Evaluation of the Level of Agreement Between Clinical Diagnosis and Two Cephalometric Analyses: Cephalometric Analysis for Orthognathic Surgery (COGS) and Soft Tissue Cephalometric Analysis (STCA)

Introduction: Hard tissue analysis, such as cephalometric analysis for orthognathic surgery (COGS), defines the nature of existing skeletal discrepancies but is incomplete in providing information concerning the facial form and proportions of the patient. The soft tissue cephalometric analysis (STCA) accounts for the soft tissue drape, which, however, is subject to significant individual, gender, and age variation. Aims and Objectives: The purpose of the study was to evaluate the conformance of the diagnostic inferences derived from two cephalometric analyses, COGS and STCA, to the clinical diagnosis of experienced clinicians. Material and Methods: Lateral cephalograms of 120 patients were traced for parameters previously diagnosed by an oral surgeon and an orthodontist. Corresponding variables were taken from two analyses, COGS and STCA, defining the (1) position of the maxilla, (2) position of the mandible, (3) growth pattern, (4) upper and lower lip prominence, (5) severity of skeletal malocclusion, and (6) need for surgical intervention. The inferences derived cephalometrically were compared to the clinical diagnosis. Results: Kappa analysis was used to compare the agreement of inferences derived from COGS and STCA with clinical diagnosis. A p-value less than 0.016 was considered significant. The agreement of both analyses with clinical diagnosis was significant and fair when the position of the mandible and intermaxillary jaw relationship was considered. COGS showed better agreement for both. COGS additionally showed fair agreement with clinical diagnosis for growth patterns too. STCA showed fair agreement with clinical diagnosis when the need for surgical intervention was evaluated. For all other parameters, the agreement was poor for both analyses. Conclusion: COGS proved to have better diagnostic accuracy than STCA, except in predicting the need for a surgical treatment plan, where STCA appeared better. Clinical Significance: The findings provide significant insights that may improve the accuracy of diagnosis and decision-making in orthodontic and surgical interventions, ultimately aiding clinicians in selecting the most appropriate treatment protocols.