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

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