Digital Orthodontic Setup as a Predictive Tool for Post-treatment Open Gingival Embrasures in Adult Extraction Cases with Fixed Appliances: A Retrospective Study

Objectives To evaluate whether digital orthodontic setups can predict the presence and severity of postoperative open gingival embrasures (OGEs) in adult extraction cases treated with fixed appliances. Materials and Methods This retrospective study included 62 adults treated with four-premolar extractions and fixed appliances (620 anterior interproximal sites). Actual OGEs were assessed on post-treatment intraoral photographs. Predicted OGEs were assessed on digital setups generated on a clear aligner platform. Binary performance was evaluated using accuracy, sensitivity, specificity, PPV, NPV, F1 score, and Cohen’s κ. Severity agreement (modified Jemt grades) was assessed using weighted κ, mean absolute error (MAE), and Spearman’s ρ. Analyses were performed overall and by arch, sex, and site. Results Predicted OGE incidence approximated the observed rate (76.5% vs 71.9%; bias +4.5%). Binary prediction showed high performance (accuracy 91.6%, sensitivity 0.916, specificity 0.918, PPV 97.3%, NPV 77.0%, F1 0.943, κ 0.823). Severity prediction showed substantial agreement (weighted κ 0.716–0.774; MAE 0.194; ρ 0.786), with exact matches in 80.8% of sites and ±1-grade agreement in 99.8%. Conclusions Digital setups provide clinically meaningful prediction of postoperative OGEs after fixed-appliance extraction treatment, with modest overprediction. Clinical Relevance Digital setup–based prediction enables early identification of embrasure sites at higher esthetic risk, supporting proactive soft-tissue risk assessment and informed treatment planning in adult extraction orthodontics.