Accuracy of digital vs. manual cephalometric tracing: A systematic review.

ABSTRACTObjectiveThe aim of this study was to assess the reliability and accuracy of several types of lateral cephalometric attributes commonly used: Angular measurements, linear measurements, and ratio when using digital cephalometric software (Nemoceph) with manual tracing method.Materials and MethodsSample size consisted of 26 lateral cephalometric radiographs. All cephalograms were subjected to both manual and digital cephalometric analysis by the same examiner. Digital analyses were performed on Nemotec digital imaging software. Cephalograms were assessed for a total of 17 cephalometric attributes. The results were assessed using Student's t-test.ResultsSix out of 17 measurements, i.e., sella, nasion, B point, ANB, incisor mandibular plane angle, mandibular plane angle, L1-NB, and Jarabak ratio, showed statistically significant difference between the manual and digital methods.ConclusionDigital measurements obtained with Nemotec digital imaging software were found to be comparable to the manual method for most of the variables used in clinical practice.How to cite this articleShah AR, Karandikar G, Ravindranath VK, Sonawane M, Mhatre A. A Comparative Study of Reliability and Accuracy of Manual and Digital Lateral Cephalometric Tracing. J Contemp D ent 2016;6(1):15-18.

Background: The skeletal and soft tissue analysis of the face in total is a very important parameter of diagnosis. Readily available and non expensive imaging software are available which can be used for cephalometric analysis for hard and soft tissues of the face to make an appropriate treatment plan. Aims: The purpose of this study was to compare the accuracy of linear and angular measurements between the digital software IMAGE J, ICY and manual tracing. Objective: The purpose of this study was to compare angular and linear measurements obtained through manual and digital cephalometric tracings using IMAGE J and ICY software with lateral cephalometric radiographs. Material and Methods: The sample consisted of 50 lateral cephalometric radiographs. One properly trained and calibrated examiner performed the 50 manual tracing and then the same radiograph was traced digitally on a digital software. Five angular measurements SNA (Sella, nasion, A point), SNB Sella, nasion, B point), ANB (A point, nasion, B point), W angle, ULA (Upper lip angle) and three linear measurements ULT (upper lip thickness), projection of upper lip to TVL (true vertical line) & WITS appraisal were traced the conventional lateral cephalogram of 50 participants were obtained. Manual tracing was done and hard tissue landmark including the above mentioned angular and linear variables were marked. In a similar way a soft copy of the above 50 radiograph was obtained and uploaded in the digital imaging software IMAGE J and ICY. Results: SNA, SNB, ANB, W angle, WITS appraisal, upper lip thickness (ULT) upper lip angle, (ULA), projection of labrale superioris to TVL showed statistically significant values when measured manually and by digital software methods. Values measured by software methods had less errors. Conclusion: The results show statistically significant values between manual and digital tracing. The actual variation lies in identification of landmarks and their measurements. landmarks are identified better in software methods than manual methods and also there was a difference in measurements of angular and linear values of soft and hard tissue landmarks.

BackgroundArtificial intelligence (AI)-based cephalometric tracing has emerged as a promising tool that reduces operator variability and offers standardized, rapid, and reproducible assessments. This study aimed to evaluate the reliability and accuracy of three cephalometric tracing methods: AI-based automatic digital tracing, semi-automatic digital tracing, and manual digital tracing.Materials & methodsThis study analyzed pre-treatment lateral cephalograms from 120 patients, comparing AI-based automatic digital tracing, semi-automatic digital tracing against manual digital tracing, which served as the control group. Angular and linear measurements were used as primary parameters, with 34 cephalometric measurements derived from 20 skeletal (SK) and 10 soft tissue (ST) landmarks. For parametric data, comparisons among the three methods were conducted using a repeated measures ANOVA test, while non-parametric data were analyzed using the Friedman test. A significance level of P ≤ 0.05 was applied to all statistical analyses.ResultsIn maxillary skeletal measurements, SNA (°) showed significant variation, with the Automatic method reporting slightly higher mean values (P < 0.001). Similarly, mandibular skeletal measurements revealed a small but significant difference in SNB (°) values (P = 0.002), while MP-SN (°) showed no notable differences (P = 0.118). For inter-maxillary measurements, ANB (°) displayed significant differences (P < 0.001), with the Automatic method reporting higher mean values. Vertical measurements, such as GO-GN to SN (°) and the Gonial Angle (°), also demonstrated significant variations (P < 0.001), with manual methods generally reporting higher values. In dental measurements, L1 to NB (°) differed significantly across methods (P = 0.022), and U1 to NA measurements showed both angular (P = 0.006) and linear (P < 0.001) significant differences, with Automatic methods tending to report lower medians. Lastly, soft tissue measurements, particularly the nasolabial angle (°), exhibited significant differences (P < 0.001), with the Manual method recording the highest mean values.ConclusionsAI-based automatic tracing tended to overestimate certain skeletal values, while manual methods showed greater consistency. Dental measurements were largely comparable across methods. The semi-automatic approach provided a practical balance between accuracy and efficiency, indicating potential for clinical application with further refinement.

Objective: To evaluate and compare the reliability, reproducibility, and speed of two cephalometric tracing methods computer-aided cephalometric tracing and manual tracing. Materials and Methods: This was an analytical, cross-sectional study. One hundred and three pretreatment cephalometric radiographs were randomly selected from the orthodontics department of a public university. Twelve cephalometric landmarks were identified, and fifteen measurements were calculated both manually and digitally using Vistadent OC software. The reliability of measurements was assessed for each method by applying the intraclass correlation coefficient (ICC). Paired t-test was used to compare the measurements' reproducibility and time difference between the two methods. Results: All angular and linear measurements for both the methods showed a range of moderate correlation (0.8 ≥ ICC ≥0.5) to strong correlation (ICC ≥0.8) except for L1-MAD, which displayed a poor correlation for both manual and digital tracing, (ICC = 0.36 and 0.33, respectively), as well as digital tracing of interincisal angle (ICC = 0.36). No statistically significant differences between the two methods were observed for all angular and linear measurements except upper anterior facial height (UAFH) and lower anterior facial height (P = 0.000). There was a statistically significant time difference between the two techniques (P = 0.000). The mean tracing time of the operator for single tracing was 18.02 min for manual tracing and 8.85 min when using the Vistadent program. Conclusion: Cephalometric measurements in conventional manual and digital cephalometric analysis are highly reliable. Although the reproducibility of some measurements between two methods showed statistically significant differences, most differences were considered minimal and clinically acceptable. Computer-assisted cephalometric analysis proved to be more time-efficient.

IntroductionLateral cephalometric analysis continues to be one of the gold standard diagnostic aids in orthodontics, with various software available to enhance this.AimThis study was done to evaluate the accuracy and reliability of linear and angular measurements obtained from OneCeph digital cephalometric tracing and manual tracings in lateral cephalometry.MethodologyThis is a cross-sectional study done on twenty pre-treatment lateral cephalometric radiographs of subjects who reported to the postgraduate orthodontic clinic for orthodontic treatment over one month. Cephalometric tracings were done using OneCeph digital software and manual tracing method to evaluate nine parameters of Steiner’s cephalometric analysis. An Independent T-sample test was done between the mean values of manual and OneCeph tracing. Intra operator reliability was evaluated by paired T-test after a week.ResultsNo significant statistical difference was observed as the p-value was greater than 0.05 for all the parameters in the two groups.ConclusionThe reliability and accuracy of OneCeph software application was found to be at par with manual cephalometric tracing

Aim: To compare and evaluate soft tissue linear and angular measurements reliability between Digital and Manual Tracing method Objectives: The objective of the study is to conclude that digital and manual tracing method for soft tissue measurements are reliable and comparable to each other Materials &amp; methods: Lateral Cephalograms of 35 patients who reported for Orthodontic Treatment irrespective of the type of malocclusion were taken. A total of 24 measurements were taken with 17 Linear Soft Tissue Measurements and 7 Angular Soft Tissue Measurements respectively. The digital images of each cephalogram was directly imported to Nemoceph Software for digital tracing whereas for manual tracing compatible printed images were used. Results: Soft Tissue Chin Thickness, Lower Lip Thickness, A’- B’, Sn’-Pog’, Upper Lip Length, Upper Lip Protrusion, Upper Lip Anterior - Lower Lip Anterior showed statistically significant difference between the two techniques among linear measurements but were clinically acceptable (difference between the digital and manual technique were less than 2 units ie 1 unit = 1mm for linear measurement and 1 degree for angular measurements). Throat Length also showed statistically significant difference between the two techniques for linear measurement but was not clinically acceptable as it exceeded 2mm difference. Amongst the Angular measurement only Z-Angle Upper Lip showed statistically significant difference between the two techniques but was clinically acceptable. Conclusion: Digital measurements were found to be reliable and comparable to manual tracing method for all soft tissue linear and angular measurements except Throat Length.

Objectives The aim of this study was to evaluate the validity and reliability of a newly designed cephalometric analysis program (Hexagon software) in comparison with manual and digital (Dolphin software) tracings. Methods Pre-treatment lateral cephalometric radiographs of 32 adult patients between 18 to 41 years (10 males and 22 females, mean age of 22.78 ± 5.17 years) were randomly chosen. For each radiograph, 10 angular and 6 linear measurements were calculated using three different methods (manual and digital using two different software programs). The cephalograms were manually traced using acetate paper, x-ray light box, 0.3 mm HB pencil, ruler, and protractor. For digital tracing, cephalograms were traced with Dolphin vertion-10 (USA) and Hexagon (Iran) software programs. All the analyses were performed by one operator 2 times with at least a four-week interval between the two tracings. The intra-class correlation coefficient (ICC) was used to evaluate the intra-examiner agreement, while the differences between the methods were analyzed using paired t-test, and ANOVA. Results The intra-examiner repeatability of all measurements in all three tracing methods showed high agreement. Differences in measurements between the two software programs and hand tracing were not statistically significant for any of the cephalometric parameters (P>0.05). Conclusion The results demonstrated that the accuracy of cephalometric tracing by the Hexagon software was similar to the Dolphin software, and the manual tracing technique.

OBJETIVO: comparar medidas cefalométricas angulares e lineares obtidas por meio de traçados cefalométricos manual e digital utilizando o programa Dolphin® Imaging 11.0, em telerradiografias laterais. MÉTODOS: a amostra foi composta de 50 telerradiografias laterais. Uma operadora, devidamente calibrada, realizou 50 traçados cefalométricos manuais e 50 digitais, utilizando 8 medidas angulares (FMA, IMPA, SNA, SNB, ANB, 1.NA, 1.NB e Eixo Y) e 6 medidas lineares (1-NA, 1-NB, Co-Gn, Co-A, Linha E-lábio inferior e AFAI). Para análise dos resultados obtidos, foi aplicado o teste t de Student. RESULTADOS: os resultados encontrados não mostraram diferenças estatisticamente significativas em nenhuma das medidas avaliadas (p&gt;0,05). CONCLUSÃO: o método convencional e o computadorizado foram concordantes em todas as medidas angulares e lineares. O programa de traçado cefalométrico Dolphin® Imaging 11.0 pode ser utilizado, de forma confiável, como recurso auxiliar no diagnóstico, planejamento, acompanhamento e avaliação de tratamentos ortodônticos no âmbito clínico e no de pesquisa

Background: Lateral cephalogram can now be traced using android-based smartphones making dentist's work easier and time saving. Various orthodontic analysis can also be carried out using these smart apps. This study was undertaken to assess the reliability of the android smartphone-based app with the manual tracing using Tweed analysis. Materials and Methods: A total of 40 lateral cephalometric radiographs were taken randomly from patients below 15 years reported for orthodontic problems. Tweed analysis was carried out for each radiograph; incisal mandibular plane angle, facial mandibular angle, and facial mandibular incisal plane angle were recorded, first manually traced, followed by digitally using android-based OneCeph digital cephalometric tracer. Values obtained by android-based OneCeph and manual methods are compared. Results: The values showed normal distribution, therefore parametric test was used to analyze the data; there was no statistically significant difference between the values obtained for Tweed analysis by android-based tracing and manual cephalometric tracing. Conclusion: This study showed that the digital tracing with the OneCeph software had the same accuracy in comparison to manual tracing and could be used instead of the traditional methods for various orthodontic analysis.

Background: The aim of the investigation was to clearly locate subspinale (point A) and supramentale (point B) on three-dimensional (3D) cone-beam computed tomography (CBCT) images and to compare the angular and linear measurements that are dependent on these anatomic landmarks with two-dimensional (2D) manual and digital cephalometric tracings. Materials and Methods: A sample of 30 North Indian subjects between 13 and 22 years of age who required CBCT imaging for treatment planning was taken. For each patient, standardized film and digital cephalograms were taken. Standardized head positioning was done for CBCT imaging. The following four groups were evaluated for statistical analysis: Group 1: Dolphin, Group 2: CBCT, Group 3: Manual tracing 1, and Group 4: Manual tracing 2. Analysis of variance was applied to find out the differences in parameters among groups. Results: The results showed that the differences between most of the measurements derived from the landmarks identified on film and digital 2D cephalometric radiographs compared with CBCT-derived cephalograms were statistically significant. Point A, which is difficult to locate on 2D cephalograms, could be identified and measured accurately and more reliably on 3D CBCT-generated cephalograms. Conclusion: 3D CBCT-generated cephalograms can be successfully used for accurate and reliable cephalometric analyses.

Aim: The aim of the study was to analyze and compare the manual cephalometric tracings with computerized cephalometric tracings using Burstone hard tissue analysis and McNamara analysis. Materials and Methods: Conventional lateral cephalograms of 20 subjects were obtained and manually traced. The radiographs were subsequently scanned and digitized using Dolphin Imaging software version 11.7. McNamara analysis and Burstone hard tissue analysis were performed by both conventional and digital method. No differentiations were made for age or gender. Data were subjected to statistical analysis. Statistical analysis was undertaken using SPSS 17.0 version (Chicago, Illinois, USA) statistical software program. A paired t-test was used to detect differences between the manual and digital methods. Statistical significance was set at the P < 0.05 level of confidence. Results: (A) From Burstone analysis variables N-Pg II Hp show statistically very significant difference, and ANS-N, U1-NF, N-B II Hp, L1-Mp, and Go-Pg shows the statistically significant difference. (B) From McNamara analysis variables Nasolabial angle and L1-APog show statistically significant differences and the Mandibular length shows the statistically very significant difference. Conclusion: According to this study, is reasonable to conclude that the manual and digital tracings show the statistically significant difference.

Aim: The aim of the study was to analyze and compare the cephalometric readings between manual tracings with digital software tracings using Steiner's analysis. Materials and Methods: The conventional lateral cephalograms of twenty participants were obtained. Six hard tissue landmarks were identified, and Steiner's analysis was carried out. The radiographs were manually traced, and the readings were recorded. Following this, the radiographs were uploaded in the FACAD digital software for digital tracing. Results: SNA, SNB, lower incisor to NB angle, and linear values show statistically significant differences. The remaining parameters do not show statistical difference. Conclusion: The results show a statistical difference between manual and digital tracing. The variation lies in the difference in identification of the hard tissue landmarks.

Aim: The aim of the research was to compare and assess the accuracy and reliability of fully automatic (artificial intelligence [AI]), conventional, and digital cephalometric analysis. Materials and Methods: Fifty-two lateral cephalometric radiographs of patients aged 15–30 years with skeletal class I malocclusion were analyzed using three methods, i.e., manual tracing, digital tracing with NemoCeph NX 2009 software, and fully automatic tracing using Ceph.io software. Out of which, manual tracings were repeated after 4 weeks to assess intraexaminer reliability. Results: Almost all the variable linear parameters have showed statistically significant difference between the two different comparisons except for lower anterior facial height who showed statistically nonsignificant difference. The fully automatic cephalometric analysis demonstrated higher accuracy and reliability in landmark identification and measurements compared to the conventional digital and manual tracing methods and the digital tracing method, while more accurate than manual tracing. Conclusion: More studies need to be conducted with regard to AI methods as it will bring significant changes in diagnosis, measurement procedures, and formulating a definitive proper treatment planning.

For more than seven decades orthodontist used cephalometric analysis as one of the main diagnostic tools which can be performed manually or by software. The use of computers in treatment planning is expected to avoid errors and make it less time consuming with effective evaluation and high reproducibility. This study was done to evaluate and compare the accuracy and reliability of cephalometric measurements between computerized method of direct digital radiographs and conventional tracing. Digital and conventional hand tracing cephalometric analysis of 50 patients were done. Thirty anatomical landmarks were defined on each radiograph by a single investi-gator, 5 skeletal analysis (Steiner, Wits, Tweeds, McNamara, Rakosi Jarabaks) and 28 variables were calculated. The variables showed consistency between the two methods except for 1-NA, Y-axis and interincisal angle measurements which were higher in manual tracing and higher facial axis angle in digital tracing. Most of the commonly used measurements were accurate except some measurements between the digital tracing with FACAD® and manual methods. The advantages of digital imaging such as enhancement, transmission, archiving and low radiation dosages makes it to be preferred over conventional method in daily use.

Background: Over the years, various researchers have attempted to compare digital cephalometry with the conventional manual approach. There is a need to comprehensively analyze the findings from the earlier studies and determine the potential advantages and limitations of each method. The present systematic review aimed to compare the accuracy of digital and manual tracing in cephalometric analysis for the identification of skeletal and dental landmarks. Methods: A systematic search was performed using the keywords "Digital" AND "Manual" AND "Cephalometry" to identify relevant studies published in the English language in the past decade. The electronic data resources consulted for the elaborate search included the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL, EMBASE, PsycINFO, Scopus, ERIC, and ScienceDirect with controlled vocabulary and free text terms. Results: A total of n = 20 studies were identified that fulfilled the inclusion and exclusion criteria within the timeframe of 2013 to 2023. The data extracted from the included articles and corresponding meta-analyses are presented in the text. Conclusions: The findings of the present systematic review and meta-analysis revealed trends suggesting that digital tracing may offer reliable measurements for specific cephalometric parameters efficiently and accurately. Orthodontists must consider the potential benefits of digital cephalometry, including time-saving and user-friendliness.