title: Influence of magnification and superimposition of structures on cephalometric diagnosis.
abstract: OBJECTIVE
  The purpose of this study was to assess the influence of magnification and superimposition of structures on CBCT-generated lateral cephalometric radiographs (LCR) using different segments of the cranium.
  
  
  METHODS
  CBCT scans of 10 patients were selected. Four LCR were generated using Dolphin Imaging(r) software: full-face, right side, left side and center of the head. A total of 40 images were imported into Radiocef Studio 2(r), and the angles of the most common cephalometric analyses were traced by the same observer twice and within a 10-day interval. Statistical analyses included intraexaminer agreement and comparison between methods by means of intraclass correlation coefficient (ICC) and Bland-Altman agreement tests.
  
  
  RESULTS
  Intraexaminer agreement of the angles assessed by ICC was excellent (> 0.90) for 83% of measurements, good (between 0.75 and 0.90) for 15%, and moderate (between 0.50 and 0.75) for 2% of measurements. The comparison between methods by ICC was excellent for 68% of measurements, good for 26%, and moderate for 6%. Variables presenting wider confidence intervals (> 6o) in the Bland-Altman tests, in intraexaminer assessment, were: mandibular incisor angle, maxillary incisor angle, and occlusal plane angle. And in comparison methods the variables with wider confidence interval were: mandibular incisor, maxillary incisor, GoGn, occlusal plane angle, Frankfort horizontal plane (FHP), and CoA.
  
  
  CONCLUSIONS
  Superimposition of structures seemed to influence the results more than magnification, and neither one of them significantly influenced the measurements. Considerable individual variability may occur, especially for mandibular and maxillary incisors, FHP and occlusal plane.
authors.affiliation: Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Leonardo Koerich de
authors.initials: LK
authors.lastname: Paula
authors.affiliation: Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Priscilla de Almeida
authors.initials: Pde A
authors.lastname: Solon-de-Mello
authors.affiliation: Department of Orthodontics, Universidade Federal Fluminense, Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Claudia Trindade
authors.initials: CT
authors.lastname: Mattos
authors.affiliation: Department of Orthodontics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Antônio Carlos de Oliveira
authors.initials: AC
authors.lastname: Ruellas
authors.affiliation: Department of Orthodontics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Eduardo Franzotti
authors.initials: EF
authors.lastname: Sant'Anna
mesh_terms: D000293:Adolescent; D002508:Cephalometry / Q000379:methods*; D002648:Child; D002680:Chin / Q000000981:diagnostic imaging; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D003766:Dental Occlusion; D004424:Ear Canal / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D007180:Incisor / Q000000981:diagnostic imaging; D008297:Male; D008334:Mandible / Q000000981:diagnostic imaging; D008437:Maxilla / Q000000981:diagnostic imaging; D008963:Molar / Q000000981:diagnostic imaging; D015588:Observer Variation; D009915:Orbit / Q000000981:diagnostic imaging; D011858:Radiographic Magnification / Q000379:methods*