Accuracy of digital vs. manual cephalometric tracing: A systematic review

Shankargouda Patil; Alia Choudhary; Harriet Young; Quinton Ashton; Aasha Patel; Reji Mathew; Frank W Licari; Tarek El-Bialy

doi:10.1016/j.ortho.2025.101064

Accuracy of digital vs. manual cephalometric tracing: A systematic review

Int Orthod. 2026 Mar;24(1):101064. doi: 10.1016/j.ortho.2025.101064. Epub 2025 Oct 3.

Authors

Shankargouda Patil¹, Alia Choudhary², Harriet Young², Quinton Ashton², Aasha Patel², Reji Mathew³, Frank W Licari², Tarek El-Bialy⁴

Affiliations

¹ College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA; College of Graduate Studies, Roseman University of Health Science, South Jordan, UT 84095, USA.
² College of Dental Medicine, Roseman University of Health Sciences, South Jordan, UT 84095, USA.
³ Midwestern University, College of Dental Medicine, Downers Grove, IL 60515, USA.
⁴ Division of Orthodontics and Department of Biomedical Engineering, Mike Petryk School of Dentistry, Faculty of Medicine and Dentistry, 7-020D Katz Group Centre for Pharmacy and Health Research, University of Alberta, Edmonton AB T6G 2E1, Canada. Electronic address: telbialy@ualberta.ca.

PMID: 41045597
DOI: 10.1016/j.ortho.2025.101064

Abstract

Purpose: This systematic review aimed to assess the accuracy of digital cephalometric tracing with manual hand tracing.

Methods: PubMed, SCOPUS and Web of Science databases were searched for relevant articles. After an initial search, which revealed 279 potentially relevant articles, their titles and abstracts were screened. After screening, 23 full-text articles were assessed in depth. Fifteen publications were removed from the analysis considering the predetermined inclusion criteria. The quality of the methodology of the selected 9 studies was analyzed using 12-point criteria, which included study design, measurement, and statistical analysis.

Results: The data thus collected was analyzed for reliable and reproducible variables. All studies were carried out on the digital format of lateral cephalograms. The analysis included both angular and linear measurements. The results brought about statistically significant differences in certain methods and were clinically acceptable even though they were minimal. A few measured variables were the cephalogram quality, lip posture, positioning, and difficulty in locating landmarks.

Conclusions: This review concluded that digital cephalometric tracing was equally reliable as tracing manually, with a moderate quality of evidence. This study also suggested that the literature presented here was accurate enough for clinical application. Thus, digital cephalometric analyses can potentially improve the workflow in clinical and research settings saving time and effort. PROSPERO - registration number (CRD42024537255).

Keywords: Accuracy; Cephalogram; Digital cephalometry; Manual tracing.

Publication types

Systematic Review
Comparative Study
Review

MeSH terms

Anatomic Landmarks
Cephalometry* / methods
Humans
Image Processing, Computer-Assisted* / methods
Reproducibility of Results