Objective: To assess the plotting reproducibility of landmarks on 3-dimensional computed tomography (3D-CT) images through use of the 95% confidence ellipse in order to propose sufficiently stable coordinate systems for 3D-CT measurements. Materials and Methods: Six dentists plotted 19 landmarks twice on 3D-CT images. Scatterplots and the 95% ellipses were produced 3-dimensionally, and the areas of the ellipses were calculated for evaluating the reproducibility of landmarks. [Or], and true porion [Po]) that are frequently used as reference points on cephalograms, Ba showed the smallest areas for all three coordinate axes, indicating high reproducibility. The coronoid process (CP) and the tooth-related landmarks showed relatively high reproducibility. Conclusion: Sufficiently stable coordinate axes could be proposed for different treatments and studies.

Objectives We propose a method for evaluating the reliability of a coordinate system based on maxillofacial skeletal landmarks and use it to assess two coordinate systems. Methods Scatter plots and 95% confidence ellipses of an objective landmark were defined as an index for demonstrating the stability of the coordinate system. A head phantom was positioned horizontally in reference to the Frankfurt horizontal and occlusal planes and subsequently scanned once in each position using cone-beam computed tomography. On the three-dimensional images created with a volume-rendering procedure, six dentists twice set two different coordinate systems: coordinate system 1 was defined by the nasion, sella, and basion, and coordinate system 2 was based on the left orbitale, bilateral porions, and basion. The menton was assigned as an objective landmark. ResultsThe scatter plot and 95% ellipse of the menton indicated the high-level reliability of coordinate system 2. The patterns with the two coordinate systems were similar between data obtained in different head positions.Conclusions The method presented here may be effective for evaluating the reliability (reproducibility) of coordinate systems based on skeletal landmarks.