Comparison between automated and manual digital diagnostic setups of orthodontic extraction cases: an in silico study

The aim of the study was to evaluate automated digital diagnostic setup in bimaxillary dentoalveolar protrusion cases using two software packages and to compare them to manual digital setup.

Pre-treatment intraoral scans of 14 patients whose treatment plans involved extraction of four first premolars were imported as Standard Tessellation Language files into dentOne^® software (DIORCO co. ltd, Yongin, South Korea) and Ortho Simulation software (MEDIT Corp, Seoul, South Korea). Following tooth segmentation and selection of the teeth to be extracted, an automatic virtual setup was performed in each software. Moreover, manual virtual setups were performed by an orthodontist using dentOne^® software. Dental arch changes and dental movements and the duration taken to perform the setups were evaluated and compared using the appropriate statistical tests.

The inter-canine, inter-premolar and inter-molar widths did not change significantly following manual virtual setup, while the arch length significantly decreased. The inter-premolar width, inter-molar width and arch length significantly decreased following both automated setups. The manual setup showed significantly greater lingual translation of maxillary and mandibular incisors compared to Ortho Simulation software (mean difference = 5.97 ± 1.10 mm and 7.02 ± 1.29 mm, respectively) and dentOne software (mean difference = 5.73 ± 0.96 mm and 6.95 ± 1.26 mm, respectively). The mesial translation of the maxillary and mandibular molars in Ortho simulation setup (8.35 ± 1.62 mm and 8.69 ± 1.91 mm, respectively) and dentOne setup (7.41 ± 1.28 mm and 7.74 ± 1.90 mm, respectively) was statistically significantly higher than that obtained using the manual setup (- 0.08 ± 0.27 mm, 0.03 ± 0.47 mm, respectively). All setups showed clinically significant lingual inclination of maxillary and mandibular incisors, with the manual setup exhibiting more lingual inclination than both automated setups. Ortho Simulation setup was the fastest method (4.14 ± 0.53 min), followed by dentOne automated setups (7.57 ± 0.94 min), then the manual setup (21.00 ± 1.66 min).

Despite being faster, the automated diagnostic setups for bimaxillary protrusion cases constricted the dental arch and did not manage the extraction spaces well, hence, simulating anchorage loss. These findings highlight the need for manual refinement of the automated setups.