A novel 3D cephalometric analysis using CBCT landmarks
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OBJECTIVES: The aim of this project is to develop a novel 3D cephalometric analysis using anatomical landmarks that cannot be easily viewed on a planar film but on a CBCT image and study the reliability of these measurements between different examiners. METHODS: Fifty CBCT images of patients with normodivergent, Class I skeletal patterns and without any noticeable craniofacial deformities were screened and included in the study based on the lateral cephalograms generated from CBCT data using the Roth/Jarabak Analysis. Fifteen predetermined landmarks that found to be reliable in another associated study were used to define six planes. Measurements were also completed on a human dry skull to confirm accuracy. Eleven different cephalometric measurements were performed by three operators three times using landmarks and planes in 3D. Descriptive statistics (mean and standard deviation) and intra-class correlation coefficient for intra- and inter-examiner reliability was performed. RESULTS: The measurements showed that the means and standard deviations of all three measurers are: for Mandibular A/P: 14.49mm ±2.26; Mandibular deviation: 1.63mm, ±1.19; Maxilla/Mandibular divergence: 24.51°, ±3.85; Maxillary deviation: 0.94mm ±0.5; Pitch (Mandibular Plane), 50.38° ±2.8; Pitch (Maxillary Plane): 74.66° ±3.53; Roll (Mandibular Plane): 87.66° ±2.38, 0.05; Roll (Maxillary Plane): 87.70° ±1.85; Yaw (Maxillary Plane): 4.41°± 2.11; Yaw (Mandibular): 3.61°± 2.43; Maxillary A/P: 2.96mm ±2.26. An interclass correlation was calculated at a range from 0.53 to 0.95. CONCLUSIONS: The means and standard deviations of the measurements can be used as a reference to study. Amongst the operators, we indicate between moderate and excellent reliability. The highest reliability was with measurement mandibular pitch. Lowest reliability was with measurement mandibular roll.