• The Journal of the Korean dental association
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• v.36 no.2 s.345
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• pp.135-143
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• 1998

Cephalogram is one of the most important tool in researching growth and development of craniofacial area, orthodontic diagnosis and treatment planning. But its inherent distortion of actual length and angles during projecting three dimensional object to two dimensional plane might cause errors in quantitative analysis of shape and size. three dimensional high quality images can be obtained using computerized tomogram and have reported in literatures. Considering its expenses and amount of exposure to radiation, limitations still remain to be solved in its application to routine practice. construction of three dimensional image using principle of orientator can be obtained by biplanar stereoradiography. Theoretically two images, lateral and P-A can be used to construct three dimensional image provided that those are taken at same time by two different focal spots. As two images(lateral and P-A) obtained by conventional cephalogram have different head posture, those need compensation to construct three dimensional images. This study introduced principle of computerized head posture compensation and showed that conventional cephalogram could be used to construct three dimensional image and could be applied to routine orthodontic practice.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.21 no.2
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• pp.174-188
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• 1999

The purpose of this study is to evaluate the precision and accuracy of a three dimensional cephalogram constructed by using the frontal and lateral cephalogram of twelve human dry skulls. After achieving the three dimensional image reconstruction program, we tried to apply this program to two dentofacial deformity patients. 1. Conventional nasion relator in cephalostat was used to reproduce the same head position for the same dry skull. The mean difference of the three dimensional cephalogram for the same dry skull was $0.34{\pm}0.33mm$. Closeness of repeated measures to each skull reveals the precision of this method for the three dimensional cephalogram. 2. Concerning the accuracy, the mean difference between the three dimensional reconstruction data and actual lineal measurements was $1.47{\pm}1.45mm$ and the mean magnification ratio was $100.24{\pm}4.68%$. This Diffrerence is attributed mainly to the ill defined cephalometric landmarks, not to the positional change of the dry skull. 3. Cephalometric measurement of lateral and frontal radiographs had no consecutive magnification ratio because of the different focus-object distance. The mean difference between the frontal and lateral cephalogram to the actual lineal measurements was $4.72{\pm}2.01mm$ and $-5.22{\pm}3.36mm$. Vertical measurements were slightly more accurate than horizontal measurements. 4. Applying to the actual patient analysis, it is recommendable to use this program for analyzing the asymmetry or spatial change after operation. The orthodontic bracket would be a favorable cephalometric landmark for constructing the three dimensional images.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.28 no.2
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• pp.363-385
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• 1998

In orthodontics and orthognathic surgery. cephalogram has been routine practice in diagnosis and treatment evaluation of craniofacial deformity. But its inherent distortion of actual length and angles during projecting three dimensional object to two dimensional plane might cause errors in quantitative analysis of shape and size. Therefore, it is desirable that three dimensional object is diagnosed and evaluated three dimensionally and three dimensional CT image is best for three dimensional analysis. Development of clinic necessitates evaluation of result of treatment and comparison before and after surgery. It is desirable that patient that was diagnosed and planned by three dimensional computed tomography before surgery is evaluated by three dimensional computed tomography after surgery. too. But Because there is no standardized normal values in three dimension now and three dimensional Computed Tomography needs expensive equipments and because of its expenses and amount of exposure to radiation. limitations still remain to be solved in its application to routine practice. If postoperative three dimensional image is constructed by pre and postoperative lateral and postero-anterior cephalograms and preoperative three dimensional computed tomogram. pre and postoperative image will be compared and evaluated three dimensionally without three dimensional computed tomography after surgery and that will contribute to standardize normal values in three dimension. This study introduced new method that computer-simulated three dimensional image was constructed by preoperative three dimensional computed tomogram and pre and postoperative lateral and postero-anterior cephalograms. and for validation of new method. in four cases of dry skull that position of mandible was displaced and four patients of orthognathic surgery. computer-simulated three dimensional image and actual postoperative three dimensional image were compared. The results were as follows. 1. In four cases of dry skull that position of mandible was displaced. range of displacement between computer-simulated three dimensional images and actual postoperative three dimensional images in co-ordinates values was from -1.8 mm to 1.8 mm and 94％ in displacement of all co-ordinates values was from -1.0 mm to 1.0 mm and no significant difference between computer-simulated three dimensional images and actual postoperative three dimensional images was noticed(p>0.05). 2. In four cases of orthognathic surgery patients, range of displacement between computer­simulated three dimensional images and actual postoperative three dimensional images in coordinates values was from -6.7 mm to 7.7 mm and 90％ in displacement of all co-ordinates values was from -4.0 to 4.0 mm and no significant difference between computer-simulated three dimensional images and actual postoperative three dimensional images was noticed(p>0.05). Conclusively. computer-simulated three dimensional image was constructed by preoperative three dimensional computed tomogram and pre and postoperative lateral and postero-anterior cephalograms. Therefore. potentiality that can construct postoperative three dimensional image without three dimensional computed tomography after surgery was presented.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.36 no.4
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• pp.262-269
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• 2010

Introduction: Accurate diagnosis and treatment planning are very important for orthognathic surgery. A small error in diagnosis can cause postoperative functional and esthetic problems. Pre-existing 2-dimensional (D) chephalogram analysis has a high likelihood of error due to its intrinsic and extrinsic problems. A cephalogram can also be inaccurate due to the limited anatomic points, superimposition of the image, and the considerable time and effort required. Recently, an improvement in technology and popularization of computed tomography (CT) provides patients with 3-D computer based cephalometric analysis, which complements traditional analysis in many ways. However, the results are affected by the experience and the subject of the investigator. Materials and Methods: The effects of the sources human error in 2-D cephalogram analysis and 3-D computerized tomography cephalometric analysis were compared using Simplant CMF program. From 2008 Jan to 2009 June, patients who had undergone CT, cephalo AP, lat were investigated. Results: 1. In the 3 D and 2 D images, 10 out of 93 variables (10.4%) and 11 out 44 variables (25%), respectively, showed a significant difference. 2. Landmarks that showed a significant difference in the 2 D image were the points frequently superimposed anatomically. 3. Go Po Orb landmarks, which showed a significant difference in the 3 D images, were found to be the artificial points for analysis in the 2 D image, and in the current definition, these points cannot be used for reproducibility in the 3 D image. Conclusion: Generally, 3-D CT images provide more precise identification of the traditional cephalometric landmark. Greater variability of certain landmarks in the mediolateral direction is probably related to the inadequate definition of the landmarks in the third dimension.

• The korean journal of orthodontics
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• v.35 no.4 s.111
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• pp.251-261
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• 2005

Enlargement is an inherent property of X-rays which occurs when straight hues diverse from small a focal spot. The purpose of the present study was to evaluate the validity of the correction of gonial angle width enlarged on frontal cephalogram, using frontal and lateral cephalograms taken orthogonally from each other. In 40 adult individuals, frontal and lateral cephalograms were taken at a $90^{\circ}$ angle using the Head Posture Aligner. The angle width was measured on the frontal cephalogram and subsequently. the corrected angle width was calculated using the magnification rate of two cephalograms. Measured and corrected angle widths were compared with the measurement from the 3D CT image. The measurement or the frontal cephalogram showed a 9.10mm of enlargement on average ranging from 7.92 to 11.31mm. Corrected angle width measurement showed a 0.14mm difference with the 3D CT image measurement, which was not statistically significant. The results of the study indicate that actual au91e width can be approached through calculation using frontal and lateral cephalograms taken orthogonally with the help of the Head Posture Aligner The study also showed that the magnitude of correction error did not show a significant correlation with the amount of menton deviation, and it suggests that the present correction method is valid even in individuals with severe facial asymmetry.

• The korean journal of orthodontics
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• v.48 no.5
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• pp.292-303
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• 2018

Objective: Biplanar imaging systems allow for simultaneous acquisition of lateral and frontal cephalograms. The purpose of this study was to compare measurements recorded on three-dimensional (3D) cephalograms constructed from two-dimensional conventional radiographs and biplanar radiographs generated using a new biplanar imaging system with those recorded on cone-beam computed tomography (CBCT)-generated cephalograms in order to evaluate the accuracy of the 3D cephalograms generated using the biplanar imaging system. Methods: Three sets of lateral and frontal radiographs of 15 human dry skulls with prominent facial asymmetry were obtained using conventional radiography, the biplanar imaging system, and CBCT. To minimize errors in the construction of 3D cephalograms, fiducial markers were attached to anatomical landmarks prior to the acquisition of radiographs. Using the 3D $Ceph^{TM}$ program, 3D cephalograms were constructed from the images obtained using the biplanar imaging system (3D $ceph_{biplanar}$), conventional radiography (3D $ceph_{conv}$), and CBCT (3D $ceph_{cbct}$). A total of 34 measurements were obtained compared among the three image sets using paired t-tests and Bland-Altman plotting. Results: There were no statistically significant differences between the 3D $ceph_{biplanar}$ and 3D $ceph_{cbct}$ measurements. In addition, with the exception of one measurement, there were no significant differences between the 3D $ceph_{cbct}$ and 3D $ceph_{conv}$ measurements. However, the values obtained from 3D $ceph_{conv}$ showed larger deviations than those obtained from 3D $ceph_{biplanar}$. Conclusions: The results of this study suggest that the new biplanar imaging system enables the construction of accurate 3D cephalograms and could be a useful alternative to conventional radiography.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.27 no.4
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• pp.321-329
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• 2001

To establish systematic diagnosis and treatment planning of dentofacial deformity patient including facial asymmetry or hemifacial microsomia patient, comprehensive analysis of three dimensional structure of the craniofacial skeleton is needed. Even though three dimensional CT has been developed, landmark identification of the CT is still questionable. In recent, a method for correcting cephalic malpositioning that enables accurate superimposition of the landmarks in different stages without using any additional equipment was developed. It became possible to compare the three-dimensional positional change of the maxillomandible without invasive procedure. Based on the principle of the method, a new program was developed for the purpose of diagnosis and treatment planning of dentofacial deformity patient via three dimensional visualization and structural analysis. This program enables us to perform following menu. First, visualization of three dimensional structure of the craniofacial skeleton with wire frame model which was made from the landmarks observed on both lateral and frontal cephalogram. Second, establishment of midsagittal plane of the face three dimensionally, with the concept of "the plane of the best-fit". Third, examination of the degree of deviation and direction of deformity of structure to the reference plane for the purpose of establishing surgical planning. Fourth, simulation of expected postoperative result by various image operation such as mirroring, overlapping.

• The korean journal of orthodontics
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• v.37 no.6
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• pp.391-399
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• 2007

Three-dimensional approaches for the diagnosis and analysis of the dentofacial area are becoming more popular in accordance with the development of cone-beam CT (CBCT). The purposes of this study were to evaluate the reliability of cephalometric measurements of lateral cephalograms generated from a CBCT image by making comparisons with the traditional digital lateral cephalogram, and to evaluate the possibility of the clinical application of CBCT generated cephalogram images. Methods: Twenty patients whose external auditory meatus could be identified in the CBCT image were selected, and both CBCT and digital cephalograms were taken. Differences between the measurements of both cephalograms were tested by paired t-test. Results: Among the 22 measurements used, only U1-FH, Mx6 to PTV, and maxillomandibular difference showed statistically significant differences between the CBCT generated cephalogram and the digital cephalogram. Conclusions: The results suggest that the CBCT generated cephalogram can be used for some cephalometric measurements not requiring porion, PTV, condylion as a landmark (SNA, SNB, U1 to SN, IMPA, interincisal angle, etc.).

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.27 no.3
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• pp.214-220
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• 2001

The clinical application of the three-dimensional radiographic technique had been limited to standard Broadbent-Bolton cephalometer with biplanar stereoradiography. We developed a new method for compensating the error of head position in ordinary non-biplanar cephalostat. It became to possible to use the three dimensional cephalogram commonly in clinical bases. 1. The method of methemetical compensation of head positioning error in non-biplanar condition was evaluated with dry skull. The error of the method of first and the second trial was $0.46{\pm}1.21$, $0.33{\pm}0.90mm$, which means the error of the head positioning correction in conventional cephalogram was within clinical acceptance. 2. The reproducibility of this system for clinical application was 0.54 mm ($-2.99{\sim}2.26mm$) which defines the absolute mean difference of the first and second trial. Compare to the The landmark identification error $1.2{\pm}1.6mm$, the error of the measurement was within the range of landmark identification error. The result indicates the adequate clinical accuracy of the computation of three-dimensional coordinates by compensation of the error of the head position in ordinary non-biplanar cephalostat.

• Imaging Science in Dentistry
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• v.42 no.4
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• pp.201-205
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• 2012

Purpose: This study was performed to assess the compatibility of cone beam computed tomography (CBCT) synthesized cephalograms with conventional cephalograms, and to find a method for obtaining normative values for three-dimensional (3D) assessments. Materials and Methods: The sample group consisted of 10 adults with normal occlusion and well-balanced faces. They were imaged using conventional and CBCT cephalograms. The CBCT cephalograms were synthesized from the CBCT data using OnDemand 3D software. Twenty-one angular and 12 linear measurements from each imaging modality were compared and analyzed using paired-t test. Results: The linear measurements between the two imaging modalities were not statistically different (p>0.05) except for the U1 to facial plane distance. The angular measurements between the two imaging modalities were not statistically different (p>0.05) with the exception of the gonial angle, ANB difference, and facial convexity. Conclusion: Two-dimensional cephalometric norms could be readily used for 3D quantitative assessment, if corrected for lateral cephalogram distortion.