What does this research mean for the field?

AI-driven and manual CBCT tooth segmentation methods provide generally consistent and reliable measurements for arch dimensions and Bolton ratios compared to intraoral scans, though specific anterior Bolton ratio values show discrepancies. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This work aims to evaluate the reliability of AI-based and manual tooth segmentation methods in measuring the Bolton ratio and arch dimensions.

May 17, 2026Open Access

Evaluation of Arch Dimensions and Bolton Ratio in Manual and Artificial Intelligence Tooth Segmentation

Key Points

This work aims to evaluate the reliability of AI-based and manual tooth segmentation methods in measuring the Bolton ratio and arch dimensions.
Included 30 patients from the College of Dentistry/University of Baghdad.
Tooth models were created using IOS and CBCT scans segmented by MIMICS and CephX software.
Statistical analyses, including paired t-tests and ICC, assessed bias and agreement between methods.
No significant bias between CephX and MIMICS methods (p > 0.05).
Significant differences found between CephX vs. IOS and MIMICS vs. IOS for Bolton ratios and arch length (p < 0.05).
Overall reliability was good to excellent; however, moderate to poor agreement for specific Bolton ratio comparisons was noted.

Abstract

Objective A 3D tooth model segmented with the use of deep learning (DL) method program (CephX) as well as MIMICS software (manual segmentation) will be evaluated for reliability in the presented work. In addition, the segmented model was compared with the intraoral scan (IOS)–generated 3D tooth model in terms of the Bolton ratio and arch dimensions. Methods and Materials A total of 30 patients attending the College of Dentistry/University of Baghdad with records of IOSs and CBCT scans were included. CBCT has been transformed into a 3D digital tooth model segmented with the use of MIMICS software and an AI‐based program (CephX), and the Bolton ratio and arch dimensions (length and width) were measured utilizing Geomagic Control X software. Statistical analyses, including the mean and standard deviation, were performed, and a paired t ‐test was used to assess the systematic bias between the three methods. Bland–Altman plots and intraclass correlation (ICC) analysis were used to assess the agreement between the three methods. Results The means of CephX, MIMICS, and IOS of all analyses were mostly similar, and the difference between them was greatest in the anterior Bolton ratio of IOS and CephX images. The systematic bias demonstrated no significant difference ( p value > 0.05) between CephX and MIMICS, but CephX versus IOS and MIMICS versus IOS demonstrated significant differences ( p value < 0.05) in several measurements, such as Bolton ratios and arch length. Agreement using ICC revealed good to excellent reliability overall, but moderate agreement in overall Bolton between MIMICS‐IOS and between CephX‐IOS, anterior Bolton and interpremolar distance between CephX‐MIMICS, and poor agreement in anterior Bolton between MIMICS‐IOS and between CephX‐IOS was found. Bland–Altman plots showed that CephX and MIMICS were consistent, implying minimal systematic bias. Conclusions Digital and AI‐driven tooth segmentation (MIMICS and CephX), and IOS methods generally provide consistent and reliable measurements in terms of the Bolton ratio and arch dimensions. However, caution is advised when interpreting certain Bolton ratio values because discrepancies and lower agreement may occur.

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