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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 11  |  Issue : 1  |  Page : 35-39

Reliability of One Ceph software in cephalometric tracing: A comparative study


Department of Pedodontics, Kannur Dental College, Kannur, Kerala, India

Date of Submission06-Oct-2019
Date of Acceptance23-Jan-2020
Date of Web Publication11-Mar-2020

Correspondence Address:
Dr. Deema Abdul Khader
Department of Pedodontics, Kannur Dental College, Kannur, Kerala
India
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DOI: 10.4103/srmjrds.srmjrds_69_19

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  Abstract 

Background: Lateral cephalogram can now be traced using android-based smartphones making dentist's work easier and time saving. Various orthodontic analysis can also be carried out using these smart apps. This study was undertaken to assess the reliability of the android smartphone-based app with the manual tracing using Tweed analysis. Materials and Methods: A total of 40 lateral cephalometric radiographs were taken randomly from patients below 15 years reported for orthodontic problems. Tweed analysis was carried out for each radiograph; incisal mandibular plane angle, facial mandibular angle, and facial mandibular incisal plane angle were recorded, first manually traced, followed by digitally using android-based OneCeph digital cephalometric tracer. Values obtained by android-based OneCeph and manual methods are compared. Results: The values showed normal distribution, therefore parametric test was used to analyze the data; there was no statistically significant difference between the values obtained for Tweed analysis by android-based tracing and manual cephalometric tracing. Conclusion: This study showed that the digital tracing with the OneCeph software had the same accuracy in comparison to manual tracing and could be used instead of the traditional methods for various orthodontic analysis.

Keywords: Cephalometry, digital cephalometry, Tweed analysis


How to cite this article:
Khader DA, Peedikayil FC, Chandru T P, Kottayi S, Namboothiri D. Reliability of One Ceph software in cephalometric tracing: A comparative study. SRM J Res Dent Sci 2020;11:35-9

How to cite this URL:
Khader DA, Peedikayil FC, Chandru T P, Kottayi S, Namboothiri D. Reliability of One Ceph software in cephalometric tracing: A comparative study. SRM J Res Dent Sci [serial online] 2020 [cited 2020 Jun 3];11:35-9. Available from: http://www.srmjrds.in/text.asp?2020/11/1/35/280374


  Introduction Top


Orthodontics and dentofacial orthopedics are greatly dependent on cephalometric tracing. Broadbent introduced cephalometry in 1931; since then it is considered as a great significance in the diagnosis and treatment of dental malocclusions and underlying skeletal discrepancies as well as for the study of the growth and development of the teeth and skull.[1] With serial cephalometric radiographs, it is feasible to study and predict orthodontic treatment effects between pre- and post-treatment measurements. Cephalometric analysis can also be used to predict the surgical outcome for treating dentofacial deformities.

In spite of its extensive application, cephalometric analysis is time-consuming and can be prone to systematic and random error. Radiographic acquisition, landmark identification, tracing, and technical measurements are the main sources of errors.[2] Recently, there has been a hike in the usage of newer mechanics in all aspects of our lives. With the rapid advancement of computer radiography, manual method is gradually replaced by the digital method. Many cephalometric programs have been advanced to perform computer-aided cephalometric analysis by digitizing the landmarks. The incidence of errors can be minimized using computers in treatment planning. It provides fast, precise, and standardized appraisal with a high rate of reproducibility.[2]

Utilization of digital radiographic systems is being favored these days, as it offers several advantages over conventional cephalograms; swift execution of measurements, easy determination of treatment plans, eradication of chemical and other environmental hazards, easy storage of images, and also it can be easily duplicated and can send anywhere in the globe easily.[3] In addition, it is also possible for cost-efficient replication of radiographs as well as its rapid superimposition.

Usage of newer technologies in all aspects of our lives has given way to the introduction of newer apps in the dental field as well. This is true particularly for smartphones, which are not only meant for phone calls. An app is a small specialized program or application downloaded by a user to a mobile device.[2] Nowadays, various cephalometric softwares are available for digital cephalometric tracing, which provides accurate diagnostic approach.[4],[5]

Dr. Charles H. Tweed established the diagnostic facial triangle to determine the normal mesiodistal position of the teeth in relation to their corresponding jaws. Tweeds analysis consists of three planes that form a diagnostic triangle. The planes used were Frankfort horizontal plane, mandibular plane, and long axis of the lower incisor. However, the triangle is formed by the three angles, which are Frankfort mandibular angle (FMA), Frankfort mandibular incisor angle (FMIA), and incisor mandibular plane angle (IMPA).

Various studies have been carried out to assess the legitimacy and reproducibility of linear and angular measurements by cephalometric software programs such as Quick Ceph 2000 (Sarasota, Florida, USA),[3] NemoCeph (Madrid, Spain),[6] Dolphin (Oakdale, Chatsworth, USA),[7] FACAD (Beilkegaten, Linkoping, Sweden)[8] Vistadent (Woodbridge, Canada),[9] and OnyxCeph Software (Neidelwaldstr, Chemitz, Germany).[10]

Very few studies are in literature regarding the android-based cephalometric tracing. Therefore, a study was done to check the reliability of the digital android phone-based program with the manual conventional approach in Tweeds analysis.


  Materials and Methods Top


Forty cephalometric radiographs were arbitrarily obtained from patients who have visited the dental department for orthodontic treatment. The informed consent was obtained from all the patients or parents, and the study was approved by the ethical committee of the institution. The inclusion criteria for the study were good-quality radiographs to permit the identification of landmarks and the radiographs taken from same machine. The poor-quality radiographs, radiographs of patients with craniofacial deformities, and radiographs of patients with unerupted or missing incisor were excluded from the study.

These cephalometric radiographs were first manually traced using a sheet of acetate tracing paper on a view box with the tracing paper securely positioned over the radiograph. Six landmarks were marked on each radiograph, and three parameters were used: incisal mandibular plane angle (IMPA), facial mandibular angle (FMA), and facial mandibular incisal plane angle. Tweed analysis diagnostic triangle was made of each radiograph [Figure 1]. All landmarks were traced by single examiner to avoid bias.
Figure 1: Tweeds diagnostic facial triangle

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OneCeph digital cephalometric tracer was downloaded from Google Play Store in the android phone, six landmarks were marked on each radiographs, and three parameters, namely incisal mandibular plane angle (IMPA), facial mandibular Angle (FMA), and facial mandibular incisal plane angle for Tweeds triangle was made by marking the points in the phone [Figure 2]. The values obtained by each methods; manual and digital were tabulated, and all values were then analyzed using Statistical Package for the Social Sciences version 20. (IBM Corporation, Chicago, IL, USA).
Figure 2: OneCeph tracing

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A descriptive and analytical statistics were done. The data were represented in terms of mean and standard deviation. The normality of continuous data was analyzed by the Shapiro–Wilk test. As the data followed normal distribution, parametric test was used to analyze the data. The independent sample t-test was used to check mean differences. The level of significance was kept at P < 0.05.


  Results Top


[Table 1] shows the comparison of mean IMPA values obtained from manual, and digital OneCeph analysis. It was found that there was no statistical significant difference (P = 0.560) in the mean IMPA values obtained from the manual and digital OneCeph analysis.
Table 1: Comparison of mean incisal mandibular plane angle values obtained from the manual and digital OneCeph analysis

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The mean FMIA values obtained from manual and digital OneCeph analysis were compared. It was found that there was no statistical significant difference (P = 0.669) in the mean FMIA values obtained from the manual and digital OneCeph analysis [Table 2]. The mean FMA values obtained from manual and digital OneCeph analysis were compared. It was found that there was no statistically significant difference (P = 0.846) in mean FMA values obtained from manual and digital OneCeph analysis [Table 3].
Table 2: Comparison of mean Frankfort mandibular incisor angle values obtained from the manual and digital OneCeph analysis

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Table 3: Comparison of mean facial mandibular angle values obtained from the manual and digital OneCeph analysis

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[Table 4] shows the values obtained by the comparison of mean IMPA, FMIA, and FMA from manual and android-based OneCeph analysis. Values obtained were found to be statistically insignificant.
Table 4: Comparison of mean incisal mandibular plane angle, Frankfort mandibular incisor angle, and facial mandibular angle values obtained from the manual and digital OneCeph analysis

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  Discussion Top


Lateral cephalogram plays an important role in our dental practice, whether in orthodontics or in pediatric dentistry, cephalometric tracing done by hand previously is being gradually replaced by the digital cephalometric tracing programs in this technological era. Recently, there has been a rise in the usage of smartphones-based apps.[2],[5]

Cephalograms are quite difficult to trace, identify, and superimpose and depend on the quality of radiographs and experience of the examiner. In the present study, the hand tracing and digital tracing in android phone are performed by the same examiner to avoid inter-examiner bias. Tracing is done by giving 1 hour gap, and a maximum of five tracing is done per day to avoid eye fatigue, which can cause changes in landmark identification and can compromise the data obtained which can affect the reliability of our study. In hand tracing, landmark identification is quite difficult, especially in identifying Porion (highest point in external auditory meatus). Moreover, the tracing is quite a time-consuming as well as the measurements of cephalometric angles using protractor is also cumbersome.[3],[6]

Measurements obtained by digital cephalometrics may vary. This may be due to the usage of various programs and also depends on how these radiographs were acquired by cephalometric tracing programs. There are various methods in transferring the cephalometric radiographs to the tracing program. Direct digital radiography helps the computer in acquiring the image directly from the X-ray machine. Moreover, indirect methods of acquisition require film to be generated by the conventional method, and then the film is scanned with a scanner by transferring the image to the digital cephalometric tracing program.[3] In this study, radiographs are obtained by direct digital radiography from the same X-ray machine to avoid any technical errors.[2],[4]

Recent technological advancements have led to the rising use of digital cephalometric analysis systems, which have several advantages such as low radiation, improved data storage, and images are easily traced. Regardless of whether the chosen technique is digital or a smartphone app, it is essential that it be reliable, safe, precise, and have a high rate of reproducibility. One of the most significant causes of tracing error is uncertainty in landmark identification, which requires skills dependent on an examiner's experience. It has been reported that there are significant differences in landmark identification between trained and untrained operators. In additional, it is well known that sufficient knowledge in digital cephalometrics decreases the errors and improves the reliability.[5]

In the present study, OneCeph cephalometric app was used. This android-based OneCeph app has programs for the most commonly used analyses in cephalometrics such as Downs, Holdway, Jarabak, McNamara, Ricketts, Steiners, Schwarz, Tweed, Wits Appraisal, Beta angle, and Yen angle. The potential of a smartphone to simplify a complex, time-consuming diagnostic task such as cephalometric analysis, while simultaneously providing structured reference and e-learning capabilities is an hallmark of this app.

While the use of digital cephalometric tracer requires calibration, improper calibration can affect linear measurements rather than the angular measurements and is highly sensitive. The study done by Chen et al.[4] on estimating the time required for cephalometric measurement by the traditional method and by computer-assisted digital cephalometric analysis system showed reduced time requirement. Uysal et al. conducted a study on evaluating the speed, repeatability, and reproducibility of digital radiography with manual versus computer-assisted cephalometric analyses found time advantage and inter- and intra-examiner errors were less in digital analysis.[7]

A recent study shows that the OneCeph app is as reliable as Dolphin cephalometric method.[2] The minimal variations in this study by Shettigar et al. can be attributed to the variations in the operator's reproducibility of the landmarks and calibration of the cephalometric image in the app.

In a study conducted by Roden-Johnson et al.[3] for landmark identification using manual, and Quick Ceph 2000 reported no statistically significant difference between the two which was in accordance with our study. Tsorovas and Karsten conducted a study on the level of measurement and the time demands of hand tracing and five different digital cephalometric programs and found that there is no statistical difference between measurements of the two, but the hand-tracing procedure took a significantly longer time which was in accordance with our study.[11]

Another study conducted by Chen et al.[12] to compare the landmark identification between traditional and computerized cephalometric tracing obtained a statistically significant difference for four landmarks (Po, Ar, PNS, and UM) out of 19 landmarks used. The same difficulty in the identification of Porion (Po) landmark is seen in our study may be attributed to the lack of any nearby anatomical point.


  Conclusion Top


In this study, there is no statistically significant difference between the values obtained for Tweed analysis by hand tracing and android-based “One Ceph” tracing. Digital tracing can be given time advantage and easy identification of landmarks. The results of this study showed that the digital tracing with the OneCeph software had the same accuracy in comparison to manual tracing and could be used instead of the traditional methods.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Broadbent BH. A new X-ray technique and its application to orthodontia. Angle Orthod 1931;1:45-66.  Back to cited text no. 1
    
2.
Shettigar P, Shetty S, Naik RD, Basavaraddi SM, Patil AK. A comparative evaluation of reliability of an android-based app and computerized cephalometric tracing program for orthodontic cephalometric analysis. Biomed Pharmacol J 2019;12:341-6.  Back to cited text no. 2
    
3.
Roden-Johnson D, English J, Gallerano R. Comparison of hand-traced and computerized cephalograms: Landmark identification, measurement, and superimposition accuracy. Am J Orthod Dentofacial Orthop 2008;133:556-64.  Back to cited text no. 3
    
4.
Chen SK, Chen YJ, Yao CC, Chang HF. Enhanced speed and precision of measurement in a computer-assisted digital cephalometric analysis system. Angle Orthod 2004;74:501-7.  Back to cited text no. 4
    
5.
Aksakallı S, Yılancı H, Görükmez E, Ramoǧlu Sİ. Reliability assessment of orthodontic apps for cephalometrics. Turk J Orthod 2016;29:98-102.  Back to cited text no. 5
    
6.
Tikku T, Khanna R, Maurya RP, Srivastava K, Bhushan R. Comparative evaluation of cephalometric measurements of monitor-displayed images by Nemoceph software and its hard copy by manual tracing. J Oral Biol Craniofac Res 2014;4:35-41.  Back to cited text no. 6
    
7.
Uysal T, Baysal A, Yagci A. Evaluation of speed, repeatability, and reproducibility of digital radiography with manual versus computer-assisted cephalometric analyses. Eur J Orthod 2009;31:523-8.  Back to cited text no. 7
    
8.
Naoumova J, Lindman R. A comparison of manual traced images and corresponding scanned radiographs digitally traced. Eur J Orthod 2009;31:247-53.  Back to cited text no. 8
    
9.
Celik E, Polat-Ozsoy O, Toygar Memikoglu TU. Comparison of cephalometric measurements with digital versus conventional cephalometric analysis. Eur J Orthod 2009;31:241-6.  Back to cited text no. 9
    
10.
Prabhakar R, Rajakumar P, Karthikeyan MK, Saravanan R, Vikram NR, Reddy A. A hard tissue cephalometric comparative study between hand tracing and computerized tracing. J Pharm Bioallied Sci 2014;6:S101-6.  Back to cited text no. 10
    
11.
Tsorovas G, Karsten AL. A comparison of hand-tracing and cephalometric analysis computer programs with and without advanced features--accuracy and time demands. Eur J Orthod 2010;32:721-8.  Back to cited text no. 11
    
12.
Chen YJ, Chen SK, Chang HF, Chen KC. Comparison of landmark identification in traditional versus computer-aided digital cephalometry. Angle Orthod 2000;70:387-92.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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