Accuracy and reliability of magnetic resonance imaging in orthodontic diagnosis and treatment planning-a systematic review and meta-analysis.

BACKGROUND: Magnetic resonance imaging (MRI) is a non-ionizing imaging technique. Using MRI in dentistry may potentially lower the general radiation dose of the examined population, provided MRI can replace various radiation-based images. Furthermore, novel MRI imaging modalities for three-dimensional and two-dimensional cephalometrics have recently been developed for orthodontic diagnosis. OBJECTIVES: This systematic review aimed to determine the diagnostic accuracy and reliability of MRI in orthodontic diagnosis and treatment planning. SEARCH METHODS: An electronic search was conducted on 20 November 2022 in the following databases: PubMed, LILACS, Web of Science, EMBASE, Scopus, and Cochrane. The search was updated on 30 August 2023. Furthermore, a grey literature search was performed in Google Scholar and Open-Grey. SELECTION CRITERIA: This review included descriptive, observational, cohort studies, cross-sectional, case-control studies, and randomized/non-randomized trials related to the research question. The study excluded studies related to patients with syndromes, chronic diseases, craniofacial anomalies, or bone diseases. DATA COLLECTION AND ANALYSIS: The included studies were quality assessed using the "Joanna Brigg's Critical Appraisal Tool for diagnostic test accuracy". The GRADE approach for non-randomized studies was used for strength-of-evidence analysis. RESULTS: Eight of the 10 included studies compared MRI with either cone beam computed tomography or lateral cephalogram and found a high intra- and inter-rater agreement for landmark identification. The risk of bias was high in four studies, moderate in three, and low in three studies. Homogeneity was lacking among the included studies in terms of MRI imaging parameters and sample characteristics. This should be taken into consideration by future studies where uniformity with respect to these parameters may be considered. CONCLUSIONS: Despite dissimilarity and heterogeneity in the sample population and other methodological aspects, all the included studies concluded that MRI enjoyed considerable intra- and inter-examiner reliability and was comparable to current diagnostic standards in orthodontics. Furthermore, the studies agreed on the innovative potential of MRI in radiation-free diagnosis and treatment planning in orthodontics in the future. REGISTRATION: CRD number: CRD420223XXXXX.

Evaluation of orthodontic habits regarding the use of miniplates in the correction of Skeletal Class III.

AIMS: To determine the habits of Orthodontists in the management of moderate skeletal class III patients by using miniplates, and to assess the relationship between the factors that may hinder the implementation of such treatment. MATERIAL AND METHODS: A questionnaire was carried out using the Google Form® platform, which included 18 questions relating to the seniority of the practice of the orthodontists, the preferential treatment, the difficulties encountered, the results obtained, and the frequency of a relapse. RESULTS: Experienced orthodontists (more than 10 years) treated skeletal class III malocclusion with the conventional facemask therapy, whereas orthodontists with less than 5 years of experience shifted to the miniplate technique which presented less dental effect and more skeletal correction with a decreased frequency of relapse. CONCLUSION: High financial cost and increased care load were considered the main obstacles regarding the placement of the titanium miniplates in treating skeletal class III patients.

Evaluation of orthodontists' experience with the surgery first protocol in orthodontic-surgical management.

AIM OF THE STUDY: The aim of this study was to analyze the popularity of surgery first among orthodontists as well as the protocols used for its implementation and to collect the opinions (favorable or unfavorable) of practitioners and patients regarding it. MATERIALS AND METHODS: A questionnaire was sent to a population of dental surgeons qualified in Dentofacial Orthopedics or in the process of specialization (residents) practicing in France. The questionnaire consisted of a total of 27 questions. There were 10 open-ended questions and 17 closed-ended questions (8 binary and 9 multiple choices). The conditional pathway allows the respondent's path through the form to be modified based on their answers. This survey was conducted using Google Forms online survey software. RESULTS: On average, the responding practitioners had 15.9 years of experience, and most of them (78.2%) work in private practice. Most treated between 200 and 400 cases per year, of which 7% were surgical cases. Orthodontists who are familiar with and practice the surgery first protocol use it on average for 7 cases per year. The most frequent indication for the surgery first protocol was: transverse maxillary defects. CONCLUSIONS: Surgery first protocol is a preferred option in cases of high severity since it prevents respiratory worsening during the pre-surgical orthodontic phase. The lack of a standardized protocol for this approach, at the pre-surgical and post-surgical levels, requires an increase in the number of high-level evidence publications to clarify the methods of application of this protocol.

Comparison between Two Methods of Skeletal Growth Evaluation: Cervical Vertebrae Maturations and Middle Phalanx Maturation.

Aim: Growth measurement has always been essential to identify the best time to employ orthopedic or orthodontic appliances. Optimal timing for orthodontic treatment is strictly linked to the identification of periods of craniofacial growth when treatment is more effective.The aim of this study was to compare two different methods, middle phalanx maturation (MPM) and cervical vertebrae maturation (CVM), used to evaluate the stage of facial growth. Materials and methods: The research data was collected from July 2018 to April 2019 at the Dental Clinic of the San Gerardo Hospital in Monza. The study included a sample of 98 patients-46 males and 52 females. For each patient, a latero-lateral teleradiography of the skull and an X-ray on the middle finger of the right hand were obtained.The statistical analysis of the comparison of the stages of skeletal maturation obtained by the MPM and CVM methods was performed using the correlation coefficient for ranks of Spearman. Results: A descriptive statistical analysis of the entire sample of 98 patients was performed (mean age of 12.2 years and median of 12.2 years). The average age of females in every single stage of MPM was significantly lower than the average age of males. Of the total sample, 87 patients (88.8%) showed complete agreement between the two methods. Conclusion: The results obtained from the statistical analysis of this study allowed us to confirm a satisfactory agreement between the two methods.The intermediate phalanx method is a valid and alternative indicator to CVM for the identification of the puberty growth peak. We can, therefore, consider the MPM method a valid indicator of skeletal maturity. How to cite this article: Mirabelli L, Bianco E, Pigato G, et al. Comparison between Two Methods of Skeletal Growth Evaluation: Cervical Vertebrae Maturations and Middle Phalanx Maturation. Int J Clin Pediatr Dent 2023;16(2):327-332.

Implications of occlusal plane in diagnosis and treatment of malocclusion. / 平面对错 畸形诊断和治疗的意义.

Occlusal plane (OP) is one of the essential factors affecting craniofacial morphology and function. The OP not only assists in diagnosing malocclusion but also serves as an important reference for making treatment plans. Patients with different types of malocclusions have different forms of OP. Compared with patients with standard skeletal facial type, the occlusal plane of patients with skeletal class Ⅱ and high angle is steeper, while that of patients with skeletal class Ⅲ and low angle is more even. In orthodontic treatment, adjusting and controlling the OP can promote the normal growth and development of the mandible in most patients with malocclusion during the early stage of growth, while causing favorable rotation of the mandible in some adults with mild-to-moderate malocclusion. For moderate-to-severe malocclusion, the OP rotation by orthodontic-orthognathic treatment can achieve better long-term stability. This article reviews the evolution of the definition of OP and its implications for diagnosing and the guiding treatment of malocclusion.

What is the current state of artificial intelligence applications in dentistry and orthodontics?

BACKGROUND: The use of Artificial Intelligence (AI) in the medical field has the potential to bring about significant improvements in patient care and outcomes. AI is being used in dentistry and more specifically in orthodontics through the development of diagnostic imaging tools, the development of treatment planning tools, and the development of robotic surgery. The aim of this study is to present the latest emerging AI softwares and applications in dental field to benefit from. TYPES OF STUDIES REVIEWED: Search strategies were conducted in three electronic databases, with no date limits in the following databases up to April 30, 2023: MEDLINE, PUBMED, and GOOGLE® SCHOLAR for articles related to AI in dentistry & orthodontics. No inclusion and exclusion criteria were used for the selection of the articles. Most of the articles included (n = 79) are reviews of the literature, retro/prospective studies, systematic reviews and meta-analyses, and observational studies. RESULTS: The use of AI in dentistry and orthodontics is a rapidly growing area of research and development, with the potential to revolutionize the field and bring about significant improvements in patient care and outcomes; this can save clinicians' chair-time and push for more individualized treatment plans. Results from the various studies reported in this review are suggestive that the accuracy of AI-based systems is quite promising and reliable. PRACTICAL IMPLICATIONS: AI application in the healthcare field has proven to be efficient and helpful for the dentist to be more precise in diagnosis and clinical decision-making. These systems can simplify the tasks and provide results in quick time which can save dentists time and help them perform their duties more efficiently. These systems can be of greater aid and can be used as auxiliary support for dentists with lesser experience.

Using a digital platform to establish odontometric variation based on race, gender and Angle classification.

Orthodontists often encounter significant clinical challenges in the finishing stages of treatment due to a disproportion in interarch tooth size relationships. Despite the increasing presence of digital technology and concomitant focus on customized treatment approaches, there is a gap in the knowledge of how generating tooth size data using digital versus traditional methods may impact our treatment regime. OBJECTIVE: This study aimed to compare the prevalence of tooth size discrepancies using digital models and a digitally based cast analysis in our cohort based on (i) Angle's Classification; (ii) gender and (iii) race. MATERIALS AND METHODS: The mesiodistal widths of teeth in 101 digital models were assessed using computerized odontometric software. A Chi-square test was used to determine the prevalence of tooth size disproportions among the study groups. The differences between all three groups of the cohort were analysed using a three-way analysis of variance (ANOVA). RESULTS: An overall Bolton tooth size discrepancy (TSD) prevalence of 36.6% was observed in our study cohort; 26.7% had an anterior Bolton TSD. No differences existed in the prevalence of tooth size discrepancies between male and female subjects as well as between the different malocclusion groups (P > .05). Caucasian subjects had a statistically significant smaller prevalence of TSD compared to Black and Hispanic patients (P < .05). CONCLUSION: The prevalence results in this study illuminate how relatively common TSD is and underscores the importance of proper diagnosis. Our findings also suggest that racial background may be an influential factor in the presence of TSD.

Implications of occlusal plane in diagnosis and treatment of malocclusion / 浙江大学学报·医学版

Occlusal plane (OP) is one of the essential factors affecting craniofacial morphology and function. The OP not only assists in diagnosing malocclusion but also serves as an important reference for making treatment plans. Patients with different types of malocclusions have different forms of OP. Compared with patients with standard skeletal facial type, the occlusal plane of patients with skeletal class Ⅱ and high angle is steeper, while that of patients with skeletal class Ⅲ and low angle is more even. In orthodontic treatment, adjusting and controlling the OP can promote the normal growth and development of the mandible in most patients with malocclusion during the early stage of growth, while causing favorable rotation of the mandible in some adults with mild-to-moderate malocclusion. For moderate-to-severe malocclusion, the OP rotation by orthodontic-orthognathic treatment can achieve better long-term stability. This article reviews the evolution of the definition of OP and its implications for diagnosing and the guiding treatment of malocclusion.

Development, Application, and Performance of Artificial Intelligence in Cephalometric Landmark Identification and Diagnosis: A Systematic Review.

This study aimed to analyze the existing literature on how artificial intelligence is being used to support the identification of cephalometric landmarks. The systematic analysis of literature was carried out by performing an extensive search in PubMed/MEDLINE, Google Scholar, Cochrane, Scopus, and Science Direct databases. Articles published in the last ten years were selected after applying the inclusion and exclusion criteria. A total of 17 full-text articles were systematically appraised. The Cochrane Handbook for Systematic Reviews of Interventions (CHSRI) and Newcastle-Ottawa quality assessment scale (NOS) were adopted for quality analysis of the included studies. The artificial intelligence systems were mainly based on deep learning-based convolutional neural networks (CNNs) in the included studies. The majority of the studies proposed that AI-based automatic cephalometric analyses provide clinically acceptable diagnostic performance. They have worked remarkably well, with accuracy and precision similar to the trained orthodontist. Moreover, they can simplify cephalometric analysis and provide a quick outcome in practice. Therefore, they are of great benefit to orthodontists, as with these systems they can perform tasks more efficiently.

Accuracy of one-step automated orthodontic diagnosis model using a convolutional neural network and lateral cephalogram images with different qualities obtained from nationwide multi-hospitals.

OBJECTIVE: The purpose of this study was to investigate the accuracy of one-step automated orthodontic diagnosis of skeletodental discrepancies using a convolutional neural network (CNN) and lateral cephalogram images with different qualities from nationwide multi-hospitals. METHODS: Among 2,174 lateral cephalograms, 1,993 cephalograms from two hospitals were used for training and internal test sets and 181 cephalograms from eight other hospitals were used for an external test set. They were divided into three classification groups according to anteroposterior skeletal discrepancies (Class I, II, and III), vertical skeletal discrepancies (normodivergent, hypodivergent, and hyperdivergent patterns), and vertical dental discrepancies (normal overbite, deep bite, and open bite) as a gold standard. Pre-trained DenseNet-169 was used as a CNN classifier model. Diagnostic performance was evaluated by receiver operating characteristic (ROC) analysis, t-stochastic neighbor embedding (t-SNE), and gradientweighted class activation mapping (Grad-CAM). RESULTS: In the ROC analysis, the mean area under the curve and the mean accuracy of all classifications were high with both internal and external test sets (all, > 0.89 and > 0.80). In the t-SNE analysis, our model succeeded in creating good separation between three classification groups. Grad-CAM figures showed differences in the location and size of the focus areas between three classification groups in each diagnosis. CONCLUSIONS: Since the accuracy of our model was validated with both internal and external test sets, it shows the possible usefulness of a one-step automated orthodontic diagnosis tool using a CNN model. However, it still needs technical improvement in terms of classifying vertical dental discrepancies.

Can anteroposterior skeletal pattern be determined from a silhouetted profile photograph? A cross-sectional study.

OBJECTIVE: To determine the degree to which the anteroposterior (AP) skeletal jaw relation can accurately be determined from a silhouetted clinical profile photograph and whether the level of agreement is influenced by patient vertical proportions. DESIGN: Cross-sectional study. SETTING: University Dental Hospital of Manchester, United Kingdom. PARTICIPANTS: Specialist orthodontists. METHOD: Eight specialist orthodontists assessed 37 silhouetted profile photographs of individuals aged 11-19 years and determined the class and severity of AP skeletal pattern. These assessments were compared to corresponding lateral cephalometric radiographs, where ANB values, supplemented by an Eastman Correction and a Wits Appraisal, where appropriate, were used for sagittal skeletal classification. RESULTS: The agreement between silhouette and cephalometric AP determination yielded a weighted kappa score of 0.207 (95% confidence interval [CI] 0.135-0.278), which indicates only a fair level of agreement. The silhouetted sagittal skeletal pattern classification, along with severity, agreed with the lateral cephalometric radiograph in 29% of instances. Class III individuals were identified correctly 19.2% of the time. There was a statistically significant difference in kappa scores between the high angle (K= 0.439; 95% CI 0.310-0.568) and low angle (K = 0.068; 95% CI 0.007-0.130) patients (P < 0.001), as well as the high and average angle (K= 0.151; 95% CI 0.031-0.270) patients (P < 0.05). CONCLUSION: AP skeletal pattern, as determined from a lateral cephalometric radiograph, has only a fair level of agreement to that from a silhouetted profile photograph. Vertical proportions were shown to have a significant effect on the determination of the sagittal skeletal pattern and class III skeletal patterns were shown to be the most difficult to identify from profile silhouettes.

Who Seeks Clear Aligner Therapy? A European Cross-National Real-World Data Analysis.

A key step prior to clear aligner therapy (CAT) is the clinical examination and case selection, which includes understanding the specific orthodontic problem to be managed and the wider evaluation of oral health. Seeking CAT may further differ along sociodemographic parameters or across countries, as may perceived orthodontic treatment needs and oral health. We aimed to characterize patients seeking CAT across five European countries. Anonymized real-life data from one large CAT provider (DrSmile, Berlin, Germany) was retrospectively sampled for the period 1 November 2021−31 December 2021. A total of 15,015 patients (68.4% females, 31.6% males, with an age range of 18−81 years, median 30.0 years) were included. The cross-national comparison revealed a significant difference in gender distribution (p < 0.001/Chi-square), with the highest proportion of males in Italy (434/1199, 36.2%) and the lowest in Poland (457/1600, 28.6%); generally, more females sought CAT. The largest motivational factor in all countries for seeking CAT was crowding, in both males and females. By and large, patients paid out of pocket for CAT. The prevalence of caries, periodontitis, and craniomandibular dysfunction as well as the numbers of missing teeth were generally low, albeit with significant differences between sociodemographic groups and countries for caries and periodontitis. Patients seeking CAT showed a low prevalence in oral conditions but differed in their sociodemographic characteristics across countries. Dentists and orthodontists should consider these country-specific differences when planning CAT.

Progress on application of artificial intelligence technology in orthodontic diagnosis and treatment / 口腔疾病防治

@#In recent years, artificial intelligence technology has developed rapidly and has been gradually applied to the fields of clinical image data processing, auxiliary diagnosis and prognosis evaluation. Research has shown that it can simplify doctors’ clinical tasks, quickly provide analysis and processing results, and has high accuracy. In terms of orthodontic diagnosis and treatment, artificial intelligence can assist in the rapid fixation of two-dimensional and three-dimensional cephalometric measurements. In addition, it is also widely used in the efficient processing and analysis of three-dimensional dental molds data, and shows considerable advantages in determining deciding whether orthodontic treatment needs tooth extraction, thus assisting in judging the stage of growth and development, orthodontic prognosis and aesthetic evaluation. Although the application of artificial intelligence technology is limited by the quantity and quality of training data, combining it with orthodontic clinical diagnosis and treatment can provide faster and more effective analysis and diagnosis and support more accurate diagnosis and treatment decisions. This paper reviews the current application of artificial intelligence technology in orthodontic diagnosis and treatment in the hope that orthodontists can rationally treat and use artificial intelligence technology in the clinic, and make artificial intelligence better serve orthodontic clinical diagnosis and treatment, so as to promote the further development of intelligent orthodontic diagnosis and treatment processes.

Updating Standards of Facial Growth in Romanian Children and Adolescents Using the Anthropometric Method-A Pilot Study.

The anthropometric method is an important tri-dimensional and non-invasive assessment instrument for accurate diagnosis in paedodontics, orthodontics, and other medical fields. Our aim was to propose a technique that is accessible for clinicians and to determine the reference values for Romanian children and adolescents for the facial parameters selected. We proposed three basic instruments: a plastic compass, a ruler, and a digital caliper. Eighty-five children and adolescents (62% girls and 38% boys), aged between 3.5 and 14.5 years, were included in the study. We selected eight transversal, 12 vertical, and three sagittal measurements. Facial indices, according to Farkas L.G., were directly determined. The correlations between facial and general growth parameters, using Pearson correlation coefficient, for the entire sample were significant, direct, and strong for the following: Zy-Zy, Go-Go, N-Gn, N-Sn, Sto-Gn, Tr-Gn, Tr-Sn, Tr-Tr (r = 0.526-0.925, p < 0.001), and insignificant for Sn-Sto (r = 0.099-0.124, p > 0.354). The highest correlation coefficient is exhibited by Tr-Gn (r = 0.893 with height and r = 0.925 with weight). When performing a gender related comparison, we noticed that the vertical and transversal linear parameters and some facial indices are increased in boys (p < 0.05), depending on the age group. The simplified anthropometric technique represents an accessible method to every clinician, bringing important information related to dentofacial growth, diagnosis, and treatment planning in dentistry.

Are the Reasons Why Patients Are Referred for an Orthodontic Visit Correct?

Who does refer patients for an orthodontic consultation? Which are the main reasons for the referral? Does the visit of the orthodontic specialist confirm these reasons or reveal undiagnosed problems? Is there the risk that only evident dental problems are addressed, while craniofacial malformations remain underdiagnosed? This cross-sectional epidemiologic study aims to answer these questions, analysing the clinical data collected during the orthodontic visits of 500 Caucasian young patients referred to a public health structure of northern Italy. All patients were visited by the same expert specialist in orthodontics. Clinical data were collected, analysing both dental and skeletal features. The reasons for the referral of the visit were analysed and compared with the specialistic diagnoses. In our sample, dentists, relatives/friends and paediatricians were the major source of the referrals, followed by family doctors and other facial specialists. In most cases, the reasons for the referral were dental irregularities, but approximately 80% of dental irregularities were associated with undiagnosed facial dysmorphism. Skeletal facial anomalies need an early diagnosis to prevent the development of severe facial malformations that would require invasive and expensive treatments. These findings reveal poor diagnostic skills regarding skeletal anomalies in dentists and paediatricians and the need for better specific training.

Scope and performance of artificial intelligence technology in orthodontic diagnosis, treatment planning, and clinical decision-making - A systematic review.

BACKGROUND/PURPOSE: In the recent years artificial intelligence (AI) has revolutionized in the field of dentistry. The aim of this systematic review was to document the scope and performance of the artificial intelligence based models that have been widely used in orthodontic diagnosis, treatment planning, and predicting the prognosis. MATERIALS AND METHODS: The literature for this paper was identified and selected by performing a thorough search for articles in the electronic data bases like Pubmed, Medline, Embase, Cochrane, and Google scholar, Scopus and Web of science, Saudi digital library published over the past two decades (January 2000-February 2020). After applying the inclusion and exclusion criteria, 16 articles were read in full and critically analyzed. QUADAS-2 were adapted for quality analysis of the studies included. RESULTS: AI technology has been widely applied for identifying cephalometric landmarks, determining need for orthodontic extractions, determining the degree of maturation of the cervical vertebra, predicting the facial attractiveness after orthognathic surgery, predicting the need for orthodontic treatment, and orthodontic treatment planning. Most of these artificial intelligence models are based on either artificial neural networks (ANNs) or convolutional neural networks (CNNs). CONCLUSION: The results from these reported studies are suggesting that these automated systems have performed exceptionally well, with an accuracy and precision similar to the trained examiners. These systems can simplify the tasks and provide results in quick time which can save the dentist time and help the dentist to perform his duties more efficiently. These systems can be of great value in orthodontics.

Quantitative Comparison of Cephalogram and Cone-Beam Computed Tomography in the Evaluation of Alveolar Bone Thickness of Maxillary Incisors.

OBJECTIVE: This study aims to quantitatively compare cephalogram and cone-beam computed tomography (CBCT) when evaluating maxillary central incisor alveolar bone thickness. METHODS: We used 30 sets of lateral cephalograms and CBCT images that were recorded at the same time. Labial, buccal, and overall alveolar bone thicknesses were measured on three measurement lines of the forward-most incisor in lateral cephalograms and four maxillary incisors in CBCT images. Paired t-test, interclass correlation coefficient analysis, one-way analysis of variance (ANOVA), and Bland-Altman analysis were used to assess cephalometrically measured alveolar bone thickness of maxillary incisors and compare these measurements with those made using CBCT images. RESULTS: Significant differences were observed between cephalometric and CBCT-based measurements of maxillary incisor alveolar bone thickness; most values showed mild or moderate correlation between the two methods. In most cases, cephalometric measurements were greater than CBCT-based measurements. Bland-Altman plots and ANOVA revealed that measurement bias increased when measurement lines moved apically. Alveolar bone thickness was always overestimated on cephalograms. CONCLUSION: Maxillary incisor alveolar bone thickness is always overestimated on cephalograms compared with CBCT-based measurements, with the overestimations ranging from 0.3 to 1.3 mm. Cephalometric measurement bias increases when measurement lines move apically. Thus, CBCT should be recommended when the accurate evaluation of alveolar bone thickness is warranted.

Comparison of a tridimensional cephalometric analysis performed on 3T-MRI compared with CBCT: a pilot study in adults.

OBJECTIVE: Since the introduction of cone-beam computed tomography (CBCT) in dentistry, this technology has enabled distortion-free three-dimensional cephalometric analysis for orthodontic and orthognathic surgery diagnosis. However, CBCT is associated with significantly higher radiation exposure than traditional routine bidimensional examinations for orthodontic diagnosis, although low-dose protocols have markedly reduced radiation exposure over time. The objective of this preliminary feasibility study is to compare the accuracy and diagnostic capabilities of an already-validated three-dimensional cephalometric analysis on CBCT to those of an analysis on 3-T magnetic resonance imaging (3T-MRI) to assess whether the latter can deliver a comparable quality of information while avoiding radiation exposure. MATERIALS AND METHODS: In order to test the feasibility of three-dimensional cephalometry on 3T-MRI, 18 subjects (4 male; 14 female) with mean age 37.8 ± SD 10.2, who had undergone both maxillofacial CBCT and maxillofacial 3T-MRI for various purposes within 1 month, were selected from the archive of the Department of Dentistry and Maxillofacial Surgery of Fondazione Ospedale Policlinico Maggiore, IRCCS, Milano, Italy. A three-dimensional cephalometric analysis composed of ten midsagittal and four bilateral landmarks and 24 measurements (11 angular, 13 linear) was performed on both scans using Mimics Research® v. 17.0 (NV, Technologielaan 15, 3001 Leuven, Belgium). Cephalometric analysis was performed twice by two independent orthodontists for each scan, and each orthodontist repeated the measurements 3 weeks later. Statistical analysis was performed with SPSS® 20.00 for Windows (IBM® Corporation, Sommers, NY, USA). A Bland-Altman test for each cephalometric value was performed to assess the agreement between the procedures. The intraclass correlation coefficient (ICC) was used to assess interobserver and intraobserver reliability. The coefficient of variation was used to evaluate precision. RESULTS: Both procedures showed good reliability, with mean intraobserver ICCs of 0.977/0.971 for CBCT and 0.881/0.912 for MRI. The average interobserver ICCs were 0.965 for CBCT and 0.833 for MRI. A Bland-Altman analysis for the cephalometric tracing revealed a similar range of agreement between the two modalities; the bias range (mean ± SD) was - 0.25-0.66 mm (0.174 ± 0.31) for distances and - 0.41-0.54° (0.12 ± 0.33) for angles. CONCLUSIONS: Within the main limitation of this pilot study, that is, the small sample, it is possible to state that cephalometric measurements on 3T-MRI seem to possess adequate reliability and repeatability and that they show satisfying agreement with values measured on CBCTs. An MRI examination does not expose patients to ionizing radiation and could provide an alternative to CBCT for three-dimensional cephalometrics in the future.

Concurrent validity and reliability of cephalometric analysis using smartphone apps and computer software.

OBJECTIVES: To assess the diagnostic accuracy of two smartphone cephalometric analysis apps compared with Viewbox software. MATERIALS AND METHODS: Pretreatment digital lateral cephalograms of 50 consecutive orthodontic patients (20 males, 30 females; mean age, 19.1 years; SD, 11.7) were traced twice using two apps (ie, CephNinja and OneCeph), with Viewbox used as the gold standard computer software program. Seven angular and two linear measurements, originally derived from Steiner cephalometric analysis, were performed. RESULTS: Regarding validity, intraclass correlation coefficients (ICCs) ranged from .903-.983 and .786-.978 for OneCeph vs Viewbox and CephNinja vs Viewbox, respectively. The ICC values for intratool reliability ranged from .647-.993. None of the CephNinja measurements was below the recommended cutoff values of ICCs for reliability. CONCLUSIONS: OneCeph has a high validity compared with Viewbox, while CephNinja is the best alternative to Viewbox regarding reliability. Smartphone apps may have a great potential in supplementing traditional cephalometric analysis.

Cone-beam computed tomography and three-dimensional orthodontics. Where we are and future perspectives.

Cone beam computerised tomography (CBCT) is becoming increasingly common in the orthodontic office and a wide range of software is now available. What is the state-of-the-art of CBCT prescription according to international guidelines? And what might we expect from CBCT in orthodontics in the future?