Comparison of Automatic and Manual Digital Bolton Analyses: Accuracy of Clear Aligner Design Software
Year: 2026
Type: article
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.
Source: Cumhuriyet Dental Journal
Institution: Muğla University
Language: English
Subfield: Orthodontics
Field: Dentistry
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7141159903