The validity and reliability of an automated method of scoring dental arch relationships in unilateral cleft lip and palate using the modified Huddart-Bodenham scoring system

Eur J Orthod. 2016 Aug;38(4):353-8. doi: 10.1093/ejo/cjw031. Epub 2016 Apr 22.


Objective: To evaluate an automated software tool for the assessment of dental arch relationships using the modified Huddart and Bodenham (MHB) index.

Design: Cohort of 43 models of subjects aged 9-21 with UCLP and the ten GOSLON reference models sets.

Method: The 53 sets of plaster models were scored using the MHB index and scanned with a benchtop scanner. The digital models were MHB scored visually using a commercial software program and landmarked for automatic scoring using a software plug-in. Scoring/landmarking was undertaken by three observers and repeated after 1 month. Intra- and inter-observer reproducibility were tested using Cronbach's alpha and intraclass correlation coefficients (ICC) (threshold > 0.9). Bland-Altman plots demonstrated inter-observer agreement for each model format. Random and systematic error with digital landmark identification error were determined using the x, y, and z co-ordinates for 28 models digitized twice 1 month apart using Cronbach's alpha and a t-test, respectively.

Results: Intra-operator landmark identification was excellent (Cronbach's alpha = 0.933) with no differences between sessions (P > 0.05). Intra-observer reproducibility was excellent for all examiners (Cronbach's alpha and ICC 0.986-0.988). Inter-observer reproducibility was highest for the software plug-in (0.991), followed by plaster (0.989) and OrthoAnalyzer (0.979) and Bland-Altman plots confirmed no systematic bias and greater consistency of scores with the automated software.

Conclusion: The automated MHB software tool is valid, reproducible, and the most objective method of assessing maxillary arch constriction for patients with UCLP.

Conflict of interest statement: The authors declare no conflict of interest or financial relationship with any organization or software used within the study.

Publication types

  • Validation Study

MeSH terms

  • Adolescent
  • Child
  • Cleft Lip / pathology*
  • Cleft Palate / pathology*
  • Constriction, Pathologic
  • Dental Arch / pathology*
  • Dental Models
  • Humans
  • Maxilla / pathology
  • Observer Variation
  • Reproducibility of Results
  • Software
  • Young Adult