Objectives-To evaluate the registration of 3D models from cone-beam CT (CBCT) images taken before and after orthognathic surgery for the assessment of mandibular anatomy and position.Methods-CBCT scans were taken before and after orthognathic surgery for ten patients with various malocclusions undergoing maxillary surgery only. 3D models were constructed from the CBCT images utilizing semi-automatic segmentation and manual editing. The cranial base was used to register 3D models of pre-and post-surgery scans (1 week). After registration, a novel tool allowed the visual and quantitative assessment of post-operative changes via 2D overlays of superimposed models and 3D coloured displacement maps.Results-3D changes in mandibular rami position after surgical procedures were clearly illustrated by the 3D colour-coded maps. The average displacement of all surfaces was 0.77 mm (SD = 0.17 mm), at the posterior border 0.78 mm (SD = 0.25 mm), and at the condyle 0.70 mm (SD = 0.07 mm). These displacements were close to the image spatial resolution of 0.60 mm. The average interobserver differences were negligible. The range of the interobserver errors for the average of all mandibular rami surface distances was 0.02 mm (SD = 0.01 mm).Conclusion-Our results suggest this method provides a valid and reproducible assessment of craniofacial structures for patients undergoing orthognathic surgery. This technique may be used to identify different patterns of ramus and condylar remodelling following orthognathic surgery.

Introduction In this study, we compared the precision of landmark identification using displays of multi-planar cone-beam computed tomographic (CBCT) volumes and conventional lateral cephalograms (Ceph). Methods Twenty presurgical orthodontic patients were radiographed with conventional Ceph and CBCT techniques. Five observers plotted 24 landmarks using computer displays of multi-planer reconstruction (MPR) CBCT and Ceph views during separate sessions. Absolute differences between each observer’s plot and the mean of all observers were averaged as 1 measure of variability (ODM). The absolute difference of each observer from any other observer was averaged as a second measure of variability (DEO). ANOVA and paired t tests were used to analyze variability differences. Results Radiographic modality and landmark were significant at P <0.0001 for DEO and ODM calculations. DEO calculations of observer variability were consistently greater than ODM. The overall correlation of 1920 paired ODM and DEO measurements was excellent at 0.972. All bilateral landmarks had increased precision when identified in the MPR views. Mediolateral variability was statistically greater than anteroposterior or caudal-cranial variability for 5 landmarks in the MPR views. Conclusions The MPR displays of CBCT volume images provide generally more precise identification of traditional cephalometric landmarks. More precise location of condylion, gonion, and orbitale overcomes the problem of superimposition of these bilateral landmarks seen in Ceph. Greater variability of certain landmarks in the mediolateral direction is probably related to inadequate definition of the landmarks in the third dimension.

CBCT can reproduce conventional cephalometric geometry with similar precision and accuracy. Orthogonal CBCT projections provided greater accuracy of measurement for midsagittal plane dimensions than perspective CBCT or conventional cephalometric images.

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The NewTom 9000 cone beam CT scanner provides better diagnostic and quantitative information on periodontal bone levels in three dimensions than conventional radiography. The accuracy in the anterior aspect of the jaws is limited.