Three-dimensional cephalometric analysis in orthodontics: a systematic review.

CONTEXT: The scientific evidence of 3D cephalometry in orthodontics has not been well established. OBJECTIVE: The aim of this systematic review was to evaluate the evidence for the diagnostic efficacy of 3D cephalometry in orthdontics, focusing on measurement accuracy and reproducibility of landmark identification. DATA SOURCES: PubMed, EMBASE and the Cochrane library (from beginning to March 13, 2012) were searched. Search terms included: cone-beam computed tomography; tomography, spiral computed; imaging, three-dimensional; orthodontics. STUDY SELECTION: Two reviewers read the retrieved articles and selected relevant publications based on pre-established inclusion criteria. The selected publications had to elucidate the hierarchical model of the efficacy of diagnostic imaging systems by Fryback and Thornbury. DATA EXTRACTION: The data was then extracted according to two protocols, which were based on the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Next, levels of evidence were categorized into 3 groups: low, moderate and high evidence. DATA SYNTHESIS: 571 publications were found by database search strategies and 50 additional studies by hand search. A total of 35 publications were included in this review. CONCLUSIONS: Limited evidence for the diagnostic efficacy of 3D cephalometry was found. Only 6 studies met the criteria for a moderate level of evidence. Accordingly, this systematic review reveals that there is still need for methodologically standardized studies on 3D cephalometric analysis.