Quantitative Comparison of Bone and Dental Morphology Between Invisalign® Integrated CBCT Images and Conventional CBCT Images

Background/Objectives: A recent feature in the Invisalign® system allowed integration of cone-beam computed tomography (CBCT) with intraoral scans, thereby enabling visualization of the tooth roots and surrounding alveolar bone. Here, we aimed to compare differences between anatomical measurements obtained from integrated CBCT using Invisalign® software and conventional CBCT images. Methods: In this cross-sectional study, we included 45 adult patients (mean age 29.53 ± 7.66 years). Alveolar bone width was measured at the crestal, mid-root, and apical levels and the root length, maxillary and mandibular outer and inner transverse widths, and symphyseal width were assessed. Intra-examiner reliability was assessed using intraclass correlation coefficients. Paired t-tests were used to compare the two methods, and Bland–Altman analysis was used to evaluate agreement. Results: Intra-examiner reliability demonstrated excellent agreement for all measurements (intraclass correlation coefficients > 0.90). Integrated CBCT models showed greater alveolar bone width, symphyseal width, and interbuccal transverse measurements than conventional CBCT, whereas the root length and interlingual transverse widths were underestimated. Most of the differences between the two methods were statistically significant (p < 0.05), although 5 of the 12 crestal measurements did not reach statistical significance (p > 0.05). For most measurements, the mean absolute differences were below 0.7 mm, except for root length, which showed larger discrepancies. Bland–Altman analysis revealed good agreement between the methods, with most observations lying within the 95% limits of agreement and no evident proportional bias. Conclusions: Most measured variables showed significant differences between integrated and conventional CBCT (p < 0.05), ranging from 0.7 mm to 1.3 mm; however, at the crestal level, 5/12 measurements showed no statistically significant difference between methods (p > 0.05).