Orthodontic Practice Management Software Compared: Cloud vs Server, and What Each Needs From Your IT

The renewal notice from your practice software vendor is on your desk, a cloud vendor's demo is booked for Thursday, and your server closet hums the way it has for years. Someone on the team says the cloud version "just works anywhere." Someone else remembers the morning the internet went down and nobody could see the schedule. Before you sign anything, you want to know what each choice will ask of your office.

This guide compares those systems by what each one needs from your IT, using the vendors' own requirement documents: servers and SQL editions, internet per workstation, remote offices, imaging capture and Macs. It sits inside our orthodontic practice technology guide, and the computers, network and backups around the software are what our dental IT support covers. It is written by Ian Lynch, who has 22 years in dental IT and oversees the NOC, onsite dispatch and client technology roadmaps at Legend Networking. It covers practice management systems only; treatment-planning and aligner-design software is a different category with different hardware needs.

Which orthodontic practice management systems are there in 2026?

The orthodontic practice management systems this guide compares are Dolphin Management, OrthoTrac (with its cloud successor, Sensei Cloud), Cloud 9, Ortho2's Edge Cloud, Greyfinch, topsOrtho and WaveOrtho. Some run on a server in your office, some run only in the vendor's cloud, and two offer both. That split matters more to your IT than any feature list.

The table below is a shortlist, not a ranking. Every cell comes from the vendor's own page or requirements document, read on October 26, 2026. Where a vendor publishes nothing on a point, the table says so.

Two notes on reading the table. First, Dolphin Management is the practice-management module of the Dolphin suite, the same family as Dolphin Imaging; for Dolphin servers and day-to-day support, see our page on Dolphin Imaging and Management IT support. Second, if your office is a general dental practice or a mixed group comparing Dentrix, Eaglesoft or Open Dental, our guide to general dental practice management software covers that list.

What the table cannot tell you is which system is right. That depends on three things this guide walks through: whether your server and SQL are near the end of support, whether every office has an internet line that can carry a cloud system, and how your X-rays, photos and CBCT get into the chart.

Which orthodontic software runs in the cloud, and which needs a server?

Cloud 9, Greyfinch, topsOrtho, Edge Cloud, Sensei Cloud and Dolphin Cloud run in the vendor's cloud, so the practice software needs no server in your office. OrthoTrac and on-premise Dolphin Management need a Windows server with SQL Server. WaveOrtho offers both. Even cloud systems still need local capture software for X-rays and scanners.

This is the deployment matrix: the grid most comparison pages leave out. Fill in the rows for the two or three systems on your shortlist and send any "not published" cell to the vendor as a written question before you sign.

Sources for each row are the vendor documents linked in the systems table above. Figures are each vendor's own minimums or recommendations as published on October 26, 2026; requirement sheets change, so check the current version before you buy hardware.

A blank row for your own shortlist looks like this: system name · server and SQL edition, or none · internet per workstation and per office · how a second office connects · how X-rays, photos and scans reach the chart · who answers when capture breaks. If the vendor cannot fill a cell in writing, treat it as unknown.

Cloud 9 vs Dolphin: what each needs from your IT

When Cloud 9 and Dolphin are on the same shortlist, they sit at opposite ends of the matrix. Cloud 9 removes the server but leans on every office's internet line. On-premise Dolphin keeps working inside the office when the internet drops, but needs a properly licensed Windows server, SQL Server and a domain. Dolphin Cloud sits between the two.

If your team already runs Dolphin Imaging for records and cephalometrics, that capture setup stays in the office whichever practice software you choose, and Legend supports the IT environment for Dolphin Imaging.

Cloud or server: which fits your practice?

Choose cloud when your server is near the end of support, every office can get a dedicated line plus a backup line, and doctors want Mac or home access. Choose a server when your internet is unreliable or you capture CBCT and non-TWAIN X-rays in-house. Some ortho offices end up hybrid: cloud software with local imaging.

Answer these five questions for your main office first, then for each satellite. Three or more answers in one column is a strong lean; a split usually means a hybrid setup.

Two cautions. A cloud system does not remove local IT work: capture PCs, printers, the network and the internet line become more important, not less. And a server system is only as safe as its backups and patches, so the "keep the server" answer includes a plan to replace it before its operating system and SQL edition run out. For the general dental version of this decision, see replace the server or move to the cloud.

What does a cloud ortho PMS need from your office?

A cloud orthodontic PMS needs a fast, dedicated internet line at each office, a second line that fails over, Windows 11 or current macOS workstations, and a Windows PC with the vendor's capture agent for every X-ray unit and scanner. The vendor runs the server; your office runs everything between the chair and the internet.

Internet: the line becomes the server cable

Cloud 9's requirements page sets the floor most clearly: "1 Mb/s download rate for each computer and 0.5 Mb/s upload per computer are our minimum recommendations." Each office "requires its own dedicated connection to the Internet," the office IP "needs to be static during office hours," and offices on DSL or T1 "should consider switching to cable service." The same page says Cloud 9 "recommends, but does not require" a secondary internet provider and that the two "should not be using the same connection type."

Dolphin Cloud publishes tiers rather than a per-computer figure, and adds a warning worth taping to the network cabinet: the speeds "are meant to be always available for Dolphin Cloud use and do not account for any other needs in the office." Its requirements also say network latency to Dolphin Cloud "should be below 85 msec ideally at all times," and that "A single Ring Video Camera in highest resolution can consume nearly all the upload bandwidth from a Practice without them even realizing it."

Ortho2's Edge Cloud System Guidelines recommend 100 Mbps download and 20 Mbps upload or more, with latency under 100 ms, and set the minimum at more than 25 Mbps down and 5 Mbps up. Ortho2 adds that "meeting minimum Internet speeds results in minimally acceptable performance." Greyfinch, topsOrtho and WaveOrtho publish no figure on the pages we read. For those, ask the vendor for a per-workstation number in writing.

Worked example: a 12-workstation office

This is an example; use your vendor's current figures. A 12-workstation office on Cloud 9 needs at least 12 Mb/s down and 6 Mb/s up for the practice software alone, because Cloud 9's minimum is per computer. Add scanners and phones on top.

The point of the exercise is the last two rows. The practice software is not the only heavy user of the line, and Dolphin's own document warns that a single Ring video camera at its highest resolution can take nearly all of a practice's upload. Cloud 9 says it does not expect larger offices to need more than 20 Mb/s of upload, and Dolphin says that once there is enough bandwidth for its sessions, more "will not change the speed." Buy the line for the whole office, then reserve a share for the practice software. Scanner bandwidth and Wi-Fi placement are covered in our guide to scanner upload and Wi-Fi requirements.

Workstations and imaging capture still live in the office

Cloud 9 lists 4 GB of RAM as the minimum and 8 GB as recommended, with Windows 11 or Apple OS X 12 and later; it still lists Windows 10 as "Valid until Oct 14, 2025," the date Microsoft ended Windows 10 support. The part to plan for is capture. Cloud 9's C9 Agent "must be installed with the appropriate TWAIN driver" to acquire X-rays and scans directly, the agent is not compatible with Mac, and "Cloud 9 currently does not store 3D images or models." Dolphin Cloud uses a small agent called TSScan for TWAIN pan and ceph units, and says a capture workstation may need Dolphin Imaging run locally for "non-TWAIN compliant X-ray machines or CBCT acquisition." Edge Cloud is "application-based software" installed on each computer, and lists Dolphin Imaging among its imaging partners.

So a cloud move still needs a capture plan per device. For how cloud software changes things in a general dental office, see cloud dental software (general dentistry).

What does a server ortho PMS need?

Beyond the smallest standalone setups, a server-based ortho PMS needs a dedicated Windows Server Standard machine (not Essentials), a supported SQL Server edition sized to your workstation count, a domain, client access licenses, gigabit wiring, SSD storage and a nightly backup that runs after the vendor's database backup step where it has one (OrthoTrac does). Built to the published minimums, that server runs a database edition Microsoft no longer supports.

Dolphin Management on premise

Dolphin's requirements document (rev. 06/25) sets out the server in a few lines. Keep this list next to any server quote:

• • Operating system: "Window Server 2016 Standard" minimum, Windows Server 2022 Standard recommended (Windows 11 is accepted only for a standalone setup or five concurrent users or fewer); "We do not support Windows Server Essentials editions." When a server operating system is used, "a Domain is required," with Microsoft client access licenses for each station, and Dolphin "is not designed to work in a multi-domain environment."
• • Database: Microsoft SQL Server 2016 (SP3) Express minimum, for a standalone setup or five concurrent users or fewer; SQL Server 2022 Standard recommended.
• • Hardware and network: 4 GB RAM minimum, 16 GB or more recommended; an "SSD RAID controller disk highly recommended"; and "Dolphin requires a minimum of Fast Ethernet (100 Mbps). Note: Dolphin recommends 1 Gigabit (1000 Mbps)."
• • Backups and remote offices: "You are responsible for making proper backups of your Dolphin data," including database, images, documents and letter templates, with offsite copies. Remote offices connect through Remote Desktop Services; Dolphin recommends 256MB RAM for each remote connection and two servers above 10 simultaneous remote connections, and limits each database to 25 locations.

More detail on running Dolphin servers sits on our Dolphin Imaging and Management IT support page.

OrthoTrac v15.7

Carestream's OrthoTrac v15.7 requirements recommend "using a dedicated server to run OrthoTrac," with Windows Server 2022 Standard and SQL Server 2022 Express on an x64 Core i7 quad-core, 16 GB RAM, 500 GB of free disk and a Gigabit network card. The minimum is a Core i5, 8 GB RAM, 100 GB and Windows Server 2016 Standard with SQL Server 2016 Express. "Small Business Server or Windows Server Essentials are not supported." Workstations run Windows 11 Professional, and OrthoTrac "is not certified for use on virtual machines or emulated operating systems."

Two lines in the same document catch offices out. Microsoft Office integration supports 32-bit Professional versions only; "Microsoft Office 365 is not supported" and "Click-to-Run" versions are not supported either. And because SQL can hold database files locked during a full-system backup, Carestream says to run "Prepare Backup" from the OrthoTrac File menu, or schedule Orthobac.exe, before the nightly backup so that usable .bak files exist.

WaveOrtho self-hosted

WaveOrtho says practices can run it "Cloud-hosted by us, or self-hosted on your own server," with the "Same application, same features." It publishes no server specification on its home page, so ask for the sheet before you budget for hardware.

Is SQL Server Express enough?

Often not for a busy ortho office. Dolphin's requirements say SQL Server Express is limited to 1 GB of RAM and one processor, and that Dolphin's performance "could be adversely impacted" by it; OrthoTrac v15.7 says practices above 15 workstations "may want to upgrade to SQL Server 2022 Standard for best performance." Check your workstation count against your vendor's sheet before you buy a server.

The date that makes this a this-year decision

Both vendors still list SQL Server 2016 as the minimum database, but Microsoft lists SQL Server 2016's extended support as ending on July 14, 2026, and Windows Server 2016 follows on January 12, 2027 (Microsoft Lifecycle). The full list of ortho-relevant dates is in the orthodontic practice technology guide. If you keep a server, size it with our notes on dental office server setup and test it against the backup and disaster recovery checklist.

What happens when the internet or the server goes down, and how do you drill it?

With a cloud PMS, losing the internet stops the schedule, chart and ledger at that office until the line or the backup line is back. With a server PMS, the office keeps working on the local network, but remote offices and online services such as claims and payments stop. A server failure stops every workstation. Carestream, for example, says on-premise OrthoTrac "does not require internet connectivity except for integrated services."

Reviewers describe both sides. One Cloud 9 user wrote, in a TrustRadius review dated January 2021, "Recently we have had a few hiccups with our internet, therefore causing Cloud 9 to be slow." On the server side, a Dolphin user wrote on Capterra in March 2018, "We have had numerous issues with Dolphin suddenly not working, office-wide or workstation specific." These are public reviews, quoted with platform and date; the reviewers are not named here, and both describe what an outage or slowdown looks like in daily use.

None of the vendor pages and documents we read describes an offline or read-only mode for its practice software, so ask each vendor in writing what staff can see when the line is down. If the vendor expects a static IP, ask whether your backup line's address must also be registered.

Run the drill again after any change to the firewall, the internet provider or the practice software. For the full outage playbook, including backup line options and a failover record, see what to do when the office internet goes down. If your phones still run on copper lines, plan for when the copper phone lines go away at the same time, because the phones and the practice software now share one internet connection.

Switching ortho software: what moves, what doesn't, and the cutover weekend

Switching ortho software moves more than patient demographics: active treatment contracts, payment plans, treatment phases, ceph tracings and years of photos and X-rays. Image conversion is often a separate job from data conversion, and every capture PC needs its agent and drivers reinstalled. Plan and test both before the cutover weekend.

The generic steps are already written up in our full Friday-to-Monday cutover runbook and the dental software migration checklist; timing and budget are in the dental software migration cost and timeline guide. What follows is only what is different in an orthodontic office.

Vendors show how separate the image work is. Ortho2's Edge Cloud onboarding package lists "one data conversion, one image conversion" as separate items, and its FAQ mentions "a one-time onboarding and data conversion fee." Sensei says OrthoTrac users face "no immediate requirement to move" and that migration to Sensei Cloud "can be planned when your practice is ready." Ask your new vendor which items are included before you sign.

Keep the old system readable, not editable, for as long as you might need to check a contract or an image that did not convert. Decide who owns that read-only copy, and where it lives, before you cancel the old licenses.

What to ask your IT provider about a practice-software change

Ask the vendor how its software behaves in your office, and ask your IT provider whether your office can carry it. Get both answers in writing before you sign, and keep them with the contract. The questions below are specific to choosing or switching ortho practice software.

For a full provider scorecard, use the one in the orthodontic practice technology guide linked at the top of this page. If a second office will share the system, the connection options are in our guide to IT for an orthodontic satellite office; if you are opening a new office instead, start with the orthodontic office technology checklist. For email that carries patient information, see email security for dental offices.

Orthodontic offices Legend has set up

These are orthodontic practices whose technology Legend set up, each described only as far as its project page states. The practice management system each office runs is not named here.

What sits behind those projects:

• • Served over 3,500 practices since 2004
• • 22+ years in dental IT (since 2004)
• • 24/7 monitoring
• • A staffed 24/7 helpdesk at 1-800-794-1588
• • In-house engineers; no outsourced first-level triage
• • Onsite dispatch by appointment across served dental markets; remote-first nationwide

Legend supports the IT environment for Dolphin Imaging. If your practice runs Cloud 9, OrthoTrac, Edge Cloud, Greyfinch, topsOrtho or WaveOrtho, that is a system your practice runs: we keep the computers, network, server, backups and accounts around it working, and the vendor supports the application.

What does IT cost around a PMS change?

The software subscription or license is only part of the bill. A PMS change usually brings IT costs of its own: a new server or none, workstations moved to Windows 11, a second internet line, capture PCs and image migration. Pricing for Legend's managed IT: Starting at $360 per month.

Hardware procurement, major cabling projects and software licensing are quoted separately. Backup protection from $39.99 per month (storage-dependent). For an ortho office the cost drivers to list before you compare quotes are:

• • Server or subscription: replacing a server and SQL licenses for an on-premise system, against the monthly subscription of a cloud system.
• • Workstations: any PC that cannot run Windows 11, or that falls short of the vendor's RAM figure.
• • Internet: a second provider on a different connection type, and a firewall that fails over.
• • Capture PCs: a Windows PC for every X-ray unit or scanner whose agent does not run on a Mac.
• • Image migration: whether the vendor charges image conversion separately.