A comparison of frontal radiographs obtained from cone beam CT scans and conventional frontal radiographs of human skulls

This study evaluated whether measurements on conventional frontal radiographs are comparable with measurements on cone beam computed tomography (CBCT)-constructed frontal cephalometric radiographs taken from dry human skulls. CBCT scans and conventional frontal cephalometric radiographs were made of 40 dry skulls. With I-Cat Vision® software, a cephalometric radiograph was constructed from the CBCT scan. Standard cephalometric software was used to identify landmarks and calculate ratios and angles. The same operator identified 10 landmarks on both types of cephalometric radiographs on all Images 5 times with a time-interval of 1 week. Intra-observer reliability was acceptable for all measurements. The reproducibility of the measurements on the frontal radiographs obtained from the CBCT scans was higher than those on conventional frontal radiographs. There is a statistically significant and clinically relevant difference between measurements on conventional and constructed frontal radiographs. There is a clinically relevant difference between angular measurements performed on conventional frontal cephalometric radiographs, compared with measurements on frontal cephalometric radiographs constructed from CBCT scans, owing to different positioning of patients in both devices. Positioning of the patient in the CBCT device appears to be an important factor in cases where a 2D projection of the 3D scan is made.