| Literature DB >> 25372707 |
Jae Joon Hwang1, Kee-Deog Kim2, Hyok Park1, Chang Seo Park1, Ho-Gul Jeong1.
Abstract
Superimposition has been used as a method to evaluate the changes of orthodontic or orthopedic treatment in the dental field. With the introduction of cone beam CT (CBCT), evaluating 3 dimensional changes after treatment became possible by superimposition. 4 point plane orientation is one of the simplest ways to achieve superimposition of 3 dimensional images. To find factors influencing superimposition error of cephalometric landmarks by 4 point plane orientation method and to evaluate the reproducibility of cephalometric landmarks for analyzing superimposition error, 20 patients were analyzed who had normal skeletal and occlusal relationship and took CBCT for diagnosis of temporomandibular disorder. The nasion, sella turcica, basion and midpoint between the left and the right most posterior point of the lesser wing of sphenoidal bone were used to define a three-dimensional (3D) anatomical reference co-ordinate system. Another 15 reference cephalometric points were also determined three times in the same image. Reorientation error of each landmark could be explained substantially (23%) by linear regression model, which consists of 3 factors describing position of each landmark towards reference axes and locating error. 4 point plane orientation system may produce an amount of reorientation error that may vary according to the perpendicular distance between the landmark and the x-axis; the reorientation error also increases as the locating error and shift of reference axes viewed from each landmark increases. Therefore, in order to reduce the reorientation error, accuracy of all landmarks including the reference points is important. Construction of the regression model using reference points of greater precision is required for the clinical application of this model.Entities:
Mesh:
Year: 2014 PMID: 25372707 PMCID: PMC4220943 DOI: 10.1371/journal.pone.0110665
Source DB: PubMed Journal: PLoS One ISSN: 1932-6203 Impact factor: 3.240
Figure 1Landmarks before reorientation.
Definition of the three spatial planes of the 19 points used in this study.
| PointName | Anatomicaldefinition | Sagittalview | Coronalview | Axialview |
| Median point ofbilateral lesserwings(MLWS) | midpointbetween themostposterior pointof bilaterallesser wing ofsphenoid bone | most PP | MP | most PP + MP |
| Sella turcica(S) | APP MPpituitary fossasphenoid bone | MP APP width | MP lateralwidth fossa,determinedantero-posteriorlyby theother twoslices(2) | MP APP andlateralwidth fossa |
| Nasion(Na) | most APfrontonasalsuture | most AP | MP | most AP+MPanterior contour |
| Basion(Ba) | most APforamenmagnum | most PP + LP | MP foramen,determinedantero-posteriorlyby the 2 | most APforamen |
| AnteriorNasalspine(Ans) | most AP andmaxillaryprocess nasalfloor region | most AP | AP + MP | AP + MP |
| Point A(A) | most PP maxillarcurvature,betweenanteriornasalspine andsupradentalpoint | most PP | MP determinedantero-posteriorlyby the 2 | AP + MP |
| PosteriorNasalspine(Pns) | most PP andmid-point palatinebone contour | most PP | PP + MP | PP + MP |
| Pogonion(Pg) | most APmandibularsymphysis | most AP | MP | AP + MP |
| Menton(Me) | LP mandibularsymphysis | LP | LP | LP + MP |
| Gnathion(Gn) | most ASPmandibularsymphysis | MA + LP | MA + LP | AP, LP + MP |
| Point B(B) | most PP anteriorsurfacemandibularsymphysis | most PP | MP determined antero-posteriorlyby the 2 | AP + MP |
| Right and leftorbitale(OrR, OrL) | most AUPinfraorbitalorbital | most AP | UP + MP | Most AP |
| Right and leftPorion (PoR.PoL) | UP and MPexternal ridge roofauditory meatus | UP + MP | UP | MP determinedsupero –inferiorly by the 2 |
| Right and leftCondylion(CoR, CoL) | UP point headright condyle | UP + most PP | most UP + MP | most PP |
| Right and leftGonion(GoR, GoL) | most PP edgebranch. Bisectiontangents posterioredge branch andlower body | most PP | most PP + MP | most PPdeterminedsupero-inferiolyby the 2 |
Anteroposterior point(APP), Midpoint(MP), Posterior point(PP), Lowest Point(LP), Upper point(UP), Anterior-lower Point(ALP), Anterior-upper Point(AUP), Posterior-lower Point(PLP), Highest Point(HP), Inner Point(IP).
Figure 2Landmarks after reorientation.
N, ROr and RPo each refers to MLWS, S and Ba according to the initial setting of Ondemand 3Dceph module.
Figure 3Reorientation axes.
y and ź are lines parallel to y and z axis respectively.
Figure 4MLWS as a new starting point.
x, y and z axis each represent reoriented transverse, anteroposterior and vertical axis.
Locating error (coordinate).
| Locating error | |||
| Landmarks | X | Y | Z |
| MLWS | 0.19(0.18) | 0.16(0.17) | 0.14(0.13) |
| Na | 0.32(0.26) | 0.20(0.15) | 0.31(0.40) |
| S | 0.39(0.33) | 0.31(0.26) | 0.38(0.33) |
| Ba | 0.30(0.22) | 0.33(0.29) | 0.20(0.15) |
| Ans | 0.27(0.22) | 0.26(0.21) | 0.24(0.22) |
| A | 0.24(0.18) | 0.20(0.22) | 0.79(0.77) |
| Pns | 0.24(0.19) | 0.25(0.21) | 0.31(0.30) |
| Pg | 0.50(0.37) | 0.17(0.13) | 0.58(0.40) |
| Me | 0.53(0.36) | 0.17(0.13) | 0.27(0.21) |
| Gn | 0.55(0.40) | 0.24(0.22) | 0.44(0.35) |
| B | 0.33(0.25) | 0.14(0.11) | 0.68(0.47) |
| OrR | 0.89(0.60) | 0.38(0.37) | 0.23(0.18) |
| OrL | 0.68(0.50) | 0.34(0.29) | 0.30(0.24) |
| PoR | 0.61(0.49) | 0.46(0.32) | 0.32(0.25) |
| PoL | 0.56(0.50) | 0.50(0.37) | 0.38(0.28) |
| CoR | 0.38(0.35) | 0.25(0.19) | 0.14(0.09) |
| CoL | 0.29(0.25) | 0.31(0.27) | 0.12(0.10) |
| GoR | 0.46(0.38) | 0.56(0.35) | 0.70(0.47) |
| GoL | 0.45(0.35) | 0.45(0.36) | 0.63(0.42) |
Figure 5Locating error (coordinate).
Reorientation error (RE) and factors influencing RE.
| Landmarks | Reorientation error(distance) | Locating error(distance) | Distance fromreoriented X axis | Sum of angle errors from Na, S, Ba(°) | ||||
| Mean(SD) | Q1 | Q3 | Mean(SD) | Q1 | Q3 | |||
| MLWS | 0.00(0.00) | 0.00 | 0.00 | 0.33(0.22) | 0.18 | 0.38 | 0.00(0.00) | |
| Na | 0.77(0.37) | 0.49 | 0.98 | 0.57(0.40) | 0.29 | 0.67 | 2.58(1.42) | |
| S | 0.84(0.39) | 0.55 | 1.06 | 0.73(0.38) | 0.45 | 0.96 | 2.59(1.42) | |
| Ba | 0.84(0.41) | 0.54 | 1.11 | 0.56(0.28) | 0.34 | 0.68 | 37.03(3.44) | |
| Ans | 1.71(1.19) | 0.90 | 2.17 | 0.51(0.28) | 0.26 | 0.65 | 55.35(2.63) | 1.10(0.39) |
| A | 2.01(1.23) | 1.08 | 2.85 | 0.92(0.74) | 0.44 | 1.22 | 61.14(2.85) | 1.04(0.37) |
| Pns | 1.27(0.74) | 0.70 | 1.56 | 0.54(0.32) | 0.33 | 0.63 | 47.82(3.66) | 1.60(0.57) |
| Pg | 2.98(2.15) | 1.34 | 3.61 | 0.88(0.38) | 0.52 | 1.12 | 120.21(5.67) | 0.66(0.22) |
| Me | 3.08(2.16) | 1.53 | 3.59 | 1.01(0.47) | 0.71 | 1.33 | 126.63(6.25) | 0.64(0.21) |
| Gn | 3.01(2.33) | 1.41 | 3.85 | 0.83(0.43) | 0.54 | 1.04 | 124.70(6.14) | 0.65(0.22) |
| B | 2.64(1.84) | 1.28 | 3.01 | 0.83(0.44) | 0.47 | 1.09 | 105.81(4.73) | 0.73(0.25) |
| OrR | 1.77(1.07) | 1.10 | 2.19 | 1.08(0.58) | 0.70 | 1.49 | 47.01(2.93) | 1.33(0.59) |
| OrL | 1.54(0.93) | 0.97 | 1.90 | 0.91(0.48) | 0.56 | 1.10 | 45.90(2.77) | 1.25(0.53) |
| PoR | 1.58(1.21) | 0.89 | 1.85 | 0.94(0.45) | 0.64 | 1.17 | 50.14(6.09) | 1.35(0.56) |
| PoL | 1.72(1.13) | 0.94 | 2.28 | 0.93(0.55) | 0.61 | 1.13 | 54.43(5.41) | 1.28(0.53) |
| CoR | 1.42(0.98) | 0.74 | 1.96 | 0.53(0.32) | 0.34 | 0.65 | 57.98(3.06) | 1.28(0.51) |
| CoL | 1.57(1.27) | 0.79 | 1.97 | 0.51(0.29) | 0.31 | 0.68 | 58.80(3.74) | 1.25(0.51) |
| GoR | 2.27(1.39) | 1.29 | 2.88 | 1.11(0.52) | 0.80 | 1.45 | 95.37(8.04) | 0.91(0.37) |
| GoL | 2.08(1.24) | 1.16 | 2.49 | 1.00(0.49) | 0.62 | 1.26 | 95.14(8.12) | 0.91(0.35) |
Figure 6DB: Locating error (distance) of a landmark (A).
represents an averaged landmark of A.
Figure 7DX: Distance from X-axis to an averaged landmark.
() The rotated arrow around X axis represents pitch rotation
Figure 8A3r: Sum of angle errors (S, Na, Ba) from an averaged landmark.
() α, β and γ represent angle errors viewed from an averaged landmark () respectively.
Variables included in multiple regression model.
| Independent variable | B | P value | VIF | Adjusted R-square | |
| T1–T2 | Db | 0.412 | 0.000 | 1.013 | 0.230 |
| DX | 0.015 | 0.000 | 1.436 | ||
| A3r | 0.242 | 0.038 | 1.447 | ||
| T1–T3 | Db | 0.677 | 0.000 | 1.024 | 0.153 |
| DX | 0.018 | 0.000 | 1.507 | ||
| A3r | 0.614 | 0.002 | 1.485 | ||
| T2–T3 | Db | 0.866 | 0.000 | 1.022 | 0.297 |
| DX | 0.022 | 0.000 | 1.342 | ||
| A3r | 0.657 | 0.000 | 1.322 | ||
| Total | Db | 0.758 | 0.000 | 1.016 | 0.233 |
| DX | 0.018 | 0.000 | 1.409 | ||
| A3r | 0.545 | 0.000 | 1.397 |
Outliers outside 3 standard deviations are excluded in regression analysis, VIF: variance inflation factor.