Promaton — Implementation Playbook (DSO)

Promaton Implementation Playbook

AI-Powered Treatment Planning for Dental Service Organizations

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1. Executive Summary

What Promaton Does

Promaton delivers AI-powered 3D dental imaging analysis and automated treatment planning, transforming CBCT scans and intraoral data into precise anatomical segmentations, implant planning workflows, and orthodontic treatment simulations. The platform automates time-intensive radiographic interpretation, generates standardized treatment recommendations, and produces patient-ready visualizations—all integrated directly into your existing clinical workflow.

Why DSOs Benefit from AI Treatment Planning

Treatment planning represents one of the highest-variability clinical processes across multi-location dental organizations. Without AI standardization, diagnosis accuracy, case acceptance rates, and treatment outcomes fluctuate based on individual provider experience and interpretation. Promaton addresses this at scale by:

• Standardizing clinical decision support — Every provider, regardless of experience level, receives the same AI-assisted anatomical analysis and treatment recommendations, reducing diagnostic variability across 15–50+ locations
• Aggregating learning across your network — As your organization's case volume flows through the platform, pattern recognition improves and benchmarking data accumulates, creating competitive intelligence no single practice could generate
• Accelerating high-value case throughput — Implant, ortho, and complex restorative cases move faster from diagnosis to acceptance to treatment, directly impacting revenue per patient
• Enabling centralized clinical oversight — CDOs can monitor treatment planning patterns, identify outlier locations, and ensure clinical protocol adherence without manual chart audits

Expected Timeline: Decision to Full Deployment

Phase	Duration	Milestone
Pre-Implementation	Weeks 1–2	Infrastructure audit, baseline metrics, stakeholder alignment
Pilot Wave (2–3 locations)	Weeks 3–6	Configuration, training, controlled go-live
Expansion Wave (5–8 locations)	Weeks 7–12	Scaled deployment with refined playbook
Full Deployment (remaining locations)	Weeks 13–20	Organization-wide rollout
Optimization	Ongoing	ROI measurement, workflow refinement

Total timeline for 25-location DSO: 16–20 weeks Total timeline for 50-location DSO: 20–28 weeks

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2. Pre-Implementation Checklist (Weeks 1–2)

Technical Requirements

Hardware Requirements per Location

☐ CBCT scanner compatibility verification (Promaton supports major manufacturers—Carestream, Planmeca, Sirona, Vatech, i-CAT) 🔵 ☐ Workstation specifications: Minimum 16GB RAM, dedicated GPU (NVIDIA GTX 1660 or higher recommended), SSD storage ☐ Monitor resolution: 1920x1080 minimum; 4K recommended for treatment visualization ☐ Intraoral scanner compatibility check if applicable (iTero, 3Shape, Medit)

Software Requirements

☐ Operating system: Windows 10/11 Pro (64-bit) or macOS 12+ ☐ Browser: Chrome 90+ or Edge 90+ for cloud-based interface ☐ PMS version verification (see Section 5 for integration requirements) ☐ Imaging software version documentation

Network Requirements

☐ Minimum bandwidth: 50 Mbps upload/download per location for CBCT file transfer ☐ Network latency: <100ms to cloud services ☐ Firewall configuration: Whitelist Promaton endpoints (obtain list from vendor) 🔵 ☐ VPN compatibility assessment if applicable

Vendor Onboarding Steps

Step	Owner	Timeline	Deliverable
🔵 Execute MSA and BAA	Legal + Promaton	Week 1, Day 1–3	Signed agreements
🔵 Establish account hierarchy	IT + Promaton	Week 1, Day 2–4	Org structure in platform
🔵 Assign customer success manager	Promaton	Week 1, Day 1	Named CSM contact
🔵 Schedule technical kickoff	IT + Promaton	Week 1, Day 3–5	Integration planning session
🔵 Obtain sandbox environment access	IT + Promaton	Week 1, Day 5	Test credentials

Key Contacts to Establish

☐ Promaton Customer Success Manager (primary escalation) ☐ Promaton Technical Integration Specialist ☐ Promaton Clinical Training Lead ☐ Promaton Support Desk (Tier 1) — document SLA response times 🔵

Data/Access Prerequisites

☐ Generate API credentials for PMS integration 🔵 ☐ Document imaging archive access (PACS connection details, DICOM endpoints) ☐ Compile provider NPI numbers for all clinicians who will use the platform ☐ Create service account for integration (avoid personal credentials) ☐ Export sample imaging data (5–10 representative cases) for validation testing ⚠️

Internal Stakeholder Alignment

Who Needs to Be Informed

Stakeholder	Information Need	Communication Format
Board/Investors	Strategic rationale, expected ROI, timeline	Executive brief (1-page)
C-Suite (CEO, CFO, COO)	Business case, resource requirements, risk register	Working session
Chief Dental Officer	Clinical validation, training approach, quality metrics	Detailed review
VP of IT	Technical architecture, security, integration scope	Technical deep-dive
Regional Managers	Rollout timeline, location impact, staff communication	Cascade briefing
Office Managers	Workflow changes, training schedule, go-live expectations	Team meeting
Providers	Clinical benefits, learning curve, daily workflow changes	Peer presentation

🟣 Who Needs to Approve

☐ CFO: Budget allocation and vendor contract ☐ CDO: Clinical workflow changes and treatment protocol modifications ☐ VP of IT: Technical architecture and security compliance ☐ CEO/COO: Rollout timeline and resource commitment ☐ Board (if applicable): Material technology investment

Baseline Metrics to Capture BEFORE Go-Live

⚠️ Critical: Capture these metrics BEFORE any pilot activity. Without baseline data, ROI measurement becomes impossible.

Clinical Metrics (Per Location)

Metric	Data Source	Collection Method
Treatment plan completion time (minutes)	Time study	Sample 20 cases
Case acceptance rate (%)	PMS	Pull 90-day report
Time from imaging to treatment start (days)	PMS	Pull 90-day report
Implant case acceptance rate (%)	PMS	Pull 90-day report
Ortho case acceptance rate (%)	PMS	Pull 90-day report
Treatment plan revision rate (%)	Chart audit	Sample 30 cases

Operational Metrics (Per Location)

Metric	Data Source	Collection Method
Average imaging interpretation time	Time study	Sample 10 CBCT reads
Provider overtime hours	Payroll	Pull 90-day average
Patient wait time for treatment plan	Scheduling data	Sample 20 cases
Referral-out rate for complex cases	PMS	Pull 90-day report

Financial Metrics (Per Location)

Metric	Data Source	Collection Method
Revenue per imaging patient	PMS/Billing	Pull 90-day report
Average case value (implant, ortho)	PMS/Billing	Pull 90-day report
Production per provider hour	PMS/Payroll	Calculate

Enterprise-Level Requirements

Network Standards Across Locations

☐ Document network topology for each location ☐ Identify locations with substandard connectivity (<50 Mbps) ☐ Plan bandwidth upgrades where necessary (flag as prerequisite for rollout) ☐ Confirm firewall policies can be standardized or document exceptions

🟣 Centralized vs. Location-Level Hosting Decision

Option	Pros	Cons	Recommendation
Cloud-hosted (Promaton SaaS)	No local infrastructure, automatic updates, centralized data	Bandwidth dependency, latency for large files	Recommended for most DSOs
Hybrid (cloud + local cache)	Faster local performance, reduced bandwidth	More complex setup, local maintenance	Consider for locations with poor connectivity
On-premise	Full data control, no cloud dependency	High maintenance, manual updates, no centralized view	Not recommended

SSO and Centralized Credentialing

☐ Document current identity provider (Okta, Azure AD, Google Workspace) ☐ Confirm Promaton SSO compatibility (SAML 2.0, OAuth 2.0 supported) 🔵 ☐ Define user provisioning workflow (manual vs. automated via SCIM) ☐ Establish role-based access control (RBAC) structure:

• Admin (central IT)
• Clinical Lead (CDO/Regional)
• Provider (location-level)
• Staff (limited access)

Stakeholder Alignment Map

                    ┌─────────────────────┐
                    │   Board/Investors   │
                    │   (Strategic OK)    │
                    └──────────┬──────────┘
                               │
                    ┌──────────▼──────────┐
                    │      C-Suite        │
                    │ CEO, CFO, COO, CDO  │
                    │   (Decision/Fund)   │
                    └──────────┬──────────┘
                               │
           ┌───────────────────┼───────────────────┐
           │                   │                   │
┌──────────▼─────────┐ ┌───────▼───────┐ ┌────────▼────────┐
│     VP of IT       │ │ VP of Clinical│ │  VP of Ops      │
│ (Technical Lead)   │ │   (CDO team)  │ │ (Rollout Lead)  │
└──────────┬─────────┘ └───────┬───────┘ └────────┬────────┘
           │                   │                  │
           └───────────────────┼──────────────────┘
                               │
                    ┌──────────▼──────────┐
                    │  Regional Managers  │
                    │  (Cascade/Execute)  │
                    └──────────┬──────────┘
                               │
           ┌───────────────────┼───────────────────┐
           │                   │                   │
┌──────────▼─────────┐ ┌───────▼───────┐ ┌────────▼────────┐
│  Office Managers   │ │   Providers   │ │   Clinical      │
│  (Local Coord)     │ │ (End Users)   │ │   Staff         │
└────────────────────┘ └───────────────┘ └─────────────────┘

Standardize Baseline Metric Collection

⚠️ Common Failure Point: Locations measure metrics differently, making cross-location comparison meaningless.

☐ Create standardized metric definitions document ☐ Distribute data collection templates to all locations ☐ Assign Regional Managers to validate data accuracy ☐ Set deadline for baseline data submission (end of Week 1) ☐ Central team aggregates and validates all submissions (Week 2) ☐ Flag locations with incomplete or suspicious data for follow-up

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3. Location Readiness Assessment

Scoring Framework

Rate each location on five dimensions (1–5 scale). Sum for composite score (max 25).

Factor 1: IT Infrastructure Maturity (1–5)

Score	Criteria
5	Fiber internet (100+ Mbps), workstations <2 years old, current PMS version, IT support on-site or same-day
4	Broadband (50–100 Mbps), workstations 2–3 years old, PMS within one version of current
3	Broadband (25–50 Mbps), workstations 3–4 years old, PMS two versions behind, IT support next-day
2	DSL/cable (<25 Mbps), workstations 4–5 years old, PMS significantly outdated
1	Unreliable internet, workstations >5 years old, legacy PMS requiring upgrade before integration

Factor 2: Staff Tenure and Adaptability (1–5)

Score	Criteria
5	<10% annual turnover, history of successful tech adoption, staff proactively requests new tools
4	10–20% turnover, neutral tech adoption history, adequate training completion rates
3	20–30% turnover, mixed tech adoption results, some resistance patterns
2	30–40% turnover, previous tech rollout struggles, training completion issues
1	>40% turnover, active resistance to change, failed prior technology implementations

Factor 3: Patient Volume Impact (1–5)

Score	Criteria
5	High volume (50+ patients/day) with high implant/ortho mix (>30% of revenue)
4	High volume with moderate specialty mix (15–30%)
3	Moderate volume (30–50 patients/day) with moderate specialty mix
2	Low-moderate volume with low specialty mix
1	Low volume or primarily hygiene-recall practice with minimal treatment planning needs

Factor 4: Existing Tech Stack Compatibility (1–5)

Score	Criteria
5	Promaton-validated PMS + imaging system, APIs enabled, existing integrations stable
4	Promaton-compatible PMS + imaging, minor configuration needed
3	Compatible systems but requires middleware or workarounds
2	One major system requires upgrade or replacement
1	Multiple systems incompatible, significant pre-work required

Factor 5: Local Champion Availability (1–5)

Score	Criteria
5	Tech-forward provider AND office manager both committed, previous champion experience
4	One strong champion (provider or manager) with peer influence
3	Potential champion identified but not yet committed
2	No obvious champion, would need to develop one
1	Leadership vacuum or active detractors in key positions

Composite Score Interpretation

Score Range	Readiness Tier	Rollout Recommendation
21–25	Tier 1: Pilot Ready	Priority candidate for Wave 1
16–20	Tier 2: Early Deployment	Strong candidate for Wave 2
11–15	Tier 3: Standard Deployment	Wave 3 with preparation
6–10	Tier 4: Needs Preparation	Address gaps before deployment
1–5	Tier 5: Deferred	Significant infrastructure/culture work required

Sample Scoring Matrix

Location	IT (1-5)	Staff (1-5)	Volume (1-5)	Tech Stack (1-5)	Champion (1-5)	Total	Tier
Downtown Metro	5	4	5	4	5	23	1
Suburban West	4	4	4	5	4	21	1
Northside Family	3	5	3	4	4	19	2
Eastside Specialty	4	3	5	3	3	18	2
Rural Clinic	2	4	2	3	3	14	3

Recommended Rollout Sequence

Based on scoring, assign locations to waves:

Wave 1 (Pilot): Select 2–3 Tier 1 locations that also represent diversity in:

• Geography (different regions if applicable)
• Specialty mix (at least one high-implant, one high-ortho)
• Provider demographics (mix of experienced and newer providers)

Wave 2 (Expansion): All remaining Tier 1 and Tier 2 locations

Wave 3 (Scale): Tier 3 locations with preparation complete

Deferred: Tier 4 and 5 locations with clear remediation plans and timeline

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4. Rollout Strategy

Wave Structure Overview

Week:  1   2   3   4   5   6   7   8   9  10  11  12  13  14  15  16  17  18  19  20
       |---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
       [  Pre-Implementation  ]
                   [    Wave 1: 2-3 Pilot Locations    ]
                                       [ Buffer ]
                                           [     Wave 2: 5-8 Locations     ]
                                                               [ Buffer ]
                                                                   [   Wave 3: Remaining   ]

Wave 1: Pilot Locations (2–3 locations, Weeks 3–6)

Selection Criteria for Wave 1

🟣 Executive Decision Required: Final pilot location selection

Select locations that are: ☐ High Readiness (Tier 1 composite score 21+) ☐ Manageable Risk — Not your highest-revenue location (protect downside) ☐ Representative — Results should be predictive of broader portfolio ☐ Visible — Success here creates internal momentum ☐ Champion-Ready — Strong local leadership committed to success

Wave 1 Timeline (4 weeks)

Week	Activities	Deliverables
Week 3	Configuration, integration, champion training	Systems connected, champion certified
Week 4	Staff training, parallel run with existing workflow	All staff trained, workflow documented
Week 5	Go-live with active monitoring	Production use begins
Week 6	Stabilization, issue resolution, learnings capture	Pilot debrief document

Daily Check-In Cadence (Wave 1)

• Days 1–5: Daily 15-minute standup (location champion + regional manager + central team)
• Days 6–14: Every-other-day check-in
• Days 15+: Weekly check-in until wave completion

Wave 2: Expansion (5–8 locations, Weeks 7–12)

🟣 Go/No-Go Criteria to Advance from Wave 1 to Wave 2

Criterion	Threshold	Source
System uptime	>99% during pilot	Promaton dashboard
Critical bugs resolved	100%	Issue tracker
Staff training completion	100%	Training log
Provider adoption	>80% of treatment plans use Promaton	Usage report
Case acceptance rate	No decrease from baseline	PMS report
Champion confidence	"Ready to recommend"	Champion survey

⚠️ Do not proceed to Wave 2 if any criterion fails. Address gaps first.

Wave 2 Timeline (6 weeks)

Week	Activities
Week 7	Apply learnings from Wave 1, update training materials, begin configuration for Wave 2 locations
Week 8–9	Champion training and staff training (parallel across locations)
Week 10	Staggered go-live (2–3 locations per day)
Week 11	Active monitoring and issue resolution
Week 12	Stabilization and Wave 2 debrief

Staggered Go-Live Schedule (Wave 2)

• Do not go live at more than 3 locations on the same day
• Space go-lives to allow support team to be present/available
• Example for 8 locations:
  • Monday W10: Locations 1–2
  • Wednesday W10: Locations 3–4
  • Friday W10: Locations 5–6
  • Tuesday W11: Locations 7–8

Wave 3: Remaining Locations (Weeks 13–20)

Go/No-Go Criteria to Advance from Wave 2 to Wave 3

Same criteria as Wave 1→2, plus:

Criterion	Threshold	Source
Cross-location consistency	<10% variance in adoption metrics	Aggregate report
Support ticket volume	Decreasing trend	Help desk
Training efficiency	Time per location decreased from Wave 1	Training log

Wave 3 Execution

Apply scaled operations:

• Champions from Wave 1/2 assist with Wave 3 training (peer credibility)
• Standardized playbook now proven—minimal customization
• Go-live pace accelerates: up to 5 locations per week
• Regional managers take primary coordination role (central team on-call)

Rollback Plan

⚠️ If a wave fails, execute the following rollback protocol:

Triggering Conditions for Rollback

• System availability <95% for >2 consecutive days
• Critical clinical error identified (misdiagnosis, patient safety issue)

• 50% of providers refuse to use system after training

• Integration failure causing data loss or corruption

Rollback Steps

1. Immediate (within 2 hours): ☐ Notify central team and vendor of rollback decision ☐ Communicate to affected location(s): "We're pausing to address issues" ☐ Revert to previous workflow (pre-Promaton treatment planning process)

2. Within 24 hours: ☐ Document root cause and contributing factors ☐ Assess impact on other locations (none if properly isolated) ☐ Update risk register with new learnings

3. Within 1 week: ☐ Develop remediation plan with vendor 🔵 ☐ Present revised timeline to executive team 🟣 ☐ Communicate transparently to all stakeholders

Isolation Protocol

• Wave failures should NOT impact other waves
• Each location's configuration is independent
• Data remains accessible regardless of rollout status
• Ensure contractual clarity on rollback data handling 🔵

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5. Configuration & Integration (Weeks 2–3)

Practice Management System Integration

Dentrix Enterprise Integration 🔵

Step	Action	Owner	Time Est.
1	Verify Dentrix version (G7.4+ required)	IT	15 min
2	Enable Dentrix API access in Security Settings	IT	30 min
3	Generate API credentials and document	IT	15 min
4	Provide credentials to Promaton integration team	IT→Promaton	5 min
5	🔵 Promaton configures Dentrix connector	Promaton	2–4 hours
6	Test patient data sync (read)	IT + Promaton	30 min
7	Test treatment plan write-back	IT + Promaton	30 min
8	Validate data mapping (procedure codes, providers)	Clinical + IT	1 hour
9	⚠️ Test with 10 real patient records (non-destructive)	Clinical	1 hour
10	Document any custom mappings	IT	30 min

Eaglesoft Integration 🔵

Step	Action	Owner	Time Est.
1	Verify Eaglesoft version (21.0+ required)	IT	15 min
2	Contact Patterson support for API enablement	IT	1–3 days
3	🔵 Configure Eaglesoft bridge with Promaton team	IT + Promaton	3–4 hours
4	Test patient data retrieval	IT + Promaton	30 min
5	Test treatment plan posting	IT + Promaton	30 min
6	⚠️ Validate procedure code translation	Clinical + IT	1 hour
7	Test imaging metadata passthrough	IT	30 min

Open Dental Integration 🔵

Step	Action	Owner	Time Est.
1	Verify Open Dental version (22.1+ recommended)	IT	15 min
2	Enable API module in Open Dental	IT	15 min
3	Generate API key with appropriate permissions	IT	15 min
4	🔵 Configure REST API connection with Promaton	IT + Promaton	1–2 hours
5	Test bidirectional patient sync	IT + Promaton	30 min
6	⚠️ Validate procedure code alignment	Clinical + IT	1 hour
7	Test image attachment linking	IT	30 min

Imaging System Integration

CBCT Scanner Integration 🔵

Step	Action	Owner	Time Est.
1	Document CBCT make/model at each location	IT	Variable
2	Verify DICOM export capability and settings	IT	30 min/location
3	Configure DICOM send to Promaton endpoint 🔵	IT + Promaton	1 hour
4	Test DICOM transmission with sample scan	IT + Promaton	30 min
5	Verify scan appears in Promaton within expected time (<5 min)	IT	15 min
6	⚠️ Validate anatomical data renders correctly	Clinical	30 min
7	Test with 5 varied case types (implant, ortho, etc.)	Clinical	2 hours

Intraoral Scanner Integration (if applicable) 🔵

Step	Action	Owner	Time Est.
1	Document IOS make/model	IT	15 min
2	Enable STL/PLY export or direct API connection 🔵	IT + Promaton	1 hour
3	Test scan upload and model rendering	IT	30 min
4	Validate alignment with CBCT data	Clinical	30 min

Test Environment Setup

Validation Checklist

☐ Patient Data Flow

• Patient demographics pull correctly
• Historical treatment data accessible
• Allergies/medications display
• Insurance information available

☐ Imaging Data Flow

• CBCT scans upload within 5 minutes
• Image quality preserved (no compression artifacts)
• Correct patient association
• All slices/views available

☐ AI Analysis

• Anatomical segmentation completes within expected time
• Nerve canal identification accurate
• Bone density measurements available
• Implant position recommendations generate

☐ Treatment Plan Output

• Plan saves to PMS correctly
• Procedure codes map appropriately
• Treatment images export for patient presentation
• Plan prints/exports cleanly

☐ User Access

• SSO login works (if configured)
• Role-based permissions enforce correctly
• Audit trail captures actions

Data Migration / Historical Data Ingestion

⚠️ Decision Point: How much historical data to migrate?

Option	Use Case	Level of Effort	Recommendation
No historical data	Clean start, new baseline	Minimal	Acceptable for most DSOs
Active patient imaging only	Continuity for in-treatment patients	Moderate	Recommended if feasible
Full archive	Complete AI learning dataset	High	Only if specific analytical goals

If Migrating Historical Data

☐ Define scope (date range, case types) ☐ Audit data quality in source system ☐ Establish patient consent/HIPAA compliance for migration ☐ 🔵 Coordinate bulk upload with Promaton ☐ ⚠️ Validate sample of migrated records for accuracy ☐ Document any data that failed migration

Security and HIPAA Compliance Verification

Enterprise HIPAA Checklist

Requirement	Verification Method	Owner	Status
Business Associate Agreement executed	Legal review	Legal	☐
Data encryption at rest (AES-256 minimum)	🔵 Vendor attestation	IT	☐
Data encryption in transit (TLS 1.2+)	🔵 Vendor attestation	IT	☐
Access logging and audit trail	Test audit report generation	IT	☐
User authentication (MFA)	Test login flow	IT	☐
Role-based access controls	Review RBAC matrix	IT + Clinical	☐
Data backup and recovery	🔵 Review backup SLA	IT	☐
Incident response plan documented	Request from vendor 🔵	IT	☐
Subprocessor list reviewed	Request from vendor 🔵	Legal	☐
Data residency requirements met	Confirm data center locations 🔵	Legal	☐
Patient data can be deleted on request	Test deletion workflow	IT	☐

Access Control Matrix

Role	View Imaging	View Analysis	Create Plan	Edit Plan	Admin	Billing
Provider	✓	✓	✓	✓	✗	✗
Hygienist	✓	Limited	✗	✗	✗	✗
Front Desk	✗	✗	✗	✗	✗	✓
Office Manager	✓	✓	✗	✗	Limited	✓
Regional Manager	✓	✓	✗	✗	✓	✓
Central IT	✗	✗	✗	✗	✓	✗
CDO	✓	✓	✓	✓	✓	✗

Enterprise Configuration Standards

Standardized Configuration Template (Apply Across All Locations)

Setting	Standard Value	Rationale
Default implant system library	[Your contracted brand(s)]	Consistency in planning
Measurement units	Millimeters	Clinical standard
Report template	Corporate branded	Patient-facing consistency
Notification settings	Email to provider + office manager	Ensure visibility
Auto-logout timeout	15 minutes	Security requirement
Image retention	Per corporate policy (typically 7+ years)	Compliance
AI confidence threshold for alerts	85%	Balance sensitivity/specificity

Location-Specific Configuration (May Vary)

| Setting