Precision of orthodontic cephalometric measurements on ultra low dose-low dose CBCT reconstructed cephalograms

OBJECTIVES: To analyze differences in variation of orthodontic diagnostic measurements on lateral cephalograms reconstructed from ultra low dose-low dose (ULD-LD) cone beam computed tomography (CBCT) scans (RLC) as compared to variation of measurements on standard lateral cephalograms (SLC), and to determine if it is justifiable to replace a traditional orthodontic image set for an ULD-LD CBCT with a reconstructed lateral cephalogram. MATERIAL AND METHODS: ULD-LD CBCT images and SLCs were made of forty-three dry human skulls. From the ULD-LD CBCT dataset, a lateral cephalogram was reconstructed (RLC). Cephalometric landmarks (13 skeletal and 7 dental) were identified on both SLC and RLC twice in two sessions by two calibrated observers. Thirteen cephalometric variables were calculated. Variations of measurements, expressed as standard deviations of the 4 measurements on SLC and RLC, were analyzed using a paired sample t-test. Differences in the number of observations deviating ≥ 2.0 mm or degrees from the grand mean between SLC and RLC were analyzed using a McNemar test. RESULTS: Mean SDs for 7 out of 13 variables were significantly smaller for SLCs than those for RLCs, but differences were small. For 9 out of 13 variables, there was no significant difference between SLC and RLC for the number of measurements outside the range of 2 mm or degrees. CONCLUSIONS: Based on the lower radiation dose and the small differences in variation in cephalometric measurements on reconstructed LC compared to standard dose LC, ULD-LD CBCT with reconstructed LC should be considered for orthodontic diagnostic purposes. CLINICAL RELEVANCE: ULD-LD CBCT with reconstructed LC should be considered for orthodontic purposes. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00784-021-04127-9.