Date of Award

9-26-2025

Department

Department of Orthodontics

First Advisor

Jonas Bianchi

First Committee Member

James Chen

Abstract

Objectives: Clear aligner therapy has been used for a wide range of malocclusions. However, crown-only virtual planning may limit insight into roots and the alveolar housing, potentially affecting diagnosis, risk assessment, and treatment decisions. This study evaluated whether the addition of cone-beam computed tomography (CBCT) information affects clinicians’ decisions during aligner treatment planning. Methods: A cross-sectional online survey was conducted, presenting six de-identified aligner cases first with conventional records (panoramic radiograph, lateral cephalometric tracing, and standardized ClinCheck views) and then representing the same cases with CBCT-integrated models in a different order to reduce recall bias. Each case used ten standardized 0–10 items (0 = not at all, 10 = extremely). Responses were provided at the item level (no averaging). Primary exposure was CBCT vs non-CBCT; outcomes were treated as ordinal. Mixed-effects ordinal logistic regression with random effects for respondent and case produced odds ratios (ORs), 95% CIs, and two-sided p-values. The survey ran from March to July 2025. De-identified data were exported from Qualtrics to Excel. Only complete, non-duplicate submissions were analyzed. Results: Fifty-one clinicians completed the survey and were included in the analysis (orthodontists and residents from the U.S. and internationally). Across the ten variables, CBCT shifted ratings upward in most domains. Effects were largest for perceived root-position accuracy (Q3) and clarity of final tooth position (Q7), followed by diagnosis confidence (Q1). The global judgment of “safe movement within the alveolar housing” (Q4) was the smallest and least consistent. Effects tended to increase with case complexity (mild < moderate < severe). Median ORs across items spanned roughly 1.31–1.98. Conclusions: Adding CBCT integration with the root and bone information to crown-based virtual planning meaningfully altered clinicians’ judgments, especially for root control and anticipated final tooth position. The impact was greater in cases of moderate and severe malocclusion. These findings support the use of selective, indication-based CBCT during aligner planning when root position and alveolar limits are important factors to consider.

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