3D predictability assessment of clear aligners versus fixed appliances using CBCT

Predictability of orthodontic tooth movement varies between clear aligners and fixed appliances, yet three-dimensional comparative evidence remains limited for complex cases. This prospective study randomized 60 complex orthodontic patients to clear aligners (n=30) or fixed appliances (n=30), using baseline/planned/post-treatment CBCT superimposition to quantify accuracy across three planes of space. Clear aligners excelled in incisor torque (87.3% versus 82.2%, p=0.001) and anterior intrusion (91.2% versus 82.8%, p=0.002), while fixed appliances were superior for canine/premolar rotation (88.9% versus 78.6%, p=0.001) and anterior extrusion (85.7% versus 76.2%, p=0.004). Overall treatment predictability was comparable (clear aligners 84.6±7.8% versus fixed 82.3±8.9%, p=0.286), revealing modality-specific strengths for targeted movements. This data help in orthodontic planning by establishing CBCT-based evidence for modality selection based on movement type, enhancing precision in complex cases.