, Dentrix Ascend, self-hosted Open Dental or Open Dental Cloud | Local IT capability, internet reliability, workflow preference and total five-year cost |
| Startup practice | Dentrix Ascend, Open Dental Cloud or a well-designed self-hosted Open Dental environment | Construction schedule, imaging compatibility, cabling, failover and opening-day support |
| Growing two-to-five-location group | Dentrix Ascend or Open Dental with one deliberately designed multi-location architecture | Central reporting, database design, data access, shared identity and acquisition onboarding |
| Large DSO | Open Dental with capable enterprise IT, Dentrix Ascend or Dentrix Enterprise | Data warehouse needs, integration governance, security baseline, implementation capacity and exit rights |
| Public health or integrated health center | Dentrix Enterprise plus any alternatives that meet the organization's clinical and interoperability requirements | Public-health workflows, centralized data, hosting, integration and procurement requirements |
Questions to ask before signing
- Which exact product, edition and tier are included in the proposal?
- Where will the production database and images live?
- Who is responsible for the server, operating system, database, backups, restore tests and network?
- What happens to the clinical schedule if the server, internet circuit or vendor platform fails?
- Can the practice export patient records, clinical notes, documents and images in usable formats?
- What export fees, notice periods or post-cancellation restrictions apply?
- Which integrations are supported in the exact product and tier being quoted?
- How will reporting work across locations and legal entities?
- What is included in conversion, validation, training and go-live support?
- What will the complete five-year cost be after hosting, security, infrastructure and implementation are included?
Frequently asked questions
Which is better for a dental practice, Dentrix or Open Dental?
Neither product is universally better. Classic Dentrix suits practices that want an established locally installed system. Dentrix Ascend suits practices and groups that want a cloud-native Dentrix environment. Dentrix Enterprise targets multilocation and integrated health organizations. Open Dental suits practices and groups that value pricing transparency, direct database access and hosting flexibility, provided they have the IT capability required for the chosen design.
Is Open Dental still open source?
No. Open Dental changed from a GPL open-source license to a proprietary license in version 24.4. Open Dental states that customer database access remained unchanged.[6]
Can Open Dental run in the cloud?
Yes. A practice can manage remote hosting of the self-hosted product, or it may qualify for Open Dental Cloud, the vendor-managed hosted service. Open Dental Cloud is currently limited to U.S. customers and limited release.[4]
Which option is better for multiple locations?
Dentrix Ascend, Dentrix Enterprise and several Open Dental architectures can support multiple locations. The right choice depends on whether the group wants vendor-managed hosting, direct database access, centralized reporting, local outage independence and responsibility for the underlying infrastructure.
How much does Open Dental cost?
As of September 2026, Open Dental publishes a U.S. self-hosted starting rate of $199 per month per location for the first year, with a current reduced rate of $149 after 12 consecutive months. Provider, service and volume adjustments apply. Open Dental Cloud starts at $430 per month per location for one provider, plus applicable provider, storage, session and migration charges.[4][5]
Does cloud software eliminate the need for dental IT support?
No. Cloud hosting removes much of the local server workload, but the practice still depends on secure workstations, user access, firewalls, Wi-Fi, internet connectivity, imaging equipment, third-party integrations and an incident-response plan supported by appropriate cybersecurity services.
What should be tested before a PMS go-live?
Validate scheduling, patient records, balances, insurance information, clinical notes, documents, images, imaging acquisition, claims, payments, prescriptions, printing, communications and reporting. Confirm the rollback decision before the final conversion starts.
Make the infrastructure decision before the software decision
A practice management platform becomes part of the clinical operating environment. Before choosing Dentrix, Dentrix Ascend, Dentrix Enterprise or Open Dental, define where the data will live, who will protect it, how the practice will work during an outage and how the information can be recovered or exported.
Legend Networking helps independent practices, startups and multi-location groups evaluate the infrastructure behind dental software, including networks, servers, cloud hosting, imaging, cybersecurity, backups and internet failover. The goal is not to force every practice into the same platform. It is to make sure the selected platform can be supported safely and reliably after implementation.