Cone beam computed tomography integration in clear aligner therapy in the treatment planning of Class II division 2 malocclusion.

OBJECTIVES: To evaluate the impact of cone-beam computed tomography (CBCT) integration on clear aligner therapy (CAT) digital treatment planning for maxillary incisors in patients with Class II division 2 malocclusion. MATERIALS AND METHODS: Digital treatment plans were developed for patients using Spark Approver software (Ormco, Orange, CA, USA), with and without CBCT integration. Planned lingual root torque (LRT) and lingual root movement (LRM) were recorded from the tooth movement table for maxillary incisors that satisfied selection criteria. Predicted lingual dehiscence (PLD) and clinical parameters including number of aligners, prescribed interproximal reduction (IPR), and number of intermediate and challenging tooth movements were recorded. Inferential statistics were used to compare treatment plans developed with and without CBCT. RESULTS: 56 maxillary incisors from 18 patients were assessed. With CBCT integration, planned LRT and LRM were significantly reduced by 51.5% and 42.4%, respectively. PLD per tooth significantly decreased from 3.7 mm (SD: 3.5) without CBCT, to 0.8 mm (SD: 1.3) with CBCT. Although no significant differences were observed in the number of aligners, prescribed IPR, or planned intermediate tooth movements, significantly fewer challenging movements were planned when CBCT was utilized. CONCLUSIONS: CBCT integration into CAT digital treatment planning significantly alters planned root movements, minimizes PLD, and limits challenging tooth movements. Clinicians must carefully review digital treatment plans to identify and modify planned movements that may exceed anatomical limits to ensure alveolar boundaries are respected.