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Don’t get screwed.</text><text x="58" y="258" font-family="Arial,Helvetica,sans-serif" font-size="30" font-weight="600" fill="#6b5b4d">Leases, TI, NNN &amp; buildouts — negotiated in your favor</text><g transform="translate(1010,86)" fill="none" stroke="#C0531F" stroke-width="9" stroke-linejoin="round"><rect x="20" y="40" width="150" height="130"/><line x1="20" y1="40" x2="95" y2="6"/><line x1="170" y1="40" x2="95" y2="6"/><rect x="50" y="80" width="36" height="36"/><rect x="104" y="80" width="36" height="36"/><rect x="74" y="128" width="42" height="42"/></g></svg>

How Do I Budget an Orthodontics or Oral-Surgery Office Buildout?

Direct Answer

Budget $150 to $300 per square foot for an orthodontics or oral-surgery office buildout — a typical 2,500-4,000 sq ft practice lands at $400,000 to $1,100,000 all-in, putting it among the most expensive professional fit-outs in commercial real estate. The cost is driven by medical gas, central vacuum and compressed air, imaging (pano/CBCT), radiation shielding, plumbing to every chair, and specialized HVAC, not finishes.

For oral surgery specifically, add a surgical suite with medical-grade gas (oxygen/nitrous), emergency power, and sterilization scope that pushes you to the top of the range.

The money move that protects you: negotiate a large tenant-improvement (TI) allowance ($60-$120 per sq ft) and free-rent buildout period, and make the landlord deliver the base building's plumbing, electrical service, and HVAC capacity — because a dental/surgical office is dramatically more demanding than the "vanilla shell" landlords price for.

The big-ticket lines are dental/surgical chairs and delivery units ($8,000-$40,000 per operatory installed), central air compressor and vacuum/suction systems ($15,000-$45,000), a CBCT/pano imaging room with lead shielding ($25,000-$120,000), medical gas piping (nitrous/oxygen) ($8,000-$30,000), and a sterilization/central supply room ($20,000-$60,000).

What Actually Drives the Number

This is medical construction wearing a retail address. Every operatory is a plumbing, electrical, gas, and vacuum endpoint.

• Operatories / chairs — Each chair needs water, drain, compressed air, suction, electrical, and data at the unit. Built-out and equipped operatories run $8,000-$40,000 each; orthodontic bays are cheaper than surgical suites.
• Central compressor + vacuum — A dry/oil-free dental air compressor and a vacuum/suction pump sized for your chair count run $15,000-$45,000 with piping to every operatory.
• Imaging + shielding — A panoramic or CBCT (cone-beam CT) machine ($60,000-$200,000 equipment) needs a dedicated room with lead shielding and a state radiation-shielding plan/inspection ($10,000-$40,000 for the room build and shielding).
• Medical gas — Nitrous oxide and oxygen piping with manifolds and alarms run $8,000-$30,000; oral surgery requires medical-grade gas and often emergency/standby power ($10,000-$40,000).
• Sterilization / central supply — A proper sterile-processing room with instrument washers, autoclaves, and pass-through casework ($20,000-$60,000).
• HVAC — Surgical and sterile areas need dedicated zoning, filtration, and sometimes negative/positive pressure ($25,000-$70,000).
• Plumbing — Extensive supply/waste runs to every chair plus an amalgam separator ($1,500-$4,000) for code compliance.
• Casework + finishes — Custom medical casework, ADA restrooms, and consult rooms are real money but secondary — typically 20-30% of total.

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Real Cost Ranges by Practice Type

Per RSMeans and CBRE Healthcare TI data, MEP, medical gas, imaging shielding, and sterilization run 60-70% of a dental/surgical buildout. Healthcare TI allowances are higher than retail because landlords know the use commands long, stable leases — use that leverage.

Don't Get Screwed by the Landlord

Healthcare tenants are gold to landlords — long leases, strong credit — so you have real leverage. Use it.

1. Get a healthcare-grade TI allowance. Don't accept a retail-level $25-$40/sq ft allowance. Push for $60-$120 per sq ft with progress draws, not back-end reimbursement that makes you finance the landlord's building.
2. Make base-building deficiencies landlord work. If the space lacks adequate electrical service, water/sewer capacity, or HVAC tonnage, those are base-building items — negotiate them as landlord-delivered, separate from your TI.
3. Secure shielding and medical-gas rights in writing. Some leases restrict penetrations, heavy equipment, or hazardous materials. Get explicit rights for radiation shielding, medical gas, and floor loading for a CBCT (imaging units are heavy).
4. Cap restoration / surrender. Tearing out medical gas, shielding, and operatory plumbing at lease end is a $50,000-$150,000 liability. Negotiate to leave improvements (they raise the space's value for the next medical tenant) and cap your restoration.
5. Free rent that matches the build. Medical buildouts take 5-9 months. Negotiate 120-180 days of free rent so you're not paying for an empty shell while contractors run gas lines.
6. Exclusive / co-tenancy where it matters. Consider an exclusivity clause preventing the landlord from leasing to a competing practice in the same building or center.

Biggest dollar move: high healthcare TI + base-building upgrades as landlord work + 120-180 days free rent + restoration capped, on a 10-15 year term that lets you amortize a seven-figure build.

A Buildout Timeline That Protects Cash

Long-lead items gate everything. Dental chairs, a CBCT, and sterilizers carry 8-16 week lead times, and the radiation-shielding plan needs state approval before you build the imaging room. Order and submit early.

How to Cut the Budget Without Cutting Corners

• Take a second-generation dental/medical space. Existing operatory plumbing, vacuum/air lines, gas, and shielded rooms can save $100,000-$300,000. This is by far the biggest lever for a new orthodontic or surgical practice.
• Phase operatories. Build and equip the chairs you'll use in year one, rough-in (but don't finish) the rest. Each deferred fully-equipped operatory saves $8,000-$40,000.
• Finance equipment separately. Chairs, CBCT, and sterilizers are financeable at 6-9% APR; reserve cash and TI for the immovable buildout.
• Centralize the air/vacuum plant sized for your full chair count from day one (cheap to oversize the pump, expensive to re-pipe later).
• Negotiate the imaging room with the landlord — a shielded imaging room is an improvement that benefits the next medical tenant, so it's a fair TI/landlord candidate.

FAQ

How much does an orthodontics office buildout cost per square foot? Plan $150-$220 per sq ft for orthodontics and $220-$300 per sq ft for oral surgery. A 3,000 sq ft practice commonly lands $450,000-$1,000,000 depending on imaging, medical gas, and surgical suites.

What makes oral surgery more expensive than orthodontics? Medical-grade gas, surgical suite construction, emergency/standby power, sedation-grade HVAC and monitoring, and heavier sterilization push oral surgery $100,000-$400,000 above a comparable orthodontic build.

Should the landlord pay for any of this? Yes. Push for a healthcare TI allowance of $60-$120 per sq ft and make base-building deficiencies (power, water, HVAC capacity) landlord work. Healthcare tenants have strong leverage because the leases are long and the credit is strong.

Do I need to worry about radiation shielding? Yes — a CBCT or pano room requires a state-approved radiation-shielding plan and inspection before opening. Budget $10,000-$40,000 for the shielded room and confirm the lease permits shielding and the floor can carry the equipment weight.

How do I avoid a huge bill at lease end? Cap your restoration/surrender obligation and negotiate to leave the medical improvements in place — gas, shielding, and operatory plumbing raise the space's value for the next medical tenant, so the landlord usually agrees rather than facing a vanilla-shell teardown.

Sources

• CBRE, *U.S. Healthcare & Medical Office Tenant Improvement Trends* — TI allowances, base-building scope, and lease terms for medical tenants.
• RSMeans (Gordian), *Healthcare & Commercial Construction Cost Data* — unit costs for operatories, medical gas, imaging shielding, and sterilization.
• JLL, *Healthcare Real Estate & Medical Office Fit-Out Guide* — per-square-foot ranges and MEP cost share for dental/medical practices.
• Cushman & Wakefield, *Healthcare Capital Markets / Medical Office MarketBeat* — leasing terms, restoration, and exclusivity norms.
• NAIOP, *Lease Negotiation resources* — TI reimbursement, restoration-cap, and tenant-protection guidance.
• American Association of Orthodontists (AAO), *Practice Facility & Equipment guidance* — operatory, imaging, and infection-control requirements.
• American Dental Association (ADA) / National Council on Radiation Protection (NCRP Report No. 145), *Dental Radiation Shielding standards* — radiographic room shielding and inspection requirements.