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Int Poster J Dent Oral Med 14 (2012), No. 2     15. June 2012

Int Poster J Dent Oral Med 2012, Vol 14 No 2, Poster 590

Precision in Cephalometric Measurements: Comparison of Cone Beam CT Lateral Cephalogram and Direct Digital Lateral Cephalogram

Language: English
 

Authors:
PhD Postgraduate Dr. Osama Al-ali, Teaching Assistant, Prof. Dr. Nasser Sawan, HOD, Assoc. Prof. Dr. Ayham Kaddah,
Department of Orthodontics, Faculty of Dentistry, Damascus University, Damascus, Syria
Prof. Dr. Tancan Uysal,
Department of Orthodontics, Dean of Faculty of Dentistry, Izmir Katip Celebi University, Izmir, Turkey

Date/Event/Venue:
19-23 June, 2011
87th Congress of the European Orthodontic Society
Istanbul, Turkey
 

Introduction

Objective: Determine whether cone beam computed tomography lateral cephalograms (CBCT-LC) are of equal precision in diagnosis and treatment planning as direct digital lateral cephalograms (DD-LC) or not.
 

Material and Methods

Ten skeletal Class II patients were selected randomly from the records of orthodontic department, Damascus University. Using InVivo5 Dental software, CBCT data of each patient was imported and the head position was reoriented digitally, then CBCT-reconstructed lateral cephalograms of the same patients were generated. A total of 20 simultaneously recorded lateral cephalograms (10 DD-LC and 10 CBCT-LC) were analyzed. On each cephalogram, 26 parameters (25 angular and 1 ratio) were traced and measured and repeated after 2 weeks by one examiner (O.A).
Statistical Analyses: A paired samples t-test was used to compare the mean values of differences and intraclass correlation coefficients (ICC) were calculated to determine intra-examiner and inter-group correlations.

Fig. 1a: PAX 400 (VATECH CO., Korea). Fig. 1b: DD-LC.
Fig. 1c: Cephalometric analysis performed using the Viewbox 3.1.1.13 cephalometric software (Halazonetis, Athens, Greece). Fig. 2a: SCANORA (Soredex, Finland).
Fig. 2b-c: CBCT-reconstructed cephalogram created using InVivo5 Dental software (Anatomage, San Jose, CA, USA).
Fig. 3: CBCT 3-D Image. DICOM files were imported and 3-D images were created using InVivo 5 Dental software (Trademark of Anatomage Inc., 111 N. Market St. #800, San Jose, Calif, CA 95113). Fig. 4a: Reoriantation. 3-D images were reoriented as suggested by Cho 2009.*
Fig. 4b-c: Reoriantation. 3-D images were reoriented as suggested by Cho 2009.*
 

Results

The intra-examiner reproducibility for all measurements were not significantly different between the 2 cephalogram types. ICC were found to be high (.862 - .999, P < .001). The differences of measurements obtained from CBCT-LC and their DD-LC counterparts were statistically significant for 7 angular variables (Table 1). The differences were less than two degrees, which is generally within one standard deviation of norm values in conventional cephalometric analysis. The measurements related to the area around the point A were the least precision.

Repeated Measurements Variables Inter-Group Comparison Repeated Measurements
Intra-Examiner Reliability DD LC X CBCT LC Intra-Examiner Reliability
DD LC DD LC CBCT LC paired t-test ICC Sig. CBCT LC
1st session 2nd session ICC Sig. Mean Mean P value 1st session 2nd session ICC Sig.
  Angular (°)  
11,21 10,96 0,962 0,000 NSL^NL 11,21 11,11 0,742 0,971 0,000 11,11 11,11 0,995 0,000
36,78 36,8 0,998 0,000 NSL^ML 36,78 37,54 0,063 09,45 0,000 37,54 37,58 0,998 0,000
69,12 69,34 0,996 0,000 N-S-Gn 69,12 69,82 0,021 0,962 0,000 69,82 69,91 0,998 0,000
125,8 126,1 0,994 0,000 N-S-Ar 125,82 126,39 0,18 0,975 0,000 126,4 126,1 0,996 0,000
144,9 144,7 0,996 0,000 S-Ar-Go 144,86 145,12 0,68 0,973 0,000 145,1 145,5 0,994 0,000
126,1 126 0,997 0,000 Ar-Go-Me 126,1 126,03 0,875 0,987 0,000 126 125,9 0,998 0,000
396,8 396,8 0,998 0,000 Sum (Björk) 396,78 397,54 0,063 0,945 0,000 397,5 397,6 0,998 0,000
51,54 51,47 0,998 0,000 N-Go-Ar 51,54 51,07 0,193 0,981 0,000 51,07 50,94 0,998 0,000
74,54 74,51 0,996 0,000 N-Go-Me 74,54 74,98 0,143 0,955 0,000 74,98 74,98 0,994 0,000
132,9 132,9 0,998 0,000 N-S-Ba 132,93 133,72 0,08 0,939 0,000 133,7 133,5 0,993 0,000
77,54 77,54 0,995 0,000 S-N-Pg 77,54 77,21 0,141 0,971 0,000 77,21 77,16 0,999 0,000
82,83 82,9 0,978 0,000 S-N-A 82,83 83,4 0,029 0,874 0,000 83,4 83,22 0,973 0,000
76,57 76,59 0,996 0,000 S-N-B 76,57 76,28 0,264 0,953 0,000 76,28 76,26 0,998 0,000
6,27 6,32 0,981 0,000 A-N-B 6,27 7,13 0,004 0,783 0,000 7,13 7,00 0,981 0,000
11,29 11,48 0,993 0,000 N-A-Pg 11,29 13,31 0,003 0,843 0,000 13,31 13,07 0,989 0,000
78,71 78,31 0,964 0,000 A-B^NL 78,71 76,89 0,002 0,849 0,000 76,89 77,00 0,989 0,000
82,78 82,36 0,955 0,000 A-Pg^NL 82,78 81,23 0,004 0,863 0,000 81,23 81,27 0,996 0,000
25,54 25,87 0,983 0,000 NL^ML 25,54 26,41 0,039 0,962 0,000 26,41 26,48 0,999 0,000
102,7 102,6 0,999 0,000 U1L^NSL 102,73 102,57 0,871 0,942 0,000 102,6 103,1 0,992 0,000
114 113,5 0,985 0,000 U1L^NL 113,96 113,68 0,749 0,902 0,000 113,7 114,2 0,983 0,000
99,34 98,92 0,961 0,000 U1L^ML 99,34 98,53 0,194 0,809 0,002 98,53 98,04 0,916 0,000
121,1 121,7 0,992 0,000 U1L^L1L 121,13 121,37 0,858 0,901 0,000 121,4 121,3 0,985 0,000
21,59 21,56 0,991 0,000 NSL^OL 21,59 21,34 0,539 0,935 0,000 21,34 21,47 0,914 0,000
10,37 10,62 0,862 0,000 OL^NL 10,37 10,23 0,78 0,872 0,029 10,23 10,34 0,964 0,035
15,18 15,26 0,996 0,000 OL^ML 15,18 16,19 0,12 0,860 0,000 16,19 16,16 0,926 0,000
  Ratio (%)  
62,08 62,08 0,996 0,000 S-Go:N-Me 62,08 61,47 0,088 0,946 0,000 61,47 61,4 0,998 0,000
Tab. 1: Intra-Examiner and Inter-Group Correlations

Conclusion

Precision was similar in both image types. The measurement differences between image types were statistically significant. Current findings substantiated the benefits of CBCT cephalometry in terms of the reliability of two-dimensional cephalometric analysis.
 

Literature

  1. * CHO HJ. A Three-Dimensional Cephalometric Analysis. J Clin Orthod 2009;43(4):235-252.
     

Abbreviations

CBCT-LC: Cone Beam Computed Tomography Lateral Cephalogram.
DD-LC: Direct Digital Lateral Cephalogram.
ICC: intraclass correlation coefficients.
 

This Poster was submitted by Dr. Osama Al-ali.
 

Correspondence address:
PhD Postgraduate Dr. Osama Al-ali
Damascus University
Faculty of Dentistry, Department of Orthodontics
P.O.Box: 10256
Aleppo
Syria