The Journal of Contemporary Dental Practice

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 20 , ISSUE 7 ( July, 2019 ) > List of Articles


Significance of Cephalometric Radiograph in Orthodontic Treatment Plan Decision

Narmin M Helal, Osama A Basri

Keywords : Extraction, Lateral cephalograms, Orthodontics, Radiation exposure

Citation Information : Helal NM, Basri OA. Significance of Cephalometric Radiograph in Orthodontic Treatment Plan Decision. J Contemp Dent Pract 2019; 20 (7):789-793.

DOI: 10.5005/jp-journals-10024-2598

License: CC BY-NC 4.0

Published Online: 01-08-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Aim: The lateral cephalometric radiograph is a standard component of clinical records taken for orthodontic diagnosis and treatment planning. The present study was conducted to assess the utility of cephalometric radiography and analysis in modern orthodontic diagnosis and treatment planning. Materials and methods: A research survey was conducted at Jacksonville University School of Orthodontics. Thirty-one residents and faculty were the participants. The survey sample was collected from the university patients’ pool. A survey was given to participants at two time points. At the first time point (T1), the participants were given full records without lateral cephalogram. At the second time point (T2), they were given full records with lateral cephalogram. Two measures were analyzed: (1) a change in orthodontic treatment decision and (2) a change in the orthodontic treatment plan. A traditional McNemar's test was used on paired binary data. We used the conditional logistic regression model with robust variance at a participant level to adjust for a participant-level clustering effect to test the difference in treatment decision before and after. A statistical significance was determined at p = 0.05. Results: It was found that 93.6% of the treatment decisions and 70% of the extraction decisions were consistent after the introduction of lateral cephalograms. There was no statistically significant association observed between two outcome measures and the use of cephalograms (p = 0.80). Conclusion: Sufficient evidence does not exist to warrant lateral cephalometric radiographs be taken as a part of standard diagnostic records on every individual seeking orthodontic treatment. Clinical significance: Evidenced-based selection criteria for prescribing lateral cephalometric radiographs should be developed to reduce the amount of radiation exposure to the general public.

  1. Proffit WR, Fields HW, et al. Contemporary orthodontics, 4th ed. St. Louis: Mosby Inc.; 2007.
  2. Graber TM, Vanarsdall RL, et al. Orthodontics: current principals and techniques, 4th ed. St. Louis: Mosby Inc.; 2005.
  3. Jacobson A, Jacobson RL. Radiographic cephalometry: from basics to 3-D imaging, 2nd ed., Quintessence Publishing Co, Inc.; 2006.
  4. Down W. Variations in facial relationship. Their significance in treatment and prognosis. Am J Orthod 1948;34:812–840. DOI: 10.1016/0002-9416(48)90015-3.
  5. Steiner C. Cephalometric for you and me. Am J Orthod 1953;39: 729–754. DOI: 10.1016/0002-9416(53)90082-7.
  6. Silling G, Rauch MA, et al. The significance of cephalometrics in treatment planning. Angle Orthod 1979 Oct;49(4):259–262. DOI: 10.1043/0003-3219(1979)049<0259:TSOCIT>2.0.CO;2.
  7. Longstreth WT Jr, Dennis LK, et al. Epidemiology of intracranial meningioma. Cancer 1993 Aug 1;72(3):639–648. DOI: 10.1002/1097-0142(19930801)72:3<639::AID-CNCR2820720304>3.0. CO;2-P.
  8. Preston-Martin S, Pike MC, et al. Increased cell division as a cause of human cancer. Cancer Res 1990 Dec 1;50(23):7415–7421.
  9. Horn-Ross PL, Ljung BM, et al. Environmental factors and the risk of salivary gland cancer. Epidemiology 1997 Jul 1;8(4):414–419. DOI: 10.1097/00001648-199707000-00011.
  10. Wingren G, Hallquist A, et al. Diagnostic X-ray exposure and female papillary thyroid cancer: a pooled analysis of two Swedish studies. Eur J Cancer Prev 1997 Dec;6(6):550–506. DOI: 10.1097/00008469-199712000-00010.
  11. Hallquist A, Hardell L, et al. Medical diagnostic and therapeutic ionizing radiation and the risk for thyroid cancer: a case-control study. Eur J Cancer Prev 1994 May;3(3):259–267. DOI: 10.1097/00008469-199403030-00004.
  12. Horner K, Islam M, et al. Basic principles for use of dental cone beam computed tomography: consensus guidelines of the European Academy of Dental and Maxillofacial Radiology. Dentomaxillofac Radiol 2009 May;38(4):187–195. DOI: 10.1259/dmfr/74941012.
  13. Han UK, Vig KWL, et al. Consistency of orthodontic treatment decisions relative to diagnostic records. Am J Orthod Dentofacial Orthop 1991;100:212–219. DOI: 10.1016/0889-5406(91)70058-5.
  14. Bruks A, Enberg K, et al. Radiographic examinations as an aid to orthodontic diagnosis and treatment planning. Swed Dent J 1999;23(2–3):77–85.
  15. Nijkamp PG, Habets LLHM, et al. A The influence of cephalometrics on orthodontic treatment planning. Eur J Orthod 2008;30:630–635. DOI: 10.1093/ejo/cjn059.
  16. Devereux L, Moles D, et al. How important are lateral cephalometric radiographs in orthodontic treatment planning? Am J Orthod Dentofacial Orthop 2011;139:e175–e181. DOI: 10.1016/j.ajodo. 2010.09.021.
  17. Atchison KA, Luke LS, et al. Contribution of pretreatment radiographs to orthodontists’ decision making. Oral Surg Oral Med Oral Path 1991;71:238–245. DOI: 10.1016/0030-4220(91)90477-T.
  18. Durão AR, Alqerban A, et al. Influence of lateral cephalometric radiography in orthodontic diagnosis and treatment planning. Angle Orthod 2014 May 21;85(2):206–210. DOI: 10.2319/011214-41.1.
  19. Goyal M, Rastogi S, et al. Importance of pilot and co-pilots in diagnosis and treatment planning of young ortho patients. Int J Scien Res 2018 13;6(5):39–41.
  20. Stupar I, Yetkiner E, et al. Influence of Lateral Cephalometric Radiographs on Orthodontic Treatment Planning of Class II Patients. Open Dent J 2018;12:296. DOI: 10.2174/1874210601812010296.
  21. Atchison KA, Luke LS, et al. An algorithm for ordering pretreatment orthodontic radiographs. Am J Orthod Dentofacial Orthop 1992;102: 29–44. DOI: 10.1016/0889-5406(92)70012-Y.
  22. American Association of Orthodontists. Clinical practice guidelines for orthodontics and dentofacial orthopedics 2008, 1–43.
  23. Keim RG, Gottlieb EL, et al. JCO Study of orthodontic diagnosis and treatment procedures. Part 1. Results and trends. J Clin Orthod 2002;36:553–556.
  24. Brooks SL. CBCT Dosimetry: Orthodontic Considerations. Semin Oncol 2009;15:14–18. DOI: 10.1053/j.sodo.2008.09.002.
  25. Currier GF, Riolo M, et al. Orthodontic exam and diagnosis. In: Essentials for orthodontic practice. Grand Haven: EFOP press; 2003. pp. 264–301.
  26. Dinçer B, Yetkiner E, et al. Influence of lateral cephalometric radiographs on extraction decision in skeletal class I patients. Head Face Med 2013;9:36. DOI: 10.1186/1746-160X-9-36.
  27. Macri V, Athanasiou AE. Sources of error in lateral cephalometry. In: Orthodontic Cephalometry. London: Mosby-Wolfe; 1995. pp. 125–140.
  28. Scholz RP. The Radiology Decision. Semin Oncol 2011;17:15–19. DOI: 10.1053/j.sodo.2010.08.001.
  29. Isaacson K, Thom A, et al. Guidelines for the use of radiographs in clinical orthodontics. London, United Kingdom: British Orthodontic Society; 2008.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.