Cephalometric landmark variability among orthodontists and dentomaxillofacial radiologists: a comparative study

Abstract

PurposeThe aim this study was to compare the accuracy of orthodontists and dentomaxillofacial radiologists in identifying 17 commonly used cephalometric landmarks, and to determine the extent of variability associated with each of those landmarks.Materials and MethodsTwenty digital lateral cephalometric radiographs were evaluated by two groups of dental specialists, and 17 cephalometric landmarks were identified. The x and y coordinates of each landmark were recorded. The mean value for each landmark was considered the best estimate and used as the standard. Variation in measurements of the distance between landmarks and measurements of the angles associated with certain landmarks was also assessed by a subset of two observers, and intraobserver and interobserver agreement were evaluated.ResultsIntraclass correlation coefficients were excellent for intraobserver agreement, but only good for interobserver agreement. The least reliable landmark for orthodontists was the gnathion (Gn) point (standard deviation [SD], 5.92 mm), while the orbitale (Or) was the least reliable landmark (SD, 4.41 mm) for dentomaxillofacial radiologists. Furthermore, the condylion (Co)-Gn plane was the least consistent (SD, 4.43 mm).ConclusionWe established that some landmarks were not as reproducible as others, both horizontally and vertically. The most consistently identified landmark in both groups was the lower incisor border, while the least reliable points were Co, Gn, Or, and the anterior nasal spine. Overall, a lower level of reproducibility in the identification of cephalometric landmarks was observed among orthodontists.

Fully Automatic System for Accurate Localisation and Analysis of Cephalometric Landmarks in Lateral Cephalograms

“…The difference in performance between the doctor1-trained and the doctor2-trained systems does not only show that the FALA system replicates the manual annotation accuracy but also highlights that there may be large annotation variations in clinical practice 3 . The latter may be due to different levels of training or experience, and other circumstances such as time pressure and physical condition (e.g.…”

“…Currently in clinical practice, cephalometric landmark positions are identified manually or semi-automatically which is very tedious, time-consuming and prone to inconsistencies within and across orthodontists. Varying levels of orthodontic training and experience may have an impact on inter -observer variations, and time-constraints and other commitments may have an impact on intra -observer consistency 3 .…”

Reliability and Reproducibility of Landmark Identification in Unilateral Cleft Lip and Palate Patients: Digital Lateral Vis-A-Vis CBCT-Derived 3D Cephalograms

“…The landmarks of Gonion, Nasion, Orbitale, and Anterior Nasal Spine (ANS) showed the most considerable median Euclidean distances for both intra- and inter-observer measurements according to Katkar et al 2013 [ 31 ]. According to Durao APR et al, the Gnathion (Gn) point was the least reliable landmark for orthodontists, while the Orbitale (Or) was the least reliable landmark for dentomaxillofacial radiologists [ 32 ].…”

Tau Angle: A New Approach for Assessment of True Sagittal Maxillomandibular Relationship

“…Various previous angles have used points with lower reproducibility like point B and condylion (Co), which reduces authenticity of these parameters. 24 Moreover, localization of Co is difficult due to differential magnification inherent in bilateral structures and resulting image distortion. 25 Several researchers have shown that Co cannot be accurately and consistently located on the closed-mouth lateral cephalogram.…”