• The korean journal of orthodontics
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• v.49 no.1
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• pp.32-40
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• 2019

Objective: Precise identification of landmarks on posteroanterior (PA) cephalograms is necessary when evaluating lateral problems such as facial asymmetry. The aim of the present study was to investigate whether the use of lateral (LA) cephalograms can reduce errors in landmark identification on PA cephalograms. Methods: Five examiners identified 16 landmarks (Cg, N, ANS, GT, Me, RO, Lo, FM, Z, Or, Zyg, Cd, NC, Ms, M, and Ag) on 32 PA cephalograms with and without LA cephalograms at the same time. The positions of the landmarks were recorded and saved in the horizontal and vertical direction. The mean errors and standard deviation of landmarks location according to the use of LA cephalograms were compared for each landmark. Results: Relatively small errors were found for ANS, Me, Ms, and Ag, while relatively large errors were found for N, GT, Z, Or, and Cd. No significant difference was found between the horizontal and vertical errors for Z and Or, while large vertical errors were found for N, GT, and Cd. The value of identification error was lower when the landmarks were identified using LA cephalograms. Statistically significant error reductions were found at N and Cd with LA cephalograms, especially in the vertical direction. Conclusions: The use of LA cephalograms during identification of landmarks on PA cephalograms could help reduce identification errors.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.37 no.1
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• pp.21-29
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• 2011

Introduction: To compare the change in frontal ramal inclination (FRI) in laterognathism after orthognathic surgery. Materials and Methods: Twenty four patients (10 men, 14 women; mean age, $22.8{\pm}5.2$ years) with minimal facial canting (${\leq}$ 2 mm) and apparent menton deviation ($5.9{\pm}2.4\;mm$) who had been operated on to correct facial asymmetry and skeletal CIII malocclusion, were selected. On a preoperative posteroanterior (PA) cephalogram, the FRI of the deviated side and non deviated side, L1 deviation amounts and menton deviation amounts were measured. The FRI differences between both sides were compared, and the correlations between the measured deviated elements and the FRI differences were analyzed. On a postoperative PA cephalogram, the shifting amount of L1, shifting amount of L7 and FRI of both sides were measured, and the correlations between the shifting elements and the change in FRI were analyzed. Results: On the preoperative PA cephalogram, the FRI of the non deviated side was significantly greater than those of the deviated side. The differences in FRI, with a menton deviation amount showed a significant correlation. On the postoperative PA cephalogram, the FRI differences between the deviated and non deviated side were decreased significantly and mandibular transverse movement toward central position was noted. The mean shifting amounts of L7 were associated with the amount of change in the deviated side of FRI. Conclusion: Transverse shifting of the mandible through orthognathic surgery decreases the FRI difference, which showed laterognathism, and improves the facial contour.

• The korean journal of orthodontics
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• v.49 no.1
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• pp.41-48
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• 2019

Objective: This in-vivo study aimed to compare landmark identification errors in anteroposterior (AP) and posteroanterior (PA) cephalograms generated from cone-beam computed tomography (CBCT) scan data in order to examine the feasibility of using AP cephalograms in clinical settings. Methods: AP and PA cephalograms were generated from CBCT scans obtained from 25 adults. Four experienced and four inexperienced examiners were selected depending on their experience levels in analyzing frontal cephalograms. They identified six cephalometric landmarks on AP and PA cephalograms. The errors incurred in positioning the cephalometric landmarks on the AP and PA cephalograms were calculated by using the straight-line distance and the horizontal and vertical components as parameters. Results: Comparison of the landmark identification errors in CBCT-generated frontal cephalograms revealed that landmark-dependent differences were greater than experienceor projection-dependent differences. Comparisons of landmark identification errors in the horizontal and vertical directions revealed larger errors in identification of the crista galli and anterior nasal spine in the vertical direction and the menton in the horizontal direction, in comparison with the other landmarks. Comparison of landmark identification errors between the AP and PA projections in CBCT-generated images revealed a slightly higher error rate in the AP projections, with no inter-examiner differences. Statistical testing of the differences in landmark identification errors between AP and PA cephalograms showed no statistically significant differences for all landmarks. Conclusions: The reproducibility of CBCT-generated AP cephalograms is comparable to that of PA cephalograms; therefore, AP cephalograms can be generated reliably from CBCT scan data in clinical settings.

• The korean journal of orthodontics
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• v.30 no.5 s.82
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• pp.543-552
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• 2000

The purposes of this study were to evaluate the reproducibility of posteroanterior(PA) cephalograms obtained by two methods, the Head Posture Aligner(HPA) method in natural head posture and the conventional method(operator-guided method), and to compare the vertical rotational differences of the head Posture between lateral and PA cephalograms according to the method. The sample was consisted of 30 adults. At first day, a PA cephalogram and a lateral cephalogram were obtained from each subject by two methods to investigate the difference of vertical rotational posture between lateral and PA cephalograms. Two weeks later, another PA cephalogram was obtained using each method to evaluate the reproducibility of head posture. Five height measurements and nine width measurements were used in the paired t-test to compare the reproducibility of the PA cephalometric measurements between two methods. The differences of vertical rotational posture between lateral and PA cephalograms were calculated from a computer program and compared according to the method used, and following results were obtained. 1. Height measurements obtained by operator-guided method showed significant differences according to the time interval and revealed low reproducibility. 2. Height measurements obtained by HPA method did not show significant differences according to the time interval and presented high reproducibility. 3. In the comparison of width measurement, two methods did not show distinct differences in reproducibility. 4. The difference of vertical rotational posture between lateral and PA cephalograms showed $0.8^{\circ}$ in the HPA method, more less than $2.5^{\circ}$ in the operator-guided method. The results of the present study suggest that the HPA may be helpful in the PA cephalometric radiography in terms of reproducibility.

• The korean journal of orthodontics
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• v.40 no.1
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• pp.6-15
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• 2010

Objective: The aim of this study is to find the most helpful midsagittal reference plane for diagnosis in PA cephalometry compared with 3D CT. Methods: The subjects consisted of 25 adults who showed no facial asymmetry by gross inspection. 3D CT and posteroanterior cephalogram of the subjects were taken. To find the most helpful midsagittal reference plane in PA cephalometry, we considered five kinds of midsagittal planes from which the distances to five landmarks were measured and compared the result with that of 3D CT. The midsagittal plane for 3D CT was determined by the landmarks Nasion, Sella and Basion. Results: PA measurements using the midsagittal reference plane on a perpendicular plane lying through the midpoint of the right and left latero-orbitales was closest to those of 3D CT. Conclusions: It was considered that latero-orbitale perpendicular could be used as the helpful midsagittal reference plane to assess facial asymmetry in PA cephalometry.

• The korean journal of orthodontics
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• v.54 no.1
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• pp.48-58
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• 2024

Objective: To quantify the effects of midline-related landmark identification on midline deviation measurements in posteroanterior (PA) cephalograms using a cascaded convolutional neural network (CNN). Methods: A total of 2,903 PA cephalogram images obtained from 9 university hospitals were divided into training, internal validation, and test sets (n = 2,150, 376, and 377). As the gold standard, 2 orthodontic professors marked the bilateral landmarks, including the frontozygomatic suture point and latero-orbitale (LO), and the midline landmarks, including the crista galli, anterior nasal spine (ANS), upper dental midpoint (UDM), lower dental midpoint (LDM), and menton (Me). For the test, Examiner-1 and Examiner-2 (3-year and 1-year orthodontic residents) and the Cascaded-CNN models marked the landmarks. After point-to-point errors of landmark identification, the successful detection rate (SDR) and distance and direction of the midline landmark deviation from the midsagittal line (ANS-mid, UDM-mid, LDM-mid, and Me-mid) were measured, and statistical analysis was performed. Results: The cascaded-CNN algorithm showed a clinically acceptable level of point-to-point error (1.26 mm vs. 1.57 mm in Examiner-1 and 1.75 mm in Examiner-2). The average SDR within the 2 mm range was 83.2%, with high accuracy at the LO (right, 96.9%; left, 97.1%), and UDM (96.9%). The absolute measurement errors were less than 1 mm for ANS-mid, UDM-mid, and LDM-mid compared with the gold standard. Conclusions: The cascaded-CNN model may be considered an effective tool for the auto-identification of midline landmarks and quantification of midline deviation in PA cephalograms of adult patients, regardless of variations in the image acquisition method.