Concordance and Reproducibility in the Location of Reference Points for a Volumetric Craniofacial Analysis: Cross-sectional Study

Overview

Journal J Dent Res Dent Clin Dent Prospects

Specialty Dentistry

Date 2023 Aug 31

PMID 37649819

Authors

Natali Romero-Tapiero

Andres Giraldo-Mejia

Adriana Herrera-Rubio

Juan Fernando Aristizabal-Perez

Affiliations

Soon will be listed here.

Abstract

Background: Considering the limitations of visualization that occur even with the use of radiographs, the cone beam computed tomography (CBCT) becomes more attractive to diagnose and propose an assertive treatment plan. This study aimed to evaluate intra and interobserver reproducibility, and concordance of 31 reference points we described considering visualization tools and the three planes of space in a bimaxillary CBCT.

Methods: Three observers located in triplicate the 31 reference points in the CBCT of six healthy patients. Friedman test was used to compare intraobserver paired samples, and interobserver concordance was determined by the intraclass correlation coefficient (ICC) with ranges>0.75 (excellent), between 0.60 and 0.74 (good), between 0.40 and 0.59 (sufficient) and<0.40 (poor). The value was set at<0.05.

Results: A high ICC (>0.75%) was obtained by comparing the x, y, and z values at the location of landmark points. Excellent ICC>0.75 was for 81.7% and poor<0.40 was 7.5% in the interobserver evaluation. Data showed that 25 points had excellent concordance on the x-plane, 25 on the y-plane, and 26 on the z-plane (0.75%).

Conclusion: Intraobserver concordance analysis indicated that location of anatomical reference points on bimaxillary CBCT is performed with great reproducibility by interpreting their location with a clear description in the three planes of space. Complexity of achieving a good precision degree in the manual marking of reference points caused by convexities of the anatomical structures involved, might explain the variability found. The systematized location of the reference points would contribute to reduce such variability.

References

Albarakati S, Kula K, Ghoneima A . The reliability and reproducibility of cephalometric measurements: a comparison of conventional and digital methods. Dentomaxillofac Radiol. 2011; 41(1):11-7. PMC: 3520271. DOI: 10.1259/dmfr/37010910. View

Hassan B, Nijkamp P, Verheij H, Tairie J, Vink C, van der Stelt P . Precision of identifying cephalometric landmarks with cone beam computed tomography in vivo. Eur J Orthod. 2011; 35(1):38-44. DOI: 10.1093/ejo/cjr050. View

Park J, Baumrind S, Curry S, Carlson S, Boyd R, Oh H . Reliability of 3D dental and skeletal landmarks on CBCT images. Angle Orthod. 2019; 89(5):758-767. PMC: 8111847. DOI: 10.2319/082018-612.1. View

Yeung A, Jacobs R, Bornstein M . Novel low-dose protocols using cone beam computed tomography in dental medicine: a review focusing on indications, limitations, and future possibilities. Clin Oral Investig. 2019; 23(6):2573-2581. DOI: 10.1007/s00784-019-02907-y. View

Neiva M, Soares A, Lisboa C, de Vasconcellos Vilella O, Motta A . Evaluation of cephalometric landmark identification on CBCT multiplanar and 3D reconstructions. Angle Orthod. 2014; 85(1):11-7. PMC: 8634811. DOI: 10.2319/120413-891.1. View

Lagravere M, Low C, Flores-Mir C, Chung R, Carey J, Heo G . Intraexaminer and interexaminer reliabilities of landmark identification on digitized lateral cephalograms and formatted 3-dimensional cone-beam computerized tomography images. Am J Orthod Dentofacial Orthop. 2010; 137(5):598-604. DOI: 10.1016/j.ajodo.2008.07.018. View

Chien P, Parks E, Eraso F, Hartsfield J, Roberts W, Ofner S . Comparison of reliability in anatomical landmark identification using two-dimensional digital cephalometrics and three-dimensional cone beam computed tomography in vivo. Dentomaxillofac Radiol. 2009; 38(5):262-73. DOI: 10.1259/dmfr/81889955. View

Na E, Aljawad H, Lee K, Hwang H . A comparative study of the reproducibility of landmark identification on posteroanterior and anteroposterior cephalograms generated from cone-beam computed tomography scans. Korean J Orthod. 2019; 49(1):41-48. PMC: 6306316. DOI: 10.4041/kjod.2019.49.1.41. View

Gupta A, Kharbanda O, Balachandran R, Sardana V, Kalra S, Chaurasia S . Precision of manual landmark identification between as-received and oriented volume-rendered cone-beam computed tomography images. Am J Orthod Dentofacial Orthop. 2016; 151(1):118-131. DOI: 10.1016/j.ajodo.2016.06.027. View

10.

Scarfe W, Azevedo B, Toghyani S, Farman A . Cone Beam Computed Tomographic imaging in orthodontics. Aust Dent J. 2017; 62 Suppl 1:33-50. DOI: 10.1111/adj.12479. View

11.

de Oliveira A, Cevidanes L, Phillips C, Motta A, Burke B, Tyndall D . Observer reliability of three-dimensional cephalometric landmark identification on cone-beam computerized tomography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 107(2):256-65. PMC: 2642991. DOI: 10.1016/j.tripleo.2008.05.039. View

12.

Huang Y, Fan F, Syben C, Roser P, Mill L, Maier A . Cephalogram synthesis and landmark detection in dental cone-beam CT systems. Med Image Anal. 2021; 70:102028. DOI: 10.1016/j.media.2021.102028. View

13.

Miguez-Contreras M, Jimenez-Trujillo I, Romero-Maroto M, Lopez-de-Andres A, Lagravere M . Cephalometric landmark identification consistency between undergraduate dental students and orthodontic residents in 3-dimensional rendered cone-beam computed tomography images: A preliminary study. Am J Orthod Dentofacial Orthop. 2016; 151(1):157-166. DOI: 10.1016/j.ajodo.2016.06.034. View

14.

van Vlijmen O, Maal T, Berge S, Bronkhorst E, Katsaros C, Kuijpers-Jagtman A . A comparison between 2D and 3D cephalometry on CBCT scans of human skulls. Int J Oral Maxillofac Surg. 2010; 39(2):156-60. DOI: 10.1016/j.ijom.2009.11.017. View

15.

Kang S, Jeon K, Kang S, Lee S . 3D cephalometric landmark detection by multiple stage deep reinforcement learning. Sci Rep. 2021; 11(1):17509. PMC: 8410904. DOI: 10.1038/s41598-021-97116-7. View

16.

Sam A, Currie K, Oh H, Flores-Mir C, Lagravere-Vich M . Reliability of different three-dimensional cephalometric landmarks in cone-beam computed tomography : A systematic review. Angle Orthod. 2018; 89(2):317-332. PMC: 8120873. DOI: 10.2319/042018-302.1. View

17.

Lagravere M, Gordon J, Guedes I, Flores-Mir C, Carey J, Heo G . Reliability of traditional cephalometric landmarks as seen in three-dimensional analysis in maxillary expansion treatments. Angle Orthod. 2009; 79(6):1047-56. DOI: 10.2319/010509-10R.1. View

18.

Ludlow J, Gubler M, Cevidanes L, Mol A . Precision of cephalometric landmark identification: cone-beam computed tomography vs conventional cephalometric views. Am J Orthod Dentofacial Orthop. 2009; 136(3):312.e1-10. PMC: 2753840. DOI: 10.1016/j.ajodo.2008.12.018. View

19.

Pittayapat P, Jacobs R, Bornstein M, Odri G, Kwon M, Lambrichts I . A new mandible-specific landmark reference system for three-dimensional cephalometry using cone-beam computed tomography. Eur J Orthod. 2015; 38(6):563-568. DOI: 10.1093/ejo/cjv088. View

20.

Reis Durao A, Morosolli A, Pittayapat P, Bolstad N, Ferreira A, Jacobs R . Cephalometric landmark variability among orthodontists and dentomaxillofacial radiologists: a comparative study. Imaging Sci Dent. 2016; 45(4):213-20. PMC: 4697005. DOI: 10.5624/isd.2015.45.4.213. View