Cephalometric superimposition on the occipital condyles as a longitudinal growth assessment reference: I-point and...

This retrospective study tests the hypothesis that superimposition referenced at the occipital condyles (defined as I-point, I-curve) and oriented to the anterior cranial base (ACB) will display a growth pattern that is more consistent with independent evaluations, such as the Melsen necropsy specimens and the Bjork implant studies, when compared with traditional superimpositions referenced at sella turcica. Twenty-eight sets of serial lateral cephalometric radiographs were selected from an archived growth study. The apparent facial growth was compared using polar coordinate analysis from superimposition tracings of the serial films for each subject. The two superimposition methods were compared. The traditional method, ACB registered on the anterior curvature of sella turcica, versus registration on I-point while maintaining ACB parallel. I-point registered superimpositions consistently displayed a facial growth pattern that was more consistent with the classic necropsy specimens of children and the cephalometric studies superimposing on implant markers. Traditional ACB superimposition suggests that airway is restricted by normal growth. This apparent physiologic artifact does not occur when superimpositions are registered on I-point. Sella turcica displays vertical movement that is consistent with brain growth. These data indicate that registration on I-point is a more accurate physiologic representation of facial growth than the traditional ACB superimpositions. When compared with the traditional registration at sella turcica, I-point superimposition better elucidates physiologic growth patterns. As cephalometrics evolve from a two to a three dimensional science, it is important to use a more biologically valid registration for evaluating therapeutics and facial growth patterns.