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Imaging Sci Dent. 2015 Dec;45(4):213-220. English. Comparative Study.
Durao AP , Morosolli A , Pittayapat P , Bolstad N , Ferreira AP , Jacobs R .
Department of Dental Radiology, Faculty of Dental Medicine, University of Porto, Porto, Portugal.
Department of Surgery, Dentistry School, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
Department of Clinical Dentistry, Faculty of Health Science, UiT The Arctic University of Norway, Tromso, Norway.
Department of Orthodontics, Faculty of Dental Medicine, University of Porto, Portugal.
Oral Imaging Center, OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium.

PURPOSE: The aim this study was to compare the accuracy of orthodontists and dentomaxillofacial radiologists in identifying 17 commonly used cephalometric landmarks, and to determine the extent of variability associated with each of those landmarks. MATERIALS AND METHODS: Twenty digital lateral cephalometric radiographs were evaluated by two groups of dental specialists, and 17 cephalometric landmarks were identified. The x and y coordinates of each landmark were recorded. The mean value for each landmark was considered the best estimate and used as the standard. Variation in measurements of the distance between landmarks and measurements of the angles associated with certain landmarks was also assessed by a subset of two observers, and intraobserver and interobserver agreement were evaluated. RESULTS: Intraclass correlation coefficients were excellent for intraobserver agreement, but only good for interobserver agreement. The least reliable landmark for orthodontists was the gnathion (Gn) point (standard deviation [SD], 5.92 mm), while the orbitale (Or) was the least reliable landmark (SD, 4.41 mm) for dentomaxillofacial radiologists. Furthermore, the condylion (Co)-Gn plane was the least consistent (SD, 4.43 mm). CONCLUSION: We established that some landmarks were not as reproducible as others, both horizontally and vertically. The most consistently identified landmark in both groups was the lower incisor border, while the least reliable points were Co, Gn, Or, and the anterior nasal spine. Overall, a lower level of reproducibility in the identification of cephalometric landmarks was observed among orthodontists.

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