Cephalometric landmarks identification and reproducibility: A Meta analysis☆,☆☆,★,★★,♢

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Abstract

To assess the magnitude of cephalometric landmarks identification error, we performed a Meta analysis on six pertinent studies. We outline the procedures used to compare and integrate the findings of these studies. The results are a measure of systematic and random errors involved when locating landmarks on lateral head films. They are presented as standard mean errors and 95% confidence intervals for the repeatability and reproducibility of 15 cephalometric landmarks commonly used in growth analysis.

Section snippets

Selection of Studies and Landmarks

Studies to be included in the analysis were identified through a computerized search on the Medline database from 1966 to 1995. Key words such as cephalometry, landmarks reproducibility, landmarks identification, and error measurements were combined to identify articles of interest. In addition, references were analyzed to find published studies that may have been omitted in the computer search. The criteria for inclusion were as follows:

  • 1.

    Purpose of the study was to determine cephalometric

RESULTS

Sample size showed pronounced effect on both x-axis and y-axis measurements for all landmarks (p-value 0.032). Number of observers and number of occasions showed no significant effect. On the basis of a one-way random effects model analysis, the y-axis measurements showed moderate variability across studies (p-value 0.089), whereas the x-axis measurements showed significant variability (p-value 0.024). Landmarks showed significant variability after removing effects due to varying sample sizes

DISCUSSION

The validity of any measurement obtained through a cephalometric radiography largely depends on the reproducibility of the cephalometric landmarks. Factors such as the quality of the radiographs, the conditions under which they are measured, and the care and skill of the operator will influence the magnitude of identification error. For this reason, it was suggested that every study should include an assessment of reproducibility, even though standard measurements are used.24 While this

CONCLUSION

On the basis of the findings of six studies, the mean errors and 95% confidence intervals for total error of 15 cephalometric landmarks are presented. According to this investigation, we recommend that 0.59 mm of total error for the x coordinate and 0.56 mm for the y coordinate are acceptable levels of accuracy. The landmarks B, A, Ptm, S, and Go on the x coordinate, and Ptm, A and S on the y coordinate presented with insignificant mean error and small value for total error. Therefore these

References (25)

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    The effect of image quality on the identification of cephalometric landmarks

    Angle Orthod

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  • J Midtgard et al.

    Reproducibility of cephalometric landmarks and errors of measurements of cephalometric cranial distances

    Angle Orthod

    (1974)

    • Cited by (0)

    ☆

    aResearch Fellow, TMD Investigation Unit, Faculty of Dentistry.

    ☆☆

    bAssociate professor, Division of Orthodontics, Faculty of Dentistry.

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    cAssociate professor, Department of Mathematical Sciences.

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    Reprint requests to: Dr. Biljana Trpkova, TMD Investigation Unit, Faculty of Dentistry, University of Alberta, Edmonton, Alberta, Canada T6G 2N8.

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    0889-5406/97/$ 5.00 + 0 8/1/77115

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    Copyright © 1997 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.