Cloud vs Server Dental Software: The 2025 Decision Guide
The real cost difference, IT overhead analysis, and the honest answer to who should still stick with a server — and who should have switched already.
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The Quick Answer
Go cloud if: You're starting fresh, your server is aging, you want to eliminate IT overhead, or you want to work from multiple locations. Curve Dental and tab32 both offer excellent options.
Stay server-based if: Your current system is working, you have spotty internet (under 10 Mbps reliable), or you're in a specialty that requires software not yet cloud-compatible.
The Real Cost Comparison
Most practices underestimate their server costs because the expenses are spread across multiple budget lines. Here's a real breakdown for a 3-chair practice:
| Cost Component | Server-Based | Cloud |
|---|---|---|
| Software license/month | $400–$700 | $299–$350 |
| Server hardware (amortized/mo) | $125–$250 | $0 |
| Managed IT support/month | $75–$150 | $0 |
| Backup solution/month | $25–$75 | $0 (included) |
| System downtime cost/year (avg) | $800–$2,000 | Near zero |
| Total monthly estimate | $625–$1,175 | $299–$350 |
For most 1–5 doctor private practices, cloud dental software is cheaper in total cost of ownership — even though the monthly subscription sometimes looks higher than a server license in isolation.
The IT Overhead Reality
Server-based dental software requires ongoing IT attention that practices chronically underestimate:
- ✕ Server patches and Windows updates (monthly)
- ✕ Backup validation (should be weekly)
- ✕ Imaging software compatibility after OS updates
- ✕ Server hardware refresh every 4–5 years
- ✕ Network security (HIPAA compliance of on-prem data)
Cloud platforms handle all of this. Security patches apply automatically. Data is encrypted and backed up by the vendor. HIPAA compliance is the vendor's problem, not yours (though you still need a BAA).
When Server-Based Still Makes Sense
Cloud dental software isn't for everyone. Stick with server-based if:
- →Unreliable internet: Cloud software requires consistent broadband. If you're in a rural area with under 10 Mbps reliable, server-based is safer.
- →Specialty-specific software: Some orthodontic or oral surgery platforms aren't cloud-compatible. If your specialty software locks you into a bridge architecture, evaluate the full stack before committing.
- →Recent server investment: If you just spent $12,000 on a new server, there's no urgency to cloud-migrate. Evaluate again at your next hardware refresh.
The Hybrid Reality
Many practices are in a hybrid state: cloud practice management with server-based imaging. This is perfectly workable. Your Dexis or Apteryx imaging stays on a local server (or workstation), while Curve Dental or tab32 handles scheduling, charting, and billing in the cloud. The bridge software connects them.
This hybrid approach lets you eliminate the most maintenance-intensive parts of server management (the PMS server) while keeping your imaging infrastructure intact until you're ready to move it to cloud imaging too.
Patient Experience Differences
Cloud dental software makes certain patient-facing capabilities much easier:
- ✓ Online appointment booking (real-time calendar sync)
- ✓ Patient portal for forms, insurance, and records access
- ✓ Automated text/email reminders (built-in, not an add-on)
- ✓ Two-way texting for scheduling changes
These features exist as add-ons for server-based software too, but they require third-party integrations that add cost and points of failure.
Our Recommendation
If your server is 3+ years old and you're evaluating software options, price cloud seriously. The math usually works out in cloud's favor within 12–18 months, and the IT overhead elimination alone is worth it for most small practices.