• 대한치과교정학회지
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• 제49권1호
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• pp.32-40
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• 2019

Objective: Precise identification of landmarks on posteroanterior (PA) cephalograms is necessary when evaluating lateral problems such as facial asymmetry. The aim of the present study was to investigate whether the use of lateral (LA) cephalograms can reduce errors in landmark identification on PA cephalograms. Methods: Five examiners identified 16 landmarks (Cg, N, ANS, GT, Me, RO, Lo, FM, Z, Or, Zyg, Cd, NC, Ms, M, and Ag) on 32 PA cephalograms with and without LA cephalograms at the same time. The positions of the landmarks were recorded and saved in the horizontal and vertical direction. The mean errors and standard deviation of landmarks location according to the use of LA cephalograms were compared for each landmark. Results: Relatively small errors were found for ANS, Me, Ms, and Ag, while relatively large errors were found for N, GT, Z, Or, and Cd. No significant difference was found between the horizontal and vertical errors for Z and Or, while large vertical errors were found for N, GT, and Cd. The value of identification error was lower when the landmarks were identified using LA cephalograms. Statistically significant error reductions were found at N and Cd with LA cephalograms, especially in the vertical direction. Conclusions: The use of LA cephalograms during identification of landmarks on PA cephalograms could help reduce identification errors.

• 대한치과교정학회지
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• 제49권1호
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• pp.41-48
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• 2019

Objective: This in-vivo study aimed to compare landmark identification errors in anteroposterior (AP) and posteroanterior (PA) cephalograms generated from cone-beam computed tomography (CBCT) scan data in order to examine the feasibility of using AP cephalograms in clinical settings. Methods: AP and PA cephalograms were generated from CBCT scans obtained from 25 adults. Four experienced and four inexperienced examiners were selected depending on their experience levels in analyzing frontal cephalograms. They identified six cephalometric landmarks on AP and PA cephalograms. The errors incurred in positioning the cephalometric landmarks on the AP and PA cephalograms were calculated by using the straight-line distance and the horizontal and vertical components as parameters. Results: Comparison of the landmark identification errors in CBCT-generated frontal cephalograms revealed that landmark-dependent differences were greater than experienceor projection-dependent differences. Comparisons of landmark identification errors in the horizontal and vertical directions revealed larger errors in identification of the crista galli and anterior nasal spine in the vertical direction and the menton in the horizontal direction, in comparison with the other landmarks. Comparison of landmark identification errors between the AP and PA projections in CBCT-generated images revealed a slightly higher error rate in the AP projections, with no inter-examiner differences. Statistical testing of the differences in landmark identification errors between AP and PA cephalograms showed no statistically significant differences for all landmarks. Conclusions: The reproducibility of CBCT-generated AP cephalograms is comparable to that of PA cephalograms; therefore, AP cephalograms can be generated reliably from CBCT scan data in clinical settings.

• 대한치과교정학회지
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• 제30권5호
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• pp.543-552
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• 2000

본 연구는 natural head posture(NHP)를 이용하여 정모 두부 방사선 규격사진 촬영시 재현도를 알아보기 위하여 시행되었다. 두개 안면부의 기형이 없는 25세 전후의 성인 남녀 30명을 대상으로 통상적인 방법(술자 유도법)과 NHP에서 Head Posture Aligner를 이용한 방법(HPA법)으로 정모 두부 방사선 사진을 각기 2주 간격으로 촬영한 후 5개의 고경 계측항목과 9개의 폭경 계측항목을 선정하여 t 검정으로 각 계측항목의 재현도를 비교하는 한편, 정모와 측모 두부 방사선 사진으로3차원 상을 합성시 오차의 요인이 되는 두부의 상하회전 정도 차이를 촬영 방법별로 비교 분석하여 다음과 같은 결과를 얻었다. 1. 시간 간격을 두고 술자 유도법으로 2회 촬영한 정모 두부 방사선 사진의 계측치는 모든 고경 계측항목에서 서로 차이를 나타내어 낮은 재현도를 보였다. 2. 시간 간격을 두고 HPA법으로 2회 촬영한 정모 두부 방사선 사진의 계측치는 모든 고경 계측항목에서 통계적으로 유의한 차이를 나타내지 않아 재현도가 높음을 보였다. 3. 폭경 계측항목의 경우 2회 계측치의 차이를 통하여 살펴 본 재현도에서 술자유도법과HPA방법간에 두드러진 차이를 보이지 않았다. 4. 정모 및 측모 두부 방사선사진으로 3차원상을 합성하기 위한 수직적 두부 위치 보정각을 계산한 결과, 술자 유도법의 경우 $2.5^{\circ}$인 반면, HPA법은 $0.8^{\circ}$로 작게 나타났다. 이상의 결과는 정모 두부 방사선 규격 사진 촬영시 두부 위치의 재현도를 증가시키기 위하여 HPA의 사용이 필요함을 시사하였다.

• 대한치과교정학회지
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• 제51권2호
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• pp.77-85
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• 2021

Objective: To evaluate the accuracy of a multi-stage convolutional neural network (CNN) model-based automated identification system for posteroanterior (PA) cephalometric landmarks. Methods: The multi-stage CNN model was implemented with a personal computer. A total of 430 PA-cephalograms synthesized from cone-beam computed tomography scans (CBCT-PA) were selected as samples. Twenty-three landmarks used for Tweemac analysis were manually identified on all CBCT-PA images by a single examiner. Intra-examiner reproducibility was confirmed by repeating the identification on 85 randomly selected images, which were subsequently set as test data, with a two-week interval before training. For initial learning stage of the multi-stage CNN model, the data from 345 of 430 CBCT-PA images were used, after which the multi-stage CNN model was tested with previous 85 images. The first manual identification on these 85 images was set as a truth ground. The mean radial error (MRE) and successful detection rate (SDR) were calculated to evaluate the errors in manual identification and artificial intelligence (AI) prediction. Results: The AI showed an average MRE of 2.23 ± 2.02 mm with an SDR of 60.88% for errors of 2 mm or lower. However, in a comparison of the repetitive task, the AI predicted landmarks at the same position, while the MRE for the repeated manual identification was 1.31 ± 0.94 mm. Conclusions: Automated identification for CBCT-synthesized PA cephalometric landmarks did not sufficiently achieve the clinically favorable error range of less than 2 mm. However, AI landmark identification on PA cephalograms showed better consistency than manual identification.

• Imaging Science in Dentistry
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• 제46권1호
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• pp.33-38
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• 2016

Purpose: Facial asymmetry has been measured by the severity of deviation of the menton (Me) on posteroanterior (PA) cephalograms and three-dimensional (3D) computed tomography (CT). This study aimed to compare PA cephalograms and 3D CT regarding the severity of Me deviation and the direction of the Me. Materials and Methods: PA cephalograms and 3D CT images of 35 patients who underwent orthognathic surgery (19 males and 16 females, with an average age of $22.1{\pm}3.3years$) were retrospectively reviewed in this study. By measuring the distance and direction of the Me from the midfacial reference line and the midsagittal plane in the cephalograms and 3D CT, respectively, the x-coordinates ($x_1$ and $x_2$) of the Me were obtained in each image. The difference between the x-coordinates was calculated and statistical analysis was performed to compare the severity of Me deviation and the direction of the Me in the two imaging modalities. Results: A statistically significant difference in the severity of Me deviation was found between the two imaging modalities (${\Delta}x=2.45{\pm}2.03mm$, p<0.05) using the one-sample t-test. Statistically significant agreement was observed in the presence of deviation (k=0.64, p<0.05) and in the severity of Me deviation (k=0.27, p<0.05). A difference in the direction of the Me was detected in three patients (8.6%). The severity of the Me deviation was found to vary according to the imaging modality in 16 patients (45.7%). Conclusion: The measurement of Me deviation may be different between PA cephalograms and 3D CT in some patients.

• 대한치과교정학회지
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• 제33권2호
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• pp.73-84
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• 2003

본 연구는 정모두부방사선사진 촬영시 수직적 두부회전이 방사선사진상의 계측치들에 어느 정도의 투사오차를 야기 시키는지 알아보고자 시행되었다. 임상검사를 통하여 두드러진 전후방 골격이상이나 뚜렷한 안면비 대칭을 보이지 않는 성인 25명을 대상으로 natural head position상태를 기준위치$(0^{\circ})$로 정하고 이 위치에 대해 양쪽 ear rod를 연결한 수평축을 중심으로 두부를 상, 하방으로 $5^{\circ},\;10^{\circ}$씩 회전시킨 상태에서 정모두부방사선사진을 각각 촬영하여 투사도를 작성한 다음 7개의 고경항목, 5개의 폭경항목, 6개의 각도항목을 계측하였다. 각 회전각도에서의 계측치를 비교 분석하여 다음과 같은 결과를 얻었다. 1. 고경계측항목의 투사오차가 폭경이나 각도계측항목에 비해 전반적으로 큰 양상을 나타냈다. 2. 고경계측항목 중 회전축으로부터 먼 계측점간의 거리를 나타내는 항목일수록 투사오차가 컸다. 3. 폭경 계측항목 중 비강폭경, 상악폭경, 상악 제1대구치간 폭경은 각 회전각도 간에 통계적 유의차가 없었으나 하악폭 경과 하악 제1대구치간 폭경은 통지적으로 유의차가 있었다. 4. 각도계측항목 중 menton의 편위정도를 나타내는 각도는 각 회전각도 간에 통계적 유의차가 없었으나 crista galli와 maxillare를 연결한 선이나 crista galli와 antegonion을 연결한 선과 수평기준선이 이루는 각도는 통계적으로 유의차가 있었다. 이상의 결과는 수직적 두부회전에 의해 정모두부방사선사진상에 투사오차가 발생하므로 유용한 정모두부방사선사진을 얻기 위해서는 촬영시마다 동일한 두부위치를 유지하기 위한 노력이 필요함을 시사하였다.

• 대한치과교정학회지
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• 제54권1호
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• pp.48-58
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• 2024

Objective: To quantify the effects of midline-related landmark identification on midline deviation measurements in posteroanterior (PA) cephalograms using a cascaded convolutional neural network (CNN). Methods: A total of 2,903 PA cephalogram images obtained from 9 university hospitals were divided into training, internal validation, and test sets (n = 2,150, 376, and 377). As the gold standard, 2 orthodontic professors marked the bilateral landmarks, including the frontozygomatic suture point and latero-orbitale (LO), and the midline landmarks, including the crista galli, anterior nasal spine (ANS), upper dental midpoint (UDM), lower dental midpoint (LDM), and menton (Me). For the test, Examiner-1 and Examiner-2 (3-year and 1-year orthodontic residents) and the Cascaded-CNN models marked the landmarks. After point-to-point errors of landmark identification, the successful detection rate (SDR) and distance and direction of the midline landmark deviation from the midsagittal line (ANS-mid, UDM-mid, LDM-mid, and Me-mid) were measured, and statistical analysis was performed. Results: The cascaded-CNN algorithm showed a clinically acceptable level of point-to-point error (1.26 mm vs. 1.57 mm in Examiner-1 and 1.75 mm in Examiner-2). The average SDR within the 2 mm range was 83.2%, with high accuracy at the LO (right, 96.9%; left, 97.1%), and UDM (96.9%). The absolute measurement errors were less than 1 mm for ANS-mid, UDM-mid, and LDM-mid compared with the gold standard. Conclusions: The cascaded-CNN model may be considered an effective tool for the auto-identification of midline landmarks and quantification of midline deviation in PA cephalograms of adult patients, regardless of variations in the image acquisition method.

• 대한치과교정학회지
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• 제36권5호
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• pp.380-387
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• 2006

본 연구는 이부편위자의 정모두부방사선사진에서 하악골상행지 경사도의 좌우 차이를 알아봄으로써 교정환자의 임상검사 시 비대칭 진단에 도움이 되고자 시행되었다. 뚜렷한 이부편위를 보이는 성인 30명을 이부편위군으로, 좌우 대칭적인 외모를 보이는 성인 30명을 대조군으로 선정하여 정모두부방사선사진을 촬영한 후 하악골상행지 경사도를 측정하고 좌우 차이를 산출, 비교 분석한 결과, 대조군의 경우 좌우 차이를 보이지 않은 반면 이부편위자에서는 하악골상행지 경사도의 좌우 차이를 보였다. 이부편위자에서 비편위측의 하악골상행지의 경사도는 편위측에 비해 통계적으로 유의하게 큰 것으로 나타났으며, 하악골상행지 경사도의 좌우차이는 이부편위 정도 및 상악고경의 좌우차이와 통계적으로 유의한 순상관관계를 보였다. 이부편위자에서 하악골상행지 경사도의 좌우차이를 규명한 본 연구 결과는 안면비대칭 환자의 진단 시 하악골상행지 경사도에 대한 분석이 필요함을 시사하였다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제34권6호
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• pp.421-425
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• 2012

Purpose: The aim of this study is to compare the soft tissue changes of the midfacial area at the repose position and the natural smiling position for the improvement of evaluation and planning in the orthognathic surgery. Methods: The total of 30 subjects, 15 male and 15 female, were included in this study. The metal point landmarks were placed at the cheek, orbital rim, subpupil, and nasal base. The movements of the landmarks were evaluated at the repose position and smiling position in the lateral and posteroanterior cephalograms. Paired t test and correlation analysis were used for the evaluation of the soft tissue changes statistically. Results: In the lateral cephalograms, the cheek point (4.49 mm in female, 4.87 mm in male) showed the most distant movement. All points presented significant movements, except the orbital rim and nasal base point in male. Cheek point presented significant positive correlation between the horizontal and vertical change in male. Subpupil point presented significant positive correlation between horizontal and vertical change in both male and female. In the posteroanterior cephalograms, the nasal base point (5.41 mm in female, 6.30 mm in male) showed the most distant movement. Subpupil point and nasal base point presented significant movements in both female and male. Nasal base point presented significant negative correlation between the horizontal and vertical change in both male and female. In the lateral and posteroanterior cephalograms, the positional changes of all points presented significant positive correlation with each other in both female and male. Conclusion: The cheek point in the sagittal view and the nasal base point in the frontal view showed the most distant movement on smile. In the sagittal view, the subpupil point and cheek point moved anteriorsuperiorly on smile. In the frontal view, the nasal base points moved laterosuperiorly on smile. In both the sagittal and frontal view, the positional changes of all point were highly correlated to each other. These results may be used in the soft tissue references for the treatment planning of the dentofacial deformity patients.

• 대한치과교정학회지
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• 제48권1호
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• pp.39-47
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• 2018

Objective: The aim of this study was to establish the normative data of dentofacial transverse dimensions according to the skeletal maturation stage in Korean adolescents with good occlusion, assess gender differences and determine correlations between transverse variables. Methods: A total of 577 Korean subjects between ages 7 to 19 years and exhibiting skeletal Class I occlusion were categorized by skeletal maturation index (SMI) of Fishman using hand-wrist radiographs. Dentofacial transverse dimensions were assessed using posteroanterior cephalograms. Independent two-sample t-tests were used to analyze differences between genders. Pearson correlation coefficient was used to determine the correlation between transverse measurements. Results: Dentofacial transverse norms relevant to skeletal maturation stages were established. The average maxillomandibular width difference and ratio at growth completion was 22.16 mm and 77.01% for males; 23.70 mm and 74.06% for females, respectively. Males had greater facial, maxillary and mandibular widths compared to females at every SMI stage. The maxillary and mandibular intermolar widths showed the strongest correlation for both sexes (r = 0.826 for males, r = 0.725 for females). Conclusions: Dentofacial transverse norms of Korean adolescents were established according to developmental stage. All dentofacial widths were greater in males at growth completion. Maxillary and mandibular intermolar widths were strongly correlated. This study may serve as a guideline for the assessment of dentofacial transverse growth according to skeletal maturation stage in Korean adolescents with good occlusion.