Value-addition of lateral cephalometric radiographs in orthodontic diagnosis and treatment planning

Abstract

Objective To investigate the value-addition of obtaining lateral cephalometric radiographs during the treatment planning phase of orthodontic treatment. Materials and Methods The records of 100 orthodontic patients were presented to seven scorers during two phases that were 6 weeks apart. In the first phase, scorers completed a seven-question survey with questions regarding treatment planning. They were given various diagnostic records that did not include a lateral cephalometric radiograph. Six weeks later, the same scorers completed the same survey for the same patient cases with the same diagnostic records that additionally included a lateral cephalometric radiograph. Correlation coefficients were used to calculate intrarater agreement and inter-rater agreement within the study. Results Cohen's kappa values showed moderate to almost perfect agreement for the majority of survey questions. Intrarater agreement ranged between 0.430 and 1. Cronbach's alpha reliability statistics showed good interrater agreement for all questions in the survey. Agreement ranged from 0.710 to 0.913 across the survey questions. Diagnosing Angle classification of occlusion had the highest level of agreement and differentiating between skeletal and dental malocclusion had the lowest level of agreement. Conclusions The lateral cephalometric radiograph is not a necessary diagnostic tool for most cases in orthodontic diagnosis and treatment planning. Weighing the usefulness of a lateral cephalometric on a case-by-case basis should be recommended to align with the principle of ALARA (as low as reasonably achievable), especially in a primarily pediatric population.

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“…U literaturi, u većini objavljenih istraživanja (10 -14), upotrebljavali su se lateralni kefalogrami za procjenu SA-e. Lateralni kefalogrami standardni su zapisi pri planiranju ortodontske terapije. Oni daju važne podatke za kefalometrijsku analizu kostiju, zuba, mekog tkiva i dišnih putova te projekcije vratnih kralješaka (15). Za određivanje SA-e korišteno je nekoliko metoda, uključujući metodu sazrijevanja vratnog kralješka (CVM) (10) i procjenu drugoga, trećega i četvrtoga vratnog kralješka (C2-4) (11,12).…”

“…Lateral cephalograms are standard treatment records when planning an orthodontic treatment. They provide significant data for a cephalometric analysis of the bones, teeth, soft tissue, and the airway of the head as well as the projections of the cervical vertebrae (15). Several methods, including the cervical vertebral maturation (CVM) method (10) and evaluation of second, third, and fourth cervical vertebrae (C2-4) (11,12) have been used to determine SA.…”

Teleorthodontics: Where Are We Going? From Skepticism to the Clinical Applications of a New Medical Communication and Management System

“…Conventionally, the diagnostic process in orthodontics is based on the analysis of specific records, such as intraoral and extraoral images, radiographic examinations, and cast stone/digital models [2]. Clinical evaluation, although essential, is not often sufficient to get a comprehensive diagnosis and to generate a detailed problem list, and the treatment planning is generally established after a deep analysis of the diagnostic records acquired [9], including, for example, hard-tissue and soft-tissue cephalometric and profile analysis [10,11]. Seated at the desk in front of a highresolution (HD) monitor, with the patient being far away from the dental office, the orthodontist analyzes the diagnostic records and "take its time" to formulate a definitive diagnosis and to develop an adequate treatment plan to correct malocclusion and to satisfy relative patients' concerns (Figure 1) [12].…”

Estimation of x-ray radiation related cancers in US dental offices: Is it worth the risk?

“…There is no justification for retaining cephalometric radiographs as part of orthodontic diagnosis or treatment planning. [36][37][38][39] By avoiding unnecessary Cephs, which are low dose, the transition to high-dose CBCTs can be prevented. Similarly, the use of high-dose CBCTs to replace low-dose Pans should be avoided.…”