Impact of Unilateral Alveolar Bone Grafting on Nasal Volume and Nasolabial Surface: A 3D Analysis

OBJECTIVE

To determine possible effects of unilateral alveolar cleft closure on internal nasal volume and external nasolabial surface.

DESIGN

Retrospective, single-arm, cohort study.

SETTING

Institutional, tertiary care.

PATIENTS

Patients with complete unilateral cleft lip, alveolus, and palate (CUCLAP), who underwent closure of the alveolar cleft with autologous bone graft (ABG) at the age of 9-11 years, with cone beam computed tomography (CBCT) and/or three-dimensional (3D) stereophotogrammetry images taken before and one year after the ABG procedure.

INTERVENTIONS

ABG-pocedure in patients with CUCLAP.

MAIN OUTCOME MEASURES

The influence of ABG on the internal and external nasal morphology.

RESULTS

A total of 28 patients (21M/7F, 14R/14L) were divided into internal (CBCT) and external (3D-stereophotogrammetry) measurement subgroups. The external nasolabial surface showed a significant decrease of the angle alar curvature right-subnasale-alar curvature left (-1.99°; P = .02; 95% CI -2.61, -0.36) and an increase of the linear measurement between these points (+1.01 mm; P = .03; 95% CI: 0.11, 1.91). No significant differences were found when comparing the distance maps of the affected side with the non-affected side (P = .50, 95% CI: -0.20, 0.29).

CONCLUSIONS

Closure of the alveolar cleft in CUCLAP patients with ABG did not affect the internal nasal volume, but significantly affected the external nasal surface. The procedure resulted in the nose becoming wider because both alar curvatures moved caudally and laterally relative to the subnasale.

[Diagnosis of ankylotic deciduous molars using intraoral scans in oligodontic patients]

In this retrospective study, 2 intraoral scans with an interval of at least 1 year were superimposed in 25 oligodontic patients. The differences in vertical eruption (mm) were measured and the orthopantomograms were analyzed for the presence of ankylotic deciduous molars with no successor. The mean eruption of deciduous molars with and without successor was significantly lower than the mean eruption of permanent molars. The eruption of permanent molars was a predictive variable for the eruption of deciduous molars. The number of agenetic elements and the presence of a successor were strongly associated with the eruption of deciduous molars. Also, the mean eruption of deciduous molars with ankylosis was significantly lower than that of deciduous molars without ankylosis. This study showed a strong relationship between the diagnosis of ankylotic deciduous molars and the measurement of negative vertical eruption when monitored by intraoral scans.

Stem cells and extracellular vesicles to improve preclinical orofacial soft tissue healing

Orofacial soft tissue wounds caused by surgery for congenital defects, trauma, or disease frequently occur leading to complications affecting patients' quality of life. Scarring and fibrosis prevent proper skin, mucosa and muscle regeneration during wound repair. This may hamper maxillofacial growth and speech development. To promote the regeneration of injured orofacial soft tissue and attenuate scarring and fibrosis, intraoral and extraoral stem cells have been studied for their properties of facilitating maintenance and repair processes. In addition, the administration of stem cell-derived extracellular vesicles (EVs) may prevent fibrosis and promote the regeneration of orofacial soft tissues. Applying stem cells and EVs to treat orofacial defects forms a challenging but promising strategy to optimize treatment. This review provides an overview of the putative pitfalls, promises and the future of stem cells and EV therapy, focused on orofacial soft tissue regeneration.

Oral health-related Quality of Life in patients with Oligodontia: a FACE-Q assessment

OBJECTIVES

The present study aimed to investigate the impact of oligodontia on appearance and on the functional and psychosocial aspects of oral health-related quality of life (OHrQoL) in patients aged 8-29 years.

METHODS

62 patients with oligodontia that were registered at -REDACTED- were included. A control group included 127 patients that were referred for a first orthodontic consultation. Participants completed the FACE-Q Dental questionnaire. Regression analyses were performed to explore relationships between OHrQoL and patient-identified gender, age, the number of congenitally missing teeth, active orthodontic treatment, and previous orthodontic treatment.

RESULTS

The only clear significant difference between the oligodontia and control groups was that patients with oligodontia scored lower in the domain, 'eating and drinking' (p<0.001). It was found that, in oligodontia the greater the number of agenetic teeth, the more difficulties eating and drinking. In fact, the Rasch score was reduced by 1.00 (95% CI: 0.23-1.77; p=0.012) for each extra agenetic tooth. Older children scored significantly lower than younger ones on five out of nine scales: appearance of the face, smile, and jaws; social function; and psychological function. Females scored significantly lower than males on four scales: appearance of the face, appearance distress, social function, and psychological function.

CONCLUSION

These findings suggested that, when treating patients with oligodontia, the number of agenetic teeth, age, and gender should be taken into account. These factors could have negative effects on their self-assessment of appearance, their facial function, and their quality of life.

CLINICAL SIGNIFICANCE

The increased difficulty with eating and drinking associated with more agenetic teeth highlighted the importance of functional (re)habilitation.

Dentition patterns in bilateral cleft lip subphenotypes: multicenter study

OBJECTIVES

Here, we retrospectively investigated cases of bilateral oral clefts (OCs) to determine the clinical relevance of detailed distinction of incomplete cleft lip subphenotypes, based on morphological severity of the cleft, within the categories cleft lip with or without alveolus (CL ± A) and cleft lip, alveolus, and palate (CLAP). We further assessed possible associations between CL subphenotypes (complete vs different incomplete types) and different dentition patterns of the lateral incisor.

MATERIALS AND METHODS

Our analysis included 151 non-syndromic Caucasian bilateral OC-patients (8-20 years old) from the Dutch Association for Cleft Palate and Craniofacial Anomalies registry. Six different deciduous and permanent lateral incisor patterns were distinguished: normal position (z/Z), supernumerary lateral incisor (n/N), presence in the anterior (x/X) or posterior (y/Y) segment of the cleft, one in each cleft segment (xy/XY), and agenesis (ab/AB). Logistic regression was performed to show the associations between the CL subphenotypes and dentition patterns of the lateral incisor.

RESULTS

One hundred three had complete, while 48 had incomplete CLs. Patterns z/Z and n/N were associated with a submucous/vermillion notch, incomplete CL, and intact alveolus. Patterns x/X, y/Y, and xy/XY were most common in patients with two-thirds to subtotal CL and complete CL. The most severe pattern, ab/AB, was most commonly associated with complete CL.

CONCLUSIONS

Based on the morphological severity of the CLs, it can be stated that the more severe the CL in bilateral CL ± A and CLAP, the more severe the abnormal pattern of the dentition.

CLINICAL RELEVANCE

Further distinction of incomplete cleft lip subphenotypes (submucous/vermillion notch, one-third to two-thirds CL, two-thirds to subtotal CL) in bilateral CL ± A and CLAP has clinical relevance.

Fusion of intra-oral scans in cone-beam computed tomography scans

PURPOSE

The purpose of this study was to evaluate the clinical accuracy of the fusion of intra-oral scans in cone-beam computed tomography (CBCT) scans using two commercially available software packages.

MATERIALS AND METHODS

Ten dry human skulls were subjected to structured light scanning, CBCT scanning, and intra-oral scanning. Two commercially available software packages were used to perform fusion of the intra-oral scans in the CBCT scan to create an accurate virtual head model: IPS CaseDesigner® and OrthoAnalyzer™. The structured light scanner was used as a gold standard and was superimposed on the virtual head models, created by IPS CaseDesigner® and OrthoAnalyzer™, using an Iterative Closest Point algorithm. Differences between the positions of the intra-oral scans obtained with the software packages were recorded and expressed in six degrees of freedom as well as the inter- and intra-observer intra-class correlation coefficient.

RESULTS

The tested software packages, IPS CaseDesigner® and OrthoAnalyzer™, showed a high level of accuracy compared to the gold standard. The accuracy was calculated for all six degrees of freedom. It was noticeable that the accuracy in the cranial/caudal direction was the lowest for IPS CaseDesigner® and OrthoAnalyzer™ in both the maxilla and mandible. The inter- and intra-observer intra-class correlation coefficient showed a high level of agreement between the observers.

CLINICAL RELEVANCE

IPS CaseDesigner® and OrthoAnalyzer™ are reliable software packages providing an accurate fusion of the intra-oral scan in the CBCT. Both software packages can be used as an accurate fusion tool of the intra-oral scan in the CBCT which provides an accurate basis for 3D virtual planning.

Symmetry of palatal shape during the first year of life in healthy infants

Objectives

The purpose of this study was to quantify the symmetry of the alveolar process of the maxilla and palate during the first year of life in healthy infants with the help of a semiautomatic segmentation technique.

Materials and methods

Maxillary plaster models of seventy healthy babies at 0, 3, 6, 9, and 12 months were collected and digitized. A semiautomatic segmentation tool was used to extract the alveolus and palate. The resulting model was aligned within a reference frame and mirrored on its medial plane. Distance maps were created and analyzed to compare and quantify the differences between the two hemispheres. Additional hemispherical width and area measurements were performed. An ANOVA test with additional post hoc tests was performed to check if the symmetry changed during development. Finally, the results were tested on intra- and interobserver variability.

Results

The absolute mean inter-surface distance between the original and mirrored models in each age group ranged between 0.23 and 0.30 mm. Width and area analysis showed a small but significant larger left palatal hemisphere. ANOVA and post hoc tests showed no significant difference in symmetry between groups. Reliability analysis showed no significant differences between observers.

Conclusions

This study showed that in this infant population, only a small degree of palatal asymmetry was present, which can be considered as normal and clinically irrelevant.

Clinical relevance

The data from this study can be used in future comparative studies as reference data. Furthermore, modeling of these data can help in predicting the growth pattern, which may lead to improved treatment protocols for children with craniofacial anomalies.

Electronic supplementary material

The online version of this article (10.1007/s00784-020-03403-4) contains supplementary material, which is available to authorized users.

Virtual setup in orthodontics: planning and evaluation

OBJECTIVES

The purpose of this study was to evaluate the clinical accuracy of virtual orthodontic setups by using a new CBCT-based approach.

MATERIALS AND METHODS

Ten patients who underwent pre-surgical orthodontics were included in this study. Pre-treatment and pre-surgical cone-beam CT (CBCT) scans and digital dental models were available. The pre-treatment digital dental model was used to create an orthodontic virtual setup. The digital dental models were fused with the corresponding CBCT scans, and the two CBCT scans were aligned using voxel-based matching. Moving each individual tooth from the virtual setup to the final outcome allows the calculation of the accuracy of the virtual setup by using an iterative closest point algorithm. Differences between virtual setup and final outcome were recorded as well as the ICC between two observers.

RESULTS

The inter-observer variability showed a high level of agreement between the observers. The largest mean difference between observers was found in the cranial/caudal direction (0.36 ± 0.30 mm) and the roll rotation (1.54 ± 0.98°). Differences between the virtual setup and final outcome were small in the translational direction (0.45 ± 0.48 mm). Rotational mean differences were larger with the pitch of the incisors (0.00 ± 7.97°) and molars (0.01 ± 10.26°) as largest difference. Excessive extrusion of all upper teeth and more anterior movement than planned were seen for both upper and lower arch. Lower molars showed less extrusion.

CLINICAL RELEVANCE

The data of this study can be used to obtain more insight in the accuracy and achievability of orthodontic virtual setup. Tooth movement can now be studied in more details which can lead to new insights.

Three dimensional maxillary growth modeling in newborns

OBJECTIVES

The aim of this study was to develop an accurate and intuitive semi-automatic segmentation technique to calculate an average maxillary arch and palatal growth profile for healthy newborns in their first year of life.

MATERIALS AND METHODS

Seventy babies born between 1985 and 1988 were included in this study. Each child had five impressions made in the first year after birth that were digitalized. A semi-automatic segmentation tool was developed and used to assess the maxillary dimensions. Finally, random effect models were built to describe the growth and build a simulation population of 10,000 newborns. The segmentation was tested for inter- and intra-observer variability.

RESULTS

The Pearson correlation coefficient for each of the variables was between 0.94 and 1.00, indicating high inter-observer agreement. The paired sample t test showed that, except for the tuberosity distance, there were small, but significant differences in the landmark placements between observers. Intra-observer repeatability was high, with Pearson correlation coefficients ranging from 0.87 to 1.00 for all measurements, and the mean differences were not significant. A third or second degree growth curve could be successfully made for each parameter.

CONCLUSIONS

These findings indicated this method could be used for objective clinical evaluation of maxillary growth.

CLINICAL RELEVANCE

The resulting growth models can be used for growth studies in healthy newborns and for growth and treatment outcome studies in children with cleft lip and palate or other craniofacial anomalies.

Rare and Common Variants Conferring Risk of Tooth Agenesis

We present association results from a large genome-wide association study of tooth agenesis (TA) as well as selective TA, including 1,944 subjects with congenitally missing teeth, excluding third molars, and 338,554 controls, all of European ancestry. We also tested the association of previously identified risk variants, for timing of tooth eruption and orofacial clefts, with TA. We report associations between TA and 9 novel risk variants. Five of these variants associate with selective TA, including a variant conferring risk of orofacial clefts. These results contribute to a deeper understanding of the genetic architecture of tooth development and disease. The few variants previously associated with TA were uncovered through candidate gene studies guided by mouse knockouts. Knowing the etiology and clinical features of TA is important for planning oral rehabilitation that often involves an interdisciplinary approach.

Dentition Patterns in Different Unilateral Cleft Lip Subphenotypes

Oral clefts play an essential role in disturbed odontogenesis of the deciduous and permanent dentition, yet little is known about this relationship. We investigated, within the categories cleft lip with or without alveolus (CL ± A) and cleft lip, alveolus and palate (CLAP), whether different CL subphenotypes based on morphological severity of the cleft show different dentition patterns and whether a more detailed subdivision of the incomplete CL has clinical relevance. In this retrospective study, 345 children with nonsyndromic unilateral CL ± A and CLAP from the Dutch Association for Cleft Palate and Craniofacial Anomalies (NVSCA) registry were included to assess the association between the CL subphenotypes and lateral incisor patterns. Five different deciduous and permanent patterns of the lateral incisor were distinguished: located in normal position (pattern z/Z), in the anterior segment (pattern x/X) or in the posterior segment of the cleft (pattern y/Y), one in each segment of the cleft (pattern xy/XY), and agenesis of the lateral incisor (pattern ab/AB). Analyses were performed by using multinomial logistic regression models. Children born with a vermillion notch or a one-third to two-thirds CL were most likely to have a deciduous pattern x and a permanent pattern X, while children born with a two-thirds to subtotal CL were most likely to have deciduous pattern xy and a permanent pattern X compared to children with a complete CL that predominantly had deciduous pattern y and a permanent pattern AB. Based on the relationship of the CL morphology with the deciduous dentition, subdivision of the CL morphology into vermillion notch to two-thirds CL, two-thirds to subtotal CL, and complete CL appears to be an optimal subdivision. Our results indicate that a more detailed subdivision of the CL has clinical relevance and that critical factors in the pathogenesis of the CL are also critical for the odontogenesis.

Thyroid Function during Early Life and Dental Development

Children with low levels of thyroid hormones (hypothyroidism) have delayed tooth eruption, enamel hypoplasia, micrognathia, and anterior open bite, whereas children with hyperthyroidism may suffer from accelerated tooth eruption, maxillary, and mandibular osteoporosis. However, it is still unknown whether thyroid function variations within the normal or subclinical range also have an impact on hard dental tissues in healthy children. The objective of this study was, therefore, to investigate the association between thyroid function from the fetal period until early childhood and dental development at school age. This study is embedded in the Generation R Study, a population-based cohort study established in Rotterdam, the Netherlands. Maternal thyroid function (thyroid-stimulating hormone [TSH], free thyroxine [FT4], and thyroid peroxidase antibody [TPOAb] concentrations) was measured during early pregnancy, and thyroid function of the offspring (TSH and FT4) was measured in cord blood at birth and in early childhood (6 y). Dental development was assessed from panoramic radiographs of children of school-going age (9 y). In total, 2,387 to 2,706 subjects were available for the multivariable linear regression analysis, depending on the point in time of thyroid function measurement. There was an inverse association between cord blood and early childhood TSH concentrations with dental development, with a -0.06 lower standard deviation (SD) per 1 mU/L of TSH (95% confidence interval [CI], -0.11 to -0.01) and a -0.06 lower SD per 1 mU/L of TSH (95% CI, -0.11 to 0.00), respectively. There was no association between the maternal thyroid function during pregnancy and the dental development score of the child. However, TPOAb-positive mothers had children with a -0.20 SD (adjusted 95% CI, -0.35 to -0.04) lower dental development score compared with TPOAb-negative mothers. The findings of this study suggest that the thyroid hormone is involved in the maturation of teeth from the early stages of life onward.

The relationship between craniofacial development and hypodontia in patients with Down syndrome

BACKGROUND/OBJECTIVE

Hypodontia is often seen in people with Down syndrome (DS). In the normal population, persons with hypodontia have a shorter cranial base and a hypoplastic maxilla, leading to a skeletal Class III tendency and a reduced face height. The purpose of this study was to examine craniofacial morphology in patients with DS at different ages and the influence of hypodontia on their craniofacial morphology.

MATERIALS AND METHODS

A comparative cross-sectional study was conducted in 63 children with DS (6-19 years old; 28 males and 35 females) at a Centre for Special Care Dentistry in Rotterdam, the Netherlands (CBT Rijnmond). Digital lateral cephalograms were obtained from all subjects and a cephalometric analysis was performed. The subjects were divided into a group with hypodontia (13 males and 25 females) and a group without hypodontia (15 males and 10 females).

RESULTS

Significant results included a decrease in antero-posterior relationship of upper and lower jaw (ANB angle -0.331° per year, P = 0.044) and a decrease in vertical dimension (S-N_Go-Gn angle -0.72° per year, P = 0.039) over the years in subjects with hypodontia compared to subjects without hypodontia.

CONCLUSION

The process of growth in DS patients is towards a reversed overjet. Hypodontia seems to have an additional effect on this development. The management of hypodontia as part of the complete treatment of dental development in DS children is important because it strongly influences the jaw relationship.

Transverse dental arch relationship at 9 and 12 years in children with unilateral cleft lip and palate treated with infant orthopedics: a randomized clinical trial (DUTCHCLEFT)

Objective

A long-term evaluation to assess the transverse dental arch relationships at 9 and 12 years of age in unilateral cleft lip and palate treated with or without infant orthopedics (IO). The hypothesis is that IO has no effect on the transverse dental arch relationship.

Material and methods

A prospective two-arm randomized controlled trial (DUTCHCLEFT) in three academic cleft palate centers (Amsterdam, Nijmegen and Rotterdam, the Netherlands). Fifty-four children with complete unilateral cleft lip and palate and no other malformations were enrolled in this evaluation. One group wore passive maxillary plates (IO+) during the first year of life, and the other group did not (IO−). Until the age of 1.5, all other interventions were the same. Hard palate was closed simultaneously with bone grafting according to protocol of all teams. Orthodontic treatment was performed when indicated. The transverse dental arch relationship was assessed on dental casts using the modified Huddart/Bodenham score to measure the maxillary arch constriction at 9 and 12 years of age.

Results

No significant differences were found between the IO+ and IO− groups. Differences between the centers increased from 9 to 12 years of age.

Conclusions

Transverse dental arch relationships at 9 and 12 years of age do not differ between children with UCLP treated with or without IO.

Clinical relevance

There is no orthodontic need to perform IO as applied in this study in children with UCLP.

Dental development in hemifacial microsomia

Hemifacial microsomia (HFM) is a congenital disorder marked by facial asymmetry. Whether facial asymmetry accounts for asymmetrical dental development is unknown. There are few data on dental development relative to mandibular development or severity of HFM, or on development over time. We hypothesized that when mandibular development was severely disturbed, local dental development was also affected. We compared dental development scores between affected and non-affected mandibular sides in patients with HFM (n = 84) and compared these data with those collected from Dutch control children (n = 451). Logistic functions were constructed for dental age over time for all four Pruzansky/Kaban types. The results showed a tendency toward delayed dental development in Pruzansky/Kaban types IIb and III at younger ages. The temporary delay of tooth formation in patients with severe forms of HFM and the distribution of agenic teeth suggest an interaction between mandibular and dental development.

Linear Mandibular Measurements: Comparison between Orthopantomograms and Lateral Cephalograms

Objective:

To investigate the reliability of length measurements of the mandible by comparing orthopantomograms (OPTs) with lateral cephalograms.

Design:

Observational study.

Setting:

OPTs and lateral cephalograms were taken of 20 human dry skulls. Four orthodontists and four maxillofacial surgeons located landmarks on all radiographs using a computer program for cephalometric measurements. Intraobserver and interobserver variability in locating landmarks was assessed, as well as positioning of the skulls prior to radiography between the x-ray assistants. Magnification differences between the left and right side of the mandible on the OPT were determined for five skulls. Kappa statistics were used to calculate the intraclass correlation coefficient for intraobserver and interobserver differences. An F test was used to assess differences between methods and between type of observer.

Results:

No significant differences were found in the magnification factor of the left and right side of the mandible. Compared with a lateral cephalogram, the OPT had comparable reliability in measuring mandibular distances condylion-gonion, gonion-menton, and condylion-menton. No significant differences were observed between the x-ray assistants in taking the OPTs and lateral cephalograms or in repositioning the skulls. Significant differences were found between orthodontists and maxillofacial surgeons for landmark measurements.

Conclusion:

An OPT is as reliable as a lateral cephalogram for linear measurements of the mandible (condylion-gonion, gonion-menton, and condylion-menton).

Surgically assisted rapid maxillary expansion in two cases of osteopathia striata with cranial sclerosis

Osteopathia striata with cranial sclerosis (OS-CS) is a rare skeletal dysplasia characterized by linear striations of the long bones, osteosclerosis of the cranium, and extraskeletal anomalies. Osteosclerosis of the cranial and facial bones can lead to disfigurement and to disability due to the pressure on the cranial nerves. We report two cases of OS-CS where surgically assisted rapid maxillary expansion was performed for widening the extremely narrow maxilla. One should be aware of the disease-related problems and the possible complications that might occur with this type of patient.

[Distraction osteogenesis in patients with craniofacial anomalies]

A cleft lip and palate is the most common congenital anomaly in the craniofacial region. There are many other congenital craniofacial anomalies. These anomalies may be part of a syndrome with a wide variety of expression. Some of these syndromes are characterized by hypoplasia of the mandible or by hypoplasia of the maxilla and the orbits, often in combination with premature closure of the skull sutures. In addition, posttraumatic and tumour resection defects are also classified as craniofacial anomalies. The care for patients with craniofacial anomalies is highly complex and, therefore, organised in multidisciplinary craniofacial teams. Some craniofacial anomalies treated by distraction osteogenesis are mandibular hypoplasia due to hemifacial microsomia or temporomandibular joint ankylosis, and mid facial hypoplasia due to craniosynostosis.

Complications in maxillary distraction using the RED II device: a retrospective analysis of 21 patients

Rigid external distraction osteogenesis (DO) in the treatment of midface hypoplasia has been shown to be effective and safe, but there have been several case reports on complications. Here is presented an overview of the complications in a series of 21 patients with various craniofacial anomalies. All patients were treated using the rigid external distraction II (RED II) device after Le Fort I or III osteotomy. Distraction started 1 week postoperatively and continued until Class I occlusion was achieved; it was then continued to include a 15% overcorrection. All data were collected and categorized retrospectively from the patients' files. After a mean period of distraction of 34 days, 42 complications were reported in six different categories. Pin loosening (42.9%) and frame migrations (28.6%) were the most common complications. Of the frame migrations 25% were traumatic. Intracranial penetration of one fixation pin occurred during removal of the RED II device in one patient. From these results it can be deduced that application of the RED II device is associated with a substantial number of specific complications that mainly concern the pins of the halo-frame. The stability of the device is discussed as the distraction distance achieved was less than expected.

[Digital cephalometrics]

There are different methods to produce digital head films and all have advantages and disadvantages. With a digital head film and a computer programme for digital cephalometry an analysis can be performed easily. All existing computer programmes for digital cephalometry use reference values to compare with the patient's values. However, the magnification factors of the two data sets, which are compared, must be known and correction to the same magnification must be possible within the programme. Furthermore, the reference values should be age, gender, and population related. Many commercially available programmes do not fulfil these criteria. A well-designed programme for digital cephalometry should have the possibility to calculate age and gender-related reference values based on values of the target population. Furthermore it should have the possibility to analyse several longitudinal head films at the same time and to present the data graphically. A national survey among Dutch orthodontists by the end of 2000 demonstrated that 35% of Dutch orthodontists used digital cephalometry in their office. The most commonly used analysis was the Steiner-Tweed analysis, which was performed by nearly 60% of the orthodontists.

The reproducibility of cephalometric measurements: a comparison of analogue and digital methods

The aim of this study was to compare the reproducibility of longitudinal cephalometric measurements between analogue and digital methods using two different resolutions. Cephalometric radiographs of 20 patients were selected at the start (T1) and end (T2) of treatment: 24 cephalometric variables were calculated at T1 and T2, and their increments (T2 - T1) were also evaluated. All measurements were performed twice by two observers. Quality of methods [analogue, digital: 300 and 600 dots per inch (DPI) resolution] was evaluated by comparing the reliability coefficients and the total error between the digital and analogue methods. The inter-observer agreement was good. The 300 DPI was comparable to the analogue method. The reproducibility for the variables was comparable, but mandibular incisor increments tended to show better results with the 300 DPI method, whereas skeletal jaw relationship increments were not reliable with either method. Maxillary incisor increments, however, were reliable with both methods. The 300 and 600 DPI resolutions were found to be comparable. Scanning of cephalometric radiographs at a resolution of 300 DPI is sufficient for clinical purposes and comparable to analogue cephalometrics. However, all methods were found to be poor in assessing skeletal jaw relationships longitudinally.