title: Diagnostic performance of various cephalometric parameters for the assessment of vertical growth pattern.
abstract: BACKGROUND
  Multiple cephalometric analyses are used to diagnose vertical skeletal facial discrepancy. A multitude of times, these parameters show conflicting results, and a specific diagnosis is hard to reach.
  
  
  OBJECTIVE
  Hence, this study aimed to identify the skeletal analysis that performs best for the identification of vertical skeletal pattern in borderline cases.
  
  
  METHODS
  The sample consisted of 161 subjects (71 males and 90 females; mean age = 23.6 ± 4.6 years). Y-axis, Sella-Nasion to mandibular plane angle (SN.MP), maxillary plane to mandibular plane angle (MMA), Sella-Nasion to Gonion-Gnathion angle (SN.GoGn), Frankfort to mandibular plane angle (FMA), R-angle and facial height ratio (LAFH.TAFH) were used to evaluate vertical growth pattern on lateral cephalograms. The subjects were divided into three groups (hypodivergent, normodivergent and hyperdivergent groups), as indicated by the diagnostic results of the majority of parameters. Kappa statistics was applied to compare the diagnostic accuracy of various analyses. To further validate the results, sensitivity and positive predictive values (PPV) for each parameter were also calculated.
  
  
  RESULTS
  SN.GoGn showed a substantial interclass agreement (k = 0.850). In the hypodivergent group, MMA showed the highest sensitivity (0.934), whereas FMA showed the highest PPV (0.964). In the normodivergent group, FMA showed the highest sensitivity (0.909) and SN.GoGn had the highest PPV (0.903). SN.GoGn showed the highest sensitivity (0.980) and PPV (0.87) in the hyperdivergent group.
  
  
  CONCLUSIONS
  SN.GoGn and FMA were found to be the most reliable indicators, whereas LAFH.TAFH is the least reliable indicator in assessing facial vertical growth pattern. Hence, the cephalometric analyses may be limited to fewer analyses of higher diagnostic performance.
authors.affiliation: Resident in Orthodontics, The Aga Khan University Hospital, Section of Dentistry, Department of Surgery, Karachi, Pakistan.
authors.forename: Maheen
authors.initials: M
authors.lastname: Ahmed
authors.affiliation: Consultant Orthodontist/Assistant Professor, Program Coordinator Orthodontics Residency Program, The Aga Khan University Hospital, Section of Dentistry, Department of Surgery, Karachi, Pakistan.
authors.forename: Attiya
authors.initials: A
authors.lastname: Shaikh
authors.affiliation: Consultant Orthodontist/Associate Professor, Program Director Orthodontics Residency Program, The Aga Khan University Hospital, Section of Dentistry, Department of Surgery, Karachi, Pakistan.
authors.forename: Mubassar
authors.initials: M
authors.lastname: Fida
mesh_terms: D002508:Cephalometry / Q000379:methods*; D003430:Cross-Sectional Studies; D005147:Facial Bones / Q000033:anatomy & histology / Q000254:growth & development*; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000033:anatomy & histology / Q000254:growth & development; D008437:Maxilla / Q000033:anatomy & histology / Q000254:growth & development; D055815:Young Adult