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Comparative Study
. 2025 May 31;25(1):866.
doi: 10.1186/s12903-025-06258-x.

Evaluating the precision and reproducibility of cephalometric landmarks in locally reconstructed lateral cephalometric radiographs from cone beam computed tomography (CBCT)

Chuan Cai #  1 , Hongkun Li #  1   2 , Haodong Zhang  1 , Na Huo  1 , Jing Wang  1 , Tianqi Li  1 , Nuo Xu  1   2 , Tong Zhang  3
Affiliations
Comparative Study

Evaluating the precision and reproducibility of cephalometric landmarks in locally reconstructed lateral cephalometric radiographs from cone beam computed tomography (CBCT)

Chuan Cai et al. BMC Oral Health. .

Abstract

Objective: The commonly used lateral cephalometric radiographs, including traditional lateral cephalometric radiographs and CBCT-synthesized lateral cephalometric radiographs, have the problem of overlapping anatomical structures, which interferes with the identification of landmarks. Therefore, we proposed a new method called CBCT-based locally reconstructed lateral cephalometric radiographs and evaluated its precision and reproducibility.

Materials and methods: CBCT and lateral cephalometric radiographs were obtained from five orthodontic patients. Twenty-six cephalometric landmarks were identified using three methods by ten orthodontists. The landmarks on each image were recorded as (X, Y), and the absolute values of the differences between each measurement and the average values of the X and Y coordinates were calculated (ΔX and ΔY). Additionally, the distance between each located point and the centroid was calculated (ΔD). The differences in ΔX, ΔY, and ΔD among the groups were compared through analysis of variance (ANOVA). Bonferroni post hoc correction was used for pairwise comparisons. p < 0.05 was considered statistically significant.

Results: The reproducibility of 14 landmarks in the CBCT-based locally reconstructed lateral cephalometric radiographs was better than that of the other methods in at least one direction (p < 0.05). Among these landmarks, the precision of the CBCT local reconstruction group was greater in all directions for five landmarks than that of the other two groups (p < 0.05).

Conclusion: The CBCT locally reconstructed lateral cephalometric radiographs proposed in this study enhanced the precision and reproducibility of cephalometric landmark identification.

Keywords: Cephalometric analysis; Cephalometric landmarks; Cone beam computed tomography; Precision and reproducibility.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was conducted in accordance with the Declaration of Helsinki and was approved by the ethics committee of the Chinese PLA General Hospital (No. 2024165). Written informed consent to participate was obtained from the participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Different parts of the CBCT data were locally reconstructed to obtain lateral cephalometric radiographs via the local reconstruction method
Fig. 2
Fig. 2
Comparison of the differences in the X coordinates (ΔX) of 26 landmarks among the three groups. The data are presented as the means ± SDs. *p < 0.05, **p < 0.01 and ***p < 0.001
Fig. 3
Fig. 3
Comparison of the differences in the Y coordinates (ΔY) of 26 landmarks among the three groups. The data are presented as the means ± SDs. *p < 0.05, **p < 0.01 and ***p < 0.001
Fig. 4
Fig. 4
Comparison of the differences in the distance (ΔD) of 26 landmarks among the three groups. The data are presented as the means ± SDs. *p < 0.05, **p < 0.01 and ***p < 0.001
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