DSO & Multi-Office Dental IT Infrastructure Guide

By Reuben Kamp, CEO & Founder – Darkhorse Tech

Scaling Dental IT Across Multiple Offices

Expanding from one dental practice to a growing network of locations—or a full DSO—introduces new layers of IT complexity. What once worked for a single site may now cause downtime, inconsistent performance, and compliance risk across your group. Complexity in these environments will mean more tickets for the support department down the road. Now is the time to stop, and plan out the typeof system you want.

At Darkhorse Tech, we currently support many many DSOs and multi-location practices in building scalable, secure, and standardized IT infrastructures. Darkhorse is the leading and largest MSP in the Dental IT space.

This guide breaks down what works best—so you can spend less time trouble shooting and more time growing.

Core Architecture Patterns: Fragmented, Hybrid & Full Cloud

When scaling IT, your architecture matters. Most dental groups fit into one of these three models:

• Fragmented: All practices have local practice level PMS, little or no standardization on PMS, Imaging, and Vendors. Connected only by remote access or syncing tools. User management all on the local level, practice by practice.
• Full Cloud: DSO utilizes EntraID or a Centralized Azure Server for User Management. All PMS is Cloud (i.e. OD Cloud, Denticon), and all 2D Imaging is Cloud (i.e. SOTA, IRIS, Apteryx).
• Hybrid: A mixture of fragmented and full cloud. Could mean Imaging, user management or PMS is local

Darkhorse Tech helps DSOs design architectures that blend performance, reliability, and scalability—while minimizing cost and complexity. Let’s break this next part down into the 5 major components a DSO should factor in:

1.       How Users Authenticate or Login with their Workstations

2.       How Users Authenticate or Login with their Practice Management Software

3.       How Practice Management Software Integrates with Imaging

4.       Role of 3^rd Party Peripherals and Applications

5.       Database Management (Practice Databases Individual or Combined)

How Users Authenticate or Login with their Workstations

User Authentication commonly called Active Directory, AD, or Entra is the way users authenticate their login credentials with a centralized service. Before cloud, this was commonly done on a local office server.

User Authentication (often called Active Directory, AD, or EntraID) controls how your team members sign into their devices and access resources securely.

Local Active Directory (Traditional Model):
Each office maintains its own server running Active Directory. This server handles usernames, passwords, and permissions. It’s reliable but limited—password resets, permissions, and policy updates have to be managed per office. Works fine for small practices, but scales poorly for DSOs.

Hosted Azure AD Server (Hybrid Model):
A middle ground where your AD server lives in Azure but mirrors on-premise rules. You get central management without full EntraID adoption. It’s cost-effective and enables smoother access for remote teams, though still requires some server management expertise.

Full EntraID (Cloud-Native Model):
EntraID (formerly Azure AD) eliminates on-prem servers entirely. It integrates seamlessly with Microsoft 365 and Intune for device management. The tradeoff: higher licensing costs, but unmatched simplicity and security. Perfect for DSOs with 5+ offices or heavy remote access needs—zero servers, centralized control, and MFA baked in.

💡 Rule of Thumb:
If you’re under 3 offices, stay local. Between 3–10 offices, go hybrid. Beyond10 offices, EntraID pays for itself in reduced downtime and admin overhead.

For the Full Cloud Approach: Hosted is the most cost-effective, and Entra is the easiest to manage but has the highest MS365 licensing cost

How Users Authenticate or Login with their Practice Management Software

Before deciding your authentication model, ask yourself: Is my PMS local, hosted, or SaaS-based?

Local PMS:
Installed on in-office servers (e.g., Open Dental, Eaglesoft). Offers direct control but requires manual updates, backups, and VPNs for remote access. The more offices you add, the more synchronization headaches you’ll face.

Hosted PMS (Private Cloud):
The same PMS hosted on a secure, centralized server (like Darkhorse’s OpenDental Hosting). Delivers consistent performance, central data access, and predictable maintenance—all managed by your IT partner. Ideal for DSOs bridging the gap between local and SaaS.

SaaS PMS (Full Cloud):
Systems like Open Dental Cloud, Denticon, or Fuse. Accessed through a web browser—no servers needed. Updates, backups, and uptime handled by the vendor. The downside: less control, vendor dependency, and variable performance for high-bandwidth tasks like 3D imaging.

💡 Pro Tip:
Mixing models (e.g., SaaS PMS with local imaging) is common—but requires tight coordination to avoid latency and permissions mismatches.

How Practice Management SoftwareIntegrates with Imaging

Integration between PMS and imaging software determines your daily workflow speed.

Local Imaging (Traditional):
All X-rays, IO scans, and CBCT data are stored on in-office servers. Fast and reliable locally but hard to scale—imaging access between offices requires remote desktop or sync tools.

2D Cloud Imaging (Hybrid):
Most modern imaging vendors (Apteryx Cloud, SOTA Cloud) now allow 2D images to sync across sites. 3D scans, however, usually stay local due to file size. This hybrid model balances convenience and speed.

Full Cloud Imaging (Emerging):
Vendors like IRIS and SOTA are pushing full-cloud 2D/3D imaging ecosystems.It’s ideal for DSOs prioritizing unified access and minimal local hardware.Expect some tradeoffs in speed until internet infrastructure catches up.

💡 Integration Priority:
Pick your PMS first, then match imaging that integrates natively with it. Avoid mismatched vendors—it’s the #1 cause of sync errors and redundant tickets.

The Role of 3^rd Party Peripherals and Applications

Dental offices depend on dozens of small yet mission-critical devices and apps.

Printers & Scanners:
Every office has at least one scanner, and printer mapping is a constant source of tickets. Standardize models across locations and push configurations via Intune or RMM tools to cut support volume.

Check Scanners & Signature Pads:
Often require local drivers and USB redirection, which complicates cloud setups. Plan early for remote USB mapping or verify vendor compatibility with hosted environments.

3rd Party Apps (Flex Dental, Jarvis, Dental Intel):
These analytics and patient communication platforms are usually web-based but depend on stable integrations with your PMS. For hosted or hybrid PMS, use a single integration layer—Darkhorse’s support can centralize those credentials and ensure consistency.

💡 Quick Win:
Make a master list of all office peripherals and assign each a “local,” “cloud,” or “hybrid” designation. This instantly highlights where bottleneck swill emerge during migration.

Database Management (Individual or Combined)

Data structure dictates reporting accuracy, speed, and your future growth flexibility.

Individual Databases (Per Practice):
Each location has its own PMS database. Easier to maintain but limits centralized reporting. Works best for smaller DSOs or when offices operate independently.

Regional Databases:
Combine practices in the same region into a shared database. Enables regional analytics, marketing, and scheduling efficiencies while limiting risk exposure if an issue arises.

Unified Database:
All practices share one PMS database. You gain full visibility, standardized workflows, and enterprise-level reporting—but need strict access control, performance tuning, and a strong server or cloud foundation.

💡 Growth Lens:
If you plan to acquire or merge offices rapidly, design for eventual consolidation—even if you start separate. Transitioning to a unified structure later is 10× harder.

Migration Strategy & Rollout Framework

Migrating to a unified IT environment requires a clear roadmap. We’ve refined a five-phase rollout framework proven to work for DSOs nationwide:

1. Assessment: Inventory all systems, hardware, and data dependencies.
2. Design: Build a standard IT template for all offices. MOST CRITICAL STEP.
3. Pilot: Test your setup in one or two locations.
4. Deployment: Deploy standardized systems, security, and remote monitoring.
5. Optimize/Post-Mortem: Gather feedback and refine processes before wider rollout.

This approach minimizes disruption and ensures every office comes online smoothly—on time, on budget, and with minimal downtime.

Case Study: Lumio Dental (95 locations)

Background:
Lumio Dental, a fast-growing DSO with nearly 100 offices across multiple states, was facing the classic pain points of rapid expansion — inconsistent systems, decentralized data, and an IT team drowning in remote logins. Each office operated as its own island: local Open Dental databases, a patchwork of imaging systems, and limited visibility across practices.

Before Darkhorse Tech

• Local Open Dental Databases: Each office hosted its own PMS, resulting in data silos, manual updates, and high maintenance overhead.
• Mixed Imaging Stack: A blend of SOTA, Apteryx, and legacy local imaging installations caused inconsistent workflows and support headaches.
• Local Servers in Every Office: High hardware costs and constant upkeep—especially as offices aged and needed replacements.
• Central Team Limitations: The centralized Lumio support team could only remote into one office at a time, creating bottlenecks and delayed resolutions.
• Lack of Visibility: Leadership had no unified reporting or real-time insight into performance metrics across locations.

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After Partnering with Darkhorse Tech

• Cloud-Based PMS Migration: All Open Dental instances were migrated to a  secure, Darkhorse-hosted cloud environment. This unified data management,     eliminated local servers, and enabled real-time collaboration.
• Regional Structure Implemented: Offices were grouped into regional “pods” for better database management and controlled access — allowing scalability while maintaining performance.
• Imaging Standardization: All imaging software was migrated to SOTA Cloud, simplifying integrations, support, and onboarding.
• Centralized Access via Microsoft: The Lumio central operations and support teams now use Microsoft EntraID and Intune to view, manage, and support all 95 offices from a single pane of glass.
• Improved Support Efficiency: Remote troubleshooting time dropped by over 60%, while cross-office user management became fully automated.
• Security & Compliance Boost: With HIPAA-compliant encryption, centralized backups, and standardized patching, Lumio’s risk profile decreased dramatically.

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Results

• 🕓 Reduced average ticket resolution time by 62%.
• 💾 Eliminated 95 local servers, cutting hardware spend by over $250,000 annually.
• 🌐 Unified access for support and leadership teams across all regions.
• 🧩 Standardized imaging and PMS, paving the way for true operational scalability.

Local MSP vs. Specialized Dental MSP

Not all IT partners are created equal. Dental organizations have unique requirements that general IT providers often overlook.

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Working with a dental-specific MSP like Darkhorse means your IT partner already understands your tools, workflows, and compliance needs.

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FAQs

Q: My PMS vendor told me by going cloud, I will not longer have IT issues?
This is hilariously false. While PMS support will typically be handled by PMS, yourusers will still submit tickets on: Onboarding, Offboarding, Printer andScanning Issues, Connectivity Issues with Network/WiFi, Connectivity Issueswith IO Cameras, IO Scanners, IO Sensors, and PAN/CBCT, just to name a few!

Q: When should a DSO move to the cloud?
Once you have more than 3–5 offices, cloud or hybrid infrastructure simplifiesdata access, backups, and maintenance significantly.

Q: Can Darkhorse Tech support offices in multiple states?
Absolutely. We have a nationwide network of engineers and virtual rollout teamsthat make multi-state deployments seamless.

Q: How long does a typical migration take?
Most office migrations take 4-8  weekspost IT onboarding, to avoid operational downtime.

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Ready to Future-Proof Your DSO IT?

DarkhorseTech has helped over 1,000 dental practices and DSOs modernize their IT infrastructure—securely and strategically.

Let’s design a system that scales as fast as you do.
👉 Schedule a Consultation

Related Resources

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Darkhorse Dental IT Is Here For You

We understand that caring for your patients is your top priority. Dealing with a computer issue, slow IT response time or HIPAA compliance requirements just aren’t high on your list of to-do’s. That’s where Darkhorse Dental Tech comes in. Our team of Dental IT specialists are experts when it comes to running a great, secure and successful practice —and so much more. Whether you’re looking for IT services for startups, or existing support and security services for your practice, Darkhorse can do it all for you, so you can get back to your patients.

Have questions? Looking for ideas? Just want to talk teeth? Drop us a line at sales@darkhorsetech.com to get the conversation started! Or head to our Contact page to send us a message. Don’t forget to follow us on Instagram!

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