Experimental and clinical assessment of three-dimensional cephalometry: A systematic review

Objectives: This study provides a systematic review of the current scientific literature on three-dimensional (3D) cephalometry. The null hypothesis was that 3D cephalometry is an accurate and reproducible diagnostic technique. To examine this hypothesis, the following three research questions were proposed: 1) What is the accuracy of 3D cephalometric measurements compared to in vitro measurements? 2) What is the intra- and inter-observer reliability of the selection of 3D cephalometric landmarks? 3) What is the reproducibility of the linear and angular measurements? Methods: A comprehensive database search was performed, using Medline, the Cochrane Central Register of Controlled Trials, Web of Science and Google Scholar. The titles and abstracts obtained from the search were screened and evaluated by two observers according to the inclusion and exclusion criteria. Results: The evaluation process yielded 21 articles. A high level of agreement (<1 mm) between the in vitro measurements and those obtained from 3D cephalometry was observed and some landmarks provided highly reproducible results. However, the linear (0.04-7.49 mm) and angular (0.99-9.30 degrees) measurements differed greatly. Conclusions: The null hypothesis was rejected. This study indicates critical points regarding 3D cephalometry and provides guidance for future research in this field. (C) 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.