Predictability of an in-office orthodontic aligner: a case report

Abstract

Contemporary orthodontics increasingly seeks treatment alternatives that combine aesthetics, comfort, and effectiveness, among which clear aligners have gained substantial prominence. First introduced in 1945 and popularized in 1997, aligners are considered a less invasive and more predictable option compared to fixed appliances. However, evidence remains limited regarding the accuracy of planned versus achieved tooth movements, particularly with in-office manufactured aligners. This prospective case report describes the treatment of a 53-year-old male patient presenting with Class II malocclusion and moderate crowding, managed using in-office fabricated aligners to correct malocclusion and create implant spaces. Digital models in STL format were analyzed through three-dimensional superimposition using MeshLab software to compare clinical outcomes with the virtual treatment plan. Two calibrated examiners performed all measurements to ensure intra- and inter-examiner reliability. In the initial treatment phase, the mean positional deviation between planned and achieved tooth positions was 0.1886 mm in the upper arch and 0.0727 mm in the lower arch. After refinement, these deviations decreased to 0.0685 mm and 0.0353 mm, respectively representing an improvement of over 60% in accuracy. These discrepancies fall within clinically acceptable thresholds reported in the literature. Overall, the results indicate that in-office aligners can achieve satisfactory predictability, especially when complemented by clinical adjustments and refinements. Despite the inherent limitations of plastic materials and biological variability in tooth movement, the findings support that, with precise planning and ongoing monitoring, in-office aligners can provide reliable outcomes and expand therapeutic possibilities in contemporary orthodontic practice.