Cephalometric Analysis: Reliability of A Mobile-Based Digital Application: A Pilot Study

Abstract

Background: Cephalometric analysis is integral to orthodontic diagnosis and treatment planning. Although conventional manual tracing is accurate, it is time-consuming and prone to operator variability. Digital methods improve precision, yet their adoption in resource-limited settings is restricted by cost and hardware requirements. Smartphone-based applications such as OneCeph® offer a potential low-cost alternative, but independent validation of their accuracy and reliability remains limited. This study compared the reliability of cephalometric measurements obtained using OneCeph® and conventional manual analysis.

Methods: A cross-sectional comparative study was conducted using 40 high-quality lateral cephalometric radiographs. Ten standard parameters (six angular: Sella-Nasion-Apoint (SNA), Sella-nasion- B point (SNB), Apoint-Nasion- B point (ANB), Upper incisor to nasion-A point (UI- NA), Lower incisor to nasion- B point (LI- NB), Interincisal angle, and four linear: UINA, LI-NB, Upper lip to S-line, Lower lip to S-line ) were measured manually on acetate film and digitally using OneCeph® (version beta 1.1, NXS Soft Solutions, India). Data were analyzed using intraclass correlation coefficients (ICC), Pearson correlation, and paired t-tests, with significance set at p < 0.05.

Results: Participants' mean age was 20.7 ± 7.8 years; 60% were female. Digital tracings demonstrated good to excellent reliability for skeletal angular and soft tissue parameters (ICC = 0.83–0.91), while manual tracings were slightly more consistent for linear dental measurements (ICC = 0.94 for UI–NAand 0.83 for LI–NB). Statistically significant correlations (r ? 0.90, p < 0.001) were observed between both methods for 9 of 10 parameters. However, paired t-test showed a statistically significant mean difference for SNA, SNB, UI–NA°, LI–NB (mm), UL-to-S-line, and LL-to-S-line.

Conclusion: Our findings highlight the potential of OneCeph® smartphone-based digital cephalometric analysis in resource-limited settings. However, the statistically significant differences in some parameters observed between digital and nanual methods suggest that results obtained using such applications should be interpreted with caution.

Keywords: Cephalometric analysis; manual tracing; OneCeph; digital tracing; smartphone application.