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standardization of cephalometric measurements to create a
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 3 Technique using lateral radiographs to make measurements of the head Planes, Angles and Linear measurements Used primarily in: Dentistry Orthodontics Anthropology History of Cephalometrics 4 Began with Craniometry in Anthropology Standard landmarks Cephalostat and methods Developed in 1931 by: Broadbent (USA) Hofrath (Germany) Images from: Essentials of Facial Growth and Radiographic Cephalometry History of Cephalometrics 5 Multiple standards developed over time Michigan London Downs Atlas- Riolo et al. (1974) Atlas- Bhaita and Leighton (1993) Analysis- Downs (1948) Ricketts Analysis- Rickets et al. (1982) History of Cephalometrics 6 Reference samples for “Normal Ranges” Usually Downs Are Analysis: 1948 20 White subjects Riolo small, white samples “Michigan Atlas”: 1974 83 White subjects there other racial/ethnic norms? History of Cephalometrics 7 Tracings of Radiograph Computerized cephalometrics Dolphin Imaging CephX Orthodontic Case File System 8 James K. Economides Donated in 2005 In practice since 1972 Unique collection New Mexicans Hispanic Native 5,910 American Unique patients 600 sibling pairs Multi-generational families Available online and in person Orthodontic Case File System 9 Online records can contain: Lateral X-rays Cephalometric measuements Panoramic X-rays Intra-oral photographs Diagnoses Orthodontic Case File System 10 Available in Physical collection only: Dental casts Full facial and profile photographs Cephalometric tracings Treatment records What wasn’t included: Race/ethnicity Orthodontic Case File System 11 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 Cephalometric Standardization 12 Reviewed and consulted: 2 atlases 8 analyses Compared and contrasted Dr. Economides’s measurements and landmarks with the existing atlases and analyses Cephalometric Standardization 13 “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. Cephalometric Standardization 14 “London Atlas” “McNamara Analysis” McNamara JA Jr, Brundon WL (2001). Orhtodontic and Dentofacial Orthopedics. Ann Arbor: Needham Press. “Michigan Atlas” Bhatia SN, Leighton BC (1993). A Manual of Facial Growth: A Computer Analysis of Longitudinal Cephalometric Growth Data. Oxford: Oxford university Press. 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. Cephalometric Standardization 15 “Ricketts Analysis” “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” Ricketts RM, Roth RH, Chaconas SJ, Schnlhof RJ, Engel A (1982). Orthodontic Diagnosis and Planning, Volumes I and II. Denver: Rocky Mountain Orthodontics 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. Cephalometric Standardization 16 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 Cephalometric Standardization 17 Discovered: Not all atlases and analyses use the same vocabulary Identical Different landmark Different names names Same landmark Cephalometric Standardization 18 Gonion- Defined differently Gonion-GO the midpoint at the angle of the mandible Bhatia and Leighton 1993 Ricketts et al. 1982 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 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 The by Economides as Ar-Go-Me angle formed by Articulare, Gonion and Menton Michigan Atlas: Menton-Gonial IntersectionArticulare, Ar-Goi-Me Constructed London Bony Gonion Atlas: Mandibular Angle, Art-Go-Me Gonion Jarabak-Bjork Constructed Analysis: Gonial Angle, Ar-Go-Me Gonion Cephalometric Standardization 20 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 Cephalometric Standardization 21 Created: 88 LOINC terms 11 LOINC parts LOINC added a graphical portion Case File System 22 http://hsc.unm.edu/programs/ocfs/ Research 23 Estimating race Cephalometric standardization Dental crowding and cephalometrics Dental development Secular change Tooth size and ethnic variation Eruption Juvenile sexing The Future 24 Additional cases?? “Hard” cases Research?? Informatics Anthropology Orthodontics Cephalometric Manual Acknowledgements 25 Supported by Award Number NIH 1 G08 LM009381-01A1 from the National Library of Medicine Philip J. Kroth, MD Heather J. H. Edgar, PhD References 26 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. Interobserver agreement on subjects' race and raceinformative characteristics. PloS One. 2011; 6(8): e23986. PMCID: MC3163683.
