Validity of 2D lateral cephalometry in orthodontics: a systematic review

Abstract

Lateral cephalometric radiography is commonly used as a standard tool in orthodontic assessment and treatment planning. The aim of this study was to evaluate the available scientific literature and existing evidence for the validation of using lateral cephalometric imaging for orthodontic treatment planning. The secondary objective was to determine the accuracy and reliability of this technique. We did not attempt to evaluate the value of this radiographic technique for other purposes. A literature search was performed using specific keywords on electronic databases: Ovid MEDLINE, Scopus and Web of Science. Two reviewers selected relevant articles, corresponding to predetermined inclusion criteria. The electronic search was followed by a hand search of the reference lists of relevant papers. Two reviewers assessed the level of evidence of relevant publications as high, moderate or low. Based on this, the evidence grade for diagnostic efficacy was rated as strong, moderately strong, limited or insufficient. The initial search revealed 784 articles listed in MEDLINE (Ovid), 1,034 in Scopus and 264 articles in the Web of Science. Only 17 articles met the inclusion criteria and were selected for qualitative synthesis. Results showed seven studies on the role of cephalometry in orthodontic treatment planning, eight concerning cephalometric measurements and landmark identification and two on cephalometric analysis. It is surprising that, notwithstanding the 968 articles published in peer-reviewed journals, scientific evidence on the usefulness of this radiographic technique in orthodontics is still lacking, with contradictory results. More rigorous research on a larger study population should be performed to achieve full evidence on this topic.

Three-dimensional positional assessment of glenoid fossae and mandibular condyles in patients with Class II subdivision malocclusion

“…9,10,11 The current study corroborated the recent findings of Li et al, 11 who reported right-and left-side differences in spatial positioning of glenoid fossae of patients with Class II subdivision malocclusion. Although they assessed the position of glenoid fossae in Class II subdivision in comparison with Class I patients, the present study is the first to have compared Class II subdivision with skeletal Class II patients.…”

“…7,8 Research has shown that to evaluate facial skeletal asymmetries, three-dimensional (3D) imaging is mandatory. 9 Indeed, with the increased use of cone beam computed tomography (CBCT), studies have found results contrasting those of previous 2D investigations. Recent 3D evidence has shown that a Class II subdivision malocclusion might be associated not only with asymmetric occlusal pattern but also with skeletal components, [9][10][11] and 3D studies show great potential to aid in the visualization of the skull and TMJ structures.…”

“…9 Indeed, with the increased use of cone beam computed tomography (CBCT), studies have found results contrasting those of previous 2D investigations. Recent 3D evidence has shown that a Class II subdivision malocclusion might be associated not only with asymmetric occlusal pattern but also with skeletal components, [9][10][11] and 3D studies show great potential to aid in the visualization of the skull and TMJ structures. [9][10][11][12] Minich et al 10 compared Class II subdivision patients with Class I controls, and although they found significant skeletal and occlusal differences between the groups, dental components contributed to twothirds of all asymmetry.…”

“…Recent 3D evidence has shown that a Class II subdivision malocclusion might be associated not only with asymmetric occlusal pattern but also with skeletal components, [9][10][11] and 3D studies show great potential to aid in the visualization of the skull and TMJ structures. [9][10][11][12] Minich et al 10 compared Class II subdivision patients with Class I controls, and although they found significant skeletal and occlusal differences between the groups, dental components contributed to twothirds of all asymmetry. Li et al, 11 who also compared Class II subdivision and Class I malocclusions, showed that asymmetric patterns contributed majorly to the distal positioning of glenoid fossae.…”

How Do Landmark Deviations Affect Angular Measurements? The Concept of Individual Cephalometric Calibration

“…Hence, computer-aided methods are currently the most clinically efficient techniques for cephalometric analyses. The aforementioned problem of random error, especially as it relates to the reproducibility of landmark identification, has been the subject of numerous studies [4,11]. However, to our knowledge, none of these previous studies has addressed the possible influence of landmark errors on cephalometric angular measurements.…”