The modern transformation of cephalometric analysis
Featured Products Promotional FeaturesPosted by: Dental Design 13th August 2023
Digital dentistry has pushed the profession to become increasingly more accurate and efficient over recent decades. From periodontics to endodontics, each field has taken advantage of the developing tools at their disposal. However, some of the biggest transformations have affected a fundamental analytical process used primarily in orthodontics, developed nearly a century ago.
Cephalometric analysis in a digital age
The use of cephalometric analysis has been considered a standard for orthodontic diagnosis since its inception in the 1930s. Conventionally, clinicians would locate cephalometric landmarks on a radiographic image, and manually measure the distances and angles between them on acetate overlays. The landmarks are used to track the growth and development of the facial skeleton to a high degree of accuracy. This can inform accurate case diagnosis, treatment planning, and an objective final evaluation.[i] Despite widespread use by orthodontists, the procedure was often time-consuming, and a manual workflow left the diagnosis prone to man-made inaccuracies within landmark identification, tracing and measurement taking.[ii]
Digital developments have meant that cephalometric tracing can now be performed by specialised artificial intelligence (AI), streamlining the diagnosis and treatment preparation process, and reducing potential errors.[iii] The best programs that are available to clinicians can consistently reproduce accurate results, whilst omitting the pitfalls associated with conventional manual methods. They will often contain fewer mistakes such as misidentification of landmarks and subsequent inaccurate measurements, whilst achieving a complete trace more quickly.[iv] This increase in efficiency can accelerate diagnoses with a reliable set of figures and images.
2D cephalometric analysis is incredibly useful, manually or digitally generated, but can have drawbacks. On a two-dimensional plane, the overlapping of different structures can make analysis difficult, with a struggle to identify landmarks within the image. A radiographic image is also prone to distortion or magnification, making linear and angular measurements potentially inaccurate.[v]
Clinicians can now acquire a clearer image by employing software that provides effective contrast within the scan to demonstrate depth, and to differentiate between hard and soft tissues. This could resolve the complications surrounding imprecise landmark identification.
In the appropriate cases, clinicians may require further knowledge that cannot be obtained from a 2D scan to provide an accurate diagnosis. The information they need may be taken from a 3D scan instead.
Development into 3D
Innovation into 3D cephalometric analysis has grown rapidly over the past couple of decades, with the invention of dental cone-beam computed tomography (CBCT) in the late 1990s as a catalyst.[vi] Prior to its development, clinicians would have needed to use multi-slice computed tomography (MSCT) to produce a 3D image.[vii] The high radiation dose associated with an MSCT was of concern to many practitioners. CBCT entered the dental field with the benefit of exhibiting significantly lower radiation doses, whilst maintaining high-quality results. This made it a popular alternative amongst clinicians.[viii]
A 3D scan holds a number of benefits over a 2D radiographic image. A CBCT scan eliminates the image distortion and anatomical structure overlap associated with a radiograph.[ix] Alongside a complete and malleable view of the skeletal structure, landmark placement and measurement taking can be more accurate. This allows clinicians to generate a better suited treatment plan.
Only a single CBCT scan is necessary for a 3D model to be generated. In 2D, multiple radiographs are necessary to completely understand the skeletal structure. They would be used to evaluate symmetry, which could be the cause of treatment,[x] however, this is established in a single CBCT scan. Treatment time is decreased by negating the need for multiple images to be taken, whilst producing the higher level of accuracy.[xi]
The 3D scan can also be utilised to obtain a more detailed insight into how orthodontic treatment will affect a patient’s jaw, as well as the surrounding bone. Studies have shown that once provided with CBCT scans, practitioners would adapt their treatment plans up to 27% of the time. This includes extreme changes to the extraction decision of impacted canines in more than one in ten cases.[xii]
The introduction of CBCT scans to modern orthodontics has allowed for revolutionary changes to diagnosis and treatment plans, maximising the best care for patients. Dentists looking for a smart and efficient system to improve their practice should consider the CS 9600 CBCT scanner from Carestream Dental. The world’s most intelligent CBCT system provides clear and precise 2D and 3D images that can inform accurate diagnosis. The versatile system is adept for orthodontists with the specialised Scan Ceph module, which creates cephalometric scan images in as little as 3 seconds, and obtains fully automated tracings in just 10 seconds, streamlining the treatment process. Its powerful imaging software enhances these images with effective contrast to make landmark identification and analysis clear and understandable.
Orthodontic dentistry has always evolved with the technology at hand. The impacts on the cephalometric analytical process could be some of the most important to date. The evolution of AI systems and CBCT scanning will only aid to drive the process forward, long into the future.
For more information on Carestream Dental visit www.carestreamdental.co.uk
For the latest news and updates, follow us on Facebook and Instagram @carestreamdental.uk
Nimisha Nariapara
Bio
Nimisha is the Trade Marketing Manager at Carestream Dental covering the UK, Middle East, Nordics, South Africa, Russia and CIS regions. She has worked at Carestream Dental for the past 7 years, where she has developed her marketing skills and industry knowledge to bring the core values and philosophy of the company to the market.
Kind regards
[i] Hlongwa, P. (2019). Cephalometric analysis: manual tracing of a lateral cephalogram. South African Dental Journal, 74(6), 318-322.
[ii] Celik, E., Polat-Ozsoy, O., & Toygar Memikoglu, T. U. (2009). Comparison of cephalometric measurements with digital versus conventional cephalometric analysis. The European Journal of Orthodontics, 31(3), 241-246.
[iii] Subramanian, A. K., Chen, Y., Almalki, A., Sivamurthy, G., & Kafle, D. (2022). Cephalometric Analysis in Orthodontics Using Artificial Intelligence—A Comprehensive Review. BioMed Research International, 2022.
[iv] Gupta, S. P., Dahal, S., & Rauniyar, S. (2021). Reproducibility and speed of cephalometric tracing between manual versus digital method. Orthodontic Journal of Nepal, 11(2), 39-45.
[v] Song, G. Y., Li, G., Lu, W. H., Han, B., & Xu, T. M. (2019). Distortion and magnification of four digital cephalometric units. Nigerian Journal of Clinical Practice, 22(12), 1644.
[vi] Maspero, C., Abate, A., Bellincioni, F., Cavagnetto, D., Lanteri, V., Costa, A., & Farronato, M. (2019). Comparison of a tridimensional cephalometric analysis performed on 3T-MRI compared with CBCT: A pilot study in adults. Progress in Orthodontics, 20(1), 1-10.
[vii] Pittayapat, P., Limchaichana‐Bolstad, N., Willems, G., & Jacobs, R. (2014). Three‐dimensional cephalometric analysis in orthodontics: a systematic review. Orthodontics & craniofacial research, 17(2), 69-91.
[viii] Pittayapat, P., Limchaichana‐Bolstad, N., Willems, G., & Jacobs, R. (2014). Three‐dimensional cephalometric analysis in orthodontics: a systematic review. Orthodontics & craniofacial research, 17(2), 69-91.
[ix] Elnagar, M. H., Aronovich, S., & Kusnoto, B. (2020). Digital workflow for combined orthodontics and orthognathic surgery. Oral and Maxillofacial Surgery Clinics, 32(1), 1-14.
[x] Maspero, C., Abate, A., Bellincioni, F., Cavagnetto, D., Lanteri, V., Costa, A., & Farronato, M. (2019). Comparison of a tridimensional cephalometric analysis performed on 3T-MRI compared with CBCT: A pilot study in adults. Progress in Orthodontics, 20(1), 1-10.
[xi] Baldini, B., Cavagnetto, D., Baselli, G., Sforza, C., & Tartaglia, G. M. (2022). Cephalometric measurements performed on CBCT and reconstructed lateral cephalograms: a cross-sectional study providing a quantitative approach of differences and bias. BMC Oral Health, 22(1), 1-12.
[xii] Rischen, R. J., Breuning, K. H., Bronkhorst, E. M., & Kuijpers-Jagtman, A. M. (2013). Records needed for orthodontic diagnosis and treatment planning: a systematic review. PLoS one, 8(11), e74186.
