The validity of two methods of mandibular superimposition: a comparison with tantalum implants

The aim of this investigation was to examine and compare the validity of Björk's and Ricketts' methods for the superimposition of serial cephalometric radiographs of the mandible for the analysis of changes over the duration of routine orthodontic treatment in growing subjects (approximately 2 years). Pre- and posttreatment lateral cephalometric radiographs of 23 children, with tantalum markers implanted in the mandible, were studied. The differences in position of six dental and skeletal landmarks between superimposition on Björk's structures and on Ricketts' corpus axis were compared with those on the basis of the implants. A rotational effect was found for corpus axis resulting from differential movement of Xi point with growth, whereas Björk's method yielded results essentially similar to those of the implant-based superimposition. This resulted in statistically significant median differences between the two methods for all landmarks except pogonion and menton. The magnitude of the differences increased with distance from the central core of the mandible and were generally greater horizontally than vertically. Although most differences were less than 2 mm, approximately 10% of the subjects showed differences greater than 4 mm for molar and incisor landmarks. These findings suggest that, for growing subjects, Björk's method should be preferred Ricketts', which cannot be relied on to indicate the true (intramandibular) changes during orthodontic treatment in growing subjects.