Systematic and random errors associated with Johnston's cephalometric analysis

This study examined intra- and interexaminer systematic and random errors associated with Johnston's cephalometric method of assessing skeletal and dental changes from pairs of radiographs. Data were obtained from the tracings of radiographs of 30 mixed dentition subjects, who had been treated to correct a Class II malocclusion. Measurements included molar and incisor crown movements relative to basal bone, apical base change, maxillary and mandibular displacement relative to the cranial base, and total molar and overjet reduction. In addition, the change in axial inclination of the incisors and molars was determined. A paired t-test for each pair of replicates for each measure was performed to examine inter- and intra-examiner bias. Estimates of the random error, the coefficient of reliability, and confidence limits (95 per cent level) of a single determination were undertaken. No systematic errors occurred between/within examiners for any linear or angular measure. Interexaminer random errors, based on the standard deviation of the mean difference between replicates, were greater than intra-examiner random errors for 12 out of 13 parameters. Measures assessing molar correction and overjet reduction had the least amount of random error variance within and across judges, while changes in mandibular position had the greatest. Because considerable random errors occurred, the Johnston analysis when used to assess skeletal changes, as well as individual molar and incisor movements, may have limited utility in clinical practice for the individual case.