Received: 30 July 2021 | Revised: 25 May 2022 | Accepted: 26 May 2022

DOI: 10.1002/cre2.605

ORIGINAL ARTICLE

Agreement of in vitro orthodontic measurements on dental

plaster casts and digital models using Maestro 3D ortho studio
software

Elaheh Rafiei1 | Alireza Haerian1 | Pooya Fadaei Tehrani2 |

Mohammad Shokrollahi2

1
Faculty of Dentistry, University of British
Columbia, Vancouver, British Columbia, Abstract
Canada
Objective: Diagnostic casts are one of the standard components of orthodontic
2
Dental Students Research Center, Shahid
Sadoughi University of Medical Sciences,
records. But they have several drawbacks such as the need for physical space for
Yazd, Iran storage and the risk of breaking due to their brittle composition. Today, the
digitalization of orthodontic models is a progress in orthodontics. The purpose of this
Correspondence
Pooya Fadaei Tehrani, Dahe Fajr Blv. Emam study was to compare and evaluate common orthodontic linear measurements on
Reza St., Dental Students Research Center,
plaster casts and digital 3D models using Maestro 3D ortho studio® scanner and
Faculty of Dentistry, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran. software (AGE Solutions®, Pontedera, Italy).
Email: [email protected]
Materials and Methods: Study casts of 30 orthodontic patients were selected. Tooth

Funding information width, space analysis, Bolton analysis, overjet, overbite, and linear measurements of
Shahid Sadoughi University of Medical dental arch dimensions were performed by two examiners on plaster casts and
Sciences, Yazd, Iran
digital models.
Statistical Analysis: Intra‐ and interexaminer agreements were evaluated in both
manual and digital methods and paired t test was used for evaluating the agreement
between the manual and digital measurement. The significance level was set at 0.05.
Results: The intraexaminer agreement was excellent (ICC > 0.75) for most variables
in both manual and digital methods. The correlation between the two examiners was
significant (p < .05) for most manual and digital measurements. The differences
between the manual and digital measurements, although maybe statistically
significant, were not clinically significant for most variables.
Conclusion: The use of “Maestro 3D” (AGE Solutions, Pontedera, Italy) scanner and
software was acceptable for orthodontic diagnostic measurements instead of study
casts.

KEYWORDS
dental model, orthodontics, plaster casts, software, three‐dimensional imaging

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited.
© 2022 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.

Clin Exp Dent Res. 2022;8:1149–1157. wileyonlinelibrary.com/journal/cre2 | 1149

1150 | RAFIEI ET AL.

1 | INTRODUCTION Anatomodels). The results indicated that tooth width measurements on

digital models can be as accurate as plaster casts and even more
Diagnosis in orthodontics is a critical element in explaining the correct repeatable and faster. Some studies found a statistically significant
goals of treatment (Jiménez‐Gayosso et al., 2018). Diagnostic casts are difference and concluded that measurements on digital models were
one of the standard components of orthodontic records and play an significantly larger (Asquith et al., 2007; Goonewardene et al., 2008;
essential role in diagnosis, patient presentation, treatment planning, Naidu & Freer, 2013; Sousa et al., 2012; Stevens et al., 2006), whereas in
evaluating treatment progress, and maintaining records. Tooth size, other reviews the values measured on digital models were substantially
crowding, spacing, overjet, overbite, and Bolton analysis are routinely smaller (Abizadeh et al., 2012; Mullen et al., 2007; Watanabe‐Kanno
measured manually on models (El‐Zanaty et al., 2010). Direct measure- et al., 2009), so it may be understood that there is no agreement on the
ments on plaster casts using calipers have been accepted as a clinical dimensional accuracy of digital models made by plaster cast scans. Due to
standard, but there are several drawbacks to plaster casts such as the the contradictory results obtained in the previous research and the limited
need for physical space for their storage and the risk of breaking due to amount of research on the accuracy of 3D scanners and orthodontic
their brittle composition (Fleming et al., 2011; Lippold et al., 2015; Wan software produced by the same manufacturer and also because previous
Hassan et al., 2016). Today, digitizing orthodontic dental models is a study (Martin et al., 2015) has shown that the Maestro 3D (AGE
breakthrough in orthodontics, and these virtual models have several Solutions®, Pontedera, Italy) scanner has the highest accuracy compared
benefits such as improved efficiency, rapid retrieval of digital information to many other commercially available desktop orthodontic scanners, the
from patient records, a quick exchange of patient data for consultation purpose of this study was to compare and evaluate in vitro conventional
and referral, cost savings, no need for physical space, elimination of the orthodontic linear measurements on plaster casts and 3D digital models
risk of damage or cracking, and ease of digital measurement using the scanner and software of Maestro 3D ortho studio® (AGE
(Wiranto et al., 2013). So far, many studies have been conducted to Solutions®, Pontedera, Italy).
compare the analysis of digital models with the gold standard method
(caliper measurement of plaster models) (Camardella et al., 2017;
Czarnota et al., 2016; Hassan et al. 2016; Reuschl et al., 2016). In a 2 | M A T E R I A L S AN D M E T H O D S
study conducted by Jiménez‐Gayosso et al. (2018) to evaluate the
accuracy of the Maestro3D Ortho Studio scanner, they concluded that This study was reviewed and approved by the Research Ethics
the manual and digital measurement models were similar for both vertical Committee. A study cast of 30 orthodontic patients referred to the
and transverse measurements. Another study by Grünheid et al. (2014) Department of Orthodontics was selected. Inclusion criteria for
examined the accuracy, reproducibility, and timing of dental measure- the study included: fully erupted permanent dentition (first molar to
ments using three different digital models (emodels, SureSmile models, one side to the other in both jaws), no previous orthodontic treatment,

FIGURE 1 An overview of the Maestro 3D ortho studio® (AGE Solutions®, Pontedera, Italy) environment.
RAFIEI ET AL. | 1151

no structural and morphological abnormalities, no extensive restorations First, all 30 pairs of plaster casts were scanned by the digital optical
that extend to the proximal surface, with no loss of mesiodistal or scanner “Maestro 3D (AGE Solutions, Pontedera, Italy)” with a precision
labiolingual dimension due to caries, repair or fracture and exclusion of 10 μm; each pair of casts was scanned three times. The first scan of
criteria included: casts that were excluded for any reason, such as both models was performed to record their relationship, the second time
inadequate scanning or artifacts. Tooth width, space analysis, Bolton the mandibular casts were scanned separately, and the third time, the
analysis, overjet, overbite, and linear measurements of dental arch maxillary cast was scanned independently. After that, various steps of
dimensions were performed by two examiners on plaster casts using digital file preparation were performed by Maestro 3D ortho studio®
two methods: software (AGE Solutions®, Pontedera, Italy), version 4. Before the
measurement of the desired parameters, three samples were evaluated
1. Traditional measurement by digital caliper “Guang Lu, China” with jointly by two examiners and the choice of points on both plaster and
measurement precision of 0.01 mm, which used no magnification digital models was discussed to calibrate the examiners and decrease the
to measure plaster models manually. amount of interexaminer variability. This joint evaluation was performed
2. Measurement of digital models by Maestro 3D ortho studio® on both digital and plaster models. At first, the variables in both study
®
software (AGE Solutions , Pontedera, Italy), version 4 with methods were determined by the first examiner, who was trained and
0.01 mm accuracy, which has the zoom and rotation capabilities calibrated. The measurements were performed by two examiners (Inter
when analyzing digital models (Figure 1). Examiner Agreement) for 15 plaster and digital models to increase the

T A B L E 1A Intraexaminer agreement
Manual method (plaster casts) Maestro™ digital models
on the manual method (plaster casts) and Variable ICC 95% CI p value ICC CI 95% p value
digital Maestro™ models: Mesiodistal
width of teeth—interclass correlation T‐W 11 0.977 0.932–0.992 <.0001 0.997 0.932–0.992 <.0001
coefficient test T‐W 12 0.959 0.884–0.986 <.0001 0.904 0.738–0.967 <.0001

T‐W 13 0.938 0.827–0.979 <.0001 0.914 0.764–0.970 <.0001

T‐W 14 0.861 0.637–0.951 <.0001 0.938 0.825–0.979 <.0001

T‐W 15 0.957 0.876–0.985 <.0001 0.930 0.806–0.976 <.0001

a
T‐W 16 0.59 0.134–0.842 .008 0.928 0.800–0.975 <.0001

T‐W 21 0.996 0.989–0.999 <.0001 0.979 0.940–0.993 <.0001

T‐W 22 0.994 0.982–0.998 <.0001 0.958 0.880–0.986 <.0001

T‐W 23 0.994 0.982–0.998 <.0001 0.967 0.904–0.989 <.0001

T‐W 24 0.976 0.930–0.992 <.0001 0.955 0.871–0.985 <.0001

T‐W 25 0.941 0.833–0.980 <.0001 0.954 0.870–0.984 <.0001

T‐W 26 0.996 0.901–0.988 <.0001 0.885 0.692–0.690 <.0001

T‐W 31 0.990 0.971–0.997 <.0001 0.785 0.472–0.922 <.0001

a
T‐W 32 0.974 0.925–0.991 <.0001 0.612 0.166–0.851 .006

T‐W 33 0.786 0.475–0.923 <.0001 0.840 0.588–0.943 <.0001

T‐W 34 0.891 0.707–0.962 <.0001 0.418 a

−0/100 – 0.758 0.054

T‐W 35 0.917 0.772–0.971 <.0001 0.904 0.738–0.967 <.0001

T‐W 36 0.908 0.748–0.968 <.0001 0.982 0.948–0.994 <.0001

T‐W 41 0.175 a
−0.353–0.619 .258 0.880 0.682–0.958 .002

T‐W 42 0.954 0.869–0.984 <.0001 0.893 0.713–0.963 <.0001

T‐W 43 0.834 0.575–0.941 <.0001 0.866 0.647–0.953 <.0001

T‐W 44 0.969 0.909–0.989 <.0001 0.797 0.497–0.927 <.0001

T‐W 45 0.941 0.833–0.980 .005 0.301a −0.231–0.694 .129

T‐W 46 0.907 0.747–0.968 <.0001 0.009a −0.490–0.504 .487

Abbreviations: CI, confidence interval; ICC, interclass correlation; T‐W, tooth width.
a
ICC < 0.75.
1152 | RAFIEI ET AL.

accuracy of the research and the reliability of the results. The first width 46 (ICC = 0.009) specified in the table marked with (a). Agreement
examiner also performed the measurements on the 15 plaster and digital in these parameters was insufficient, moderate to good, moderate to
models after 2 weeks (Intra Examiner Agreement). After completion of good, and moderate to good, respectively. The ICC value in the manual
manual and digital measurements, data were entered into SPSS software measurement method (plaster casts) was at its lowest for tooth width 41
(v. 23; IBM, NY, USA). Then statistical analysis was done by the (ICC = 0.175), and on the digital models for tooth width 46 (ICC = 0.009).
mentioned software. Intraexaminer agreement for both manual and
digital methods was evaluated separately by statistical analysis of
interclass correlation coefficients (ICC). Pearson correlation statistical 3.2 | Interexaminer agreement
analysis was performed to evaluate interexaminer agreement in both
manual and digital measurement methods. A paired t test was used for The interexaminer agreement showed that the correlation between the
the statistical analysis of the two methods. The significance level was set two examiners in the manual method was significant for all variables
at 0.05. (p < .05) (Tables 2A and 2B) except for tooth width 46 (p = .23), and in the
digital method (3D models) the correlation between two examiners was
significant for all variables (Tables 2A and 2B) except for tooth width 45
3 | RESULTS (p = .174) and tooth width 46 (p = .561) marked by (a) in the table.

3.1 | Intraexaminer agreement

3.3 | Agreement between measurements made
ICC of jaw measurements (single measurements) averaged 0.90 ± 0.02 for manually (plaster casts) compared to Maestro® digital
manual methods and 0.86 ± 0.03 for digital models. The intraexaminer models
agreement for all measurements in the manual method was excellent
(ICC > 0.75) (Tables 1A and 1B), except for the parameters: width 41 For some of the measured variables, p < .05 indicated a
(ICC = 0.175), width 16 (ICC = 0.592), anterior Bolton ratio (ICC = 0.70), statistically significant difference between the manual and digital
total Bolton ratio (ICC = 0.688) which are marked with (a) in the table. methods (Tables 3A and 3B). But according to the American
Agreement in these parameters was insufficient, moderate to good, Board of Orthodontics Objective Grading System (ABO OGS), a
moderate to good, and moderate to good, respectively. The intraexaminer difference of less than 0.5 mm in the vertical, horizontal,
agreement for digital measurement models were excellent for all and anterior−posterior measurements is not clinically signifi-
parameters (ICC > 0.75) (Tables 1A and 1B), except for the parameters cant (Torassian et al., 2010). Hence, mean differences of less than
width 32 (ICC = 0.612), width 34 (ICC = 0.418), width 45 (ICC = 0.301), 0.5 mm in the measurement of tooth width and linear parameters

T A B L E 1B Intraexaminer agreement
Manual method (plaster casts) Maestro™ digital models
Variable ICC CI 95% p value ICC CI 95% p value on the manual method (plaster casts) and
digital models of Maestro™: Linear
Max. Space available 0.998 0.995–0.999 <.0001 0.994 0.981–0.998 <.0001 parameters—interclass correlation
Man. Space available 0.991 0.974–0.997 <.0001 0.991 0.973–0.997 <.0001 coefficient test

Max. Space required 0.991 0.975–0.997 <.0001 0.991 0.974–0.997 <.0001

Man. Space required 0.983 0.951–0.994 <.0001 0.948 0.52–0.982 <.0001

a
Anterior Bolton ratio 0.703 0.316–0.889 .001 0.783 0.468–0.922 <.0001
a
Total Bolton ratio 0.688 0.289–0.883 .002 0.843 0.595–0.944 <.0001

Max. IMW 0.999 0.998–1.000 <.0001 0.998 0.995–0.999 <.0001

Man. IMW 0.998 0.994–0.999 <.0001 0.987 0.962–0.996 <.0001

Max. ICW 0.998 0.995–0.999 <.0001 0.996 0.989–0.999 <.0001

Man. ICW 0.998 0.995–0.999 <.0001 0.998 0.994–0.999 <.0001

Overjet 0.995 0.986–0.998 <.0001 0.940 0.832–0.979 <.0001

Overbite 0.999 0.998–1.000 <.0001 0.985 0.957–0.995 <.0001

Abbreviations: CI, confidence interval; ICC, interclass correlation; ICW, intercanine width; IMW,
intermolar width; Man, mandibular; Max, maxillary.
a
ICC < 0.75.
RAFIEI ET AL. | 1153

T A B L E 2B Interexaminer agreement on the manual method

T A B L E 2A Interexaminer agreement on the manual method
(plaster casts) and digital Maestro™ models: Linear parameters—
(plaster casts) and digital Maestro™ models: Mesiodistal width of
Pearson correlation test
teeth—Pearson correlation test
Manual method Maestro™
Manual method Maestro™
(plaster casts) digital models
(plaster casts) digital models
Pearson Pearson
Pearson Pearson
Variable correlation p value correlation p value
Variable correlation p value correlation p value
Max. Space 0.982 <.0001 0.953 <.0001
T‐ W 11 0.897 <.0001 0.946 <.0001
available
T‐ W 12 0.926 <.0001 0.897 <.0001
Man. Space 0.926 <.0001 0.952 <.0001
T‐ W 13 0.926 <.0001 0.925 <.0001 available

T‐ W 14 0.762 0.001 0.925 <.0001 Max. Space 0.954 <.0001 0.981 <.0001
required
T‐ W 15 0.888 <.0001 0.848 <.0001
Man. Space 0.951 <.0001 0.956 <.0001
T‐ W 16 0.727 .002 0.908 <.0001
required
T‐ W 21 0.946 <.0001 0.934 <.0001
Anterior Bolton 0.700 .004 0.658 .008
T‐ W 22 0.905 <.0001 0.927 <.0001 ratio

T‐ W 23 0.889 <.0001 0.901 <.0001 Total Bolton 0.609 .016 0.750 .001
ratio
T‐ W 24 0.969 <.0001 0.880 <.0001
Max. IMW 0.995 <.0001 0.995 <.0001
T‐ W 25 0.913 <.0001 0.876 <.0001
Man. IMW 0.987 <.0001 0.978 <.0001
T‐ W 26 0.891 <.0001 0.948 <.0001
Max. ICW 0.991 <.0001 0.995 <.0001
T‐ W 31 0.816 <.0001 0.863 <.0001
Man. ICW 0.966 <.0001 0.960 <.0001
T‐ W 32 0.899 <.0001 0.690 .004
Overjet 0.946 <.0001 0.936 <.0001
T‐ W 33 0.903 <.0001 0.922 <.0001
Overbite 0.994 <.0001 0.963 <.0001
T‐ W 34 0.947 <.0001 0.951 <.0001
Abbreviations: ICW, intercanine width; IMW, intermolar width; Man,
T‐ W 35 0.949 <.0001 0.918 <.0001 Mandibular; Max, Maxillary.
T‐ W 36 0.858 <.0001 0.935 <.0001

T‐ W 41 0.896 <.0001 0.899 <.0001

T‐ W 42 0.858 <.0001 0.902 <.0001 4 | D IS CU SS IO N

T‐ W 43 0.911 <.0001 0.899 <.0001

T‐ W 44 0.954 <.0001 0.888 <.0001 The present study was performed to evaluate and compare different
orthodontic parameters on plaster casts and digital models using
T‐ W 45 0.772 .001 0.371a .174
Maestro 3D ortho studio® software and Maestro 3D scanner (AGE
a a
T‐ W 46 0.854 .23 0.163 .561 Solutions, Pontedera, Italy). ICC of jaw measurements in the present
Abbreviation: T‐W, tooth width. study for manual and digital models was excellent according to a
a
Statistically insignificant correlations. study conducted by Roberts and Richmond (1997). Czarnota
et al. (2016) reported that intraexaminer reliability for some of the
parameters was low. In that study, ICC for digital measurements of
between the two methods, although may be statistically signifi- the width 41 parameter was at its lowest (ICC = 0.61), and in the
cant, are not clinically significant. The mean difference between manual method, it was at its lowest for the overjet parameter
total Bolton ratios and anterior Bolton ratios in manual and digital (ICC = 0.82). Mullen et al. (2007) found that intraexaminer agreement
methods were 0.67% and 1.03%, respectively, and these values was slightly higher when using the manual method (plaster casts)
were converted to millimeters (mm) to assess their clinical compared to the digital method. They hypothesized that this
relevance (Naidu & Freer, 2013). Using Bolton's formula and difference was due to the use of a different version of the software
mean tooth width in the whole specimen, 0.67% difference in for the second measurement in the digital method. In the present
overall Bolton ratios was 0.73 mm in the tooth size and the study also intraexaminer reliability, although being excellent in both
difference (discrepancy) of 1.03% in the anterior Bolton ratios methods, was slightly higher in the manual method compared to the
was 1.32 mm in the tooth size, which is not clinically significant digital technique. One explanation could be due to the examiner's
according to Proffit et al. (2018). lower experience in using software for measuring digital models.
1154 | RAFIEI ET AL.

T A B L E 3A Agreement between measurements made manually (plaster casts) compared to Maestro™ digital models: Mesiodistal width of
teeth—paired t test

Mean Mean
Pairs Mean ± SD differences p value Pairs Mean ± SD differences p value
a
M‐W11 8.67 ± 0.62 0.12 .020 M‐W31 5.54 ± 0.34 0.09 .002a

D‐W11 8.56 ± 0.64 D‐W31 5.45 ± 0.36

M‐W12 6.94 ± 0.72 0.22 <.0001 a

M‐W32 6.02 ± 0.37 −0.02 .597

D‐W12 6.72 ± 0.69 D‐W32 6.00 ± 0.37

a
M‐W13 7.80 ± 0.60 0.11 .046 M‐W33 6.77 ± 0.52 0.06 .104

D‐W13 7.70 ± 0.49 D‐W33 6.71 ± 0.45

a
M‐W14 6.96 ± 0.52 0.11 .003 M‐W34 7.14 ± 0.54 0.08 .012a

D‐W14 7.07 ± 0.51 D‐W34 7.22 ± 0.56

M‐W15 6.63 ± 0.47 −0.12 .009 a

M‐W35 7.17 ± 0.53 −0.13 .002a

D‐W15 6.75 ± 0.56 D‐W35 7.30 ± 0.54

a
M‐W16 10.13 ± 0.87 0.27 .019 M‐W36 10.98 ± 0.59 0.10 .021a

D‐W16 10.40 ± 0.67 D‐W36 11.08 ± 0.56

a
M‐W21 8.75 ± 0.67 0.12 .001 M‐W41 5.50 ± 0.30 0.03 .030a

D‐W21 8.63 ± 0.61 D‐W41 5.47 ± 0.33

M‐W22 6.97 ± 0.68 −0.18 <.0001 a

M‐W42 5.98 ± 0.50 0.02 .515

D‐W22 6.79 ± 0.72 D‐W42 6.00 ± 0.45

M‐W23 7.81 ± 0.46 0.16 <.0001a M‐W43 6.72 ± 0.49 −0.04 .363

D‐W23 7.64 ± 0.46 D‐W43 6.69 ± 0.43

M‐W24 7.05 ± 0.49 0.05 .051 M‐W44 7.20 ± 0.55 −0.06 .138

D‐W24 7.10 ± 0.48 D‐W44 7.26 ± 0.57

M‐W25 6.62 ± 0.48 −0.06 .123 M‐W45 6.94 ± 0.52 0.34 .028a

D‐W25 6.68 ± 0.47 D‐W45 7.27 ± 0.92

M‐W26 10.17 ± 0.60 0.09 .088 M‐W46 10.91 ± 0.59 0.02 .919

D‐W26 10.26 ± 0.62 D‐W46 10.90 ± 0.95

Abbreviations: D‐W, digital width; M‐W, manual width; SD, standard deviation.
a
Statistically significant.

Another explanation is the better repeatability of the manual method experience of the examiners who measure the variables can still
which can be attributed to the possibility of physical landmark cause measurement errors (Hassan et al., 2016). In the present study,
identification on the plaster casts. The amount of training and the mean differences between the two methods in measuring tooth
coordination of the two examiners in determining the reference widths and linear parameters were less than 0.5 mm except for
points before their formal measurement can affect interexaminer maxillary space available parameters (0.59 mm), and required space in
reliability. Due to the calibration performed to identify landmarks the maxilla (0.57 mm) and intermolar width in the maxilla (1.55 mm).
between the two examiners in the present study, this issue was According to the American Board of Orthodontics Objective Grading
minimized. According to the results of the present study in both System (ABO OGS), a difference of less than 0.5 mm in the vertical,
manual and digital methods, if the practice and coordination of the horizontal, and anterior−posterior measurements is not clinically
reference points are sufficient, regardless of different examiners or significant. The difference between the required and available
time intervals, they are reliable measurement tools. In general, in the maxillary space parameters between the manual and digital methods
present study, we tried to reduce the systematic error in the can be attributed to the physical barrier of plaster casts, which can
measurements by performing the calibration process; however, the prevent the teeth from being measured properly due to the crowding
fatigue caused by a large number of measurements and the low of teeth. In other words, adjacent teeth can prevent the caliper tip
RAFIEI ET AL. | 1155

T A B L E 3B Agreement between measurements made manually (plaster casts) compared to Maestro™ digital models: Linear parameters—
paired t test

Pairs Mean ± SD Mean differences p value Pairs Mean ± SD Mean differences p value

Manual Max. Space available 74.35 ± 5.40 0.59 a

.088 Manual Max. IMW 46.52 ± 8.22 −1.55 a
.309

Digital Max. Space available 74.94 ± 5.42 Digital Max. IMW 48.07 ± 2.65

Manual Man. Space available 65.02 ± 4.24 −0.16 .396 Manual Man. IMW 42.35 ± 2.58 −0.02 .624

Digital Man. Space available 65.17 ± 4.09 Digital Man. IMW 43.33 ± 2.65

Manual Max. space required 74.19 ± 4.69 −0.57 a

<.0001 b
Manual Max. ICW 33.28 ± 2.94 0.03 .474

Digital Max. space required 73.63 ± 4.46 Digital Max. ICW 33.25 ± 2.88

Manual Man. space required 64.98 ± 3.73 −0.38 .071 Manual Man. ICW 25.62 ± 2.60 −0.01 .749

Digital Man. space required 65.36 ± 3.81 Digital Man. ICW 25.60 ± 2.57
b
Manual Anterior Bolton ratio 77.93 ± 2.65 1.03% <.0001 Manual Overjet 3.25 ± 2.22 0.07 .615

Digital Anterior Bolton ratio 78.96 ± 6.69 Digital Overjet 3.18 ± 2.27

Manual Total Bolton ratio 92.02 ± 2.50 0.67% .003b Manual Overbite 2.98 ± 1.75 −0.11 .074

Digital Total Bolton ratio 92.69 ± 2.18 Digital Overbite 2.87 ± 1.80

Abbreviations: ICW, intercanine width; IMW, intermolar width; Man, Mandibular; Max, Maxillary; SD, standard deviation.
a
Clinically significant.
b
Statistically significant.

from being placed correctly during the measurement process, which orthodontic problem list (Proffit et al., 2018). In the present study,
may compromise the accuracy of the results. However, the clinical considering insignificant clinical differences in the measurement of Bolton
difference in the required space parameter in the maxilla can be ratios between the manual and digital methods, it seems that the ease of
because this parameter is the result of the sum of several separate calculating the Bolton ratios by software in the digital method can confirm
parameters, and as a result of the sum of the individual measure- the better performance of this method compared to the manual method.
ments, their measurement error increases and becomes clinically Repeat scanning of plaster casts due to artifacts was one of the executive
meaningful. The difference between the manual and digital methods problems of this study. It is recommended that for evaluating the
in the available and required maxillary space parameters was 0.59 accuracy of the scanner and software studied, a similar study be
and 0.57 mm, respectively, although clinically significant, but this conducted in samples with different crowding rates (mild, moderate, and
difference was very close to 0.5 mm. The difference in intermolar severe).
width can also be related to the instability in determining the points
of interest for measuring intermolar width on the cusp tips of the
upper first molar teeth. In general, the accuracy of the digital 5 | CONCLUSION
measurement of dental models depends strongly on the correct
determination of the points. 1. Although the measurements performed by Maestro 3D ortho studio®
Identifying a three‐dimensional relationship on a two‐dimensional software (AGE Solutions®, Pontedera, Italy) on 3D digital models
computer monitor is an essential factor when measuring. Stevens scanned by Maestro 3D scanners had some significant differences in
et al. (2006) noted that, unlike plaster casts that provide accurate 3D some parameters with the measurements made by the gold standard
representation, the partial rotation of digital models on the computer method (i.e., plaster cast measurements by digital calipers), the
screen could rapidly alter operator perception. Therefore, examiners need differences were minimal in most landmarks and were not clinically
to rotate the digital models to make sure the landmarks are correctly significant.
identified. This action can reduce the efficiency of measurements 2. This study demonstrates that the Maestro LED noncontact 3D
compared to plaster casts. However, some authors argue that digital optical scanner and the related software, Maestro Ortho Studio®
models are more efficient for measuring Bolton ratios than plaster models (AGE Solutions®, Pontedera, Italy) are clinically useful. So, it could
because the software can calculate these ratios automatically after they be an additional option to the systems currently available for
are measured (Lemos et al., 2015; Quimby et al., 2004; Tomassetti producing 3D models.
et al., 2001). A Bolton discrepancy of less than 1.5 mm is rarely significant, 3. If the examiners have sufficient pre‐training, the Maestro scanner
but larger discrepancies create treatment problems in achieving ideal and software are reliable measurement tools and can be a good
interdigitation, overjet, and overbite, and must be included in the option for replacing plaster casts in orthodontic diagnostic fields.
1156 | RAFIEI ET AL.

AUTHOR CONTRIBUTIONS El‐Zanaty, H. M., El‐Beialy, A. R., Abou El‐Ezz, A. M., Attia, K. H., El‐Bialy,
A. R., & Mostafa, Y. A. (2010). Three‐dimensional dental measure-
ments: An alternative to plaster models. American Journal of
Pooya Fadaei Tehrani contributed to reviewing and editing the
Orthodontics and Dentofacial Orthopedics, 137(2), 259–265.
manuscript and was a major contributor to the writing. Elaheh Rafiei https://doi.org/10.1016/j.ajodo.2008.04.030
planned the methodology of the study and administrated the project Fleming, P. S., Marinho, V., & Johal, A. (2011). Orthodontic measurements
and was a major contributor to the writing of the manuscript. Alireza on digital study models compared with plaster models: A systematic
review. Orthodontics & Craniofacial Research, 14(1), 1–16. https://
Haerian contributed to reviewing and editing the manuscript and also
doi.org/10.1111/j.1601-6343.2010.01503.x
provided the resources. Mohammad Shokrollahi performed the Goonewardene, R. W., Goonewardene, M. S., Razza, J. M., & Murray, K.
investigation and was a major contributor to the writing of the (2008). Accuracy and validity of space analysis and irregularity index
manuscript. All authors read and approved the final manuscript. measurements using digital models. Australian Orthodontic Journal,
24(2), 83–90.
Grünheid, T., Patel, N., De Felippe, N. L., Wey, A., Gaillard, P. R., &
A C KN O W L E D G M E N T S
Larson, B. E. (2014). Accuracy, reproducibility, and time efficiency of
The authors gratefully acknowledge that this report is based on a dental measurements using different technologies. American Journal
thesis that was submitted to the School of Dentistry, Shahid of Orthodontics and Dentofacial Orthopedics, 145(2), 157–164.
Sadoughi University of Medical Sciences, in partial fulfillment of the https://doi.org/10.1016/j.ajodo.2013.10.012
Jiménez‐Gayosso, S. I., Lara‐Carrillo, E., López‐González, S., Medina‐Solís,
requirement for the DDS degree (#867). This study was financially
C. E., Scougall‐Vilchis, R. J., Hernández‐Martínez, C. T., Colomé‐Ruiz,
supported and approved by the Vice Chancellor for Research at G. E., & Escoffié‐Ramirez, M. (2018). Difference between manual
Shahid Sadoughi University of Medical Sciences, Yazd, Iran. and digital measurements of dental arches of orthodontic patients.
Medicine, 97(22), e10887. https://doi.org/10.1097/MD.
0000000000010887
CO NFL I CT OF INTERES T
Lemos, L. S., Rebello, I. M., Vogel, C. J., & Barbosa, M. C. (2015). Reliability
The authors declare no conflict of interest. of measurements made on scanned cast models using the 3 Shape R
700 scanner. Dento Maxillo Facial Radiology, 44(6), 20140337.
D A TA A V A I L A B I L I T Y S T A T E M E N T https://doi.org/10.1259/dmfr.20140337
Lippold, C., Kirschneck, C., Schreiber, K., Abukiress, S., Tahvildari, A.,
The data sets used and analyzed during the current study are
Moiseenko, T., & Danesh, G. (2015). Methodological accuracy of
available from the corresponding author on reasonable request. digital and manual model analysis in orthodontics—A retrospective
clinical study. Computers in Biology and Medicine, 62, 103–109.
ETHICS STATEME NT https://doi.org/10.1016/j.compbiomed.2015.04.012
Martin, C. B., Chalmers, E. V., McIntyre, G. T., Cochrane, H., &
This study was reviewed and approved by the Research Ethics
Mossey, P. A. (2015). Orthodontic scanners: What's available?
Committee of Shahid Sadoughi University of Medical Sciences under Journal of Orthodontics, 42(2), 136–143. https://doi.org/10.1179/
the code of IR. SSU. REC.1396.141. 1465313315Y.0000000001
Mullen, S. R., Martin, C. A., Ngan, P., & Gladwin, M. (2007). Accuracy of
space analysis with emodels and plaster models. American Journal of
ORCID
Orthodontics and Dentofacial Orthopedics, 132(3), 346–352. https://
Elaheh Rafiei http://orcid.org/0000-0003-4204-8953
doi.org/10.1016/j.ajodo.2005.08.044
Alireza Haerian https://orcid.org/0000-0003-0086-9331 Naidu, D., & Freer, T. J. (2013). Validity, reliability, and reproducibility of
Pooya Fadaei Tehrani http://orcid.org/0000-0001-9021-9484 the iOC intraoral scanner: a comparison of tooth widths and Bolton
ratios. American Journal of Orthodontics and Dentofacial Orthopedics,
144(2), 304–310. https://doi.org/10.1016/j.ajodo.2013.04.011
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