Newly defined landmarks for a three-dimensionally based cephalometric analysis: a retrospective cone-beam computed tomography scan review

To identify two novel three-dimensional (3D) cephalometric landmarks and create a novel three-dimensionally based anteroposterior skeletal measurement that can be compared with traditional two-dimensional (2D) cephalometric measurements in patients with Class I and Class II skeletal patterns. Full head cone-beam computed tomography (CBCT) scans of 100 patients with all first molars in occlusion were obtained from a private practice. InvivoDental 3D (version 5.1.6, Anatomage, San Jose, Calif) was used to analyze the CBCT scans in the sagittal and axial planes to create new landmarks and a linear 3D analysis (M measurement) based on maxillary and mandibular centroids. Independent samples t-test was used to compare the mean M measurement to traditional 2D cephalometric measurements, ANB and APDI. Interexaminer and intraexaminer reliability were evaluated using 2D and 3D scatterplots. The M measurement, ANB, and APDI could statistically differentiate between patients with Class I and Class II skeletal patterns (P < .001). The M measurement exhibited a correlation coefficient (r) of -0.79 and 0.88 with APDI and ANB, respectively. The overall centroid landmarks and the M measurement combine 2D and 3D methods of imaging; the measurement itself can distinguish between patients with Class I and Class II skeletal patterns and can serve as a potential substitute for ANB and APDI. The new three-dimensionally based landmarks and measurements are reliable, and there is great potential for future use of 3D analyses for diagnosis and research.