Aim: This study aimed to evaluate the reliability and agreement of a semi-automated evaluation of the electronic cast–radiograph evaluation (E-CRE) model score, as developed by the American Board of Orthodontics (ABO), compared to manual measurements. Methods: A total of 67 study models of patients who had completed orthodontic treatment were available, both as digital scans and as plaster models. Manual and digital evaluations followed the E‑CRE guidelines, assessing six criteria: alignment, marginal ridges, buccolingual inclination, occlusal relationships, overjet and root angulation, which was assessed visually on panoramic radiographs. The digital models were graded using a semi-automated software tool in OnyxCeph ³ ™ Lab (version 3.5, Image Instruments GmbH, Chemnitz, Germany), while the plaster models were scored manually using the ABO measurement gauge. In addition, 20 models were scored manually and digitally by a second observer to assess interobserver reliability. Results: The interobserver reliability was excellent for digital measurements (intraclass correlation coefficient [ICC] 0.94–1.00) and higher compared to those for manual measurements (ICC 0.90–0.97). The reliability between digital and manual measurements was very high, with correlation coefficients ranging from 0.95 to 0.99. However, the digital evaluation produced slightly higher scores for alignment than the manual measurement (mean difference: +0.93). Conclusion: Semi-automated evaluation of ABO E‑CRE scores using OnyxCeph ³ ™ is highly reliable and involves less interpersonal variance than manual grading. However, scores measured digitally were on average 0.79 point higher than those measured manually (scores below 30 are considered as acceptable treatment outcome).

Background: Aligner workflows range from outsourcing the design and manufacturing process to in-office scanning, planning, and fabrication. This exploratory retrospective study aimed to evaluate whether discrepancies between planned and achieved anterior tooth movements with SureSmile aligners remain within predefined clinical thresholds. Methods: A total of 21 dental arches from 14 patients who underwent SureSmile aligner treatment with in-office fabricated aligners were retrospectively analyzed. Digital models of the planned setup were superimposed on models of the clinically achieved outcomes to assess the accuracy of anterior tooth movements by comparing planned and clinically achieved outcomes. Results: Rotational movements showed larger discrepancies than translational movements. Mean discrepancies for angulation and axial rotation were 3.42 ± 1.50° and 4.50 ± 2.12°, respectively, both exceeding the predefined clinical threshold of 2°. In contrast, translational discrepancies remained below the clinical threshold of 0.5 mm, with mean values of 0.17 ± 0.11 mm for mesiodistal, 0.27 ± 0.16 mm for labiolingual, and 0.38 ± 0.17 mm for vertical movements. Translational discrepancies were significantly lower than the predefined clinical threshold in patient-level analyses, whereas rotational discrepancies were not. Conclusions: In-office SureSmile aligner workflows showed acceptable accuracy for translational anterior tooth movements, whereas angular movements frequently exceeded predefined clinical thresholds.