Validation of a digital tool for Moyers mixed dentition analysis: agreement and efficiency compared with the manual method

Abstract

ABSTRACT Introduction: Mixed dentition analysis is essential for predicting space requirements and guiding early orthodontic decision-making. Moyers analysis is widely used due to its simplicity and clinical applicability, however, manual execution may increase execution time and introduce operator-dependent errors. Objective: This study aimed to develop and validate an automated digital tool based on Moyers analysis, to improve efficiency and support orthodontic education. Material and Methods: This cross-sectional study included 20 participants (10 undergraduate and 10 graduate dental students) who performed mixed dentition analysis on a standardized plaster model using the manual method and a software-based method at separate time points. Agreement between methods was evaluated using intraclass correlation coefficients (ICC), Bland-Altman analysis, and linear regression to assess proportional bias. Execution time was recorded and compared using paired t tests. Participant preference was also assessed. Results: Excellent reliability was observed (ICC > 0.95). No statistically significant differences were found between the manual and software-based methods (p > 0.05), and Bland-Altman analysis demonstrated substantial agreement without proportional bias. The software-based method reduced execution time by 38.2% (p < 0.001). All participants preferred the software-based method. Conclusion: The software-based method demonstrated agreement comparable to the manual Moyers analysis, while significantly reducing execution time. Its usability and efficiency support its application in orthodontic education and clinical workflow optimization.