STANDARDIZATION OF CEPHALOMETRIC MEASUREMENTS TO CREATE A DATA REPOSITORY OF ORTHODONTICS PATIENT CASES

Shamsi Daneshvari, PhDAMIA Dental Informatics Working Group WebinarSeptember 4, 2014

Outline2

Cephalometric history Orthodontic Case File System Cephalometric standardization Current research The future

Cephalometrics

Technique using lateral radiographs to make measurements of the head Planes, Angles and Linear measurements Used primarily in: DentistryOrthodontics Anthropology

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History of Cephalometrics

Images from: Essentials of Facial Growth and Radiographic Cephalometry

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Began with Craniometry in Anthropology Standard landmarks

Cephalostat and methods Developed in 1931 by:Broadbent (USA) Hofrath (Germany)

History of Cephalometrics5

Multiple standards developed over timeMichigan Atlas- Riolo et al. (1974)

London Atlas- Bhaita and Leighton (1993)

Downs Analysis- Downs (1948)

Ricketts Analysis- Rickets et al. (1982)

History of Cephalometrics

Reference samples for Normal Ranges Usually small, white samples Downs Analysis: 1948

20 White subjects Riolo Michigan Atlas: 1974

83 White subjects

Are there other racial/ethnic norms?

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History of Cephalometrics

Tracings of Radiograph

Computerized cephalometrics Dolphin

Imaging CephX

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Orthodontic Case File System

James K. Economides Donated in 2005 In practice since 1972

Unique collection New Mexicans Hispanic Native American

5,910 Unique patients 600 sibling pairsMulti-generational families

Available online and in person

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Orthodontic Case File System

Online records can contain: Lateral X-rays Cephalometric measuements Panoramic X-rays Intra-oral photographs Diagnoses

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Orthodontic Case File System

Available in Physical collection only: Dental casts Full facial and profile photographs Cephalometric tracings Treatment records

What wasnt included: Race/ethnicity

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Orthodontic Case File System

Cephalometrics and Dr. Economides Relatively static Changed measurement group 3 times over 20+ years 88 used most commonly

Used multiple standards Recorded for large number of patients

Cephalometrics and the Case File SystemWanted to be able to add additional cases with

cephalometrics

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Cephalometric Standardization

Reviewed and consulted: 2 atlases 8 analyses

Compared and contrasted Dr. Economidess measurements and landmarks with the existing atlases and analyses

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Cephalometric Standardization

Downs Analysis Downs WB (1948). Variations in Facial Relationships: Their Significance in Treatment

and Prognosis. American Journal of Orthodontics, 34:812-840.

Frontal Analysis Grummons DC, Kappeneye van de Coppelo MA (1987). A Frontal Asymmetrical

Analysis. The Journal of Clinical Orthodontics, 21: 448-465.

Grummons DC, Ricketts RM (2004). Frontal Cephalometrics: Practical Application. World Journal of Orthodontics, 5: 99-119.

Jarabak-Bjork Analysis Jarabak JR, Fizzell JA (1972). Technique and treatment with light-wire edgewise

appliances. Saint Louis: C. V. Mosby Co.

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Cephalometric Standardization

London Atlas Bhatia SN, Leighton BC (1993). A Manual of Facial Growth: A Computer Analysis of

Longitudinal Cephalometric Growth Data. Oxford: Oxford university Press.

McNamara Analysis McNamara JA Jr, Brundon WL (2001). Orhtodontic and Dentofacial Orthopedics.

Ann Arbor: Needham Press.

Michigan Atlas Riolo ML, Moyers RE, McNamara JA, Hunter WS (1974). An Atlas of Craniofacial

Growth: Cephalometric Standards from the University School Growth Study, The University of Michigan. Ann Arbor: The University of Michigan.

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Cephalometric Standardization

Ricketts Analysis Ricketts RM, Roth RH, Chaconas SJ, Schnlhof RJ, Engel A (1982). Orthodontic

Diagnosis and Planning, Volumes I and II. Denver: Rocky Mountain Orthodontics

Soft Tissue Analysis Holdaway RA (1983). A Soft Tissue Cephalometric Analysis and its Use in

Orthodontic Planning, Part I. American Journal of Orthodontics, 84: 1-28.

Holdaway RA (1984). A Soft Tissue Cephalometric Analysis and its Use in Orthodontic Planning, Part II. American Journal of Orthodontics, 85: 279-293.

Tweed Analysis Tweed CH (1954). The Frankfort Mandibular Incisal Angle (FMIA) in Orthodontic

Diagnosis, Treatment Planning, and Prognosis. The Angle Orthodontics, 24: 121-169.

Steiner Analysis Steiner CC (1953). Cephalometrics for You and Me. American Journal of

Orthodontics, 39: 729-755.

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Cephalometric Standardization

Method for cross-referencing: Identify anatomical landmarks Verify variable name is consistent with existing point

naming convention Define cephalometric measurements used in our case

file systemManually examine the atlases and analyses and cross

reference

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Cephalometric Standardization

Discovered: Not all atlases and analyses use the same vocabulary Identical names

Different landmark Different names

Same landmark

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Cephalometric Standardization

Gonion- Defined differently

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Gonion-GO the midpoint at the angle of the mandible Bhatia and Leighton 1993

Gonion-GO intersection of the line connecting the most distal aspect of the condyle to the distal border of the ramus, and the line at the base of the mandible

Ricketts et al. 1982

Gonial Intersection-GOI the intersection of the mandibular plane with a plane through Articulare, Posterior and along the portion of the mandibular ramus inferior to it

Riolo et al. 1974

Gonion-GO the midpoint of the angle of the mandible, found by bisecting the angle formed by the mandibular plane and a plane through Articulare, Posterior and along the portion of the mandibular ramus inferior to it

Riolo et al. 1974

Cephalometric Standardization19

Gonial Angle Defined by Economides as Ar-Go-Me The angle formed by Articulare, Gonion and Menton

Michigan Atlas: Menton-Gonial Intersection-Articulare, Ar-Goi-MeConstructed Gonion

London Atlas: Mandibular Angle, Art-Go-Me Bony Gonion

Jarabak-Bjork Analysis: Gonial Angle, Ar-Go-MeConstructed Gonion

Cephalometric Standardization

LOINC Free to access Internationally recognizedMaintained and allows for expansion Allows mapping to each atlas and analysis

measurement

http://search.loinc.org/search.zul?query=ar-go-me

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Cephalometric Standardization

Created: 88 LOINC terms 11 LOINC parts

LOINC added a graphical portion

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Case File System

http://hsc.unm.edu/programs/ocfs/

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Research

Estimating race Cephalometric standardization Dental crowding and cephalometrics Dental development Secular change Tooth size and ethnic variation Eruption Juvenile sexing

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The Future

Additional cases?? Hard cases

Research?? Informatics AnthropologyOrthodontics

Cephalometric Manual

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Acknowledgements

Supported by Award Number NIH 1 G08 LM009381-01A1 from the National Library of Medicine

Philip J. Kroth, MD Heather J. H. Edgar, PhD

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References

Kroth PJ, Daneshvari S, Harris EF, Vreeman DJ, Edgar HJ. Using LOINC to link 10 terminology standards to one unified standard in a specialized domain. J Biomed Inform. 2012; 45(4):674-82. PMCID: PMC3288380.

Edgar HJH, Daneshvari S, Harris EF, Kroth P. Inter-observer agreement on subjects' race and race-informative characteristics. PloS One. 2011; 6(8): e23986. PMCID: MC3163683.

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