3D review and approval: approve or reject a design

3D review and approval is the step where the clinician signs off the lab's work in Cympha dental lab case management software; this guide covers both plan and appliance approvals.

Audience: Clinicians whose case has reached Awaiting Approval status and who own the case (you submitted it).

You'll come away knowing: which approval steps your case will walk through (two cycles for Ortho, AlignerBot, and Implant; one for lab services), what the green Approve … button, Request changes, and Escalate to lab manager buttons each do, why AlignerBot rejections require an XML or GPK file, and when to escalate versus reject.

Time required: Around five to ten minutes per review for a typical case. Longer for AlignerBot Phase-1 plans where you want to dry-run the staging.

Before you start

You need:

A case in your account whose status is Awaiting Approval. The approval page is gated on this status; if the case is in any other status, you'll be redirected back to the case detail.
To be the case owner (you submitted the case). Colleagues you shared the case with have read-only access — they can view the case but cannot approve, reject, or write anything on it.
For AlignerBot or ClearAligner.AI cases that you intend to reject: either an .xml tooth-position file exported from Cympha Studio or a .gos.gpk transfer pack from GuideMia OrthoPlus Planner. Free-text instructions cannot be applied to the AlignerBot planner.

If you don't have AlignerBot rejection tooling installed, you can still Approve or Escalate without it. The structured-artifact requirement applies only to Request changes.

Step 1 — Open the approval page

When the lab requests approval, Cympha emails you a notification with a link to the case detail page (app.cympha.com/cases/<case-id>). From the case detail page, click Review and Approve in the header to reach the approval page (/cases/<case-id>/approve). You can also reach it from the case row on your dashboard — clicking into a case in Awaiting Approval lets you navigate to the approval flow.

The page shows:

A back link, the patient name, the status badge (Awaiting Approval), and the approval step label (Treatment Plan / Appliance Design / Design).
A Download lab slip (PDF) link with the clinical brief.
The full file list. Click View on any row to open the case detail in a new tab for previews.
Action buttons in the bottom right of the approval card: Escalate to lab manager, Request changes (rose-red), and the green Approve Plan / Approve Appliance / Approve Design primary button.

Step 2 — Understand which step you're on

How many approval gates you'll see depends on the category:

Ortho, AlignerBot, and Implant cases have two approval cycles — you'll come through this page twice:

Treatment Plan (the first cycle) — the lab (or the AlignerBot agent) has produced the plan: staged tooth movements for an aligner case, the planned setup for an ortho case, the surgical plan for an implant case. Review the plan itself — staging, IPR, attachments, positions. Approving sends the case back to Designing for the appliance cycle, typically with the same designer.
Appliance Design (the second cycle) — the appliance geometry is finished. Review the deliverable set. This is the final gate: approving here completes the case.

Lab-service cases have a single approval cycle, labelled Design — one gate at the end, and the button reads Approve Design.

The button label adapts to the step: Approve Plan on the Treatment Plan cycle, Approve Appliance on the Appliance Design cycle, Approve Design for a lab service.

Step 3 — Approve

Click the green Approve Plan / Approve Appliance / Approve Design button. There is no extra confirmation dialog on approval — the green colour and the explicit label are the confirmation. While the request is in flight the button reads Approving….

Approved is a pivot, not a resting state. What happens next depends on where you are:

An approval cycle remains (you just approved the Treatment Plan on an Ortho, AlignerBot, or Implant case): the case goes back to Designing for the appliance cycle. For AlignerBot, the agent picks up Phase 2 shortly and you'll get another approval email when it's back.
That was the final cycle on a digital case (Ortho, AlignerBot, Implant): the case advances straight to Delivered. There is no manufacturing step for digital deliverables.
A physical lab-service case: the case stops at Approved and waits for the lab to manually move it into In Manufacturing on its own schedule, then on through Shipping to Delivered.

Step 4 — Request changes (the normal back-to-designer path)

Click Request changes when the work needs another round with the same designer or AlignerBot agent. A confirmation dialog opens titled "Request changes to this deliverable?".

For an Ortho, Implant, or lab-service case the dialog reads "The case goes back to the designer who built it. You can describe the changes you want in the case chat." Click the Request changes confirm button. The case status flips to Changes Requested with the same designer assigned. Then type the change request into the case chat so the designer has the prose context.

For an AlignerBot or ClearAligner.AI case the dialog is stricter. If no .xml or .gpk is already attached, the Request changes confirm button is disabled and an amber notice appears with the title "Upload one of the following first:":

An XML tooth-position file exported from Cympha Studio's 3D review.

A .gos.gpk transfer pack saved from GuideMia OrthoPlus Planner.

A Get the planner → link to /downloads also appears in the dialog. The confirm button stays disabled until you cancel, upload the artifact on the case detail page, and come back. This guard exists because the AlignerBot planner has no English parser — a comment that says "move tooth 8 buccally" is not actionable. You either hand it an updated XML (typically by re-staging in Cympha Studio's 3D review and exporting the tooth-position XML) or a replacement GPK (typically by opening the case in OrthoPlus Planner, editing, and saving the transfer pack).

Once the artifact is attached and you confirm, the agent re-dispatches Phase 1 with the new artifact as the overlay.

Step 5 — Escalate to lab manager (the exception path)

Click Escalate to lab manager when the case has a problem that the designer can't fix on their own — quality concerns that suggest the wrong protocol was followed, schedule problems, or the wrong patient files were used. A confirm dialog titled "Escalate this case to the lab manager?" explains the consequence: the lab manager will review the case directly, used when you need a more senior look (quality concerns or schedule problems). Click the Escalate confirm button.

Escalation flips the case to Escalated. The lab manager triages from their case queue and decides whether to reassign, take it themselves, or contact you.

Escalation is not a stronger form of rejection. It's a different routing decision. If the designer's work is fine but you want one more iteration, use Request changes. Reserve Escalate for situations where you actually want a senior eye.

What happens next

After approve. The case advances per the pivot rules in Step 3: back to Designing if another cycle remains, straight to Delivered on the final cycle of a digital case, or resting at Approved on a lab-service case until the lab starts manufacturing.
After request changes. A success toast confirms the case is back with the designer. The case returns to the designer who built the deliverable. The chat is where you put the prose context. The activity log records the rejection event so the history is permanent.
After escalate. A success toast confirms the escalation. The lab manager picks the case up from their case queue.

Troubleshooting

The approval page redirects me to the case detail. Either the case is not in Awaiting Approval anymore (someone else approved it, or it got moved) or you're not the case owner. The dashboard row's badge will tell you the current status.

I clicked Request changes by mistake. You can re-approve later — when the designer resubmits, the case returns to Awaiting Approval and the approval page comes back. There is no undo on the immediate rejection event itself.

The Approve button is greyed out. Either an approval, rejection, or escalation request is mid-flight (look for the spinner), or a network hiccup interrupted a previous click. Refresh the page; the status will show the true state.

For AlignerBot — Cympha is asking for an XML I don't know how to produce. Open the case in Cympha Studio, switch to the 3D review, adjust the staging, and export the tooth-position .xml. Upload it on the case detail page, then return to the approval page and try Request changes again.

Related how-to: see I just got a Cympha case-share email — what do I do? if a colleague shared this case with you and you're not sure why you can't approve it.