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How Consultations Work on Cympha: From Empty Template to Patient Approval

When the plan calls for lab work, the consultation branches into a lab case, and from there the case runs in dental lab case management software with its files attached.

A consultation on Cympha is a structured workspace that lives inside a clinical case. It's where the doctor thinks, captures, generates the plan, and shares it with the patient. Fourteen templates ship today — General, Endodontic, Oral Surgery, Pediatric, TMD / Orofacial Pain, Oral Medicine, Sleep Apnea, Pre-prosthetic / Full-Mouth Rehabilitation, Geriatric, plus the original five (Aligner, Implant, Smile Design, Periodontal, Restorative). This cookbook walks the consultation surface end to end, including how Cympha checks that you've documented what the template thinks matters.

1. Pick the right template

From the case detail page, click Add consultation. A picker opens listing every template by name. Each template defines a different clinical scope:

  • General Dental Consultation — broad intake, when the case isn't yet clearly one specialty.
  • Endodontic Consultation — pulpal + periapical diagnosis (AAE terminology), restorability, RCT vs retreatment vs extraction.
  • Oral Surgery / Extraction Consultation — Pell-Gregory + Winter classifications, IAN / sinus proximity, MRONJ and anticoagulant screening.
  • Pediatric Dental Consultation — Frankl behavior rating, caries risk (CAMBRA-pediatric), behavior management plan, space maintenance.
  • TMD / Orofacial Pain Consultation — DC/TMD Axis I diagnoses, range of motion measured in mm, parafunction.
  • Oral Medicine / Mucosal Lesion Consultation — biopsy decision tree, oral cancer red-flag screening, 2-week persistence rule.
  • Sleep Apnea / Oral Appliance Consultation — STOP-BANG, Epworth, Mallampati, sleep-physician coordination.
  • Pre-prosthetic / Full-Mouth Rehabilitation Consultation — VDO assessment, CR-MIP relationship, mounted records, provisional phase.
  • Geriatric / Special-Needs Consultation — polypharmacy review, dexterity, root caries, denture audit, caregiver involvement.
  • Aligner Consultation — DC/TMD pre-screen, skeletal vs dental classification, anchorage planning.
  • Implant Consultation — MRONJ, opposing dentition, vertical restorative space, keratinized tissue, prosthetic-driven planning.
  • Smile Design (DSD) Consultation — facial / dento-facial analysis, phonetic check, occlusal stability, gummy smile etiology.
  • Periodontal Consultation — AAP/EFP 2017 stage and grade, bleeding on probing %, furcation classification, recession classification.
  • Restorative Consultation — caries risk, pulpal status per tooth, restorability factors, occlusal scheme.

You can run multiple consultations on the same case — for example, "general intake" first, then "endodontic" for tooth #19 after radiographs come back. Each consultation is independent; they share files but not findings.

When you pick a template, Cympha freezes a snapshot of that template's structure into the consultation row. Editing the template later (changing required fields, adding sections, etc.) does NOT retroactively change how existing consultations render — your historical consultations stay stable.

2. Fill what you have

The consultation page shows section by section in the template's defined order. Most templates have:

  • Chief Concern — free text. Patient's own words preferred.
  • Relevant Medical / Dental History — rich text. The doctor or DA dictates what matters: medications, allergies, smoking, prior treatment, sleep apnea, antiresorptives, anticoagulants. Each template lists which items it specifically wants — for example, the Implant template specifically asks about MRONJ history, smoking status, head/neck radiation, diabetes control, and anticoagulant status.
  • Clinical Notes — rich text. Examination findings, radiographic observations, percussion / vitality tests, pain history, range of motion measurements.
  • Records / Assets — a picker showing every confirmed case file. Tick the ones relevant to this consultation. Doctor can use Upload by Phone right from this section if they need to grab another photo.
  • Diagnosis, Options, and Plan Notes — rich text. Where the doctor's clinical reasoning lives.

You don't have to fill everything in any order. Type the chief concern, jump to clinical notes, come back to history later. The page autosaves on every change; there's also an explicit Save button if you want a visible confirmation.

3. The checklist sidebar

To the right of the consultation page sits the Checklist. Each item is one row, marked required (red asterisk) or optional. Items light up green automatically when their satisfied-by sources are present.

For example, in the General template, "Chief concern documented" is required and satisfied by any of:

  • text in the Chief Concern section
  • chief-concern mention in Clinical Notes
  • AI extraction having pulled a chief concern from your text

You're not asked to fill the same thing twice. If you wrote it once anywhere, the checklist counts it.

The checklist is also where each template surfaces its specialty-specific requirements. The Implant template, for example, carries 18 checklist items — 15 of them required — including:

  • MRONJ risk screened
  • Smoking status documented
  • Anticoagulant status documented
  • Opposing dentition assessed
  • Vertical restorative space assessed
  • Keratinized tissue assessed at planned site
  • CBCT available or recommended
  • Prosthetic-driven plan documented

The doctor doesn't need to remember to ask these questions — the sidebar is a permanent visual reminder.

Required items don't gate publishing. Cympha never blocks you from sharing a plan or branching to a lab case because the checklist isn't 100% green. The reasoning: clinical practice has edge cases, and software that blocks documented patient care is worse than a soft visual nudge. The checklist surfaces what's missing; the doctor decides.

4. Run AI extraction

Once you've written some text in the consultation, click Run AI extraction.

Cympha reads:

  • The text in every text section of the consultation
  • The metadata (filenames, content types) of the records you selected

And produces a structured object following the template's defined output schema. For example, the General template's schema includes:

  • affected_teeth: list of Universal tooth numbers (1-32)
  • diagnoses: list
  • treatment_options: list
  • recommended_plan: string
  • missing_information: list
  • red_flags: list
  • risk_history: nested object (allergies, anticoagulants, antiresorptives, smoking, diabetes, pregnancy, radiation, immunosuppression, anxiety/sedation needs)

Specialty templates produce their own structured shapes — the Periodontal template emits AAP/EFP 2017 stage and grade as discrete fields, the TMD template emits range-of-motion in mm, the Endodontic template emits AAE pulpal + periapical diagnoses verbatim.

The AI is bound by three rules:

  • Never invent findings. If the doctor didn't write it, the AI doesn't add it.
  • Mark unclear data. Anything the doctor mentioned ambiguously goes into missing_information for the doctor to clarify.
  • Tooth numbering. Universal system (1-32 permanent, A-T primary). The doctor's own term goes in parentheses when in doubt.

The extracted structured object appears in the AI Extracted Findings section, with every field editable. You can fix typos, add findings the AI missed, or remove ones you disagree with.

The checklist sidebar re-evaluates after AI extraction — items with "ai_extraction" in their satisfied-by list light up if the AI populated the relevant field.

5. Generate plans

When you're ready, click Generate plans.

Cympha generates two plans using the template's plan structure:

  • Internal Plan — clinical-tone, full detail, structured by the template's internal_plan section titles. The Implant template's internal plan has 15 sections; the Pediatric template's has 21. Each section is one heading + body text.
  • Patient Plan — plain-language, patient-readable. Same content, written for the patient: Your Concern, What We Found, Your Treatment Options, Recommended Treatment, Risks and Limitations, Next Steps, Approval / Questions.

The plan generator uses the consultation's curated treatment_option_library — every specialty template ships with 10–17 clinically vetted treatment options (indications, benefits, limitations, requirements). The AI picks from this library rather than inventing treatments.

Both plans open in a rich-text editor. You can edit headings, paragraphs, bold text, add lists, and attach pictures from the case to either plan. The plan editor is one continuous document per plan — write as freely as you would in any rich-text tool.

Plans never include cost or fee information. Doctors discuss cost offline, and Cympha's AI is explicitly instructed not to invent dollar amounts.

6. Attach pictures to the plan

Below the plan editor is a Pictures attached to the plan section. Click "Attach pictures" to open a picker of every image file on the case. Tick the ones you want patients to see — annotated photos, before/after references, treatment area close-ups.

The attached pictures appear:

  • Below the plan text in the internal plan editor (your reference)
  • Below the plan text in the shared patient view (the patient's reference)

7. Share with the patient

When the plan reads how you want it, click Share with patient. A dialog asks for the patient's email (or the caregiver's email for pediatric / geriatric / special-needs cases — share with whoever will read the plan).

What happens at share time:

  • Cympha freezes the current patient plan into a snapshot — the patient sees this snapshot, not the live working copy. If you keep editing later, the patient still sees the document you actually sent.
  • A CaseShare row is created keyed on the recipient's email.
  • The recipient gets an email with a link to a phone-friendly page where they can read the plan.
  • If the recipient doesn't have a Cympha account, they get a Clerk invitation to sign up — sign-up only, no sign-in / role-selection confusion. After signup the share auto-links.

On the patient page they see:

  • Plan section headings + body (the snapshot)
  • Attached pictures
  • Approve button
  • Ask Questions form (free-text response)
  • Chat with your doctor (open-ended back-and-forth)

The doctor sees the patient's response immediately in the consultation's Patient Review / Approval section, in the case activity log, and (for chat) in the case's chat section.

8. What happens if you edit after approval

If you edit the plan text after the patient already approved, Cympha automatically:

  • Clears the prior approval state on the consultation row
  • Emits a "Plan edited after approval — prior response cleared" audit event into the case events log
  • Toasts you a notice

The patient is never bound to a document they didn't see. If you want the patient to approve the edited plan, re-share — the snapshot is refreshed and the patient sees the new version.

9. Branching to a lab case

If the consultation recommends treatment that needs lab work, click Branch this case from the case detail page (not the consultation page — it's a case-level action). A picker shows every consultation on the case, newest first, plus a "No consultation reference" option for general branching.

When you pick a consultation, the new lab case is auto-populated:

  • Patient demographics from the parent case
  • Chief complaint from the consultation's Chief Concern section
  • Full internal plan content (all sections) into the new case's description field — so the lab sees the entire plan, not just a recommendation tagline
  • Files referenced by the consultation (records section + plan images) pre-selected for inheritance

You can untick any pre-selected file or add other parent-case files before submitting. After branching, the new lab case enters the orchestration flow; the consultation it came from is recorded in the parent case's activity log with a child-case link.

10. The activity log

Every consultation action emits a case event. The activity log on the case detail page shows them in reverse chronological order:

  • Consultation created
  • AI extraction run
  • Plan generated
  • Plan shared with patient
  • Patient approved (or asked questions)
  • Plan edited after approval (with prior-state lineage)
  • Workflow trigger run (e.g., "Doctor triggered: Create Implant Consultation")

All consultation events are visible to the doctor on their own case. The activity log is the audit trail — what happened, when, who did it, and with what payload.

Putting it all together

A real consultation on a real case, end to end:

  • Pick the template — the checklist for that specialty comes with it.
  • Write what you have: chief concern, history, clinical notes, records. The page autosaves as you go.
  • Run AI extraction, then read what came back and correct it. Nothing is added that you didn't write.
  • Generate plans, edit the wording, attach the pictures the patient should see.
  • Share with the patient. What they receive is a frozen snapshot — the document you actually sent, not a copy that keeps moving underneath them.

That sequence is the Dialogue and Intent dimensions of a Living Case doing their work: the reasoning behind a plan is captured where the treatment lives, and the patient's answer comes back to the same place. For the doctor it means care documented as it happens instead of reconstructed at the end of the day, an approval trail that holds up when someone asks what the patient agreed to, and a plan the patient understood before they left the chair. For the lab it means a branched case that arrives carrying the whole internal plan and the referenced files — so the first message back is a question about the design, not a request for the context that should have travelled with the case.

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