Introduction: Current methods to evaluate root position either are inaccurate (panoramic radiograph) or expose patients to relatively large amounts of radiation (cone-beam computed tomography [CBCT]). A method to evaluate root position by generating an expected root position (ERP) setup was recently reported but has not been validated. The purpose of this study was to quantitatively assess the accuracy and reliability of the ERP setup with adequate statistical power. Methods: This retrospective study included 15 subjects who had completed phase 2 orthodontic treatment. An ERP setup was generated for all patients after treatment. The ERP setup was compared with the posttreatment CBCT scan, which served as the control. The mesiodistal angulation and buccolingual inclination of all teeth in both the ERP setup and the posttreatment CBCT scan were measured and compared. Bland-Altman analysis was used to assess interoperator reliability, intraoperator reliability, and agreement between the ERP setup and the posttreatment CBCT scan. Results: Bland-Altman plots showed high interoperator and intraoperator reliabilities. These plots also showed strong agreement between the ERP setup and the posttreatment CBCT scan; 11.8% of teeth measured for mesiodistal angulation and 9.6% of teeth measured for buccolingual inclination were outside the 62.5 range of clinical acceptability. Conclusions: We validated that the method to generate an ERP setup to evaluate root position for posttreatment orthodontic assessment is accurate and reliable.

BackgroundAccurate root position is integral for successful orthodontic treatment. Current methods of monitoring root position are either inaccurate, exhibit poor resolution, or use relatively large amount of radiation relative to the benefits for the patient. The purpose of this study was to present an approach that can monitor root position during orthodontic treatment with minimal radiation.MethodsCone-beam computed tomography (CBCT) scans were taken for a patient at pre-treatment and at a dedicated reset appointment. An extra-oral laser scan of a poured up cast was taken at the reset appointment. An expected root position (ERP) setup, an approximation of the root position at the reset appointment, was generated using the pre-treatment CBCT scan and reset appointment cast. The ERP setup was compared to the CBCT scan taken at the reset appointment which served as the control. Color displacement maps were generated to measure any differences between the expected and true root positions.ResultsColor map displacement analysis after indirect superimposition found displacement differences of 0.021 mm ± 0.396 mm for the maxillary roots and 0.079 mm ± 0.499 mm for the mandibular roots.ConclusionsThis approach was demonstrated in a patient at the reset appointment to have the potential to accurately monitor root positions during treatment in three dimensions without the need for additional radiographs.

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Introduction: Accurate root position is imperative for successful orthodontic treatment that is stable and functional. Current methods to monitor root position are either inaccurate or use relatively high levels of radiation. A method to generate an expected root position (ERP) setup has been reported to have the potential to accurately evaluate root position with minimal radiation. The purpose of this study was to determine the accuracy and reliability of the clinical decisions made on root position using the ERP setup. Methods: This retrospective study included 10 subjects who had pretreatment and midtreatment cone-beam computed tomography (CBCT) scans and study models. An ERP setup was generated for all patients at midtreatment. Four examiners assessed both the CBCT scan and ERP setup and made clinical decisions regarding the root position with each method. Cohen's kappa was determined to assess intraoperator and intermethod reliability. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated to determine the accuracy of the ERP setup. Results: The kappa values for intraoperator reliability for both the CBCT scan and ERP setup fell within the 0.61-0.80 range. The kappa values for intermethod reliability between the CBCT scan and ERP setup fell within the 0.61-0.80 range for all tooth groups. The sensitivity of the ERP setup ranged from 0.72 to 0.90, specificity ranged from 0.89 to 0.97, positive predictive value ranged from 0.57 to 0.85, and negative predictive value ranged from 0.93 to 0.99. Conclusions: This study demonstrated that the ERP setup, when compared with the gold standard CBCT scan, was accurate and reliable in making clinical decisions regarding root position at midtreatment. (Am J Orthod Dentofacial Orthop 2019;156:566-73)

Introduction: Accurate root placement is important for successful orthodontic treatment. Current radiographic techniques to monitor root positions are inaccurate, exhibit poor definition, or use relatively large amounts of radiation in relation to the benefit to the patient. A new methodology that generates an "expected root position" (ERP) setup may be a potential alternative to monitor root position accurately and with minimal radiation. Materials and Methods: This retrospective pilot study included five patients who have completed phase II orthodontic treatment. An ERP setup was generated for all patients at posttreatment. The ERP setup was compared to the posttreatment cone-beam computed tomography (CBCT) scan which served as the control. Mesiodistal angulation and buccolingual inclination of all teeth in both the ERP setup and posttreatment CBCT scans were compared to assess the accuracy of the ERP setup. A power analysis was performed. Results: A total of 128 teeth were measured in this study. Nine teeth (7.0%) were measured for mesiodistal angulation and seven teeth (5.5%) were measured for buccolingual inclination which were outside of the ±2.5° range of clinical acceptability. Conclusion: The methodology of generating an "ERP" has the potential to accurately monitor root movement during orthodontic treatment. The power analysis found that 15 patients would be necessary to validate this methodology with adequate power.