Abstract
References
- 1. Bolton WA. The clinical application of a tooth-size analysis. Am J Orthod Dentofacial Orthop 1962;48(7):504-529.
- 2. Lavelle CL. Maxillary and mandibular tooth size in different racial groups and in different occlusal categories. Am J Orthod 1972;61:29-37.
- 3. Turtinen H, Sarja M, Hyvärinen J, Pirhonen P, Pesonen P, Pirttiniemi P, et al. Associations between Bolton ratio and overjet deviations in a Finnish adult population. Acta Odontol Scand 2021;79(8):593-599.
- 4. Bayram M, Özer M. Mandibular incisor extraction treatment of a class I malocclusion with Bolton discrepancy: a case report. Eur J Dent 2007;1(01):54-59.
- 5. Khalil SK, Mudhir AM, Sirri MR. Accuracy of CBCT and intraoral scanner images for measuring tooth widths and Bolton’s ratio: a comparative study with gold standard (plaster models) in Duhok’s adult population. SN Appl Sci 2023;5(10):257.
- 6. Santoro M, Galkin S, Teredesai M, Nicolay OF, Cangialosi TJ. Comparison of measurements made on digital and plaster models. Am J Orthod Dentofacial Orthop 2003;124(1):101-105.
- 7. Hassan WNW, Othman SA, Chan CS, Ahmad R, Ali SN, Rohim AA. Assessing agreement in measurements of orthodontic study models: digital caliper on plaster models vs 3-dimensional software on models scanned by structured-light scanner. Am J Orthod Dentofacial Orthop 2016;150(5):886-895.
- 8. Grünheid T, Patel N, De Felippe NL, Wey A, Gaillard PR, Larson BE. Accuracy, reproducibility, and time efficiency of dental measurements using different technologies. Am J Orthod Dentofacial Orthop 2014;145(2):157-164.
- 9. Rafiei E, Haerian A, Fadaei Tehrani P, Shokrollahi M. Agreement of in vitro orthodontic measurements on dental plaster casts and digital models using Maestro 3D ortho studio software. Clin Exp Dent Res 2022;8(5):1149-1157.
- 10. Salcedo L, NE HH. Degree of reliability of the assessment of the Bolton analysis in three-dimensional virtual models versus plaster models. a review. Revista Cientifica Odontologica (Universidad Cientifica del Sur) 2023;11(2):e155-e155.
- 11. Shailendran A, Weir T, Freer E, Kerr B. Accuracy and reliability of tooth widths and Bolton ratios measured by ClinCheck Pro. Am J Orthod Dentofacial Orthop 2022;161(1):65-73.
- 12. Tunca Y, Fahrzadeh N, Tunca M. How reliable is the amount of interproximal reduction that the ClinCheck software recommends? Meandros Med Dent J 2024;25(4):481-491.
- 13. Lam M, Hajdarević A, Čirgić E, Sabel N. Validity of digital analysis versus manual analysis on orthodontic casts. J World Fed Orthod 2024;13(5):221-228.
- 14. Adobes Martin M, Lipani E, Bernes Martinez L, Alvarado Lorenzo A, Aiuto R, Garcovich D. Reliability of tooth width measurements delivered by the Clin-Check Pro 6.0 software on digital casts: a cross-sectional study. Int J Environ Res Public Health 2022;19(6):3581
- 15. Teixeira Santana T, Copello F, Marañón-Vásquez GA, Issamu Nojima L, Franzotti Sant’Anna E. Diagnostic performance of ClinCheck, Dolphin Imaging, and 3D Slicer software for Bolton discrepancy analysis. Angle Orthod 2025;95(1):51-56.
- 16. Im J, Kim JY, Yu HS, Lee KJ, Choi SH, Kim JH, et al. Accuracy and efficiency of automatic tooth segmentation in digital dental models using deep learning. Sci Rep 2022:12(1);9429.
- 17. Kalemaj Z, Levrini L. Quantitative evaluation of implemented interproximal enamel reduction during aligner therapy: a prospective observational study. Angle Orthod 2021;91:61-66.
- 18. Morton J, Derakhshan M, Kaza S, Li C. Design of the Invisalign system performance. Semin Orthod 2017;23:3-11.
- 19. Krieger E, Seiferth J, Marinello I, Jung BA, Wriedt S, Jacobs C, et al. Invisalign® treatment in the anterior region: were the predicted tooth movements achieved? J Orofac Orthop 2012;73:365-376.
- 20. Soheilifar S, Mohebi S, Nazila A. Maxillary molar distalization using conventional versus skeletal anchorage devices: a systematic review and meta-analysis. Int Orthod 2019;17(3):415-424.
- 21. Diar-Bakirly S, Feres MFN, Saltaji NH, Flores-Mir C, El-Bialy T. Effectiveness of the transpalatal arch in controlling orthodontic anchorage in maxillary premolar extraction cases: a systematic review and meta-analysis. Angle Orthod 2017;87(1):147-158.
- 22. Yu JH, Kim JH, Liu J, Mangal, U, Ahn HK, Cha JY. Reliability and time-based efficiency of artificial intelligence-based automatic digital model analysis system. Eur J Orthod 2023;45(6): 712-721.
COMPARISON OF AUTOMATIC AND MANUAL DIGITAL BOLTON ANALYSES: ACCURACY OF CLEAR ALIGNER DESIGN SOFTWARE
Abstract
Objectives: This study aimed to compare the accuracy of automated and manual digital Bolton analyses performed using two different clear aligner therapy (CAT) planning software.
Materials and Methods: Digital intraoral scans of 40 patients undergoing CAT were analyzed. Mesiodistal tooth widths and Bolton ratios were measured using: (1) a manual digital method via OrthoViewer software, (2) the ClinCheck system, and (3) DentOne software employing AI-based segmentation. The anterior and total Bolton values, as well as individual tooth width measurements, were statistically compared among the three methods. The Kruskal-Wallis test was performed to compare the differences. The Mann-Whitney U test was used for the post-hoc comparison between the groups. Measurement reliability was assessed using intra- and inter-observer intraclass correlation coefficients (ICC).
Results: No significant differences were observed in anterior Bolton ratios across groups (p>0.05), whereas total Bolton values showed significant differences between software and manual measurements (p<0.05). ClinCheck demonstrated smaller deviations from manual measurements compared to DentOne, particularly for maxillary molars and incisors. The largest discrepancies were observed in the posterior region. For teeth 26 and 16, the average deviations from the manual digital method were 0.56 mm and 0.47 mm for ClinCheck, and 0.84 mm and 0.87 mm for DentOne, respectively.
Conclusions: While the automated Bolton analyses performed by ClinCheck and DentOne are clinically acceptable, statistically significant differences exist when compared to manual digital methods. These discrepancies are more pronounced in posterior teeth, likely due to anatomical complexity and limitations in intraoral scanning. Thus, clinicians should perform meticulous intraoral scans and consider manual verification when interpreting automated Bolton results, particularly for molars and crowded segments.
Ethical Statement
This retrospective study received ethical approval from the Izmir Bakırçay University, Ethics Committee, as per decision number 2226, on 30 April 2025.
References
- 1. Bolton WA. The clinical application of a tooth-size analysis. Am J Orthod Dentofacial Orthop 1962;48(7):504-529.
- 2. Lavelle CL. Maxillary and mandibular tooth size in different racial groups and in different occlusal categories. Am J Orthod 1972;61:29-37.
- 3. Turtinen H, Sarja M, Hyvärinen J, Pirhonen P, Pesonen P, Pirttiniemi P, et al. Associations between Bolton ratio and overjet deviations in a Finnish adult population. Acta Odontol Scand 2021;79(8):593-599.
- 4. Bayram M, Özer M. Mandibular incisor extraction treatment of a class I malocclusion with Bolton discrepancy: a case report. Eur J Dent 2007;1(01):54-59.
- 5. Khalil SK, Mudhir AM, Sirri MR. Accuracy of CBCT and intraoral scanner images for measuring tooth widths and Bolton’s ratio: a comparative study with gold standard (plaster models) in Duhok’s adult population. SN Appl Sci 2023;5(10):257.
- 6. Santoro M, Galkin S, Teredesai M, Nicolay OF, Cangialosi TJ. Comparison of measurements made on digital and plaster models. Am J Orthod Dentofacial Orthop 2003;124(1):101-105.
- 7. Hassan WNW, Othman SA, Chan CS, Ahmad R, Ali SN, Rohim AA. Assessing agreement in measurements of orthodontic study models: digital caliper on plaster models vs 3-dimensional software on models scanned by structured-light scanner. Am J Orthod Dentofacial Orthop 2016;150(5):886-895.
- 8. Grünheid T, Patel N, De Felippe NL, Wey A, Gaillard PR, Larson BE. Accuracy, reproducibility, and time efficiency of dental measurements using different technologies. Am J Orthod Dentofacial Orthop 2014;145(2):157-164.
- 9. Rafiei E, Haerian A, Fadaei Tehrani P, Shokrollahi M. Agreement of in vitro orthodontic measurements on dental plaster casts and digital models using Maestro 3D ortho studio software. Clin Exp Dent Res 2022;8(5):1149-1157.
- 10. Salcedo L, NE HH. Degree of reliability of the assessment of the Bolton analysis in three-dimensional virtual models versus plaster models. a review. Revista Cientifica Odontologica (Universidad Cientifica del Sur) 2023;11(2):e155-e155.
- 11. Shailendran A, Weir T, Freer E, Kerr B. Accuracy and reliability of tooth widths and Bolton ratios measured by ClinCheck Pro. Am J Orthod Dentofacial Orthop 2022;161(1):65-73.
- 12. Tunca Y, Fahrzadeh N, Tunca M. How reliable is the amount of interproximal reduction that the ClinCheck software recommends? Meandros Med Dent J 2024;25(4):481-491.
- 13. Lam M, Hajdarević A, Čirgić E, Sabel N. Validity of digital analysis versus manual analysis on orthodontic casts. J World Fed Orthod 2024;13(5):221-228.
- 14. Adobes Martin M, Lipani E, Bernes Martinez L, Alvarado Lorenzo A, Aiuto R, Garcovich D. Reliability of tooth width measurements delivered by the Clin-Check Pro 6.0 software on digital casts: a cross-sectional study. Int J Environ Res Public Health 2022;19(6):3581
- 15. Teixeira Santana T, Copello F, Marañón-Vásquez GA, Issamu Nojima L, Franzotti Sant’Anna E. Diagnostic performance of ClinCheck, Dolphin Imaging, and 3D Slicer software for Bolton discrepancy analysis. Angle Orthod 2025;95(1):51-56.
- 16. Im J, Kim JY, Yu HS, Lee KJ, Choi SH, Kim JH, et al. Accuracy and efficiency of automatic tooth segmentation in digital dental models using deep learning. Sci Rep 2022:12(1);9429.
- 17. Kalemaj Z, Levrini L. Quantitative evaluation of implemented interproximal enamel reduction during aligner therapy: a prospective observational study. Angle Orthod 2021;91:61-66.
- 18. Morton J, Derakhshan M, Kaza S, Li C. Design of the Invisalign system performance. Semin Orthod 2017;23:3-11.
- 19. Krieger E, Seiferth J, Marinello I, Jung BA, Wriedt S, Jacobs C, et al. Invisalign® treatment in the anterior region: were the predicted tooth movements achieved? J Orofac Orthop 2012;73:365-376.
- 20. Soheilifar S, Mohebi S, Nazila A. Maxillary molar distalization using conventional versus skeletal anchorage devices: a systematic review and meta-analysis. Int Orthod 2019;17(3):415-424.
- 21. Diar-Bakirly S, Feres MFN, Saltaji NH, Flores-Mir C, El-Bialy T. Effectiveness of the transpalatal arch in controlling orthodontic anchorage in maxillary premolar extraction cases: a systematic review and meta-analysis. Angle Orthod 2017;87(1):147-158.
- 22. Yu JH, Kim JH, Liu J, Mangal, U, Ahn HK, Cha JY. Reliability and time-based efficiency of artificial intelligence-based automatic digital model analysis system. Eur J Orthod 2023;45(6): 712-721.
Details
| Primary Language | English |
|---|---|
| Subjects | Orthodontics and Dentofacial Orthopaedics |
| Journal Section | Research Article |
| Authors | |
| Submission Date | July 22, 2025 |
| Acceptance Date | December 2, 2025 |
| Publication Date | March 27, 2026 |
| DOI | https://doi.org/10.7126/cumudj.1747593 |
| IZ | https://izlik.org/JA66AK87WC |
| Published in Issue | Year 2026 Volume: 29 Issue: 1 |
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