Abstract
Background Cephalometric analysis is essential in orthodontic diagnosis and treatment planning. With the emergence of digital tools for cephalometric analysis such as OneCeph, WebCeph, and NemoCeph, there is growing interest in their reliability compared to traditional manual tracings. This study aimed to compare the reliability of these digital tools with manual tracings in doing cephalometric analysis. Methodology Cephalometric radiographs from a diverse patient population were analyzed using OneCeph (NXS, Hyderabad, India), WebCeph (AssembleCircle Corp., Republic of Korea), NemoCeph (Nemotec, Madrid, Spain), and manual tracings by experienced orthodontists. Interobserver reliability and agreement with manual tracings were assessed using the intraclass correlation coefficient (ICC). Results The comparison of cephalometric measurements using the four methods - manual, OneCeph, WebCeph, and NemoCeph - revealed significant differences in the Sella-Nasion to Point A angle (SNA) (P = 0.002) and angle of difference between Sella-Nasion to Point A angle and Sella-Nasion to Point B angle (ANB) (P<0.001). Specifically, WebCeph produced significantly higher SNA measurements than manual tracing, while NemoCeph, OneCeph, and WebCeph yielded higher ANB measurements than manual tracing. There were no significant differences in other measurements, including Sella-Nasion to Point B angle (SNB), Nasion to Point A (N to Pt A), Nasion to Point B (N to Pt B), Gonion-Gnathion to Sella-Nasion angle (Go-Gn to SN), Lower Anterior Facial Height (LAFH), Y-axis (growth axis angle), facial axis, the sum of posterior measurements, and various angular and linear distances [1 to NA, 1 to SN, 1 to NB, 1 to Apog, Incisor Mandibular Plane Angle (IMPA), Sella to Upper Lip (S to UL), and Sella to Lower Lip (S to LL)]. The reliability analysis indicated a strong internal consistency with Cronbach's α values of 0.811 for manual vs. NemoCeph, 0.859 for manual vs. OneCeph, and 0.861 for manual vs. WebCeph, and good agreement in the ICC (P<0.001). Conclusion OneCeph, WebCeph, and NemoCeph demonstrate promising reliability for cephalometric analysis. However, the results should be interpreted with caution, considering the limitations of digital tools. Ongoing research and collaboration among developers, researchers, and clinicians are essential to validate these the performance of these tools and improve their clinical applicability.