How important are lateral cephalometric radiographs in orthodontic treatment planning?

Influence of Lateral Cephalometric Radiography on Treatment Planning and Preferences in Skeletal Open-Bite Patients: Do Lateral Cephalograms Influence Treatment Planning?

“…The results of this study revealed limited disagreements for treatment modality preferences and no disagreement for extraction decision when the LCRs were omitted. This is in accordance with previous studies questioning the benefit of routine LCR prescription (4)(5)(6)(7). This outcome may lead us to a possible assumption that the routine prescription of the three sets of LCRs may not be due to actual need but as a result of the orthodontist's training.…”

“…However, there are reports pointing at the opposite direction in addition to the effects of extraction being controlled by the clinical via managing extraction spaces (4,5,10,11). This may highlight the importance of such an irreversible decision needed to be taken under solid diagnostic material obtained from the patient.…”

“…It has been reported that data obtained from the LCRs can be used to support the decision of premolar extraction as well as the determination of anchorage need by some specialists (10,11). Similarly, the appliance preference has been found to differ between practitioners depending on diagnostic records, but the consistency of these decisions was reported to be rather low (5,6). The question that arises is, was this influence mainly focused on diagnosis of the malocclusion or could it also determine the treatment planning and its progress as well?…”

“…It provides linear and angular associations for sagittal and vertical levels of facial bone structures but does not comprise the transversal dimension or function -in other words, the third dimension (1,2). This drawback has led to the questioning of routine prescription and interpretation of LCR regarding its influence on specific malocclusions (3)(4)(5)(6)(7).…”

Can less be more in orthodontic diagnosis?

“…Despite all radiation exposure guidelines recommending against routine radiographic exposure of any kind [8][9][10][11][12], some orthodontists are advocating routinely taking cone beam computer tomographs (CBCT) on all orthodontic patients, including children, only to convert them into two dimensional cephalometric radiographs to perform traditional measurements developed over half a century ago [13][14][15][16][17]. Systematic reviews have concluded that there is no high quality evidence to support the use of CBCT in orthodontics [18,19] and cephalometric radiographs have been shown not to contribute significantly to treatment planning decisions [20][21][22]. Despite the radiation we routinely expose our patients to, we frequently plan the position of the teeth based on an unrelated view of the dental arches orientated with the occlusal plane parallel to the floor.…”