How important are lateral cephalometric radiographs in orthodontic treatment planning?

The purpose of this study was to investigate whether lateral cephalometric radiographs influence orthodontic treatment planning. It aimed to compare the odds of a change in treatment plan in three groups of orthodontists who treatment planned six cases on two occasions, T1 and T2, with the provision of a lateral cephalometric radiograph being varied.

The records of 6 orthodontic patients were copied onto compact discs and sent to the 199 participating orthodontists. The orthodontists were allocated to 3 groups, A, B, and C. Clinicians in group A were given all records except the lateral cephalometric radiographs at the T1 and T2 planning sessions. Clinicians in group B were given all records except the lateral cephalometric radiograph at T1 and all records including the lateral cephalometric radiograph and tracing at T2. Clinicians in group C were given all records including the lateral cephalometric radiographs and tracings at T1 and T2. All participants were sent records at T1; those who returned the treatment-planning questionnaire were sent the second set of records and questionnaire at T2, 8 weeks later. Invitations to participate were distributed to all specialist orthodontists who were members of the British Orthodontic Society (n = 950). Of these, 199 orthodontists agreed to take part, a response rate of 21%. Of the 199 who agreed to participate, 149 completed the first treatment-planning questionnaire (T1), for a response rate of 75%. Of the 149 who completed that questionaire, 114 completed the second treatment-planning questionnaire (T2), for a 77% response rate.

The availability of a lateral cephalometric radiograph and its tracing did not make a significant difference to any treatment-planning decisions, with the exception of the decision to extract or not between groups B and C for all 6 patients combined, and between groups B and C and groups B and A for patient 4 (Class I incisor relationship on a Class II skeletal base).

For most treatment-planning decisions in these 6 patients, the availability of a lateral cephalometric radiograph and its tracing did not make a significant difference to the treatment decisions. For 1 patient, there was a significant change in the extraction decision when a lateral cephalometric radiograph was provided. This highlights the uncertainty surrounding the necessity for lateral cephalometric radiographs in treatment planning. Further research in this area is encouraged to resolve this dichotomy.