Multiple design rounds in ClearAligner.AI (the clinician's how-to)

After the first paid Phase-2 round, a ClearAligner.AI case can be refined with an .xml or .gpk; this guide explains each further round of AI clear aligner design and how credits are counted.

Audience: Clinicians using ClearAligner.AI directly at app.cympha.com/caai who need more than one round of design — a refined plan, an updated appliance, or a fresh staging starting from new tooth positions. This builds on Use ClearAligner.AI direct; read that first if you've never submitted a CAAI case before.

You'll come away knowing: how to drive a single case through multiple Phase-1 and Phase-2 cycles, what each round costs (the answer is usually nothing extra after the first credit), and when to start a new case instead of iterating on the current one.

Time required: Around twenty minutes to read. A real multi-round case typically clears two or three rounds inside an afternoon, with most of the wall-clock spent waiting for OrthoPlus.

Before you start

You need:

A ClearAligner.AI case already submitted at app.cympha.com/caai/cases/new. The single-round path is fully covered in Use ClearAligner.AI direct.
For any refinement round on the same case: either Cympha Studio's 3D review (to export an XML tooth-position file — Studio runs in the browser, nothing to install) or GuideMia OrthoPlus (to save a .gos.gpk transfer pack — available from app.cympha.com/downloads).
At least one credit on your wallet if you haven't already self-approved Phase-1 on this case. Re-runs on the same case are free.

The one-line rule for credits on a ClearAligner.AI case: one credit covers one case end-to-end. Phase-1 planning is free; the credit is charged when you self-approve to dispatch the appliance design; re-runs on the same case are free. You only pay again when you submit a new case.

The single-round picture (refresher)

A first-time ClearAligner.AI case goes through two automatic phases:

Phase-1 (planning) — free. Cympha's central design service runs OrthoPlus's planning cascade against the scans and parameters you submitted and uploads a .gvw review file. Your case lands at Awaiting Approval with the Plan Approval Pending label and you get an email from Cympha.
Phase-2 (appliance) — one credit on self-approve. When you self-approve on the case page, Cympha deducts one credit, flips the case back to Designing, and the service runs the appliance cascade. You get a second approval email when the per-stage aligners (or arch models or bracket guides, depending on what you chose) are ready.

If you approve that second review, the case advances to Delivered and the workflow is finished. That's the one-round happy path.

Step 1 — Decide what kind of refinement you need

Three different situations call for three different actions:

The plan looks close but a few teeth need adjustment — you want OrthoPlus to re-run with a tweaked starting point. Use Request changes with an XML or .gpk artefact on the same case. No new credit.
The plan is fine but you want a different design kind — for example, you chose Aligner models at intake but you now want an arch model. Change it on the case page's Design options card and click Re-run design — saving the options alone doesn't dispatch anything. Re-runs on a paid case are free.
The case is the wrong shape at the root — wrong scans, wrong patient, wrong jaw, wrong intent. Start a new case. Refining isn't going to recover from a bad intake.

The rest of this doc walks through the first situation, since it's the one that actually exercises the multi-round machinery.

Step 2 — Open the approval page and click Request changes

When Phase-1 (or Phase-2) lands in Awaiting Approval, your email points at the case detail page. Follow the Your approval is needed prompt through to app.cympha.com/cases/<case-id>/approve.

The page lists the patient name, the status badge, the step label (Treatment Plan for Phase-1, Appliance Design for Phase-2), and three actions in the bottom right:

The approve action — don't click this if you're requesting changes.
Request changes — this is the one you want.
Escalate to lab manager — not relevant on ClearAligner.AI cases; there is no lab.

Click Request changes. A confirmation dialog opens.

Step 3 — Upload the revision artefact

ClearAligner.AI cases enforce a structured revision artefact. The confirm button on the dialog stays disabled until a file with extension .xml or .gpk is attached to the case. An amber notice in the dialog spells out the two valid paths:

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 points at /downloads if you need OrthoPlus.

The reason the dialog blocks free-text instructions: the OrthoPlus planner cascade has no English parser. Typing "move tooth 8 buccally" into the case chat won't translate into a planner input. The XML and GPK formats are structured inputs OrthoPlus actually consumes.

Path A — XML from Studio (lighter weight). Open the Phase-1 .gvw in Cympha Studio's 3D review — it runs in the browser. Edit the tooth positions and export them as an .xml. Cancel the dialog on the approval page, go to the case detail page, drop the XML into the Files panel, then return to the approval page and click Request changes again. The confirm button is now active.

Path B — GPK from OrthoPlus (full control). If you have GuideMia OrthoPlus, edit the plan there and save a .gos.gpk transfer pack. Upload it to the case. Click Request changes and confirm.

Step 4 — Confirm and wait for the re-dispatch

Click the Request changes confirm button. The case status flips to Changes Requested.

Shortly after, the central design service picks the case up and dispatches OrthoPlus again with your XML or GPK applied. When the run finishes the case comes back to Awaiting Approval — same as the first round, except now your refinements are baked into the staging.

You get a fresh approval email from Cympha. Open the approval page. Review. Either approve, or repeat steps 2-4 with another XML or GPK if you need yet another refinement.

There is no hard limit on how many refinement rounds a case can go through. Practically, two or three rounds is typical before a case is either approved or abandoned.

Step 5 — Approve, or move to Phase-2

If you approve the refined Phase-1 plan, the service dispatches Phase-2 against the latest plan (no extra credit). Phase-2 produces the per-stage appliance files. You approve those, and the case flips to Delivered.

If the refined Phase-2 appliance also needs adjustment, you can run the same Request changes loop on the Phase-2 review page. The XML / GPK rule still applies; the round still costs nothing extra.

How many credits a multi-round case typically uses

The accounting is simple:

Zero credits if you only ever run Phase-1 and decide not to dispatch the appliance. Phase-1 is fully free.
One credit for the first self-approve on a case, no matter how many rounds the case ultimately runs.
Zero credits for every refinement round after the first self-approve — the credit is charged once per case lifetime, so once a case is paid, re-runs and re-approvals don't deduct again.

A typical multi-round case spends one credit total. If you find yourself starting many new cases to work around one tricky patient, that's the time to stop and use refinement rounds instead.

When to start a new case rather than refine

Refinement is the right tool when the plan or appliance is close but needs adjustment. (Remember the design kind is not a reason to start over — change it on the Design options card and Re-run design.) Starting fresh is the right tool when:

The scans were bad — re-scan and start fresh.
You need a different per-jaw plan range (All vs. 3-3 vs. 4-4 vs. 5-5) or other intake parameters reworked from the root.

For those, start a new case at /caai/cases/new. The new case will deduct one credit on its first self-approve.

Troubleshooting

The Request changes confirm button is greyed out. No .xml or .gpk is attached to the case yet. Cancel the dialog, go to the case detail page, upload the artefact in the Files panel, then return to the approval page and click Request changes again.

I uploaded the XML but the case didn't re-dispatch. Check the status badge on /cases/<case-id>. The case must be in Changes Requested for the service to run another pass — simply uploading the XML doesn't trigger a dispatch on its own. You must click Request changes and confirm.

I'm out of credits in the middle of a refinement round. You aren't — refinements are free. If the case is asking you to buy credits, you're looking at a new case that hasn't been paid for yet, not a refinement of an already-paid case.

I ran out of credits before the first self-approve. Click through to app.cympha.com/credits and buy credits. They land in your wallet immediately and the case's self-approve action works again.

Phase-1 ran but the refined plan looks identical to the first one. Two common causes: the XML was empty (no edits exported), or you uploaded the XML but never clicked Request changes. Check the case activity log for the change-request entry. If it isn't there, you skipped the confirm.

I approved Phase-2 by accident. The approve action is immediate and there's no undo. The case is now Delivered. To run another round, submit a new case starting from your latest scans (one new credit).

The case keeps cycling Phase-1 without producing a Phase-2. You're requesting changes on the Phase-1 plan repeatedly without ever approving it. If you're happy with the staging and want to see appliances, the answer is to approve the plan, not to refine it again.

Last updated 2026-07-30.