Guide & research
Retirement Plans for Dental Practices: A Decision Framework
The right practice retirement plan can shelter a multiple of what a basic 401(k) allows — but the best design depends on your income, age, and team. This guide compares the options and shows where the big deductions come from.
Updated August 2026 · Practice 401(k), profit sharing & cash balance plans
The plan landscape
| Plan | Best for | Notes |
|---|---|---|
| Solo 401(k) | Owner, no employees | High limits, Roth option, loans |
| SEP IRA | Owner, few/no employees | Simple; employer-only; no Roth |
| SIMPLE IRA | Small teams | Low-cost, lower limits |
| 401(k) + profit sharing | Practices with staff | Flexible; pairs with cash balance |
| Cash balance plan | High-earning owners | Large deductions on top of a 401(k) |
Where the big deductions come from
A 401(k) with profit sharing is the foundation for a practice with employees. For a profitable owner who wants to shelter more, a cash balance plan — a type of defined-benefit plan — layered on top can allow substantially larger tax-deferred contributions, scaling with age and income. Together they’re one of the most powerful tools available to a high-earning dentist.
Choosing the design
- Start with your goal — how much you want to shelter, and your timeline.
- Factor your team — staff coverage and nondiscrimination rules shape the design.
- Model the cost — cash balance plans commit you to funding; make sure cash flow supports it.
- Coordinate with taxes and personal accounts (HSA, backdoor Roth) for the full picture.
A note on staff
Plans that include employees add contribution costs and compliance, but a well-designed plan can reward the owner efficiently while providing a genuine benefit that helps recruit and retain a team — itself one of a practice’s biggest financial levers.
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