The full case round-trip — clinician to lab to patient

This walkthrough traces one ortho case across every surface of Cympha dental lab case management software, from the clinician's scans to the patient opening the final plan.

Audience: Anyone who wants to see one real ortho case travel through every Cympha surface. Useful for a clinician onboarding their first lab, a lab manager auditing their handoffs, or a designer who's only ever seen the middle of the workflow.

You'll come away knowing: how a case goes from intraoral scans in Cympha Studio to a patient opening their finalised treatment plan on a phone — and which app, role, and route is responsible for each handoff.

Time required: Twenty minutes to read. The real case itself takes hours to days depending on lab turnaround.

Before you start

You need:

A clinician with a Cympha account and a lab they've already connected with (found via the lab search on the new-case form — there is no public lab directory).
A lab with a Lab Manager + at least one Designer approved on /team. The designer should already have their workstation wired — if not, walk through Wire a designer's workstation end-to-end first.
Either a real intraoral scan set or Cympha Studio's demo patient. The workflow is identical.
The patient's email address for the final step.

If this is your first Cympha case ever, What do you need covers the prerequisite checklist.

Step 1 — Clinician assembles the virtual patient in Cympha Studio

The clinician opens studio.cympha.com. They import the intraoral scans (STL or PLY), any CBCT volume, photos, and a bite registration if they have one. Studio composes the lot into one virtual patient: aligned upper and lower arches, CBCT registered to the scans, photo gallery in the side panel.

They orbit to the area of concern, drop a distance measurement on the arch, and capture a labelled view to the gallery. They annotate any soft-tissue concern or note for the lab. None of this leaves the browser yet — Studio is a single-user planning surface until they hit save.

Step 2 — Create Cympha Case from Studio

The clinician clicks Create Cympha Case in Studio. Studio packages the session — meshes, zipped DICOM, photos, measurements — into a single .cyp bundle and uploads it through the same Cympha account they're signed into.

When the upload finishes, the browser navigates to /cases/new on app.cympha.com with the .cyp already attached. The clinician searches for their lab, picks the category (AlignerBot, Orthodontics, Implant, or Lab Service), fills in the patient demographics, and clicks Submit.

Behind the scenes the case is promoted from draft to Submitted, held by the lab manager. Both the clinician and the lab manager get an email from Cympha confirming the submission.

Step 3 — Lab manager triages from /queue

The lab manager opens app.cympha.com/queue. The new case appears at the top with status Submitted, the patient name, the category, and the clinician's name in the Customer column.

They click the row to open /cases/<id>. They scan the files, the lab slip (downloadable as a PDF via Download Lab Slip), and the parameters the clinician filled in. If the case is complete enough to design, they assign a designer — a dialog lists the lab's designers.

The lab manager picks the right designer and confirms. Status flips to Designing, the holder becomes the designer, and the case leaves the lab manager's primary queue view.

If your lab has a Case Intaker on staff, the case passes through Intake Review first — the intaker validates files and parameters before assignment. Without an intaker the case goes Submitted → Designing directly. The mechanics from the lab manager's side are in Assign a case to a designer.

Step 4 — Agent Manager downloads the case to the designer's workstation

On its next poll (the agent checks for new cases every 20 seconds), the designer's Cympha Agent Manager downloads the case files — the .cyp bundle plus any standalone STLs — into the workspace folder the designer chose when configuring Cloud Monitoring. Cases land as {workspace}\{category}\{PatientName_Date_caseID}\, and every case folder gets a lab_slip.pdf that refreshes whenever the case changes.

Three things happen on the designer's side, in roughly this order:

They get an email from Cympha about the assignment.
The case appears in My Assignments at app.cympha.com/assignments with status Designing.
The case folder fills with files in their workspace.

The designer doesn't have to do anything for the download — the agent handles it. If the agent isn't paired, the download will stall. The pair-recovery instructions are in Install and pair Cympha Agent Manager.

Step 5 — Designer opens the .cyp in Studio and refines in OrthoPlus

Cympha Studio is a browser app — there's nothing to launch from File Explorer. The designer opens the .cyp in Studio in the browser (the case page links out to the Studio workspaces), which brings back the clinician's assembled virtual patient — meshes, CBCT, photos, measurements. The designer doesn't have to reconstruct context.

For the design work itself they open the downloaded scans from the workspace folder in OrthoPlus. OrthoPlus runs the planner, the designer adjusts staging, attachments, IPR, whatever the case needs, and saves the output into the case's workspace folder.

The agent watches that folder. A .gvw review file (and any .zip design output) uploads automatically; most other file types appear in the agent's Cloud Monitor panel and wait for a click on Upload, so the designer can vet what leaves the machine. The .gos project file is OrthoPlus's working file and stays local — it is not something the agent uploads. Once uploaded, the Files panel on /cases/<id> populates within seconds. For the designer-perspective walkthrough of the design-and-upload loop, see A designer's first day on Cympha.

Step 6 — Designer clicks Request Approval

When the design is uploaded and the designer is satisfied, they open the case detail page at app.cympha.com/cases/<id> and click Request Approval in the actions bar. (On aligner-style cases there's a shortcut: a .gvw review file arriving via the agent requests approval by itself — no click needed.)

Status flips from Designing to Awaiting Approval. A system label appears — Plan Approval Pending for the first round of an ortho/aligner case, Appliance Approval Pending for the second, or Design Approval Pending for single-step lab services. The holder transfers to the clinician.

The clinician receives an email from Cympha with a link to /cases/<id>/approve.

Step 7 — Clinician approves on /cases/<id>/approve

The clinician clicks the email link and lands on the deliberately narrow approve page. The header reads the patient name plus the Awaiting Approval badge with the step label underneath — "Approval needed — Treatment Plan".

The page shows the lab slip download, the file list, and three actions at the bottom right:

Approve — accept the deliverable. Status flips to Approved. For two-cycle categories like Orthodontics or AlignerBot, the case goes back to Designing for the next cycle (Treatment Plan → Appliance Design) with the same designer holding it. On the final cycle a digital case advances straight to Delivered.
Request changes — bounces the case back to the designer who built it. Status flips to Changes Requested. The clinician can describe the changes in the case chat. For AlignerBot and ClearAligner.AI cases specifically, this button requires an XML tooth-position file (exported from Cympha Studio's 3D review) or a .gos.gpk transfer pack (from GuideMia OrthoPlus) to be uploaded first — free-text instructions can't drive the planner, and the dialog points at the two valid artefact types.
Escalate to lab manager — routes the case to the lab manager for a more senior review. Status flips to Escalated.

The clinician picks Approve. The case moves to Approved, then onto the next step or delivery depending on the category. The full approve-page walkthrough lives in Approve or reject a design.

Step 8 — Clinician clicks Share to Patient

Once the final deliverable is approved and the case has its production .gvw, the clinician opens the case detail page and finds the Share to Patient button in the header (sits next to the regular Share button — that one is for colleague shares, not patient shares).

They click it. In the share dialog they enter the patient's email address and pick which .gvw export to share — the final confirmed plan. Sharing is per single file: the patient will see only that plan, never the case, its other files, or its messages. Re-sharing a newer .gvw to the same patient updates their existing share rather than creating a duplicate.

They send the invitation. The patient gets an invitation email from Cympha; new patients set up a patient account from the link, returning patients just sign in.

The full patient-share walkthrough is in Share a treatment plan with a patient.

Step 9 — Patient signs up at /patient/sign-up and opens the plan

The patient taps the email link. They land on /patient/sign-up on app.cympha.com with the invitation ticket pre-filled. They set a password and accept. They're routed to /patient — a deliberately narrow workspace listing only the case the doctor just shared.

The patient cannot see other patients, other cases of the doctor, the doctor's case folder, or any editing tools. The Cympha Studio chrome is hidden in the patient workspace; only the viewer is shown.

They click Open. Cympha Studio opens with the shared .gvw loaded — same view the doctor approved, but read-only. They can orbit, step through aligner stages, zoom in on attachments. The patient-side walkthrough is in Open your treatment plan as a patient.

What success looks like

End state across all four parties:

Clinician sees the case with status Delivered (digital categories advance there automatically on the final approval), an entry under My Patients if you enrolled the patient in Ortho Monitoring (see How to enroll a patient in Ortho Monitoring), and the chat thread with the lab still open if they need follow-up — Delivered is deliberately not a dead end.
Lab manager sees the case has cleared their queue; it sits under Delivered until they Mark as Finished to archive it.
Designer still holds the delivered case — Delivered deliberately keeps its holder so the person who built the design can field follow-ups. Their workspace folder still has the case folder for reference.
Patient sees their plan on /patient, opens it in Studio, and gets ortho-monitoring reminders if you enrolled them.

Troubleshooting

Studio's Create Cympha Case action is missing. Studio opens and renders without a sign-in, but writing back to Cympha — including creating a case — requires being signed in. Sign in and try again.

The case appeared with status Submitted but no files. The .cyp upload from Studio probably stalled. Look at /cases/<id> activity log — if there are zero file events, ask the clinician to re-upload from Studio.

The designer's My Assignments view doesn't show the assigned case. The designer is probably still Pending Designer. Have the lab manager approve them on My Team — see Wire a designer's workstation end-to-end.

The clinician clicked Request changes on an AlignerBot case and the confirm button is greyed out. AlignerBot cases require a structured revision artefact — an XML tooth-position file (from Cympha Studio's 3D review) or a .gos.gpk transfer pack (from GuideMia OrthoPlus) — uploaded before the reject can confirm. The dialog itself surfaces the two paths; the clinician should upload one of those file types first.

Share to Patient is missing on the case detail page. It only appears on Orthodontics, AlignerBot, and ClearAligner.AI cases (the categories that produce a .gvw the patient can usefully view). On Implant and Lab Service cases there's nothing to share with a patient.

Patient opens /patient and sees nothing. Confirm the share targeted the email they signed up with — not an alias. If the doctor typed jane@gmail.com and the patient signed up with jane@hotmail.com, the invitation sits against the address you sent it to, not the one they use day-to-day. Re-send via Share to Patient to their actual address.