{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T12:02:42Z","timestamp":1788177762407,"version":"build-2803163510"},"reference-count":42,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2021,2,2]],"date-time":"2021-02-02T00:00:00Z","timestamp":1612224000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The aim of the retrospective observational study was to compare the precision of landmark identification and its reproducibility using cone beam computed tomography-derived 3D cephalograms and digital lateral cephalograms in unilateral cleft lip and palate patients. Methods: Cephalograms of thirty-one (31) North Indian children (18 boys and 13 girls) with a unilateral cleft lip and palate, who were recommended for orthodontic treatment, were selected. After a thorough analysis of peer-reviewed articles, 20 difficult-to-trace landmarks were selected, and their reliability and reproducibility were studied. These were subjected to landmark identification to evaluate interobserver variability; the coordinates for each point were traced separately by three different orthodontists (OBA, OBB, OBC). Statistical analysis was performed using descriptive and inferential statistics with paired t-tests to compare the differences measured by the two methods. Real-scale data are presented in mean \u00b1 SD. A p-value less than 0.05 was considered as significant at a 95% confidence level. Results: When comparing, the plotting of points posterior nasal spine (PNS) (p &lt; 0.05), anterior nasal spine (ANS) (p &lt; 0.01), upper 1 root tip (p &lt; 0.05), lower 1 root tip (p &lt; 0.05), malare (p &lt; 0.05), pyriforme (p &lt; 0.05), porion (p &lt; 0.01), and basion (p &lt; 0.05) was statistically significant. Conclusion: In patients with a cleft lip and palate, the interobserver identification of cephalometric landmarks was significantly more precise and reproducible with cone beam computed tomography -derived cephalograms vis-a-vis digital lateral cephalograms.<\/jats:p>","DOI":"10.3390\/jcm10030535","type":"journal-article","created":{"date-parts":[[2021,2,2]],"date-time":"2021-02-02T05:44:42Z","timestamp":1612244682000},"page":"535","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Reliability and Reproducibility of Landmark Identification in Unilateral Cleft Lip and Palate Patients: Digital Lateral Vis-A-Vis CBCT-Derived 3D Cephalograms"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6611-6143","authenticated-orcid":false,"given":"Anuraj Singh","family":"Kochhar","sequence":"first","affiliation":[{"name":"Former Consultant Orthodontist Max Hospital Gurgaon, Haryana 122001, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludovica","family":"Nucci","sequence":"additional","affiliation":[{"name":"Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maninder Singh","family":"Sidhu","sequence":"additional","affiliation":[{"name":"Department of Orthodontics &amp; Dean, Research &amp; Development Faculty of Dental Sciences, SGT University Gurugram, Haryana 122505, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4951-0506","authenticated-orcid":false,"given":"Mona","family":"Prabhakar","sequence":"additional","affiliation":[{"name":"Department of Orthodontics &amp; Dean, Research &amp; Development Faculty of Dental Sciences, SGT University Gurugram, Haryana 122505, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6671-2380","authenticated-orcid":false,"given":"Vincenzo","family":"Grassia","sequence":"additional","affiliation":[{"name":"Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Letizia","family":"Perillo","sequence":"additional","affiliation":[{"name":"Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gulsheen Kaur","family":"Kochhar","sequence":"additional","affiliation":[{"name":"Department of Pediatric &amp; Preventive Dentistry, National Dental College &amp; Hospital, Punjab 140507, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ritasha","family":"Bhasin","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry, University of Toronto, Toronto, ON M5G1G6, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7354-1962","authenticated-orcid":false,"given":"Himanshu","family":"Dadlani","sequence":"additional","affiliation":[{"name":"Senior Consultant Department of Dentistry (Periodontology), Max Hospital, Gurgaon, Haryana 122001, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0291-9339","authenticated-orcid":false,"given":"Fabrizia","family":"d\u2019Apuzzo","sequence":"additional","affiliation":[{"name":"Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,2,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1016\/0002-9416(83)90322-6","article-title":"The analysis of errors in orthodontic measurements","volume":"83","author":"Houston","year":"1983","journal-title":"Am. J. Orthod."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.ajodo.2016.06.027","article-title":"Precision of manual landmark identification between as-received and oriented volume-rendered cone-beam computed tomography images","volume":"151","author":"Gupta","year":"2017","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1259\/dmfr\/81889955","article-title":"Comparison of reliability in anatomical landmark identification using two-dimensional digital cephalometrics and three-dimensional cone beam computed tomography in vivo","volume":"38","author":"Chien","year":"2009","journal-title":"Dentomaxillofacial Radiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1597\/1545-1569_1997_034_0111_cotroc_2.3.co_2","article-title":"Comparison of the reliability of craniofacial anatomic landmarks based on cephalometric radiographs and three-dimensional CT scans","volume":"34","author":"Kragskov","year":"1997","journal-title":"Cleft Palate Craniofacial J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1055\/s-0039-1698918","article-title":"A comparison of three-dimensional and two-dimensional cephalometric evaluations of children with cleft lip and palate","volume":"5","author":"Tulunoglu","year":"2011","journal-title":"Eur. J. Dent."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1597\/06-236.1","article-title":"Identification of cephalometric landmarks in unilateral cleft lip and palate patients: Are there alternatives for Point A, ANS, and PNS?","volume":"45","author":"Bongaarts","year":"2008","journal-title":"Cleft Palate Craniofacial J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1016\/0002-9416(76)90274-8","article-title":"Comprehensive care of cleft lip and palate children at Z\u00fcrich University: A preliminary report","volume":"70","author":"Hotz","year":"1976","journal-title":"Am. J. Orthod."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1597\/1545-1569_1992_029_0398_asciso_2.3.co_2","article-title":"A six-center international study of treatment outcome in patients with clefts of lip and palate: Part Craniofacial form and soft tissue profile","volume":"29","author":"Dahl","year":"1992","journal-title":"Cleft Palate Craniofacial J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1597\/02-119.2.1","article-title":"The Eurocleft study: Intercenter study of treatment outcome in patients with complete cleft lip and palate. Part 2: Craniofacial form and nasolabial appearance","volume":"42","author":"Semb","year":"2005","journal-title":"Cleft Palate Craniofacial J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/S0011-8532(22)01309-X","article-title":"Three-dimensional computed tomography imaging in dentistry","volume":"44","author":"Kawamata","year":"2000","journal-title":"Dent. Clin. N. Am."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1597\/10-198","article-title":"Alveolar bone morphology in patients with bilateral complete cleft lip and palate in the mixed dentition: Cone beam computed tomography evaluation","volume":"49","author":"Garib","year":"2012","journal-title":"Cleft Palate Craniofacial J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"431","DOI":"10.2319\/042715-289.1","article-title":"Evaluation of dehiscence and fenestration in adolescent patients affected by unilateral cleft lip and palate: A retrospective cone beam computed tomography study","volume":"86","author":"Buyuk","year":"2016","journal-title":"Angle Orthod."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.2319\/092614-691.1","article-title":"Assessment of the alveolar bone support of patients with unilateral cleft lip and palate: A cone-beam computed tomography study","volume":"85","author":"Ercan","year":"2015","journal-title":"Angle Orthod."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1597\/13-287","article-title":"A novel semiautomatic technique for volumetric assessment of the alveolar bone defect using cone beam computed tomography","volume":"52","author":"Linderup","year":"2015","journal-title":"Cleft Palate Craniofacial J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1093\/ejo\/cju082","article-title":"Effects of cleft lip and palate on the development of permanent upper central incisors: A cone-beam computed tomography study","volume":"37","author":"Celebi","year":"2014","journal-title":"Eur. J. Orthod."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1097\/SCS.0000000000000619","article-title":"Facial soft-tissue asymmetry in three-dimensional cone-beam computed tomography images of children with surgically corrected unilateral clefts","volume":"25","author":"Starbuck","year":"2014","journal-title":"J. Craniofacial Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1597\/15-077","article-title":"Asymmetric dental development investigated by cone-beam computed tomography in patients with unilateral cleft lip and alveolus","volume":"53","author":"Zhang","year":"2016","journal-title":"Cleft Palate Craniofacial J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1597\/11-182","article-title":"Tooth lengths of the permanent upper incisors in patients with cleft lip and palate determined with cone beam computed tomography","volume":"50","author":"Zhou","year":"2013","journal-title":"Cleft Palate Craniofacial J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"482","DOI":"10.4103\/2231-0762.168645","article-title":"Oral health related quality of life in cleft lip and palate patients rehabilitated with conventional prostheses or dental implants","volume":"5","author":"Papi","year":"2015","journal-title":"J. Int. Soc. Prev. Community Dent."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"758","DOI":"10.2319\/082018-612.1","article-title":"Reliability of 3D dental and skeletal landmarks on CBCT images","volume":"89","author":"Park","year":"2019","journal-title":"Angle Orthod."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"312.e1","DOI":"10.1016\/j.ajodo.2008.12.018","article-title":"Precision of cephalometric landmark identification: Cone-beam computed tomography vs conventional cephalometric views","volume":"136","author":"Ludlow","year":"2009","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Kochhar, A.S., Sidhu, M.S., Prabhakar, M., Bhasin, R., Kochhar, G.K., Dadlani, H., Spagnuolo, G., and Mehta, V.V. (2021). Intra- and Interobserver Reliability of Bone Volume Estimation Using OsiriX Software in Patients with Cleft Lip and Palate Using Cone Beam Computed Tomography. Dent. J., 9.","DOI":"10.3390\/dj9020014"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.tripleo.2008.05.039","article-title":"Observer reliability of three-dimensional cephalo-metric landmark identification on cone-beam computerized tomography","volume":"107","author":"Cevidanes","year":"2009","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endodontol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"762","DOI":"10.2319\/090413-652.1","article-title":"Reliability of anatomic structures as landmarks in three-dimensional cephalometric analysis using CBCT","volume":"84","author":"Naji","year":"2014","journal-title":"Angle Orthod."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Kochhar, A.S., Sidhu, M.S., Prabhakar, M., Bhasin, R., Kochhar, G.K., Dadlani, H., and Spagnuolo, G. (2020). Frontal and axial evaluation of craniofacial morphology in repaired unilateral cleft lip and palate patients utilizing cone beam computed tomography; an observational study. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17217786"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1093\/ejo\/cjy066","article-title":"CBCT in orthodontics: A systematic review on justification of CBCT in a paediatric population prior to orthodontic treatment","volume":"41","author":"Ayaz","year":"2019","journal-title":"Eur. J. Orthod."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1053\/j.sodo.2005.04.002","article-title":"Reliability of digital versus conventional cephalometric radiology: A comparative evaluation of landmark identification error","volume":"11","author":"McClure","year":"2005","journal-title":"Semin. Orthod."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"286","DOI":"10.2319\/030909-135.1","article-title":"Accuracy and landmark error calculation using cone-beam computed tomography-generated cephalograms","volume":"80","author":"Grauer","year":"2010","journal-title":"Angle Orthod."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e289","DOI":"10.1016\/j.ajodo.2011.06.024","article-title":"Landmark identification errors on cone-beam computed tomography-derived cephalograms and conventional digital cephalograms","volume":"140","author":"Chang","year":"2011","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e678","DOI":"10.4317\/medoral.17721","article-title":"A study on the reproducibility of cephalometric landmarks when undertaking a three-dimensional (3D) cephalometric analysis","volume":"17","author":"Zamora","year":"2012","journal-title":"Med. Oral Patol. Oral Cir. Bucal."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"20130059","DOI":"10.1259\/dmfr.20130059","article-title":"Comparison of observer reliability of three-dimensional cephalometric landmark identification on subject images from Galileos and i-CAT cone beam CT","volume":"42","author":"Katkar","year":"2013","journal-title":"Dentomaxillofacial Radiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"213","DOI":"10.5624\/isd.2015.45.4.213","article-title":"Cephalometric landmark variability among orthodontists and dentomaxillofacial radiologists: A comparative study","volume":"45","author":"Morosolli","year":"2015","journal-title":"Imaging Sci. Dent."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"11","DOI":"10.2319\/120413-891.1","article-title":"Evaluation of cephalometric landmark identification on CBCT multiplanar and 3D reconstructions","volume":"85","author":"Soares","year":"2015","journal-title":"Angle Orthod."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1111\/ocr.12205","article-title":"Accuracy and reliability of landmark-based, surface-based and voxel-based 3D cone-beam computed tomography superimposition methods","volume":"20","author":"Ghoneima","year":"2017","journal-title":"Orthod. Craniofacial Res."},{"key":"ref_35","first-page":"155","article-title":"The effects of differences in landmark identification on the cephalometric measurements in traditional versus digitized cephalometry","volume":"74","author":"Chen","year":"2004","journal-title":"Angle Orthod."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1773","DOI":"10.1016\/S0140-6736(09)60695-4","article-title":"Cleft lip and palate","volume":"374","author":"Mossey","year":"2009","journal-title":"Lancet"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/j.ajodo.2006.09.065","article-title":"Craniofacial computerized tomography analysis of the midface of patients with repaired complete unilateral cleft lip and palate","volume":"134","author":"Suri","year":"2008","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1016\/j.ajodo.2008.07.018","article-title":"Intraexaminer and interexaminer reliabilities of landmark identification on digitized lateral cephalograms and formatted 3-dimensional cone-beam computerized tomography images","volume":"137","author":"Low","year":"2010","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1002\/hed.20866","article-title":"Variations of supraorbital foramina in living subjects evaluated with multidetector computed tomography","volume":"30","author":"Demir","year":"2008","journal-title":"Head Neck"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1894","DOI":"10.1097\/SCS.0000000000005557","article-title":"Precision analysis of supraorbital transcranial exits using three dimensional multidetector computed tomography","volume":"30","author":"Lim","year":"2019","journal-title":"J. Craniofacial Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"130","DOI":"10.3344\/kjp.2013.26.2.130","article-title":"Anatomic characteristics of supraorbital foramina in Korean using three-dimensional model","volume":"26","author":"Woo","year":"2013","journal-title":"Korean J. Pain"},{"key":"ref_42","first-page":"104","article-title":"A descriptive anatomy of the face in human fetuses with unilateral cleft lip and palate","volume":"4","author":"Atherton","year":"1967","journal-title":"Cleft Palate Craniofacial J."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/3\/535\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:18:37Z","timestamp":1760159917000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/3\/535"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,2]]},"references-count":42,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,2]]}},"alternative-id":["jcm10030535"],"URL":"https:\/\/doi.org\/10.3390\/jcm10030535","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,2]]}}}