Requirements for Electronic Case Submission (ECS)

If you or your orthodontic imaging software can meet the following requirements, you are eligible to submit one or more of your cases using electronic case submission (ECS). Note that ECS enrollment is optional and offered during exam registration.


The requirements for ECS eligibility are as follows:


  1. All patient records for all timepoints within a case, with the exception of study models and periodontal documentation (as necessary), must be submitted in industry standard JPEG format.
  2. Patient records in digital format include all photos, radiographs, tracings, superimpositions and, where necessary, periodontal documentation. See discussion below regarding digital models.
  3. An additional digital record, tracing on cephalogram as one image, is required.
  4. All cephalograms, with and without a tracing overlay, must have a calibration ruler on the image.
  5. All required digital records must be submitted to the ABO one week prior to the first day of exams.

 The following Case Preparation requirements pertain to digital records submitted to the ABO. You must also refer to related discussions on the ABO website for all case requirements.


Records Preparation

  • No notebook required
  • No labels required for digital files. Label must be affixed to plaster models.
  • Industry standard JPEG format (see Perio documentation exception)
  • Doctor, Practice or School name must not be visible in images
  • Format images to ABO specifications
  • Orient each image to the natural line of sight


Bring to the exam

  1. Physical study models 
  2. Stapled copy of each case report
  3. Printout of superimpositions, attached as applicable
  4. Printed montage of digital models from original scanner software, attached as applicable
  5. One folder containing these printed records

Digital Models 


  • Pretreatment and interim or pre-surgical digital models may be submitted in universal file formats (PLY, STL, or OBJ) if they are also constructed according to ABO specifications. Otherwise, they will be submitted in the form of physical models.
  • For digital interim models between Phase One and Phase Two to be acceptable, all active appliances must be removed prior to impression taking.
  • Final models must be submitted in the form of physical models (stone, plaster or 3D printed with accompanying digital file. See ABO Digital Model Requirements).

 Digital Photographs   (required for ECS)


The ABO recommends 24-bit color-depth, JPEG photographic images with medium compression that are appropriately cropped and rotated.


  • Provide photographs in color.
  • All photographs should be of the same dpi and scale.
  • Only individual photo images, not photo composites, are acceptable.


Digital Radiographs    (required for ECS)


  • Provide radiographs in grayscale.
  • All radiographs should be of the same dpi and scale.
  • Required lateral cephalogram must have a calibration mechanism (e.g. a ruler, wire, or image of specified length) visible on the image. 

 This is essential to allow for proper preparation of the cephalometric tracing.  A calibration ruler of 100mm is typical for scanned images, and most direct digital x-ray systems include a scale somewhere in the system.  Alternatively, a 100mm length of wire can be affixed to the cephalometric head stabilizer so that it appears in the image and yet does not interfere with the anatomy.


  •  If submitting a periapical and bitewing radiograph, submit as a composite image.
  •  If submitting supplemental radiographs, submit as composite images.


The ABO recommends that scanned radiographic images be 8-bit grayscale, JPEG with medium compression that are appropriately cropped and rotated. Examinees with direct capture digital x-ray machines should submit their records using the native resolution of their system. 


For example, if your digital panoramic machine captures an 8-bit grayscale, 500x1200 pixel image, please submit it that way, just save it in JPEG format.


Digital Tracings and Superimposed Tracings    (required for ECS)


Computer generated tracings from anatomical points on the radiograph are acceptable, but the examinee is responsible for the accurate representation of all anatomical landmarks, planes and angles. Hand-traced cephalograms and manual superimpositions may be scanned at 100% scale into JPEG images.


Cephalometric Tracing specifications:


  • Tracings must be provided in industry standard JPEG format.
  • Tracings must be rendered in black, blue, or red as specified for level of treatment. All landmarks, reference lines, and measurements must be recorded, preferably in the same color.
  • Additionally, include the tracing and the lateral cephalogram with a calibration ruler as one digital image. For this image, use black, blue, or red for tracing, reference lines and measurements, as specified for level of treatment.
  • All tracings, except superimpositions, must be sized at a 1:1 ratio to the cephalogram. You may need to print and verify a 1:1 ratio prior to uploading.
  • Where your tracing is rendered by software, ensure that the lateral cephalogram and the tracing are saved in a 1:1 ratio to each other by following these steps:
  1. Digitize the ceph and save it as a JPG.
  2. Trace the digitized ceph and save the combined ceph-with-tracing image as a JPG.
  3. Extract the tracing (i.e. hide the ceph), and save the tracing as a JPG.

Superimposition specifications:


  • Superimpositions are not required if radiographs were taken on differing machines; there is a checkbox in the Written Case Report under Results Achieved in which to make note of this.
  • Register the superimpositions using the true radiographic anatomical outlines in accordance with superimposition instructions on this website.
  • Arrange the three superimpositions (Craniofacial, Maxillary, Mandibular) on a single page as demonstrated at Example of Superimpositions on the ABO website.
  • Preferred sizing of each superimposition is at 1:1 ratio to the cephalogram. However, a 1:1 ratio may not be possible using certain software and, therefore, is not required at the current time.
  • The final arrangement must be captured as a JPG. If you are using software that will not capture to JPG, use a screen capture (or print screen) utility, then save as a JPG.


Periodontal Documentation    (for ECS, if necessary)

  •  Provide only as required.
  • Radiographs will be provided in industry standard JPEG format and conform to specifications stated in the Digital Radiographs section
  • Written documentation is provided in PDF format.