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Comparison of the accuracy of 2D and 3D cephalometry: a systematic review and meta-analysis Cover

Comparison of the accuracy of 2D and 3D cephalometry: a systematic review and meta-analysis

By: Yuran Qian,  Hui Qiao,  Xu Wang,  Qi Zhan,  Yuan Li,  Wei Zheng and  Yu Li  
Open Access
|Mar 2022

Figures & Tables

Figure 1.

Study flow diagram.
Study flow diagram.

Figure 2.

Forest plots of pooled DM for the CBCT group versus the X-ray group (A) SNA, (B) SNB, (C) ANB, (D) SN-MP.
Forest plots of pooled DM for the CBCT group versus the X-ray group (A) SNA, (B) SNB, (C) ANB, (D) SN-MP.

Figure 3.

Forest plots of pooled DM for the CBCT group versus the X-ray group (A) ANS-Me, (B) ANS-PNS, (C) N-ANS, (D) N-Me, (E) N-S, (F) Po-NB.
Forest plots of pooled DM for the CBCT group versus the X-ray group (A) ANS-Me, (B) ANS-PNS, (C) N-ANS, (D) N-Me, (E) N-S, (F) Po-NB.

Figure 4.

Forest plots of pooled DM for the CBCT group versus the X-ray group (A) L1-MP, (B) U1-L1(°), (C) L1-NB(mm), (D) L1-NB (°), (E) U1-NA(mm), (F) U1-NA(°).
Forest plots of pooled DM for the CBCT group versus the X-ray group (A) L1-MP, (B) U1-L1(°), (C) L1-NB(mm), (D) L1-NB (°), (E) U1-NA(mm), (F) U1-NA(°).

Figure 5.

Forest plots of pooled DM for the CBCT group versus the X-ray group (A) Ar(Co)-Go, (B) FH-MP, (C) Me-Go, (D) OP-SN.
Forest plots of pooled DM for the CBCT group versus the X-ray group (A) Ar(Co)-Go, (B) FH-MP, (C) Me-Go, (D) OP-SN.

Result of sensitivity analysis_

IndexOriginal resultExclusion of Zamora, N 2011 and Jung, Pil-Kyo 2015Exclusion of Zamora, N 2011Exclusion of and Jung, Pil-Kyo 2015
SNA0.02 (-0.98, 1.02) P = 0.9710.05 (-1.40, 1.51) P = 0.9420.04 (-1.00, 1.07) P = 0.9480.03 (-1.35, 1.40) P = 0.970
SNB-0.10 (-0.64, 0.43) P = 0.7000.09 (-0.83, 1.00) P = 0.855-0.05 (-0.63, 0.54) P = 0.8810.01 (-0.82, 0.83) P = 0.987
ANB0.05 (-0.18,0.27) P = 0.677-0.04 (-0.28, 0.21) P = 0.760
Ar(Co)-Gn10.76 (4.93, 16.60) P = 0.00010.76 (12.94, 20.39) P = 0.000
ANS-PNS-0.86 (-10.92, 9.20) P = 0.867
ANS-Me-0.35 (-1.38, 0.69) P = 0.513-0.49 (-2.22, 1.23) P = 0.577-0.36 (-1.42, 0.70) P = 0.507-0.44 (-2.06, 1.18) P = 0.593
N-ANS0.17 (-0.59, 0.92) P = 0.6630.07 (-0.19, 0.33) P = 0.599
N-Me-0.53 (-1.73, 0.66) P = 0.379-0.85 (-3.13, 1.44) P = 0.468-0.61 (-1.84, 0.62) P = 0.332-1.04 (-2.74, 0.65) P = 0.229
FH-MP-0.34 (-0.70, 0.02) P = 0.063-0.44 (-0.99, 0.11) P = 0.119
SN-MP-1.20 (-3.06, 0.66) P = 0.206-1.57 (-3.67, 0.53) P = 0.142
Me-Go9.15 (2.99, 15.31) P = 0.00413.53 (4.60, 22.47) P = 0.003
N-S2.12 (-1.86, 6.09) P = 0.2973.30 (-3.43, 10.03) P = 0.337
Po-NB0.40 (-0.08, 0.89) P = 0.104
L1-MP-0.21 (-1.54, 1.12) P = 0.756-0.32 (-2.91, 2.28) P = 0.812-0.27 (-1.79, 1.24) P = 0.726-0.28 (-2.43, 1.87) P = 0.799
OP-SN-0.71 (-2.58, 1.15) P = 0.454
L1-NB(mm)-0.20 (-0.82, 0.42) P = 0.526
L1-NB(°)0.69 (-1.95, 3.34) P = 0.608
U1-L11.55 (1.09, 2.00) P = 0.0001.75 (0.86, 2.64) P = 0.0001.55 (1.10, 2.01) P = 0.0001.5 (1.11, 2.02) P = 0.000
U1-NA(mm)0.20 (-0.34, 0.73) P = 0.465
U1-NA(°)0.28 (-2.49, 3.05) P = 0.845

The QUAMAS (Quality Assessment of Measurement Accuracy Studies) tool used in the study_

Parameter of evaluationScore
Study design (5√)AObjective clearly formulated (√)1
BRandomized sample (√)1
CSample size: Considered adequate (number≥50)(√)1
DSimilar baseline characteristics (√)1
ESelection criteria: Clearly described and adequate (√)1
Study measurement (5√)FMeasurement method is appropriate (√)1
GGold standard is appropriate (√)1
HAdequate examiners and independent measurement (√)1
IReliability: Described and adequate level of agreement (√)1
JAppropriate examination time interval (√)1
Statistical analysis (5√)KStatistical analysis is appropriate for data (√)1
LReliability: intra-examiner (√) and inter-examiner (√)2
MStatistical significance level: P value (√) and confidence intervals (√)2
Total 15

Quality assessment of the included studies using the QUAMAS tool_

Study designStudy measurementStatistical Analysis
StudiesABCDEFGHIJKLMTotal
Jung, 2015111111101111112
Wen, 20171010.51110.51012111
Zamora, 2011100000.510101116.5
Miao, 201610011110011018
Na, 2012100111101110210
Zhiyao, 20161010.511101111110.5
Mingming, 20161000.51110111119.5
Yang, 201210010110.5011017.5

Search strategies in the study_

DatabasesStepsStrategies
PubMed#1“Cephalometry”[Mesh] OR Craniometry OR cephalometric OR Cephalometry
#2“X-Ray Film”[Mesh] OR X Ray Film OR Xray Film OR Film, Xray OR Films, Xray OR Radiographic Film OR Xray Films OR Film, Radiographic OR Films, Radiographic OR Radiographic Films OR Film, X-Ray OR Film, X Ray OR Films, X-Ray OR Films, X-Ray OR radiograph OR roentgenogram OR scotograph OR Lateral cephalometric radiograph
#32d OR two-dimensional OR 2 dimension OR two dimension OR 2 dimensional OR bidimensional OR 2 d
#4#2 OR #3
#5“Cone-Beam Computed Tomography”[Mesh] OR Cone-Beam CAT Scan OR Computed Tomography, Cone-Beam OR Cone Beam Computed Tomography OR CT Scan, Cone-Beam OR CT Scan, Cone Beam OR CT Scans, Cone Beam OR CT Scans, Cone-Beam OR Cone-Beam CT Scan OR Cone-Beam CT Scans OR Scan, Cone-Beam CT OR Scans, Cone-Beam CT OR Tomography, Cone-Beam Computed OR Tomography, Cone Beam Computed OR Tomography, Volume Computed OR Computed Tomography, Volume OR Volume Computed Tomography OR Volumetric CT OR CT, Volumetric OR Volumetric Computed Tomography OR Computed Tomography, Volumetric OR Tomography, Volumetric Computed OR CAT Scan, Cone-Beam OR CAT Scan, Cone Beam OR CAT Scans, Cone-Beam OR CT, Volume OR Cone-Beam CAT Scan OR Cone-Beam CAT Scans OR Scans, Cone-Beam CAT OR Cone-Beam Computer-Assisted Tomography OR Scan, Cone-Beam CAT OR Computer-Assisted Tomography, Cone-Beam OR Cone Beam Computer Assisted Tomography OR Tomography, Cone-Beam Computer-Assisted OR Cone-Beam Computerized Tomography OR Computerized Tomography, Cone-Beam OR Cone Beam Computerized Tomography OR Tomography, Cone-Beam Computerized OR Cone-Beam CT OR CT, Cone-Beam OR Cone Beam CT OR Volume CT OR CBCT OR Cone Beam Computed Tomography
#6#1 AND #4 AND #5
Embase#1'Cone-Beam Computed Tomography’/exp OR ‘Computed Tomography, Cone-Beam’ OR ‘Cone Beam Computed Tomography’ OR ‘CT Scan, Cone-Beam’ OR ‘CT Scan, Cone Beam’ OR ‘CT Scans, Cone-Beam’ OR ‘Cone-Beam CT Scan’ OR ‘Cone-Beam CT Scans’ OR ‘Scan, Cone-Beam CT’ OR ‘Scans, Cone-Beam CT’ OR ‘Tomography, Cone-Beam Computed’ OR ‘Tomography, Cone Beam Computed’ OR ‘Tomography, Volume Computed’ OR ‘Computed Tomography, Volume’ OR ‘Volume Computed Tomography’ OR ‘Volumetric CT’ OR ‘CT, Volumetric’ OR ‘Volumetric Computed Tomography’ OR ‘Computed Tomography, Volumetric’ OR ‘Tomography, Volumetric Computed’ OR ‘CAT Scan, Cone-Beam’ OR ‘CAT Scan, Cone Beam’ OR ‘CAT Scans, Cone-Beam’ OR ‘Cone-Beam CAT Scan’ OR ‘Cone-Beam CAT Scans’ OR ‘Scan, Cone-Beam CAT’ OR ‘Scans, Cone-Beam CAT’ OR ‘Cone-Beam Computer-Assisted Tomography’ OR ‘Computer-Assisted Tomography, Cone-Beam’ OR ‘Cone Beam Computer Assisted Tomography’ OR ‘Tomography, Cone-Beam Computer-Assisted’ OR ‘Cone-Beam Computerized Tomography’ OR ‘Computerized Tomography, Cone-Beam’ OR ‘Cone Beam Computerized Tomography’ OR ‘Tomography, Cone-Beam Computerized’ OR ‘Cone-Beam CT’ OR ‘CT, Cone-Beam’ OR ‘Cone Beam CT’ OR ‘Volume CT’ OR ‘CT, Volume” OR ‘CBCT'
#2'Cephalometry’/exp OR ‘Cephalometry’ OR ‘Craniometry’ OR ‘cephalometry'
#3'X-Ray Film’/exp OR ‘X Ray Film’ OR ‘Xray Film’ OR ‘Film, Xray’ OR ‘Films, Xray’ OR ‘Radiographic Film’ OR ‘Xray Films’OR ‘Film, Radiographic’ OR ‘Films, Radiographic’ OR ‘Radiographic Films’ OR ‘Film, X-Ray’ OR ‘Film, X Ray’ OR ‘Films, X-Ray’ OR ‘Films, X-Ray’ OR ‘radiograph’ OR ‘roentgenogram’ OR ‘scotograph’ OR ‘Lateral cephalometric radiograph'
#4'2-d’ OR ‘two-dimensional’ OR ‘2 dimension’ OR ‘two dimension’ OR ‘2-dimensional’ OR ‘bidimensional’ OR ‘2 d'
#5#3 OR #4
#6#1 AND #2 AND #5
CNKI#1Cephalometry OR Craniometry
#2Lateral cephalometric radiograph OR 2 d
#3Cone Beam Computed Tomography OR CBCT
#4#1 AND #2 AND #3 AND #4
Web of Science#1Cephalometry OR Craniometry OR cephalometric
#2X Ray Film OR Xray Film OR Film, Xray OR Films, Xray OR Radiographic Film OR Xray Films OR Film, Radiographic OR Films, Radiographic OR Radiographic Films OR Film, X-Ray OR Film, X Ray OR Films, X-Ray OR Films, X-Ray OR radiograph OR roentgenogram OR scotograph OR Lateral cephalometric radiograph
#32d OR two-dimensional OR 2 dimension OR two dimension OR 2 dimensional OR bidimensional OR 2d
#4#2 OR #3
#5Cone-Beam CAT Scan OR Computed Tomography, Cone-Beam OR Cone Beam Computed Tomography OR CT Scan, Cone-Beam OR CT Scan, Cone Beam OR CT Scans, Cone Beam OR CT Scans, Cone-Beam OR Cone-Beam CT Scan OR Cone-Beam CT Scans OR Scan, Cone-Beam CT OR Scans, Cone-Beam CT OR Tomography, Cone-Beam Computed OR Tomography, Cone Beam Computed OR Tomography, Volume Computed OR Computed Tomography, Volume OR Volume Computed Tomography OR Volumetric CT OR CT, Volumetric OR Volumetric Computed Tomography OR Computed Tomography, Volumetric OR Tomography, Volumetric Computed OR CAT Scan, Cone-Beam OR CAT Scan, Cone Beam OR CAT Scans, Cone-Beam OR CT, Volume OR Cone-Beam CAT Scan OR Cone-Beam CAT Scans OR Scans, Cone-Beam CAT OR Cone-Beam Computer-Assisted Tomography OR Scan, Cone-Beam CAT OR Computer-Assisted Tomography, Cone-Beam OR Cone Beam Computer Assisted Tomography OR Tomography, Cone-Beam Computer-Assisted OR Cone-Beam Computerized Tomography OR Computerized Tomography, Cone-Beam OR Cone Beam Computerized Tomography OR Tomography, Cone-Beam Computerized OR Cone-Beam CT OR CT, Cone-Beam OR Cone Beam CT OR Volume CT OR CBCT OR Cone Beam Computed Tomography OR CBCT
#6#1 AND #4 AND #5
SIGLE#1(Craniometry OR cephalometric OR Cephalometry) AND (X Ray Film OR Lateral cephalometric radiograph OR radiograph OR 2-d OR two-dimensional OR 2 dimension OR two dimension OR 2-dimensional OR 2 d) AND (Cone-Beam Computed Tomography OR CBCT OR CT Scan OR Cone-Beam CT)
Cochrane Central Register of Controlled Trials (CENTRAL)#1(Craniometry OR cephalometric OR Cephalometry) AND (X Ray Film OR Lateral cephalometric radiograph OR radiograph OR 2-d OR two-dimensional OR 2 dimension OR two dimension OR 2-dimensional OR 2 d) AND (Cone-Beam Computed Tomography OR CBCT OR CT Scan OR Cone-Beam CT)

General information of the included studies_

StudiesCountrySample typeSample sizeSample information2D type3D typeCBCT parametersNumber of examiners/measurement times
Jung, 2015KoreaPatients5012 males and 38 females (mean age 19.40 ± 6.40 years)Conventional lateral cephalogramsCBCT120 kV, 5 mA, 0.3 mm voxel size1/3 times
Wen, 2017ChinaPatients6021 males and 39 females (mean age 21.3 years)Conventional lateral cephalogramsCBCT110 kV, 5 mA, 0.25mm voxel size2/unknown
Zamora, 2011SpainPatients84 males and 4 females (mean age 15.55 ± 6.25 years)Conventional lateral cephalogramsCBCT (NemoCeph 3D and InVivo5)120 kV, 23.87 mA, 8.9 seconds, 0.4 mm3 voxel size,1/twice
Miao, 2016ChinaPatients20Unknown (age18-35 years)Conventional frontal cephalogramsCBCTUnknownUnknown/twice
Na, 2012ChinaPatients4018 males and 22 females (age 12-18 years)Conventional lateral cephalogramsCBCT120 kV, 5 mA, 4 seconds, 0.4 mm3 voxel size1/twice
Zhiyao, 2016ChinaPatients10050 males and 50 females (age 18-40 years)Conventional lateral cephalogramsCBCT120 kV, 5 mA, 0.3 mm voxel size1/twice
Mingming, 2016ChinaPatients3014 males and 16 females (age 20-26 years)Conventional lateral cephalogramsCBCT120 kV, 5 mA, 4 seconds, 0.25 mm voxel sizeUnknown/3 times
Yang, 2012ChinaPatients148 males and 6 females (age 15 ± 1.2 years)Conventional cephalogramsCBCTUnknown1/twice

Results of publication bias_

IndexBegg’s testEgger’s test
SNA0.492890.20611
SNB0.680750.14336
ANB0.297150.00829
Ar(Co)-Gn0.117850.00061
ANS-PNS1.000000.89425
ANS-Me0.404250.54673
N-ANS0.707110.61827
N-Me0.297150.02517
FH-MP0.620690.38980
SN-MP0.707110.94893
Me-Go0.144400.00522
N-S0.834830.67174
Po-NB1.000000.66028
L1-MP0.137650.10617
OP-SN1.000000.09144
L1-NB(mm)0.734100.59868
L1-NB(°)0.734100.85952
U1-L10.348080.95074
U1-NA(mm)0.734100.95712
U1-NA(°)0.734100.48943

Original result_

Index X ¯ 95%CI P value
SNA0.02(-0.98, 1.02) P = 0.971
SNB-0.10(-0.64, 0.43) P = 0.700
ANB0.05(-0.18, 0.27) P = 0.677
Ar(Co)-Gn10.76(4.93, 16.60) P = 0.000
ANS-PNS-0.86(-10.92, 9.20) P = 0.867
ANS-Me-0.35(-1.38, 0.69) P = 0.513
N-ANS0.17(-0.59, 0.92) P = 0.663
N-Me-0.53(-1.73, 0.66) P = 0.379
FH-MP-0.34(-0.70, 0.02) P = 0.063
SN-MP-1.20(-3.06, 0.66) P = 0.206
Me-Go9.15(2.99, 15.31) P = 0.004
N-S2.12(-1.86, 6.09) P = 0.297
Po-NB0.40(-0.08, 0.89) P = 0.104
L1-MP0.21(-1.54, 1.12) P = 0.756
OP-SN-0.71(-2.58, 1.15) P = 0.454
L1-NB(mm)-0.20(-0.82, 0.42) P = 0.526
L1-NB(°)0.69(-1.95, 3.34) P = 0.608
U1-L11.55(1.09, 2.00) P = 0.000
U1-NA(mm)0.17(-0.33, 0.68) P = 0.502
U1-NA(°)0.28(-2.49, 3.05) P = 0.845
DOI: https://doi.org/10.2478/aoj-2022-0015 | Journal eISSN: 2207-7480 | Journal ISSN: 2207-7472
Language: English
Page range: 130 - 144
Submitted on: Nov 1, 2021
Accepted on: Mar 1, 2022
Published on: Mar 28, 2022
Published by: Australian Society of Orthodontists Inc.
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year

© 2022 Yuran Qian, Hui Qiao, Xu Wang, Qi Zhan, Yuan Li, Wei Zheng, Yu Li, published by Australian Society of Orthodontists Inc.
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.