Evaluation of Clear-Aligner-Therapy Software Default Settings for Orthodontic Success Criteria

Objectives: Increasing patient demands have driven multiple Clear Aligner Therapy Systems(CATS) to be used for various ranges of malocclusion, including the complex severe crowding cases. Severity level may pose a challenge in CATS especially if the treatment is digitally designed by the software without any orthodontist involvement. There is limited data on the assessment of CAT software's automatic default settings and its achievement of successful orthodontic treatment outcomes. The aim of this study was to evaluate the predicted post-treatment digital models created from pre-treatment models with mild, moderate and severe crowding that were treated with a CAT software’s default treatment simulation. Pre-treatment models were compared with the digital proposals for various factors such as the maintenance of mandibular dental arch form, inter-canine(ICD)-intermolar(IMD) distances, occlusion, overjet, overbite, and Curve of Spee.
Methods: Pretreatment study models of 54 patients(age 13–25; Class I malocclusion; mild, moderate and severe crowding, n=18) were randomly selected and scanned using ATOS scanBox lab scanner. All cases were digitally treated using uLab software’s full-arch-automatic set-up default treatment simulation function with no modifications. Digital pretreatment and predicted post-treatment ICDs and occlusal parameters were measured and statistically analyzed(paired t-test, regression, pairwise comparisons, p<0.05).
Results: In predicted post-treatment models, ICD increases(38.9%) and decreases(46.3%) were not significant(±0.6mm) in any crowding severity group(p>0.05). The overbite and number of heavy-occlusal-contacts significantly increased while the overjet and curve of Spee significantly decreased(p<0.05). Majority of the mandibular teeth experienced buccal axial inclination(91.7%) and buccal linear protrusion(66.7%).
Conclusions: CAT software’s default simulation treatment without orthodontist involvement could successfully maintain the desired ICD for post-treatment stability in various crowding severities. However, the periodontal health and stability could be jeopardized by tooth movement unsupervised by clinicians, suggesting that allowing CAT software to simulate treatment solely based on artificial intelligence will not allow for proper and healthy occlusal and periodontal relationships.