Comparison of three-dimensional tooth movements in virtual setups using different software packages for clear aligner therapy.

BACKGROUND

With the advent of clear aligner therapy and their increasing popularity across the orthodontic field, many software packages have been introduced that implement the concept of virtual setups and consequently, the fabrication of in-house aligners. The objective of the present study was to evaluate and compare the differences in the resultant tooth movements when the same tooth movement values of virtual setups are implemented into four different software packages for clear aligner treatment, in patients with various degrees of dental crowding.

METHODS

Forty-four stereolithography (STL) files of adult Invisalign-treated patients were included in this in silico study and were divided according to the amount of existent dental crowding into 2 groups; Moderate (2.5-5 mm), and Severe (> 5 mm). Initial STL files were imported into the other three tested software programs (Ortho Analyzer, Maestro 3D Ortho Studio Blue Sky Plan), and the teeth were moved to replicate those performed in the virtual setup from ClinCheck Pro. The final outcome was then exported from the four software packages, with ClinCheck Pro STL files used as references, whereas those from the remaining software considered targets. Superimpositions were performed afterwards using Medit Link software between reference and target STL files to calculate the overall deviation.

RESULTS

Statistically significant deviation values were recorded between ClinCheck-Ortho Analyzer, and those recorded with both ClinCheck-Maestro and ClinCheck-Blue Sky in the moderate crowding group for the upper and lower models (p < 0.05). However, the differences in ClinCheck-Maestro and ClinCheck-Blue Sky deviation values were not statistically significant (p > 0.05). In the severe crowding group, statistically significant variances were documented among the investigated software programs, in contrast to the benchmark (p < 0.05). As per the reported outcomes, the highest deviation was attributed to ClinCheck-Ortho Analyzer, followed by ClinCheck-Blue Sky and ClinCheck-Maestro (p < 0.05).

CONCLUSIONS

With the same tooth movement values provided, the four examined programs produced diverse final virtual tooth setups, with greater variance in cases of severe dental crowding. This deviation arises since every software operates using a distinct algorithm, with a different segmentation method and rotation center for the moving teeth.