Reliability of cephalometric superimposition for the assessment of craniofacial changes: a systematic review

Abstract

Summary Background Superimposition of serial cephalometric radiographs enables the assessment of craniofacial changes over time, and therefore, several methods have been suggested in the literature. Objective The aim of the present study is to summarize and critically evaluate the available evidence on the reliability of methods used to superimpose serial cephalometric radiographs. Search methods Electronic searches were performed in MEDLINE, EMBASE, Google Scholar, and Cochrane Databases, without time limit (last update: 1 November 2020). Unpublished literature was searched on the Open Grey and Grey Literature Report databases. Selection criteria Studies that tested the accuracy, precision, or agreement between different cephalometric superimposition techniques, used to evaluate the craniofacial changes due treatment or growth. Data collection and analysis Reference lists of relevant articles were screened and authors were contacted, if needed. All study selection steps, data extraction, and risk of bias (QUADAS-2 tool) assessments were performed independently by two authors on predefined forms. Results There were 27 eligible studies. From these, 17 tested superimpositions methods on the anterior cranial base, 10 on the maxilla and 12 on the mandible. There were three studies that compared superimpositions on the cranial base with those on the maxilla and one that compared the cranial base with the mandibular superimposition. There was high heterogeneity among studies in terms of sample size, growth, radiographic machines, selection criteria, superimposition methods, references, and outcomes measured. Furthermore, almost all studies presented important methodological limitations, with only two studies having unclear risk of bias and the rest 25 presenting high risk. Conclusions Currently, there is no cephalometric superimposition method that has been proved to deliver accurate results. There is an urgent need for further research in this topic, since this is a primary assessment method to assess craniofacial changes over time for several relevant disciplines. Registration PROSPERO (CRD42020200349).

Occlusal characteristics in modern humans with tooth agenesis

“…The sample population was restricted to individuals with white-European ancestry, limiting the generalizability of the findings to other populations 1 , 52 . Also, the analyzed lateral cephalometric radiographs provide valuable information, but have inherent limitations in capturing three-dimensional craniofacial features 53 .…”

Comparison of three-dimensional maxillary growth across spheno-occipital synchondrosis maturation stages

“…In which its late ossification and contribution to post-natal cranial base growth play critical role in facial development [1,2,[50][51][52]. Moreover, the CBCT have been used widely in dental field, so the SOS may be considered as suitable method as CBCT provides the benefits of low-cost, high-resolution, accurate three-dimensional imaging (3D) without the risk of increased radiation exposure to the patient, and easy visualization of superimposed bony structures [53]. On the other hand, Hand -wrist method requires expert knowledge and expenditure of time by the operator, and their accuracy is not very high.…”

Precision of a Hand-Held 3D Surface Scanner in Dry and Wet Skeletal Surfaces: An Ex Vivo Study

“…The facial structures were selected because of their high clinical relevance and importance for human life [ 28 ], as well as because of their complexity in form. The anterior cranial base structures were selected because this area is often used as superimposition reference when comparing consecutive patient scans [ 29 , 30 ], and also because its anatomy is totally different than that of the facial hard tissues. Mandibles were also assessed representing facial structures that might have more resemblance to different skeletal configurations, such as the long bones.…”