Diagnosis and treatment planning of orthodontic patients with 3-dimensional dentofacial records

•Most diagnostic decisions have moderate agreement.•Skeletal, dental relationships, decision to extract or surgery had substantial agreement.•Most evaluators (91.7%) thought that cephalometric x-rays are needed sometimes.•Class I malocclusions without open bites or crossbites can be diagnosed and planned without a cephalometric radiograph.

IntroductionCephalometrics has been the foundation of orthodontic diagnosis for many years. However, for many orthodontic patients, a lateral cephalogram might not be necessary. The aim of this study was to compare the diagnosis and treatment planning agreement between standard records and nonradiographic 3-dimensional (3D) dentofacial photogrammetry records.MethodsTwenty patients had standard orthodontic records taken for their treatment as well as extraoral and intraoral 3D images. Twelve evaluators examined the standard records and then completed diagnosis and treatment planning questionnaires. They repeated the process 4 to 6 weeks later by using 3D photographic images along with the panoramic radiographs. Each evaluator also evaluated 2 random orthodontic cases twice with each method to evaluate consistency within each method. At the end of study, each evaluator was asked to complete a survey to document his or her experiences with the 3D photogrammetry method. Descriptive and kappa statistics were used to determine the agreement.ResultsMost diagnosis parameters had fair agreement between the methods and within each method. Skeletal and dental relationships had excellent agreement between and within the methods as well as most treatment decisions such as the need for extractions and surgery. Most evaluators (91.7%) thought that cephalometric x-rays would be needed only some of the time in diagnosis and treatment planning. Most evaluators (83.33%) thought that cephalometric radiographs are not needed in patients with a Class I ± a quarter cusp with crowding or spacing.ConclusionsMost diagnostic decisions had fair agreement within and between the 2 methods. The decision to extract and the need for orthognathic surgery had excellent agreement between the cephalometric and photogrammetric methods. The majority of examiners agreed that patients with Class I malocclusions ± a quarter cusp with no obvious skeletal discrepancy can be diagnosed and planned without a cephalometric radiograph.