CBCT in Aligner Treatment Planning: a Game-Changer or an Unnecessary Complexity?

Imagine you're planning a road trip to a place you've never been before. No stress, no second thoughts — you simply enter the destination into your GPS, and it instantly maps out the best route, guiding you turn by turn. But what if you had to plan the same trip 30 years ago? You’d need a paper map, a carefully planned route, and plenty of patience in case of unexpected detours. Less accuracy, less predictability, more stress.

The same shift has happened in orthodontics. Just a few decades ago, planning precise tooth movements was a difficult task. Today, digital tools allow us to visualize the entire treatment process before even placing the first aligner. But if we compare aligner treatment to a road trip, what are we missing?

The answer: the road itself. While using 3D models in aligner software provides a clear start and finish, it doesn’t always show the terrain—the anatomical landscape we’re working with. And that’s where CBCT scans come in handy. They provide the “road conditions,” helping us navigate obstacles like bone structures and root positions, ensuring a smoother, safer journey for both doctor and patient.

CBCT Integration: The Gold Standard

CBCT (Cone Beam Computed Tomography) has become one of the most reliable and informative diagnostic tools in today's dentistry. Unlike traditional 2D imaging, CBCT provides a comprehensive, 3D view of the patient's dental and skeletal structures, allowing for greater accuracy in diagnosis and treatment planning.

In orthodontics, CBCT is not just useful—it’s essential. From evaluating bone density to assessing root positioning and anatomical limitations, it offers insights that simply aren’t possible with standard X-rays. That’s why combining CBCT with digital treatment planning isn’t just an option; it’s becoming the gold standard in aligner therapy.

Now, let’s take a closer look at how CBCT enhances aligner planning and why it matters for successful treatment outcomes.

Structure of Bone Tissue

One of the most critical factors in orthodontic treatment planning is understanding the availability and quality of bone tissue. If there’s not enough bone, there’s nowhere for the tooth to move. Applying orthodontic forces in areas with insufficient bone can lead to further resorption—or even tooth loss.

With CBCT, orthodontists can assess bone volume and density before starting treatment. This allows them to anticipate potential risks and adjust their approach accordingly. In some cases, this might mean modifying the treatment plan, using additional anchorage like mini-screws, or even preparing the patient with bone augmentation procedures before initiating tooth movement.

Aligning teeth isn’t just about their crowns—root positioning plays a crucial role in achieving stable and functional results. In cases of enamel wear, for example, determining the true root position can be challenging since the crown shape no longer reflects the original anatomy. Without proper visualization, treatment planning becomes a guessing game.

CBCT integration eliminates this uncertainty by providing a full 3D view of the entire tooth, from crown to root. By overlaying CBCT data onto a digital model, orthodontists can visualize the relationship between tooth roots and the cortical plate—one of the key limiting factors in expansion. A heat map highlights root proximity to the cortical bone, giving a clear indication of how much movement is possible without increasing the risk of complications. Red areas indicate where the root is the closest to the cortical plate.

Proximity to Anatomical Structures

Just like a road trip can come with unexpected detours and barriers, tooth movement in orthodontics isn’t always a smooth journey. Certain anatomical structures can act as obstacles, limiting how far or in what direction teeth can move.

Take the maxillary sinus, for example. No matter how advanced aligner materials or attachment protocols become, if the roots of the upper molars are deeply positioned within the sinus, large-scale movements simply won’t be possible—at least not without additional planning. In such cases, orthodontists need to consider alternative mechanics or supplementary anchorage to safely achieve the desired result.

But how do we know where these obstacles are? How close is the sinus? How much will it impact treatment? That’s where CBCT integration makes all the difference. By overlaying CBCT data onto a digital model, orthodontists get a clear, 3D view of these anatomical limitations, allowing for more precise and predictable treatment planning.

Jaw Expansion Limitations

Expansion is at the core of most orthodontic treatments. It’s one of the most natural and biologically favorable movements, helping to create more space and improve overall arch form. But how far can we expand the jaw in each individual case? Every patient is unique, and relying solely on generalized data isn’t enough for precise treatment planning.

This is where CBCT integration makes a difference. By providing a detailed visualization of the relationship between tooth roots and the cortical bone, it helps orthodontists determine the optimal expansion limits for each patient.

CBCT in Aligner Software

Providing a 3D digital model along with standard X-rays might seem sufficient for orthodontic treatment planning. However, integrating CBCT takes precision and predictability to the next level. The question is—how can orthodontists easily incorporate CBCT into their digital workflow?

In eXceed, our advanced web-based aligner software, CBCT scans can be overlaid onto a 3D digital model. This powerful feature enhances treatment planning by offering a comprehensive view of not just the crowns and the gums, but also the roots and surrounding bone structures—everything at once. 

With this integration, clinicians gain crucial insights for:

• Digital Smile Design — Achieve highly accurate aesthetic planning with full anatomical context.

• Positioning & Jaw Expansion — Visualize tooth roots in relation to cortical bone to ensure safe and effective movements.

• Anatomical Limitations — Identify potential obstacles like sinus proximity and prevent complications. 

With CBCT integration, orthodontists can refine their approach, minimize risks, and offer patients the most predictable and effective aligner treatment possible.

Quick Integration

Adding CBCT to your aligner treatment planning is simple. When placing an order in eXceed, you can upload your CBCT scan in DICOM format along with the STL files. Our team will handle the overlay, ensuring precise alignment with the 3D model.

Once processed and done, you’ll receive a detailed and fully customized aligner treatment plan designed by the eXceed team. Before proceeding, you’ll have the opportunity to review the plan carefully and, if necessary, request refinements to ensure optimal treatment outcomes.

All data is securely stored on our cloud-based platform, allowing you to access your treatment plans anytime, anywhere—whether from a desktop or a mobile device.

What are the requirements of a CBCT scan for eXceed aligner treatment planning?

There are no strict technical requirements for CBCT scans. We accept DICOM files (.dcm format) as long as the scan quality is sufficient. Ideally, the scan should:

• Have optimal exposure and contrast for clear visualization;

• Cover all teeth and their roots, including unerupted and impacted ones;

• Be taken with a slightly open bite for better occlusal reference.

Frequently Asked Questions

What are the requirements of a CBCT scan for eXceed aligner treatment planning?

There are no strict technical requirements for CBCT scans. We accept DICOM files (.dcm format) as long as the scan quality is sufficient. Ideally, the scan should:

• Have optimal exposure and contrast for clear visualization;

• Cover all teeth and their roots, including unerupted and impacted ones;

• Be taken with a slightly open bite for better occlusal reference.

Can I submit an order without a CBCT scan?

Yes, you can place an order with a panoramic X-ray, granted you also provide a STL file, photographs (both intraoral and facial), and case objectives. CBCT is optional. 

Does CBCT integration extend the turnaround time?

No, CBCT integration does not typically delay the treatment planning process. Regardless of whether CBCT is included, you will receive a comprehensive aligner treatment plan within 5 business days.

Can I track root movement in the treatment simulation?

Yes! The treatment timelapse in eXceed software includes not just crown movement but also root positioning. This allows you to visualize the full scope of orthodontic changes.

What else can I do with CBCT in the eXceed interface?

You can access a heatmap that shows the proximity of cortical bone to the roots, examine the occlusal surface, and measure anatomical structures using an interactive ruler. For a full list of features, please refer to our manual.

Conclusion

If you're planning a long road trip today, would you rely on paper maps, or would you gather as much information as you could? Orthodontic treatment is very similar in this regard—aligner planning without CBCT is like driving with a two-dimensional map, ignoring the benefits of GPS and real-time navigation.
  
CBCT integration brings that extra layer of precision and predictability, helping orthodontists make well-informed decisions. From assessing bone availability to identifying anatomical structures, it provides helpful insights that 2D X-rays and 3D models alone might overlook.

With eXceed, incorporating CBCT into aligner treatment planning is simple. Our system seamlessly overlays CBCT data onto the 3D model, ensuring you have the most accurate information at every step—without adding extra work to your process.