title: Evaluation of 3-dimensional superimposition techniques on various skeletal structures of the head using surface models.
abstract: OBJECTIVE
  To test the applicability, accuracy, precision, and reproducibility of various 3D superimposition techniques for radiographic data, transformed to triangulated surface data.
  
  
  METHODS
  Five superimposition techniques (3P: three-point registration; AC: anterior cranial base; AC + F: anterior cranial base + foramen magnum; BZ: both zygomatic arches; 1Z: one zygomatic arch) were tested using eight pairs of pre-existing CT data (pre- and post-treatment). These were obtained from non-growing orthodontic patients treated with rapid maxillary expansion. All datasets were superimposed by three operators independently, who repeated the whole procedure one month later. Accuracy was assessed by the distance (D) between superimposed datasets on three form-stable anatomical areas, located on the anterior cranial base and the foramen magnum. Precision and reproducibility were assessed using the distances between models at four specific landmarks. Non parametric multivariate models and Bland-Altman difference plots were used for analyses.
  
  
  RESULTS
  There was no difference among operators or between time points on the accuracy of each superimposition technique (p>0.05). The AC + F technique was the most accurate (D<0.17 mm), as expected, followed by AC and BZ superimpositions that presented similar level of accuracy (D<0.5 mm). 3P and 1Z were the least accurate superimpositions (0.79<D<1.76 mm, p<0.005). Although there was no difference among operators or between time points on the precision of each superimposition technique (p>0.05), the detected structural changes differed significantly between different techniques (p<0.05). Bland-Altman difference plots showed that BZ superimposition was comparable to AC, though it presented slightly higher random error.
  
  
  CONCLUSIONS
  Superimposition of 3D datasets using surface models created from voxel data can provide accurate, precise, and reproducible results, offering also high efficiency and increased post-processing capabilities. In the present study population, the BZ superimposition was comparable to AC, with the added advantage of being applicable to scans with a smaller field of view.
authors.affiliation: Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Gkantidis
authors.affiliation: Department of Orthodontics, University of Marburg, Marburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Schauseil
authors.affiliation: Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland.
authors.forename: Pawel
authors.initials: P
authors.lastname: Pazera
authors.affiliation: Department of Orthodontics, Cumhuriyet University, Sivas, Turkey.
authors.forename: Berna
authors.initials: B
authors.lastname: Zorkun
authors.affiliation: Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland.
authors.forename: Christos
authors.initials: C
authors.lastname: Katsaros
authors.affiliation: Private orthodontic office, Traben-Trarbach, Germany; Department of Orthodontics, University of Saarland, Homburg/Saar, Germany.
authors.forename: Björn
authors.initials: B
authors.lastname: Ludwig
mesh_terms: D000293:Adolescent; D000465:Algorithms; D000704:Analysis of Variance; D002508:Cephalometry / Q000379:methods*; D003198:Computer Simulation; D005260:Female; D005539:Foramen Magnum / Q000000981:diagnostic imaging; D006257:Head / Q000528:radiation effects*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008953:Models, Anatomic; D011859:Radiography; D015203:Reproducibility of Results; D019291:Skull Base / Q000000981:diagnostic imaging; D015898:Tomography Scanners, X-Ray Computed; D055815:Young Adult; D015050:Zygoma / Q000000981:diagnostic imaging