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Table 1 Publications related to the importance and contribution of cephalometry on the orthodontic treatment planning

From: Validity of 2D lateral cephalometry in orthodontics: a systematic review

Authors (year) Aim of the study Observers Subjects Design of the study Statistical method Results according to authors Level of evidence
Silling et al. [9] Assess usefulness of cephalometric analysis 24 orthodontists 6 patients Stratified random design: 12 orthodontists analysed 6 patients with cephalograms and 12 orthodontists studied 6 patients without cephalogram Not referred Class I patient: disagreement on extractions, anchorage and growth potential decisions Low
No need for lateral cephalometry, except for atypical class II division 1 patients, by 4 orthodontists
Anchorage problems SS between patients with and without lateral cephalogram
Bruks et al. [6] Evaluation of lateral cephalometric and panoramic radiography 4 dentists and senior orthodontist 70 patients Clinical evaluations and treatment plan by 4 dentists: Descriptive statistics and statistical analyses with computer software. Kruskal-Wallis test to evaluate differences between groups Impact on diagnosis relating to the ordering sequence of cephalogram: first choice, 68%; second choice, 73%; third choice, 80% Low
1. Study casts + photographs 93% of cases: same treatment plan before and after radiographic analysis
2. Adding radiographs
Pae et al. [7] Examine the link between lateral cephalograms and occlusal trays 16 orthodontists 80 patients T1: casts evaluated; T2 (1 week later): casts + lateral cephalograms Rash model, regression plots, two-way ANOVA, post hoc multiple comparison Bonferroni and paired t test Class II division 2 patients: 126 extractions planned at T1; 80 at T2 Moderate
A lateral cephalogram influenced degree of severity, but not the difficulty of treatment
Nijkamp et al. [3] Influence of lateral cephalometry on treatment plan 10 post-graduatetrainees and 4 orthodontists 48 patients Randomised crossover design - T1: casts, T2 (1 month after): with lateral cephalometry and tracing, and T3 and T4 (repeated after 1 and 2 months) Overall proportion of agreement Consistency of treatment plan was NS between the use only of dental casts or with additional cephalometry Low
Influence of cephalometrics on orthodontic treatment planning: NS
Devereux et al. [2] Influence of lateral cephalometry on treatment plan 114 orthodontists 6 patients 3 groups: (a) no lateral cephalogram and tracings, (b) some with lateral cephalogram and tracings and (c) all with lateral cephalogram and tracings Chi-square and binary logistic regression Treatment plan changed for extraction pattern (42.9%), anchorage reinforcement (24%) and decision to extract (19.7%) Low
Class I patient: lateral cephalogram less times ordered. Only patients where treatment plan changed after its analysis
NS impact of cephalometrics on treatment plan
Atchison et al. [4] Determine quantitatively the diagnosis and treatment plan information after radiograph evaluation 39 orthodontists 6 patients A 2-h interview for diagnosis and treatment planning of 6 cases. Study cast, intra- and extra-oral photographs, tracing and clinical findings available. Analysis of variance with repeated measures and covariance, homogeneity value and descriptive statistics 98% of cases: at least one of the radiographs unproductive Low
A radiograph only if judged helpful 3/4 of radiographs did not provide information to change diagnosis and treatment plan
Atchison et al. [10] Identify selection criteria for ordering orthodontic radiographs 39 orthodontists 6 patients A 2-h interview for diagnosis and treatment planning of 6 cases. Study cast, intra- and extra-oral photographs, tracing and clinical findings available Not referred 14.4% of radiographs ordered for skeletal relationship of the jaws Low
Lateral cephalograms accounted for 34% of required information
26% of all ordered radiographs produced modifications on diagnosis or treatment plan
Pretreatment lateral cephalogram required in all patients needing orthodontic treatment
  1. NS, non-significant.