STANDARDIZATION OF CEPHALOMETRIC MEASUREMENTS 04, 2014 آ  Cephalometric Standardization “Ricketts

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

    Shamsi Daneshvari, PhD AMIA Dental Informatics Working Group Webinar September 4, 2014

  • Outline 2

     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:  Dentistry Orthodontics  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 Cephalometrics 5

     Multiple standards developed over time Michigan 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 pairs Multi-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 wasn’t 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 System  Wanted 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. Economides’s 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 system Manually 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 Standardization 19

     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-Me Constructed Gonion

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

     Jarabak-Bjork Analysis: Gonial Angle, Ar-Go-Me Constructed Gonion

  • Cephalometric Standardization

     LOINC  Free to access  Internationally recognized  Maintained 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  Anthropology  Orthodontics

     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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