Objective: To evaluate an automated software tool for the assessment of dental arch relationships using the modified Huddart and Bodenham (MHB) index. Design: Cohort of 43 models of subjects aged 9-21 with UCLP and the ten GOSLON reference models sets. Method: The 53 sets of plaster models were scored using the MHB index and scanned with a benchtop scanner. The digital models were MHB scored visually using a commercial software program and landmarked for automatic scoring using a software

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... n. Scoring/landmarking was undertaken by three observers and repeated after 1 month. Intra-and inter-observer reproducibility were tested using Cronbach's alpha and intraclass correlation coefficients (ICC) (threshold > 0.9). Bland-Altman plots demonstrated inter-observer agreement for each model format. Random and systematic error with digital landmark identification error were determined using the x, y, and z co-ordinates for 28 models digitized twice 1 month apart using Cronbach's alpha and a t-test, respectively. Results: Intra-operator landmark identification was excellent (Cronbach's alpha = 0.933) with no differences between sessions (P > 0.05). Intra-observer reproducibility was excellent for all examiners (Cronbach's alpha and ICC 0.986-0.988). Inter-observer reproducibility was highest for the software plug-in (0.991), followed by plaster (0.989) and OrthoAnalyzer (0.979) and Bland-Altman plots confirmed no systematic bias and greater consistency of scores with the automated software. Conclusion: The automated MHB software tool is valid, reproducible, and the most objective method of assessing maxillary arch constriction for patients with UCLP. Figure 4 Bland-Altman plots for total modified Huddart and Bodenham scores for all examiners with different mediums. (a) Plaster. (b) Orthoanalyzer. (c) Software plug-in. C.B. Martin et al.