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Comparison of the accuracy of 2D and 3D cephalometry: a systematic review and meta-analysis


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Figure 1.

Study flow diagram.
Study flow diagram.

Figure 2.

Forest plots of pooled DM for the CBCT group versus the X-ray group (A) SNA, (B) SNB, (C) ANB, (D) SN-MP.
Forest plots of pooled DM for the CBCT group versus the X-ray group (A) SNA, (B) SNB, (C) ANB, (D) SN-MP.

Figure 3.

Forest plots of pooled DM for the CBCT group versus the X-ray group (A) ANS-Me, (B) ANS-PNS, (C) N-ANS, (D) N-Me, (E) N-S, (F) Po-NB.
Forest plots of pooled DM for the CBCT group versus the X-ray group (A) ANS-Me, (B) ANS-PNS, (C) N-ANS, (D) N-Me, (E) N-S, (F) Po-NB.

Figure 4.

Forest plots of pooled DM for the CBCT group versus the X-ray group (A) L1-MP, (B) U1-L1(°), (C) L1-NB(mm), (D) L1-NB (°), (E) U1-NA(mm), (F) U1-NA(°).
Forest plots of pooled DM for the CBCT group versus the X-ray group (A) L1-MP, (B) U1-L1(°), (C) L1-NB(mm), (D) L1-NB (°), (E) U1-NA(mm), (F) U1-NA(°).

Figure 5.

Forest plots of pooled DM for the CBCT group versus the X-ray group (A) Ar(Co)-Go, (B) FH-MP, (C) Me-Go, (D) OP-SN.
Forest plots of pooled DM for the CBCT group versus the X-ray group (A) Ar(Co)-Go, (B) FH-MP, (C) Me-Go, (D) OP-SN.

Result of sensitivity analysis.

Index Original result Exclusion of Zamora, N 2011 and Jung, Pil-Kyo 2015 Exclusion of Zamora, N 2011 Exclusion of and Jung, Pil-Kyo 2015
SNA 0.02 (-0.98, 1.02) P = 0.971 0.05 (-1.40, 1.51) P = 0.942 0.04 (-1.00, 1.07) P = 0.948 0.03 (-1.35, 1.40) P = 0.970
SNB -0.10 (-0.64, 0.43) P = 0.700 0.09 (-0.83, 1.00) P = 0.855 -0.05 (-0.63, 0.54) P = 0.881 0.01 (-0.82, 0.83) P = 0.987
ANB 0.05 (-0.18,0.27) P = 0.677 -0.04 (-0.28, 0.21) P = 0.760
Ar(Co)-Gn 10.76 (4.93, 16.60) P = 0.000 10.76 (12.94, 20.39) P = 0.000
ANS-PNS -0.86 (-10.92, 9.20) P = 0.867
ANS-Me -0.35 (-1.38, 0.69) P = 0.513 -0.49 (-2.22, 1.23) P = 0.577 -0.36 (-1.42, 0.70) P = 0.507 -0.44 (-2.06, 1.18) P = 0.593
N-ANS 0.17 (-0.59, 0.92) P = 0.663 0.07 (-0.19, 0.33) P = 0.599
N-Me -0.53 (-1.73, 0.66) P = 0.379 -0.85 (-3.13, 1.44) P = 0.468 -0.61 (-1.84, 0.62) P = 0.332 -1.04 (-2.74, 0.65) P = 0.229
FH-MP -0.34 (-0.70, 0.02) P = 0.063 -0.44 (-0.99, 0.11) P = 0.119
SN-MP -1.20 (-3.06, 0.66) P = 0.206 -1.57 (-3.67, 0.53) P = 0.142
Me-Go 9.15 (2.99, 15.31) P = 0.004 13.53 (4.60, 22.47) P = 0.003
N-S 2.12 (-1.86, 6.09) P = 0.297 3.30 (-3.43, 10.03) P = 0.337
Po-NB 0.40 (-0.08, 0.89) P = 0.104
L1-MP -0.21 (-1.54, 1.12) P = 0.756 -0.32 (-2.91, 2.28) P = 0.812 -0.27 (-1.79, 1.24) P = 0.726 -0.28 (-2.43, 1.87) P = 0.799
OP-SN -0.71 (-2.58, 1.15) P = 0.454
L1-NB(mm) -0.20 (-0.82, 0.42) P = 0.526
L1-NB(°) 0.69 (-1.95, 3.34) P = 0.608
U1-L1 1.55 (1.09, 2.00) P = 0.000 1.75 (0.86, 2.64) P = 0.000 1.55 (1.10, 2.01) P = 0.000 1.5 (1.11, 2.02) P = 0.000
U1-NA(mm) 0.20 (-0.34, 0.73) P = 0.465
U1-NA(°) 0.28 (-2.49, 3.05) P = 0.845

The QUAMAS (Quality Assessment of Measurement Accuracy Studies) tool used in the study.

Parameter of evaluation Score
Study design (5√) A Objective clearly formulated (√) 1
B Randomized sample (√) 1
C Sample size: Considered adequate (number≥50)(√) 1
D Similar baseline characteristics (√) 1
E Selection criteria: Clearly described and adequate (√) 1
Study measurement (5√) F Measurement method is appropriate (√) 1
G Gold standard is appropriate (√) 1
H Adequate examiners and independent measurement (√) 1
I Reliability: Described and adequate level of agreement (√) 1
J Appropriate examination time interval (√) 1
Statistical analysis (5√) K Statistical analysis is appropriate for data (√) 1
L Reliability: intra-examiner (√) and inter-examiner (√) 2
M Statistical significance level: P value (√) and confidence intervals (√) 2
Total 15

Quality assessment of the included studies using the QUAMAS tool.

Study design Study measurement Statistical Analysis
Studies A B C D E F G H I J K L M Total
Jung, 2015 1 1 1 1 1 1 1 0 1 1 1 1 1 12
Wen, 2017 1 0 1 0.5 1 1 1 0.5 1 0 1 2 1 11
Zamora, 2011 1 0 0 0 0 0.5 1 0 1 0 1 1 1 6.5
Miao, 2016 1 0 0 1 1 1 1 0 0 1 1 0 1 8
Na, 2012 1 0 0 1 1 1 1 0 1 1 1 0 2 10
Zhiyao, 2016 1 0 1 0.5 1 1 1 0 1 1 1 1 1 10.5
Mingming, 2016 1 0 0 0.5 1 1 1 0 1 1 1 1 1 9.5
Yang, 2012 1 0 0 1 0 1 1 0.5 0 1 1 0 1 7.5

Search strategies in the study.

Databases Steps Strategies
PubMed #1 “Cephalometry”[Mesh] OR Craniometry OR cephalometric OR Cephalometry
#2 “X-Ray Film”[Mesh] OR X Ray Film OR Xray Film OR Film, Xray OR Films, Xray OR Radiographic Film OR Xray Films OR Film, Radiographic OR Films, Radiographic OR Radiographic Films OR Film, X-Ray OR Film, X Ray OR Films, X-Ray OR Films, X-Ray OR radiograph OR roentgenogram OR scotograph OR Lateral cephalometric radiograph
#3 2d OR two-dimensional OR 2 dimension OR two dimension OR 2 dimensional OR bidimensional OR 2 d
#4 #2 OR #3
#5 “Cone-Beam Computed Tomography”[Mesh] OR Cone-Beam CAT Scan OR Computed Tomography, Cone-Beam OR Cone Beam Computed Tomography OR CT Scan, Cone-Beam OR CT Scan, Cone Beam OR CT Scans, Cone Beam OR CT Scans, Cone-Beam OR Cone-Beam CT Scan OR Cone-Beam CT Scans OR Scan, Cone-Beam CT OR Scans, Cone-Beam CT OR Tomography, Cone-Beam Computed OR Tomography, Cone Beam Computed OR Tomography, Volume Computed OR Computed Tomography, Volume OR Volume Computed Tomography OR Volumetric CT OR CT, Volumetric OR Volumetric Computed Tomography OR Computed Tomography, Volumetric OR Tomography, Volumetric Computed OR CAT Scan, Cone-Beam OR CAT Scan, Cone Beam OR CAT Scans, Cone-Beam OR CT, Volume OR Cone-Beam CAT Scan OR Cone-Beam CAT Scans OR Scans, Cone-Beam CAT OR Cone-Beam Computer-Assisted Tomography OR Scan, Cone-Beam CAT OR Computer-Assisted Tomography, Cone-Beam OR Cone Beam Computer Assisted Tomography OR Tomography, Cone-Beam Computer-Assisted OR Cone-Beam Computerized Tomography OR Computerized Tomography, Cone-Beam OR Cone Beam Computerized Tomography OR Tomography, Cone-Beam Computerized OR Cone-Beam CT OR CT, Cone-Beam OR Cone Beam CT OR Volume CT OR CBCT OR Cone Beam Computed Tomography
#6 #1 AND #4 AND #5
Embase #1 'Cone-Beam Computed Tomography’/exp OR ‘Computed Tomography, Cone-Beam’ OR ‘Cone Beam Computed Tomography’ OR ‘CT Scan, Cone-Beam’ OR ‘CT Scan, Cone Beam’ OR ‘CT Scans, Cone-Beam’ OR ‘Cone-Beam CT Scan’ OR ‘Cone-Beam CT Scans’ OR ‘Scan, Cone-Beam CT’ OR ‘Scans, Cone-Beam CT’ OR ‘Tomography, Cone-Beam Computed’ OR ‘Tomography, Cone Beam Computed’ OR ‘Tomography, Volume Computed’ OR ‘Computed Tomography, Volume’ OR ‘Volume Computed Tomography’ OR ‘Volumetric CT’ OR ‘CT, Volumetric’ OR ‘Volumetric Computed Tomography’ OR ‘Computed Tomography, Volumetric’ OR ‘Tomography, Volumetric Computed’ OR ‘CAT Scan, Cone-Beam’ OR ‘CAT Scan, Cone Beam’ OR ‘CAT Scans, Cone-Beam’ OR ‘Cone-Beam CAT Scan’ OR ‘Cone-Beam CAT Scans’ OR ‘Scan, Cone-Beam CAT’ OR ‘Scans, Cone-Beam CAT’ OR ‘Cone-Beam Computer-Assisted Tomography’ OR ‘Computer-Assisted Tomography, Cone-Beam’ OR ‘Cone Beam Computer Assisted Tomography’ OR ‘Tomography, Cone-Beam Computer-Assisted’ OR ‘Cone-Beam Computerized Tomography’ OR ‘Computerized Tomography, Cone-Beam’ OR ‘Cone Beam Computerized Tomography’ OR ‘Tomography, Cone-Beam Computerized’ OR ‘Cone-Beam CT’ OR ‘CT, Cone-Beam’ OR ‘Cone Beam CT’ OR ‘Volume CT’ OR ‘CT, Volume” OR ‘CBCT'
#2 'Cephalometry’/exp OR ‘Cephalometry’ OR ‘Craniometry’ OR ‘cephalometry'
#3 'X-Ray Film’/exp OR ‘X Ray Film’ OR ‘Xray Film’ OR ‘Film, Xray’ OR ‘Films, Xray’ OR ‘Radiographic Film’ OR ‘Xray Films’OR ‘Film, Radiographic’ OR ‘Films, Radiographic’ OR ‘Radiographic Films’ OR ‘Film, X-Ray’ OR ‘Film, X Ray’ OR ‘Films, X-Ray’ OR ‘Films, X-Ray’ OR ‘radiograph’ OR ‘roentgenogram’ OR ‘scotograph’ OR ‘Lateral cephalometric radiograph'
#4 '2-d’ OR ‘two-dimensional’ OR ‘2 dimension’ OR ‘two dimension’ OR ‘2-dimensional’ OR ‘bidimensional’ OR ‘2 d'
#5 #3 OR #4
#6 #1 AND #2 AND #5
CNKI #1 Cephalometry OR Craniometry
#2 Lateral cephalometric radiograph OR 2 d
#3 Cone Beam Computed Tomography OR CBCT
#4 #1 AND #2 AND #3 AND #4
Web of Science #1 Cephalometry OR Craniometry OR cephalometric
#2 X Ray Film OR Xray Film OR Film, Xray OR Films, Xray OR Radiographic Film OR Xray Films OR Film, Radiographic OR Films, Radiographic OR Radiographic Films OR Film, X-Ray OR Film, X Ray OR Films, X-Ray OR Films, X-Ray OR radiograph OR roentgenogram OR scotograph OR Lateral cephalometric radiograph
#3 2d OR two-dimensional OR 2 dimension OR two dimension OR 2 dimensional OR bidimensional OR 2d
#4 #2 OR #3
#5 Cone-Beam CAT Scan OR Computed Tomography, Cone-Beam OR Cone Beam Computed Tomography OR CT Scan, Cone-Beam OR CT Scan, Cone Beam OR CT Scans, Cone Beam OR CT Scans, Cone-Beam OR Cone-Beam CT Scan OR Cone-Beam CT Scans OR Scan, Cone-Beam CT OR Scans, Cone-Beam CT OR Tomography, Cone-Beam Computed OR Tomography, Cone Beam Computed OR Tomography, Volume Computed OR Computed Tomography, Volume OR Volume Computed Tomography OR Volumetric CT OR CT, Volumetric OR Volumetric Computed Tomography OR Computed Tomography, Volumetric OR Tomography, Volumetric Computed OR CAT Scan, Cone-Beam OR CAT Scan, Cone Beam OR CAT Scans, Cone-Beam OR CT, Volume OR Cone-Beam CAT Scan OR Cone-Beam CAT Scans OR Scans, Cone-Beam CAT OR Cone-Beam Computer-Assisted Tomography OR Scan, Cone-Beam CAT OR Computer-Assisted Tomography, Cone-Beam OR Cone Beam Computer Assisted Tomography OR Tomography, Cone-Beam Computer-Assisted OR Cone-Beam Computerized Tomography OR Computerized Tomography, Cone-Beam OR Cone Beam Computerized Tomography OR Tomography, Cone-Beam Computerized OR Cone-Beam CT OR CT, Cone-Beam OR Cone Beam CT OR Volume CT OR CBCT OR Cone Beam Computed Tomography OR CBCT
#6 #1 AND #4 AND #5
SIGLE #1 (Craniometry OR cephalometric OR Cephalometry) AND (X Ray Film OR Lateral cephalometric radiograph OR radiograph OR 2-d OR two-dimensional OR 2 dimension OR two dimension OR 2-dimensional OR 2 d) AND (Cone-Beam Computed Tomography OR CBCT OR CT Scan OR Cone-Beam CT)
Cochrane Central Register of Controlled Trials (CENTRAL) #1 (Craniometry OR cephalometric OR Cephalometry) AND (X Ray Film OR Lateral cephalometric radiograph OR radiograph OR 2-d OR two-dimensional OR 2 dimension OR two dimension OR 2-dimensional OR 2 d) AND (Cone-Beam Computed Tomography OR CBCT OR CT Scan OR Cone-Beam CT)

General information of the included studies.

Studies Country Sample type Sample size Sample information 2D type 3D type CBCT parameters Number of examiners/measurement times
Jung, 2015 Korea Patients 50 12 males and 38 females (mean age 19.40 ± 6.40 years) Conventional lateral cephalograms CBCT 120 kV, 5 mA, 0.3 mm voxel size 1/3 times
Wen, 2017 China Patients 60 21 males and 39 females (mean age 21.3 years) Conventional lateral cephalograms CBCT 110 kV, 5 mA, 0.25mm voxel size 2/unknown
Zamora, 2011 Spain Patients 8 4 males and 4 females (mean age 15.55 ± 6.25 years) Conventional lateral cephalograms CBCT (NemoCeph 3D and InVivo5) 120 kV, 23.87 mA, 8.9 seconds, 0.4 mm3 voxel size, 1/twice
Miao, 2016 China Patients 20 Unknown (age18-35 years) Conventional frontal cephalograms CBCT Unknown Unknown/twice
Na, 2012 China Patients 40 18 males and 22 females (age 12-18 years) Conventional lateral cephalograms CBCT 120 kV, 5 mA, 4 seconds, 0.4 mm3 voxel size 1/twice
Zhiyao, 2016 China Patients 100 50 males and 50 females (age 18-40 years) Conventional lateral cephalograms CBCT 120 kV, 5 mA, 0.3 mm voxel size 1/twice
Mingming, 2016 China Patients 30 14 males and 16 females (age 20-26 years) Conventional lateral cephalograms CBCT 120 kV, 5 mA, 4 seconds, 0.25 mm voxel size Unknown/3 times
Yang, 2012 China Patients 14 8 males and 6 females (age 15 ± 1.2 years) Conventional cephalograms CBCT Unknown 1/twice

Results of publication bias.

Index Begg’s test Egger’s test
SNA 0.49289 0.20611
SNB 0.68075 0.14336
ANB 0.29715 0.00829
Ar(Co)-Gn 0.11785 0.00061
ANS-PNS 1.00000 0.89425
ANS-Me 0.40425 0.54673
N-ANS 0.70711 0.61827
N-Me 0.29715 0.02517
FH-MP 0.62069 0.38980
SN-MP 0.70711 0.94893
Me-Go 0.14440 0.00522
N-S 0.83483 0.67174
Po-NB 1.00000 0.66028
L1-MP 0.13765 0.10617
OP-SN 1.00000 0.09144
L1-NB(mm) 0.73410 0.59868
L1-NB(°) 0.73410 0.85952
U1-L1 0.34808 0.95074
U1-NA(mm) 0.73410 0.95712
U1-NA(°) 0.73410 0.48943

Original result.

Index X ¯ 95%CI P value
SNA 0.02 (-0.98, 1.02) P = 0.971
SNB -0.10 (-0.64, 0.43) P = 0.700
ANB 0.05 (-0.18, 0.27) P = 0.677
Ar(Co)-Gn 10.76 (4.93, 16.60) P = 0.000
ANS-PNS -0.86 (-10.92, 9.20) P = 0.867
ANS-Me -0.35 (-1.38, 0.69) P = 0.513
N-ANS 0.17 (-0.59, 0.92) P = 0.663
N-Me -0.53 (-1.73, 0.66) P = 0.379
FH-MP -0.34 (-0.70, 0.02) P = 0.063
SN-MP -1.20 (-3.06, 0.66) P = 0.206
Me-Go 9.15 (2.99, 15.31) P = 0.004
N-S 2.12 (-1.86, 6.09) P = 0.297
Po-NB 0.40 (-0.08, 0.89) P = 0.104
L1-MP 0.21 (-1.54, 1.12) P = 0.756
OP-SN -0.71 (-2.58, 1.15) P = 0.454
L1-NB(mm) -0.20 (-0.82, 0.42) P = 0.526
L1-NB(°) 0.69 (-1.95, 3.34) P = 0.608
U1-L1 1.55 (1.09, 2.00) P = 0.000
U1-NA(mm) 0.17 (-0.33, 0.68) P = 0.502
U1-NA(°) 0.28 (-2.49, 3.05) P = 0.845
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Medizin, Vorklinische Medizin, Grundlagenmedizin, andere