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Abstract The aim of this study was to evaluate the intra- and inter-observer reliability of maxillary digital dental model integration into cone-beam computed tomography (CBCT) scans to reconstruct three-dimensional (3D) skeletodental models for orthognathic patients. This retrospective study consisted of CBCT and digital maxillary dentition images of 20 Class III orthognathic patients. After two repeated fusions of digital cast images with reconstructed CBCT images by a digital engineer and an orthodontist respectively, the 3D coordinate values of the canines, first molars, and central incisors were evaluated. The intra- and inter-observer reliability of 3D positions of maxillary teeth were compared using intraclass correlation coefficients (ICCs). Intra-observer reliability of x-, y-, and z-coordinate values of maxillary teeth showed significant and excellent agreement in an engineer (0.946 ≤ ICC ≤ 1.000) and an orthodontist (0.876 ≤ ICC ≤ 1.000). The inter-observer reliability of the y- and z-coordinates of each tooth was significantly excellent or good, but that of the x-coordinates showed insignificantly poor to moderate agreement. This study showed that the integration of maxillary digital models into CBCT scans was clinically reliable. However, considering the low inter-observer reliability on the x-coordinates of dentition, clinical experience and repeated learning are needed for accurate application of digital skeletodental model in orthognathic patients.

Abstract Some craniofacial diseases or anatomical variations are found in radiographic images taken for other purposes. These incidental findings (IFs) can be detected in orthodontic patients, as various radiographs are required for orthodontic diagnosis. The radiographic data of 1020-orthodontic patients were interpreted to evaluate the rates of IFs in three-dimensional (3D) cone-beam-computed tomography (CBCT) with a large field of view (FOV) and investigate the effectiveness and accuracy of two-dimensional (2D) radiographs for detecting IFs compared to CBCT. Prevalence and accuracy in five areas was measured for sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). The accuracies of various 2D-radiograph were compared through a proportion test. A total of 709-cases (69.5%) of 1020-subjects showed one or more IFs in CBCT images. Nasal cavity was the most affected area. Based on the CBCT images as a gold standard, different accuracies of various 2D-radiographs were observed in each area of the findings. The highest accuracy was confirmed in soft tissue calcifications with comprehensive radiographs. For detecting nasal septum deviations, postero-anterior cephalograms were the most accurate 2D radiograph. In cases the IFs were not determined because of its ambiguity in 2D radiographs, considering them as an absence of findings increased the accuracy.