Abstract
IntroductionCone-Beam Computed Tomography (CBCT) images can be superimposed, allowing three-dimensional (3D) evaluation of craniofacial growth/treatment effects. Limitations of 3D superimposition techniques are related to imaging quality, software/hardware performance, reference areas chosen, and landmark points/volumes identification errors. The aims of this research are to determine/compare the intra-rater reliability generated by three 3D superimposition methods using CBCT images, and compare the changes observed in treated cases by these methods.MethodsThirty-six growing individuals (11–14 years old) were selected from patients that received orthodontic treatment. Before and after treatment (average 24 months apart) CBCTs were analyzed using three superimposition methods. The superimposed scans with the two voxel-based methods were used to construct surface models and quantify differences using SlicerCMF software, while distances in the landmark-derived method were calculated using Excel. 3D linear measurements of the models superimposed with each method were then compared.ResultsRepeated measurements with each method separately presented good to excellent intraclass correlation coefficient (ICC ≥ 0.825). ICC values were the lowest when comparing the landmark-based method and both voxel-based methods. Moderate to excellent agreement was observed when comparing the voxel-based methods against each other. The landmark-based method generated the highest measurement error.ConclusionsFindings indicate good to excellent intra-examiner reliability of the three 3D superimposition methods when assessed individually. However, when assessing reliability among the three methods, ICC demonstrated less powerful agreement. The measurements with two of the three methods (CMFreg/Slicer and Dolphin) showed similar mean differences; however, the accuracy of the results could not be determined.
Highlights
Cone-Beam Computed Tomography (CBCT) images can be superimposed, allowing threedimensional (3D) evaluation of craniofacial growth/treatment effects
Intra-examiner reliability of 3D superimposition per method Voxel-based CMFreg/slicer method: first and second Cranial Base superimposition Using ten pre-determined 3D linear distances, good to excellent agreement for intra-examiner reliability was found on all skeletal landmarks as indicated by an Intraclass Correlation Coefficient (ICC) ≥ 0.904
All these ICC values were considered acceptable; lower bound of CI of two landmarks (APoint and OrR) were below 0.50 (Table 2)
Summary
Cone-Beam Computed Tomography (CBCT) images can be superimposed, allowing threedimensional (3D) evaluation of craniofacial growth/treatment effects. Superimposing tracings of serial lateral cephalograms has facilitated knowledge about normal craniofacial growth and Several studies [8,9,10,11,12,13,14] have proposed the use of the anterior cranial base as reference for superimposition since there is little or no growth after 7–8 years of age when the spheno-ethmoidal synchondrosis ceases to (2020) 16:1 Maxilla. A- The point at the deepest midline concavity on the maxilla between the Point anterior nasal spine and prosthion. OrR The lowest point in the inferior margin of the right orbit. Me Menton – The most inferior midline point on the mandibular symphysis.
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