Comparison of digital and manual methods that are being used for cephalometric radiograps analysis

The purpose of this study was to evaluate the reliability and reproducibility of conventional hand-tracing and digital cephalometric tracing methods. Three hundred pretreatment lateral cephalometric radiographs were included in the study. Pre-treatment digital cephalometric radiographs were traced using Nemoceph Dental Studio NX Pro 10.4.2 software programs and by hand tracing of the printouts. Twenty-four anatomic points were identified by the same investigator and 12 skeletal, 10 dental and 3 soft tissue parameters were measured. Conventional and digital tracings and measurements were repeated on the randomly selected 75 radiographs by the same investigator after 1 month interval. For each method, Test-retest (CI) and intraclass correlation coefficient (ICC) were calculated to determine the consistence of all measured values between intra-investigator reliability and methods. If the coefficient is close to 1, it indicates that there is a high correlation between the values in the same group. The reproducibility between methods was calculated by paired t-test. The level of statistical significance was set at p<0.05. The intra-investigator reliability for all measurements were upon 0.90 ICC (strong correlation) for both methods. Significant differences between the two methods were observed for all angular and linear measurements except for L1-NB angle (p=0,061) and Nasolabial angle (p=0,777). Among these methods, good consistence was observed in all measurements except for the Gonial angle (ICC = 0.751) and Nasolabial angle (ICC = 0.780). According to the results of this study, both methods of conventional and digital cephalometric analysis are highly reliable. Although there is a statistically significant difference between the reproducibility of the two methods, most of the differences are not clinically significant.