German Dental FHIR Profiles (R4)
0.36.1 - trial-use DE

German Dental FHIR Profiles (R4) - Local Development build (v0.36.1) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Clinical Lab Orders

Clinical Dental Lab Orders

This page describes how DentalLabServiceRequestDE models the complete communication between dental practice and dental laboratory — combining administrative data (BEL II / beb'97 billing) with clinical specifications for the lab technician.

The Gap This Profile Fills

Internationally, no FHIR standard exists for clinical dental laboratory orders. The VDDS Laborschnittstelle (Germany) and its successor eLABZ cover only billing data (BEL II positions, invoices). Clinical information — what shade, what material, what preparation type — is still communicated via free-text notes, paper slips, or proprietary formats.

FHIR has exactly one comparable resource: VisionPrescription for optometry (lens specifications). DentalLabServiceRequestDE follows the same principle: structured clinical parameters for a custom-manufactured medical device.

Standard Scope Clinical Content
VDDS Laborschnittstelle (XML) Billing (BEL II / beb'97) No
eLABZ (TI/KIM) Billing via Telematikinfrastruktur No
ISO 18618 (CAD/CAM) Digital design file transfer Technical only
DentalLabServiceRequestDE Billing + Clinical Yes

Profile Structure

The profile combines an administrative block (SWS 2.0 compatible) with a clinical block via extensions:

Administrative Block (existing)
Element Description
identifier Lab order ID
subject Patient reference
basedOn Link to HKP / CarePlan (Satzart 11)
performer Dental laboratory (Organization)
category Order type: festsitzend, herausnehmbar, kombiniert, reparatur, kfo, schiene, implantat

Associated ChargeItem resources carry BEL II / beb'97 billing positions with bel-punkte and ztl-material extensions.

Clinical Block (new)
Extension Type Description Example
RestorationTypeExt CodeableConcept (0..*) Type of restoration Krone, Bruecke, Teleskop
ToothColorVitaExt CodeableConcept (0..1) Tooth shade (VITA Classical A1-D4) A3
MaterialSpecificationExt CodeableConcept (0..*) Material for framework/veneer Zirkon, NEM, Keramik
PreparationTypeExt CodeableConcept (0..1) Preparation form Stufe, Hohlkehle
AntagonistSituationExt string (0..1) Opposing arch description "Natural dentition with composite on 36"
OcclusionConceptExt CodeableConcept (0..1) Desired occlusion scheme Front-Eckzahn-Fuehrung
ImplantAbutmentExt complex (0..1) Implant system, abutment type, platform diameter Straumann BLT, 4.1mm
Supporting Data
Element Description
bodySite Affected teeth (FDI notation, ISO 3950)
supportingInfo References to digital impressions (STL), photos, bite registrations
note Free-text instructions to the lab technician
occurrencePeriod Requested delivery timeframe

Code Systems

This feature introduces 6 new CodeSystems:

CodeSystem Codes Description
RestorationTypeCS 23 All restoration types (festsitzend, herausnehmbar, KFO, sonstiges)
VitaClassicalCS 20 VITA Classical shade guide A1-D4 incl. Bleach shades
DentalMaterialCS 15 Material classes (keramik, metall, kunststoff, kombinationen)
PreparationTypeCS 5 Preparation forms (Stufe, Hohlkehle, Tangential, etc.)
DentalLabOrderTypeCS 7 Order categories
OcclusionConceptCS 4 Occlusion concepts

All ValueSets use extensible binding — labs and practices can add custom codes.

Examples

Simple: Zirconia Crown on Tooth 26

A monolithic zirconia crown (Stufenpraeparation, shade A3, digital workflow):

Complex: Telescopic Denture on 4 Implants

A combined prosthesis (NEM primary telescopes, PMMA base) on Straumann BLT implants:

Relationship to Other Standards

                    ┌─────────────────────────────────┐
                    │  DentalLabServiceRequestDE       │
                    │  (this profile)                  │
                    │                                  │
                    │  Administrative + Clinical       │
                    └──────────┬──────────────────────┘
                               │
              ┌────────────────┼────────────────┐
              │                │                │
    ┌─────────▼──────┐  ┌─────▼──────┐  ┌──────▼─────────┐
    �� VDDS/eLABZ     │  │ ISO 18618  │  │ VisionPrescript │
    │ (Billing)      │  │ (CAD/CAM)  │  │ (Optik-Analog)  │
    │ BEL II/beb'97  │  │ STL/Design │  │ Sph/Cyl/Axis   │
    └────────────────┘  └────────────┘  └────────────────┘
  • VDDS/eLABZ covers the billing layer — DentalLabServiceRequestDE adds the clinical layer on top
  • ISO 18618 covers CAD/CAM file transfer — referenced via supportingInfo
  • VisionPrescription is the conceptual model — same pattern (clinical specs for custom device), different domain

International Relevance

This profile addresses a gap that exists globally. No country has standardized clinical dental lab orders in FHIR. The extensions and CodeSystems are designed to be internationally applicable:

  • FDI tooth numbering (ISO 3950) — used in 150+ countries
  • VITA shade system — de facto global standard for dental shade matching
  • Material classifications — based on material science, not national codes
  • Preparation types — universal prosthodontic terminology

The billing layer (BEL II / beb'97) is Germany-specific, but the clinical layer is ready for international adoption.