Operational Workflows & State Machines

Clinical dental care and operatory management follow deterministic, state-driven lifecycles. Every patient visit, treatment plan phase, dental laboratory fabrication, and sterilization cycle executes through controlled state transitions guarded by domain invariants.

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1. End-to-End Patient Clinical Journey

The clinical journey orchestrates administrative intake, chairside operatory care, infection control, and downstream financial settlement:

flowchart TD
    A["Patient Check-In at Reception"] --> B["Operatory Assigned & Verified Clean"]
    B --> C["Patient Seated in Dental Chair"]
    C --> D["Medical Health Alerts Verified by Dentist"]
    D --> E["Clinical Exam, Odontogram & Perio Charting"]
    E --> F{"Active Treatment Required?"}

    F -->|No: Clean Maintenance| M["Perform Routine Prophylaxis"]
    F -->|Yes: Treatment Needed| G["Formulate & Sequence Treatment Plan"]

    G --> H["Present Estimates & Obtain Informed Consent"]
    H --> I["Administer Local Anesthesia & Record Carpules"]
    I --> J["Scan Sterile Cassette Barcode at Chairside"]
    J --> K["Execute Procedure & Log Material Lots"]
    K --> L["Attending Dentist Digitally Signs Encounter"]

    M --> L
    L --> N["Encounter Sealed & Locked"]
    N --> O["Patient Dismissed to Checkout"]
    O --> P["Mandatory Room Turnover Aerosol & Disinfection"]
    P --> Q["Room Ready for Next Patient"]

    N -.->|Asynchronous Event Emission| Downstream["Post Billing (FMS) / Decrement Stock (SCM) / Schedule Recare (CRM)"]

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2. Operatory Encounter State Machine

The OperatoryEncounter aggregate enforces a strict operational lifecycle ensuring clinical safety and infection control compliance:

stateDiagram-v2
    [*] --> Scheduled
    Scheduled --> PatientArrived: Front Desk Check-in
    PatientArrived --> PatientSeated: Assistant Escorts to Chair
    PatientSeated --> MedicalCleared: Dentist Reviews Allergies & Vitals
    MedicalCleared --> InProgress: Anesthesia Given & Cassette Scanned
    InProgress --> ClinicianSigned: Procedures Completed & Lots Logged
    ClinicianSigned --> Sealed: Front Desk Checkout & Co-pay Hand-off
    Sealed --> RoomSanitized: Turnover Disinfection Completed
    RoomSanitized --> [*]

Operatory Encounter State Transition Table

Current State	Target State	Triggering Event / Action	Guard Conditions	Primary Actor	Domain Event Emitted
Scheduled	PatientArrived	Patient checks in at reception desk	Scheduled time within acceptable early/late window	Receptionist	DentalPatientArrived
PatientArrived	PatientSeated	Assistant escorts patient into assigned operatory	Target operatory is in RoomSanitized state	Dental Assistant	DentalPatientSeated
PatientSeated	MedicalCleared	Dentist reviews systemic anamnesis and vital signs	Blood pressure recorded; allergies confirmed; antibiotic pre-medication validated	Attending Dentist	MedicalAlertVerified
MedicalCleared	InProgress	Local anesthesia administered; sterile cassette opened	Active signed consent on file; valid unexpired sterile cassette scanned	Attending Dentist	DentalEncounterInProgress
InProgress	ClinicianSigned	Dentist finalizes treatment notes and confirms completion	All executed procedures mapped to CDT codes; material lots recorded	Attending Dentist	DentalEncounterSigned
ClinicianSigned	Sealed	Financial checkout complete; patient dismissed	Clinician signature present; zero unresolved execution items	Front Desk Clerk	DentalEncounterSealed
Sealed	RoomSanitized	Dental assistant completes room turnover disinfection protocol	Mandatory turnover buffer elapsed; biohazard waste removed; fresh barrier film applied	Dental Assistant	OperatorySanitized

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3. Treatment Plan State Machine

The TreatmentPlan aggregate governs long-term clinical care and financial sequencing:

stateDiagram-v2
    [*] --> Draft: Dentist Charts Diagnoses
    Draft --> Presented: Clinical Estimate & Sequencing Prepared
    Presented --> Accepted: Patient Signs Informed Consent
    Presented --> Modified: Patient Declines Elective Items
    Modified --> Presented: Dentist Adjusts Phasing & Scope
    Accepted --> InExecution: First Phase Scheduled & Underway
    InExecution --> Completed: Final Restoration / Hygiene Seated
    InExecution --> Abandoned: Patient Relocates or Ceases Care
    Completed --> [*]
    Abandoned --> [*]

Treatment Plan State Transition Table

Current State	Target State	Trigger / Action	Guard Conditions	Primary Actor	Domain Event Emitted
Draft	Presented	Treatment proposal generated with phased CDT codes	Valid anatomical teeth; tooth-surface validation checks pass	Attending Dentist	TreatmentPlanPresented
Presented	Accepted	Patient accepts clinical plan and financial terms	Written or electronic informed consent signed by patient or guardian	Patient & Treatment Coordinator	TreatmentPlanAccepted
Presented	Modified	Scope adjusted based on patient preference or insurance budget	Phase 1 (Urgent/Pain) cannot be removed if acute infection exists	Attending Dentist	TreatmentPlanModified
Accepted	InExecution	Encounter opened referencing a planned procedure item	Consent token verified; clinical clearance active	Attending Dentist	TreatmentPlanExecutionStarted
InExecution	Completed	All planned procedure items transition to Completed	All phase gates passed; no pending restorative items	Attending Dentist	TreatmentPlanCompleted
InExecution	Abandoned	Patient terminates treatment or fails to attend for 180+ days	Clinical summary exported; formal notice sent to patient	Practice Manager	TreatmentPlanAbandoned

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4. Dental Laboratory Prosthetic State Machine

The DentalLabOrder aggregate ensures indirect restorations are fabricated, inspected, and ready prior to chairside cementation:

stateDiagram-v2
    [*] --> PrescriptionDraft: Preparation Completed Chairside
    PrescriptionDraft --> Dispatched: Scan STL Exported & Sent to Lab
    Dispatched --> InFabrication: Lab Acknowledges Receipt
    InFabrication --> TryInDelivered: Interim Framework / Biscuit Bake Sent
    TryInDelivered --> TryInEvaluated: Chairside Try-In Encounter
    TryInEvaluated --> InFabrication: Adjustment / Regaze Requested
    TryInEvaluated --> FinalDelivered: Framework Approved & Finished
    InFabrication --> FinalDelivered: Direct Monolithic Crown Finished
    FinalDelivered --> Inspected: Clinic Quality Inspection Passed
    Inspected --> SeatedAndCemented: Permanent Seating Encounter Complete
    SeatedAndCemented --> [*]

Dental Laboratory Transition Table

Current State	Target State	Trigger / Action	Guard Conditions	Primary Actor	Domain Event Emitted
PrescriptionDraft	Dispatched	Clinic dispatches digital intraoral scan or analog courier	Shade recipe specified; target tooth specified; margin clearly visible in scan	Attending Dentist	DentalLabOrderDispatched
Dispatched	InFabrication	Lab confirms order intake and validates mesh integrity	Digital STL file non-corrupted; margin lines readable	Lab Technician	DentalLabOrderAcknowledged
InFabrication	TryInDelivered	Lab ships interim framework, coping, or unglazed biscuit unit	Delivery tracking number attached	Lab Technician	DentalLabTryInReceived
TryInDelivered	TryInEvaluated	Clinician evaluates fit, margin, and bite intraorally	Try-in encounter active	Attending Dentist	DentalLabTryInEvaluated
InFabrication	FinalDelivered	Lab delivers finished prosthesis to clinic	Final delivery package received at front desk	Receiving Staff	DentalLabRestorationReceived
FinalDelivered	Inspected	Clinic assistant or dentist verifies shade, margins, and integrity	Restoration free of fractures; shade matches prescription recipe	Dental Assistant / Dentist	DentalLabRestorationInspected
Inspected	SeatedAndCemented	Dentist permanently bonds or cements prosthesis	Tooth preparation cleaned; isolation maintained; bite adjusted	Attending Dentist	DentalLabRestorationSeated

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5. Sterilization Batch & Cassette Lifecycle

The SterilizationCycleBatch aggregate enforces infection control safety:

stateDiagram-v2
    [*] --> Decontamination: Contaminated Instruments Washed
    Decontamination --> PackagedAndWrapped: Cassette Sealed & Barcoded
    PackagedAndWrapped --> ChamberLoaded: Placed in Autoclave
    ChamberLoaded --> CycleRunning: Saturated Steam Cycle Initiated
    CycleRunning --> CyclePassed: Physical Benchmarks Satisfied (134°C, 2.1 bar, 4m)
    CycleRunning --> CycleFailed: Pressure Drop or Thermal Failure
    CyclePassed --> SporeIncubation: Biological Indicator Tested (Weekly/Daily)
    SporeIncubation --> ActiveInventory: Spore Test Negative (Clear)
    SporeIncubation --> Quarantined: Spore Test Positive (Bacterial Growth)
    CycleFailed --> Quarantined: Reprocess Entire Batch
    ActiveInventory --> ChairsideConsumed: Barcode Scanned in Encounter
    ChairsideConsumed --> Decontamination: Post-Treatment Return

Sterilization Batch Rules

• Immediate Quarantine: If an autoclave cycle aborts due to a vacuum leak or heater failure, or if a biological spore indicator culture tests positive for bacterial growth, the entire batch is flagged Quarantined.
• Automated Revocation: All sterile cassette barcodes generated in a quarantined cycle are immediately blacklisted in the system. Any attempt to scan them at chairside produces an urgent red validation halt.