Accuracy of digital predictions with CAD/CAM labial and lingual appliances: A retrospective cohort study

Purpose: To compare the treatment efficacy and efficiency of the two CAD/CAM customized bracket systems Incognito (lingual) and Insignia (labial) for differences in: 1) ABO Cast and Radiograph Evaluation system scores, 2) efficiency as assessed by three clinical measures of efficiency, and 3) final treatment outcome and the virtual set up. Materials & Methods: Consecutive patients treated with Insignia (n = 21) and Incognito (n = 16) treatment systems had STL Images evaluated at pretreatment, post treatment and virtual set-up (predicted outcome); predicted and post treatment STL images were superimposed upon each other and differences were recorded. Results: Incognito patients had fewer emergency appointments. ABO scores were also better for Incognito in 4 of the 8 categories and in total score; a “pass” total score of <27 was achieved in 87.5% on Incognito cases versus 42.9% of Insignia cases. Predicted versus actual outcomes assessment showed the following: right-left symmetry for incognito (95.2%) and Insignia (75.0%), more efficacious linear tooth movements of <0.5 mm for Incognito (78.6% vs 57.1%), more efficacious angular tooth movements of <2.0° for Insignia (21.4% vs 7.1%). Incognito was more effective with linear predicted versus actual outcomes and more efficaciousness especially in remaining within clinical significance guidelines. Incognito out performed Insignia in the maxilla, especially by staying within the clinical significant guidelines, and Incognito also out performed Insignia in the mandible, except for mandibular tip discrepancies. Conclusions: Based upon the conditions of the present study, the Incognito treatment system was more efficacious than Insignia when the two treatment systems were critically compared.