Landmark identification error in posteroanterior cephalometric radiography. A systematic review

Objective: To evaluate the reliability of landmark identification in posteroanterior cephalometrics. Materials and Methods: A literature search was conducted to identify all articles concerning landmark identification error in the frontal radiograph. Electronic databases (PubMed, Web of Science, Cochrane Database, PubMed Central, and HubMed) were searched. Abstracts that appeared to fulfill the initial selection criteria were selected, and the full-text original articles were then retrieved and analyzed. Only articles that fulfilled the initial selection criteria were finally considered. Their references were also hand searched for possible missing articles from the database searches. Results: Twelve abstracts met the initial inclusion criteria, and these articles were retrieved. From these, eight were immediately rejected because of methodological issues. Only the four articles remaining seemed to fulfill the selection criteria, but two articles were later rejected, one because no landmark identification error mean values were provided and the other because of the sample. Only one article fulfilled the inclusion and exclusion criteria of this study. Midline landmarks were more reproducible than bilateral skeletal landmarks. Conclusion: Only one study fulfilled the additional inclusion and exclusion criteria. Few studies exist about the random error in localization of landmarks in posteroanterior cephalograms, and several methodological issues affected these few studies. Thus, future well-designed studies are needed to allow the orthodontist to choose the most appropriate cephalometric analysis