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CBCT and clear aligner software integration

Updated: Mar 6

As dental professionals strive to provide the best possible care, the integration of cutting-edge technologies plays a pivotal role in enhancing treatment planning and outcomes. In 2023, one such advancement that holds great promise is the integration of Cone Beam Computed Tomography (CBCT) in clear aligner treatment planning software.

In this blogpost I will describe the pros and cons regarding CBCT integration in aligner software as of 2024.

screenshot of dental CBCT

Understanding CBCT:

CBCT, a technology that produces detailed 3D images of dental structures, has been widely used in various dental specialties, including orthodontics. Its ability to provide comprehensive visualizations of teeth, roots, and surrounding structures makes it an invaluable tool for precise treatment planning.

Potential benefits of CBCT in Clear Aligner treatment planning:

  1. Improved Diagnostic Accuracy: CBCT allows for a more detailed and accurate assessment of dental anatomy compared to traditional 2D imaging. This enhanced diagnostic capability aids in identifying complex issues such as impactions, root resorption, and bone morphology.

  2. Precise Tooth Movement Prediction: Integrating CBCT data into clear aligner treatment planning software enables clinicians to predict and plan tooth movements with unprecedented accuracy. This ensures more predictable treatment outcomes and reduces the likelihood of mid-treatment adjustments.

  3. Enhanced Treatment Customization: With CBCT, dentists can customize clear aligner treatments based on the patient's unique dental anatomy. This level of customization leads to more efficient and comfortable treatment experiences for patients.

  4. Optimized Root Positioning: Clear aligner treatment aims not only to straighten teeth but also to achieve optimal root positioning. CBCT aids in visualizing root structures, allowing dentists to plan movements that prioritize both esthetics and long-term dental health.

  5. Patient Education and Engagement: The 3D visualizations provided by CBCT can be valuable tools for patient education. Clear communication of treatment plans enhances patient understanding and engagement, fostering a collaborative approach to orthodontic care.

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Invisalign CBCT integration showing teeht, bone, attachments and IPR

Challenges and Considerations:

While the integration of CBCT in clear aligner treatment planning is a promising development, it is essential for dental professionals to be mindful of certain considerations. These may include radiation exposure, cost implications, the need for additional training in interpreting 3D imaging and most importantly: The limitations of the current software solutions.

Limitations realted to the use of CBCT in clear aligner treatment planning

  1. Limited precision No CBCT scanner on the market is able to capture the fine bone (1 mm. and thinner) around the most coronal part of the anterior teeth. 

  2. Flawed surface representation The beautiful 3D images shown in the aligner software (as well as in the CBCT imaging software) are only a software generated surface representation. 

  3. CBCT should only serve as a rough reference The combination of STL and DICOM files (Triangular surface generating shapes and 3D cubes (voxels)) is a whole discussion in itself. It is highly complex and still not precise when it comes to an exact surface representation.  Therefore we should be very careful using the 3D image of the surface of the hard tissue for anything else than a very rough guide.

  4. Static versus dynamic In addition to the CBCT creates a static image of the patient prior to treatment. We currently don’t know what will happen with the bone once we start moving the teeth. 

A fast conclusion would be that a CBCT integrated in the clear aligner software is currently a very rough guide at best. But nothing more. 

Looking Ahead:

As technology continues to advance, the integration of CBCT in clear aligner treatment planning is poised to become more commonplace. Dental professionals should stay informed about updates in software capabilities, attend relevant continuing education courses, and consider how these advancements can benefit their practice and, ultimately, their patients.


The integration of CBCT in clear aligner treatment planning software marks a significant stride forward in the field of orthodontics. By harnessing the power of 3D imaging, dental professionals will be able ot elevate the precision, predictability, and customization of clear aligner treatments in the future. As we navigate the landscape of dental technology in 2024, embracing these advancements will undoubtedly contribute to improved patient outcomes and the continued success of modern orthodontic practices.

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Jesper Hatt DDS smiling to the camera

Kind regards

Jesper Hatt DDS International key opinion leader for 9 years on CBCT and digital workflows for KaVo

Phone: +41 78 268 0078

AlignerService helps dentists create realistic, safe and predictable treatment plans with clear aligners.

Currently, we help approximately 1500 dental practices in 19 different countries. AlignerService is a preferred partner of ClearCorrect.

In addition AlignerService clear aligner experts work with Invisalign, SureSmile and Spark.


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