Printer Friendly

Reliability of Measurements on Plaster and Digital Models of Patients with a Cleft Lip and Palate.

INTRODUCTION

Cleft lip and palate (CLP) is the second most common congenital anomaly with the incidence of 0.6%-1% (1, 2). The treatment protocol of patients with CLP consists of interventions in special time periods over approximately 18-20 years. Therefore, records are not only used for diagnosis and fabrication of plate for presurgical orthopedic treatment in infancy, but also to evaluate the treatment progress, growth changes, and treatment outcomes over years. Moreover, records are required to communicate and transfer the history of the individual to the forthcoming specialist (3). Briefly, taking and archiving of the records of these cases is much more important than of traditional orthodontic cases.

The assessment and recording of the cleft deformity is performed using different methods. Photography, one of the oldest two-dimensional (2D) recording methods, needs training and effort of the professionals for standardization (4). Furthermore, this technique loses the three-dimensional (3D) nature of the anatomy (5). Facial anthropometry may deliver the most precise data; nevertheless, it unfortunately has shortcomings, such as the difficulty and a long duration during direct measurements on the face, particularly in infants and small children. The other disadvantage is the lack of communication of professionals without the presence of the patient (6).

Recently, the most frequently used 3D recoding method in cleft clinics is impression taking and cast model production. These methods are superior over photography and direct anthropometry, regarding the 3D evaluation and ease of communication and data transfer between specialists. However, tissue deformation due to the weight of the impression material, the risks of the impression-taking procedure, duration of the model production, the storage requirements, probable data loss due to model fragility, and difficulties in the analyzing of anatomic structures of models are the shortcomings of this method that could not be overcome for years (7-9).

Currently, thanks to the advancements in medical technology, 3D imaging systems including photo-optical, laser-optical scanning (10-12), and stereophotogrammetry (13-15) are introduced to enable the digitalization, even of former cast models and full computer-based management of patient records. Stereophotogrammetry, obtaining images by taking multiple photographs simultaneously, is usually used for facial soft tissue assessments; however, researchers suggest that it is also proper for imaging of plaster casts (16, 17). The inter-method measurement reliability between 3D images and anthropometric assessment (18, 19), as well as 3D virtual models and intraoral stone casts, was satisfying (17). In addition, several studies emphasized that the manipulation of 3D images is easy and uncomplicated (18-20). Certainly, identification of reliable 3D landmarks, and also performing of reproducible measurements, is related with the observer's familiarity (involving knowledge and skill) to 3D images and software programs. As in every manipulation skill, training in 3D image visualization and analysis is required. In a study by Radeke et al. (21), three examiners with different degrees of expertise in dentistry measured the mesio-distal width of each tooth on cast models manually and on 3D images digitally. They concluded that the measurements from software-based methods did not diverge from conventional manual methods if performed even by observer who have a weaker background in dentistry. Nevertheless, the tooth forms assessed in the aforementioned study were more precise compared with abnormal anatomical variations such as a cleft lip and palate. In fact, to the best of our knowledge, none evaluated the effect of experience about the cleft anatomy on the reliability of plaster model and also 3D image assessments. Furthermore, no evaluation of the intra-reliability and shortcomings of lecturer in this topic were evident. Overall, the determination of less reliable measurements and the more reliable method in evaluating patients with craniofacial anomalies will enable to make up a checklist and integrate courses into the educational curriculum in postgraduate settings for the measurements and the method, respectively.

Therefore, the purpose of this study was to determine (1) the more and less reliable measurements/methods and (2) the influence of knowledge and skill on the inter- examiner, intra-examiner, and inter-method reliability of nasolabial measurements on plaster casts and three dimensional (3D) stereophotogrammetric images of casts in infants with unrepaired unilateral cleft lip and palate (UUCLP).

METHODS

This study was carried out on facial models of infants with UUCLP from the archive of the Orthodontic Department of Yeditepe University School of Dentistry. Patient data were handled according to the requirements and recommendations of the Declaration of Helsinki. Ethical approval (no.58/490) was obtained from the institutional review board of Yeditepe University.

Facial plaster models of 42 infants with UUCLP were selected from the archive. The models that were broken or had deficient representation of the anatomical morphology were excluded from the study. Then, the 3D sterephotogrammetric acquisition of the plaster models was performed with the 3dMDface system (3dMD, Atlanta, GA). The stereophotogrammetric system is composed of two modular units of six medical-grade machine vision cameras and a flash system. The models were placed 1 m away from the cameras, and images were captured in 1.5 miliseconds. All 3D images were imported to the 3dMD patient software program (3dMD, Atlanta, GA) for measurements.

Two examiners (R.B.N.Y. and M.A.) performed the measurements. One of the raters (R.B.N.Y.) was a lecturer experienced in patients with CLP and their variable anatomical structures and an active staff member in the cleft clinic over 10 years. She had the experience in handling of both the facial plaster model and 3D stereophotogrammetric images. The second rater (M.A.) was a postgraduate student in the orthodontic department, in the fifth semester. Although, she was theoretically familiar with the cleft lip and palate anatomy and manual measurements of teeth on plaster models, she never performed any measurements on facial plaster models as well as on 3D images of the models. However, she assisted regularly in the cleft clinic upon her first semester and was postgraduate student chef in the cleft clinic. Lecturer gave instruction lessons about not only the use of digital calipers and the 3D software program, but also the definition of the anatomical landmarks to the student. After training, both examiners located the anatomical landmarks and performed the measurements in the nasolabial areas on plaster models and 3D digital images.

Eighteen landmarks were identified to perform 19 linear measurements, consisting of 12 vertical and five horizontal measurements (Figure 1, 2; Table 1, 2). A digital caliper (Opto-Rs 232 simplex/duplex, Sylvac/Fowler, Crissier, Switzerland) was used for the measurements on plaster models, whereas the caliper function of the software program (3dMD, Atlanta, GA) was used for the measurements on 3D digital images.

Statistical Analysis

All plaster models and 3D images were remeasured within a 3-week interval by both examiners. Statistical analyses were performed using the Statistical Package for Social Sciences version 22 (IBM Corp.; Armonk, NY, USA) for Windows. Intraclass correlation coefficients (ICC) were used to determine intra-examiner, inter-examiner agreement for each measurement. ICC has a maximum value of 1 when there is total homogeneity. On the other hand, ICC values above 0.75 and 0.9 are considered as good and excellent, respectively.

RESULTS

The intra-examiner assessment of the plaster model measurements showed that the lecturer was consistent in the repeated measurements (ICC were greater than 0.90 for almost all measurements and had a lower boundary of 0.804), whereas the ICC of the half of the measurements performed by the postgraduate student were greater than 0.75 (Table 3).

The intra-examiner reliability of all the 3D digital measurements of the lecturer was good (ICC greater than 0.75) except for the nasal width. Similarly, the intra-examiner reliability for most of the measurements carried out by the postgraduate student was good. The ICC values of only the philtral width, nasal tip protrusion, noncleft side nostril floor width, and lateral nostril height measurements were below 0.75 (Table 3).

An inter-examiner agreement was not present for the philtral width, nasal tip protrusion, nostril floor width, and the non-cleft side medial nostril height and cleft-side lateral nostril height measured on both plaster models and 3D digital images. An inter-examiner agreement was identified in more 3D digital measurements compared to those on plaster models (Table 4). Overall, the measurement performed by the lecturer showed a good inter-method agreement (Table 4).

DISCUSSION

Patients with impaired facial appearances such as a cleft lip and palate have a long treatment period, and the follow-ups are frequently difficult to manage; therefore, reliable, user-friendly, and easy-to-achieve documentation methods are necessary (22). Certainly, direct clinical evaluation and anthropometry is the golden standard in documentation (6). However, performing the measurements directly on the face to classify the deformity, to determine the treatment plan, to evaluate the treatment progress, as well as outcomes, is not easy, particularly in infants and children, or patients with mental retardation. Consequently, impression taking has been used more frequently to remodel the facial anatomy. Visually, the plaster models accumulate in the archives of clinicians over years, insomuch that some of the oldest ones have to be trashed. In addition to the storage requirement, fragile cast models are also prone to damage. Nowadays, more and more centers digitize the plaster models and transfer them into software programs to avoid data loss. Additionally, these virtual models allow easier communication between professionals due to the convenience of sharing files (23).

Virtual models may be an advantageous tool in converting the physical archives into digital ones; however, the reliability of the measurements performed on 3D models needs to be evaluated. Fleming et al. (24) compared the reliability of measurements performed on plaster and digital models in their systematic review and concluded that the use of digital models as an alternative to plaster models can be recommended. However, they also added that the reliability is based on various variables. One of the most important factors in the assessment of the performance of any new system, or in other words any invention introduced into a workflow, is the users' experience (21). In addition, after determination of the reliability of measurements and evaluation methods performed by postgraduate students, a lecturer may make up guidelines for the students and integrate courses into the dental educational curriculum. Therefore, the purpose of this study was to determine (1) the more and less reliable measurements/methods and (2) the influence of knowledge and skill on the inter-examiner, intra-examiner, and inter-method reliability of nasolabial measurements on plaster casts and 3D stereophotogrammetric images of casts in infants with UUCLP.

The intra-examiner agreement of all plaster model measurements and all 3D digital measurements (except for the nasal width) performed by the lecturer were good or excellent (ICC equal or greater than 0.75 and 0.9, respectively). For the postgraduate student, most of the digital measurements showed a good reliability, whereas only half of the plaster model measurements showed an ICC above 0.75. The reliability of measurements carried out on plaster models depends on the ability of landmark identification, knowledge about the anatomy, and exact transfer of quantitative data to the computer. Furthermore, the operator has to deal sensitively with the plaster models, to avoid any breakage or deformation of anatomical structures during measurements (25, 26). Similarly, the reliability of measurements on 3D images are bases on a 3D landmark identification, the morphology of the anatomical structure, and image quality. Radeke et al. (21) compared the tooth-width measurements of operators with different levels of experience or even without dentistry background. They concluded that the measurements revealed no statistically significant differences between examiners. However, because the cleft anatomy is much more complicated for an inexperienced examiner, the intra-examiner as well as inter-examiner reliability showed differences between examiners in our study. Overall, another important factor affecting the reliability of measurements in both methods is the examiners experience not only regarding the anatomy of the observed structures, but also in handling of both measurement methods. Othman et al. (27), emphasized that the reproducibility of the identification of landmarks on 3D images by one operator is acceptable, but they concluded that further research of the inter-examiner reproducibility is required. Indeed, the familiarity of the examiner with 3D images and software programs plays a major role in the accuracy and repeatability of the measurements. The familiarity of the experienced examiner with 3D images and also the cleft anatomy may be the reason for the acceptable reliability of measurements.

On 3D facial scans, landmark identification on well-defined borders is easier, and therefore the reproducibility is higher. On the other hand, points located on curving slopes such as the alare point are difficult to determine (20). Accordingly, in our study, we found that the nasal width measurement was not reliable. In addition, it appeared that the experience factor did not matter. The ICC for the philtral width, nostril floor width, and medial nostril height (on NCS) measurements on 3D images done by the student were below 0.75. Anatomical areas, which show individual variations in cleft cases, such as the lateral subnasale inferior (sbnNCS), and areas most affected from the deformity, such as christa philtri (cph'NCS), have to be inspected with attention. The lateral subnasale inferior point, defined as the lowest point of the lateral, internal, and outer contour of the nostril, may be placed on different levels at the vertical plane depending on the shape of the nostril. If the examiner does not have enough experience about the cleft anatomy and the aforementioned anatomical variations, a divergence of measurements may occur (21). The nostril area on the noncleft side in cases with UCLP is also a small area so that validity is more difficult to achieve (28).

The intra-examiner reliability of the measurements performed by the lecturer on virtual models was higher than on the plaster models. Furthermore, the inter-examiner reliability was also higher for 3D images. The caliper manipulation requires experience and training. Sforza et al. (17) mentioned that the tip of the caliper may contact the plaster and afterwards landmarks cancelled the dot, inducing impression in the values of measurements. If measurements are performed on plaster models, the caliper has to be manipulated sensitively so that no anatomical structure is deformed. On the other hand, cancelling the dot on 3D images is not possible. In addition, 3D images enhance accurate measurements by enabling the researcher to rotate and to zoom into the image (29-31). In other words, software programs used in the 3D imaging technology may facilitate the manipulation skill of the operator and may be user-friendly, especially for inexperienced operators. Thus, 3D imaging may be used for training of postgraduate students.

CONCLUSION

* Measurements of curving slopes such as the nasal width, of small dimensions such as nostril floor width, and deformity-affected anatomic parts such as philtrum width presented low reliability.

* The reliability of measurements performed by the experienced examiner was high for both methods, whereas the intra-examiner reliability of some measurements performed by the inexperienced examiner showed low ICC.

* The reliability of a number of 3D digital measurements performed by the inexperienced examiner was found to be higher than plaster model measurements. Therefore, it may be recommended to use 3D digital images of infants with CLP for nasolabial measurements, especially if performed by inexperienced users.

Ethics Committee Approval: Ethics committee approval was received for this study from the Ethics Committee of Yeditepe University (No-58/490).

Informed Consent: Written informed consent was obtained from the patients who participated in this study.

Peer-review: Externally peer-reviewed.

Author Contributions: Concept - R.B.N.Y.; Design - R.B.N.Y, D.G., H.I.C.; Data Collection and/or Processing - R.B.N.Y., M.A.; Analysis and/or Interpretation -R.B.N.Y, M.A.; Literature Search - R.B.N.Y.; Writing Manuscript - R.B.N.Y.; Critical Review - D.G., H.I.C.

Conflict of Interest: The authors have no conflict of interest to declare.

Financial Disclosure: The authors declared that this study has received no financial support.

REFERENCES

(1.) Nur RB, Ilhan D, Fisekcioglu E, Oktay I, Arun T. Prevalence of orthodontic malocclusion and evaluation criteria in 7 geographic regions of Turkey. Turk J Orthod 2014; 26: 154-61. [CrossRef]

(2.) Tomatr AG, Demirhan H, Sorkun HC, Koksal A, Ozerdem F, Cilengir N. Major congenital anomalies: a five-year retrospective regional study in Turkey. Genet Mol Res 2009; 8: 19-27. [CrossRef]

(3.) Rosenstein SW. A new concept in the early orthopedic treatment of cleft lip and palate. Am J Orthod 1969; 55: 765-75. [CrossRef]

(4.) Vegter F, Hage JJ. Standardized facial photography of cleft patients: just fit the grid? Cleft Palate Craniofac 2000; 37: 435-40.

(5.) Arnett GW, Gunson MJ. Facial planning for orthodontists and oral surgeons. Am J Orthod Dentofacial Orthop 2004; 126: 290-5. [CrossRef]

(6.) Farkas LG, Hajnis K, Posnick JC. Anthropometric and anthroposcopic findings of the nasal and facial region in cleft patients before and after primary lip and palate repair. Cleft Palate Craniofac J 1993; 30: 1-12.

(7.) Bacher M, Goz G, Pham T, Bacher U, Werner O, Buchner P, et al. Three-dimensional analysis of cleft palate topology in newborn infants with reference to the cranial skeleton. Cleft Palate Craniofac J 1998; 35: 379-95.

(8.) Ferrario VF, Sforza C, Schmitz JH, Colombo A. Quantitative description of the morphology of the human palate by a mathematical equation. Cleft Palate Craniofac J 1998; 35: 396-401. [CrossRef]

(9.) Holdberg C, Schwenzer K, Mahaini L, Rudzki-Janson I. Accurancy of facial plaster casts. Angle Orthod 2006; 76: 605-11.

(10.) Bootvong K, Liu Z, McGrath C, Hagg U, Wong RW, Bendeus M, et al. Virtual model analysis as an alternative approach to plaster model analysis: reliability and validity. Eur J Orthod 2010; 32: 589-95. [CrossRef]

(11.) Castalos PA, Sarraf K, Cangialosi TJ, Efstratiadis S. Evaluation of the accuracy of digital model analysis for the American Board of Orthodontics objective grading system for dental casts. Am J Orthod Dentofacial Orthop 2005; 128: 624-9. [CrossRef]

(12.) Dirksen D, Diederichs S, Runte C, von Bally G, Bollmann F. Three-dimensional acqusition and visiualisation of dental arch features from optically digitized models. J Orofac Orthop 1999; 60: 152-9. [CrossRef]

(13.) Ayoub AF, Wray D, Moos KF, Jin J, Niblett TB, Urguhart C, et al. A three-dimensional imaging system for archiving dental study casts: a preliminary report. Int J Adult Orthodon Orthognath Surg 1997; 12: 79-84.

(14.) Bell A, Ayoub AF, Siebert P. Assessment of the accuracy of a three-dimensional imaging system for archieving dental study models. J Orthod 2003; 30: 219-23. [CrossRef]

(15.) Berkowitz S, Pruzansky S. Stereophotogrammetry of serial casts of cleft palate. Angle Orthod 1968; 38: 136-49.

(16.) Littlefield TR, Cherney JC, Luisi JN, Beals SP, Kelly KM, Pomatto JK. Comparison of plaster casting with three-dimensional cranial imaging. Cleft Palate Craniofac J 2005; 42: 157-64. [CrossRef]

(17.) Sforza C, De Menezes M, Bresciani E, Ceron-Zapata AM, Lopez-Palacio AM, Rodriguez-Ardilla MJ, et al. Evaluation of a 3D stereophotogrammetric technique to measure the stone casts of patients with cleft lip and palate. Cleft Palate Craniofac J 2012; 49: 477-83. [CrossRef]

(18.) Germec Cakan D, Canter HI, Nur B, Arun T. Comparison of facial soft tissue measurements on three-dimensional images and models obtained with different methods. J Craniofac Surg 2010; 21: 1393-9. [CrossRef]

(19.) Tse R, Booth L, Keys K, Saltzman B, Stuhaug E, Kapadia H, et al. Reliability of nasolabial anthropometric measures using three-dimensional stereophotogrammetry in infants with unrepaired unilateral cleft lip. Plast Reconstr Surg 2014; 133: 530-42. [CrossRef]

(20.) Duffy S, Noar JH, Evans RD, Sanders R. Three-dimensional analysis of the child cleft face. Cleft Palate Craniofac J 2000; 37: 137-44. [CrossRef]

(21.) Radeke J, vonderWense C, Lapatki BG. Comparison of orthodontic measurements on dental plaster casts and 3D scans. J Orofac Orthop 2014; 75: 264-74. [CrossRef]

(22.) Shaw WC, Dahl E, Asher-McDade C, Brattstrom V, Mars M, McWilliam J, et al. A six-center international study of treatment outcome in patients with clefts of the lip and palate: part 5. General discussion and conclusions. Cleft Palate Craniofac J 1992; 29: 413-8.

(23.) Enemark H, Friede H, Paulin G, Semb G, Abyholm F, Bolund S, et al. Lip and nose morphology in patients with unilateral cleft lip and palate from four Scandinavian centres. Scand J Plast Reconstr Surg Hand Surg 1993; 27: 41-7. [CrossRef]

(24.) Fleming PS, Marinho V, Johal A. Orthodontic measurements on digital study models compared with plaster models: a systematic review. Orthod Craniofac Res 2011; 14: 1-16. [CrossRef]

(25.) Jamison PL, Ward RE. Measurement size, precision, and reliability in craniofacial anthropometry - bigger is better. Am J Phys Anthropol 1993; 90: 495-500. [CrossRef]

(26.) Seckel NG, van der Tweel I, Elema GA, Specken TF. Landmark positioning on maxilla of cleft lip and palate infant- a reality? Cleft Palate Craniofac J 1995; 32: 434-41.

(27.) Othman SA, Ahmad R, Mericant AF, Jamaludin M. Reproducibility of facial soft tissue landmarks captured on a 3D camera. Aust Orthod J 2013; 29: 58-65.

(28.) Ward RE, Jamison PL. Measurement precision and reliability in craniofacial anthropometry: implications and suggestions for clinical applications. J Craniofac Genet Dev Biol 1991; 11: 156-64.

(29.) Ghoddousi H, Edler R, Haers P, Wertheim D, Greenhill D. Comparison of three methods of facial measurements. Int J Oral Maxillofac Surg 2007; 36: 250-8. [CrossRef]

(30.) Weinberg SM, Scott NM, Neiswanger K, Brandon CA, Marazita ML. Digital three-dimensional photogrammetry: evalaution of anthropometric precision and accuracy using a Genex 3D camera system. Cleft Palate Craniofac J 2004; 41: 507-18. [CrossRef]

(31.) Wong JY, Oh AK, Ohta E, Hunt AT, Rogers GF, Mulliken JB, et al. Validity and reliability of craniofacial anthropometric measurement of 3D digitial photogrammetric images. Cleft Palate Craniofac J 2008; 45: 232-9. [CrossRef]

R. Burcu Nur Yilmaz (1)[iD], Derya Germec Cakan (1), Merve Altay (1) [iD], Halil ibrahim Canter (2)

(1) Department of Orthodontics, Yeditepe University School of Dentistry, istanbul, Turkey

(2) Department of Plastic, Esthetic and Reconstructive Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, istanbul, Turkey

Address for Correspondence: R. Burcu Nur Yilmaz, Department of Orthodontics, Yeditepe University School of Dentistry, istanbul, Turkey

E-mail: drburcunur@gmail.com

Received: April 30, 2018

Accepted: August 26, 2018

Cite this article as: Yilmaz RBN, Germec Cakan D, Altay M, Canter Hi. Reliability of Measurements on Plaster and Digital Models of Patients with a Cleft Lip and Palate. Turk J Orthod 2019; 32(2): 65-71.

DOI: 10.5152/TurkJOrthod.2019.18035
Table 1. The definition of the nasolabial landmarks

Landmark                     Definition

Pronasale (prn)              The most anterior midtip point of the nasal
                             tip
Subnasale (sn)               The midpoint on the nasolabial soft tissue
                             contour between the columella crest and the
                             upper lip
Subnasale CS (snCS)          The point at the margin of the midportion
                             of the columella crest at CS
Subnasale NCS (snNCS)        The point at the margin of the midportion
                             of the columella crest at NCS
Alare CS (alCS)              The most lateral point on the alar contour
                             at CS
Alare NCS (alNCS)            The most lateral point on the alar contour
                             at NCS
Labiale superior (ls)        The midpoint of the vermillion line of the
                             upper lip
Crista philtri CS (cphCS)    The point on crossing of the vermillion
                             line and the elevated margin of the
                             philtrum at CS
Crista philtri NCS           The point on crossing of the vermillion
(cphNCS)                     line and the elevated margin of the
                             philtrum at NCS
Christa philtri' NCS'        The point at the noncleft side crossing the
(cph'NCS')                   vermillion line and the elevated margin of
                             the philtrum, corresponding the same point
Lateral subnasale inferior   The lowest point of the lateral internal
CS (sbnCS)                   outer contour of nostril at CS
Lateral subnasale inferior   The lowest point of the lateral internal
NCS (sbnNCS)                 outer contour of nostril at NCS
Lateral subnasale superior   The highest point of the lateral internal
CS (zCS)                     outer contour of nostril at CS
Lateral subnasale superior   The highest point of the lateral internal
NCS (zNCS)                   outer contour of nostril at NCS
Medial nostril superior      The highest point of the medial internal
CS (tCS)                     outer contour of nostril at CS
Medial nostril superior      The highest point of the medial internal
NCS (tNCS)                   outer contour of nostril at NCS
Nostril top point CS (cCS)   The highest point between lateral subnasale
                             superior and medial nostril superior point
                             on CS
Nostril top point NCS        The highest point between lateral subnasale
(cNCS)                       superior and medial nostril superior point
                             on NCS

CS, cleft side; NCS, noncleft side

Table 2. The definition of the nasolabial measurements

Measurements                    Definition

Cleft lip gap                   Distance between cph'NCS' and cphCS
Philtrum median height          Distance between sn and ls
Philtrum lateral height (CS)    Distance between snCS and cph'NCS'
Philtrum lateral height (NCS)   Distance between snNCS and cphNCS
Philtral width (NCS)            Distance between cph'NCS' and cphNCS
Lateral lip height (CS)         Distance between cphCS and sbnCS
Lateral lip height (NCS)        Distance between cphNCS and sbnNCS
Nasal width                     Distance between alCS and alNCS
Nostril floor width (CS)        Distance between sbnCS and snCS
Nostril floor width (NCS)       Distance between sbaNCS and snNCS
Nasal tip protrusion            Distance between sn and prn
Nostril height (CS)             Distance between snCS and cCS
Nostril height (NCS)            Distance between snNCS and cNCS
Medial nostril height (CS)      Distance between snCS and tCS
Medial nostril height (NCS)     Distance between snNCS and tNCS
Lateral nostril height (CS)     Distance between sbnCS and zCS
Lateral nostril height (NCS)    Distance between sbnNCS and zNCS
Nostril diameter (CS)           Distance between snCS and zCS
Nostril diameter (NCS)          Distance between snNCS and zNCS

CS: cleft side, NCS: noncleft side

Table 3. Interclass correlation and 95 percent confidence interval for
intra-examiner agreement of experienced and inexperienced operator

                                Intra-examiner reliability
                                     Plaster models
                       Experienced operator   Inexperienced operator

Cleft lip gap          0.976 (0.957-0.987)    0.917 (0.850-0.954)
Philtrum median        0.929 (0.872-0.961)    0.594 (0.357-0.759)
height
Philtrum lateral       0.977 (0.958-0.988)    0.891 (0.805-0.940)
height (CS)
Philtrum lateral       0.955 (0.918-0.976)    0.705 (0.512-0.830)
height (NCS)
Philtral width         0.814 (0.680-0.896)    0.466 (0.192-0.672)
(NCS)
Lateral lip height     0.957 (0.921-0.977)    0.808 (0.670-0.892)
(CS)
Lateral lip height     0.927 (0.868-0.960)    0.770 (0.611-0.870)
(NCS)
Nasal width            0.988 (0.978-0.994)    0.942 (0.894-0.968)
Nostril floor width    0.984 (0.970-0.991)    0.935 (0.883-0.965)
(CS)
Nostril floor width    0.904 (0.829-0.947)    0.574 (0.331-0.746)
(NCS)
Nasal tip protrusion   0.961 (0.929-0.979)    0.688 (0.488-0.819)
Nostril height (CS)    0.834 (0.712-0.907)    0.694 (0.497-0.823)
Nostril height (NCS)   0.946 (0.902-0.971)    0.445 (0.167-0.658)
Medial nostril         0.804 (0.664-0.890)    0.692 (0.495-0.822)
height (CS)
Medial nostril         0.895 (0.813-0.942)    0.704 (0.512-0.829)
height (NCS)
Lateral nostril        0.989 (0.979-0.994)    0.919 (0.854-0.955)
height (CS)
Lateral nostril        0.920 (0.855-0.956)    0.791 (0.643-0.882)
height (NCS)
Nostril diameter       0.872 (0.774-0.929)    0.747 (0.575-0.855)
(CS)
Nostril diameter       0.898 (0.818-0.944)    0.430 (0.149-0.647)
(NCS)

                                Intra-examiner reliability
                                      3D images
                       Experienced operator   Inexperienced operator

Cleft lip gap          0.997 (0.994-0.998)    0.949 (0.907-0.972)
Philtrum median        0.970 (0.946-0.984)    0.882 (0.790-0.935)
height
Philtrum lateral       0.999 (0.997-0.999)    0.944 (0.898-0.969)
height (CS)
Philtrum lateral       0.996 (0.993-0.998)    0.783 (0.630-0.877)
height (NCS)
Philtral width         0.947 (0.904-0.971)    0.547 (0.294-0.728)
(NCS)
Lateral lip height     0.969 (0.943-0.983)    0.866 (0.764-0.925)
(CS)
Lateral lip height     0.994 (0.988-0.997)    0.915 (0.847-0.953)
(NCS)
Nasal width            0.509 (0.246-0.702)    0.970 (0.945-0.984)
Nostril floor width    0.890 (0.805-0.939)    0.892 (0.808-0.940)
(CS)
Nostril floor width    0.748 (0.577-0.856)    0.530 (0.272-0.716)
(NCS)
Nasal tip protrusion   0.995 (0.990-0.997)    0.698 (0.503-0.826)
Nostril height (CS)    0.997 (0.995-0.998)    0.896 (0.815-0.943)
Nostril height (NCS)   0.990 (0.982-0.995)    0.914 (0.846-0.953)
Medial nostril         0.966 (0.938-0.982)    0.831 (0.707-0.906)
height (CS)
Medial nostril         0.929 (0.872-0.961)    0.853 (0.741-0.919)
height (NCS)
Lateral nostril        0.987 (0.977-0.993)    0.792 (0.642-0.883)
height (CS)
Lateral nostril        0.982 (0.966-0.990)    0.691 (0.492-0.821)
height (NCS)
Nostril diameter       0.998 (0.997-0.999)    0.963 (0.932-0.980)
(CS)
Nostril diameter       0.996 (0.993-0.998)    0.861 (0.755-0.923)
(NCS)

Table 4. Interclass correlation and 95 percent confidence interval for
inter-examiner and inter-method agreement of experienced and
inexperienced operator

                          Inter-examiner reliability
                       Plaster models        3D images

Cleft lip gap          0.859 (0.753-0.922)   0.934 (0.880-0.964)
Philtrum median        0.648 (0.432-0.794)   0.792 (0.645-0.883)
height
Philtrum lateral       0.849 (0.736-0.916)   0.903 (0.827-0.947)
height (CS)
Philtrum lateral       0.760 (0.596-0.864)   0.770 (0.624-0.875)
height (NCS)
Philtral width         0.504 (0.239-0.699)   0.388 (0.098-0.616)
(NCS)
Lateral lip height     0.772 (0.614-0.871)   0.772 (0.613-0.871)
(CS)
Lateral lip height     0.824 (0.695-0.901)   0.840 (0.721-0.911)
(NCS)
Nasal width            0.925 (0.865-0.959)   0.296 (0.005-0.548)
Nostril floor width    0.941 (0.893-0.968)   0.901 (0.823-0.945)
(CS)
Nostril floor width    0.623 (0.397-0.778)   0.382 (0.091-0.612)
(NCS)
Nasal tip protrusion   0.737 (0.561-0.850)   0.583 (0.342-0.752)
Nostril height (CS)    0.663 (0.452-0.803)   0.833 (0.710-0.906)
Nostril height         0.783 (0.631-0.877)   0.787 (0.636-0.879)
(NCS)
Medial nostril         0.549 (0.297-0.729)   0.802 (0.660-0.888)
height (CS)
Medial nostril         0.407 (0.121-0.631)   0.467 (0.189-0.675)
height (NCS)
Lateral nostril        0.433 (0.152-0.649)   0.659 (0.447-0.801)
height (CS)
Lateral nostril        0.353 (0.059-0.591)   0.733 (0.554-0.847)
height (NCS)
Nostril diameter       0.902 (0.825-0.946)   0.922 (0.859-0.957)
(CS)
Nostril diameter       0.818 (0.686-0.898)   0.827 (0.700-0.903)
(NCS)

                               Inter-method reliability
                       Experienced operator   Inexperienced operator

Cleft lip gap          0.961 (0.929-0.979)    0.816 (0.683-0.897)
Philtrum median        0.947 (0.904-0.971)    0.576 (0.333-0.748)
height
Philtrum lateral       0.960 (0.927-0.978)    0.783 (0.631-0.877)
height (CS)
Philtrum lateral       0.884 (0.795-0.936)    0.653 (0.438-0.797)
height (NCS)
Philtral width         0.710 (0.521-0.833)    0.403 (0.117-0.628)
(NCS)
Lateral lip height     0.931 (0.875-0.962)    0.646 (0.428-0.792)
(CS)
Lateral lip height     0.929 (0.872-0.961)    0.691 (0.493-0.821)
(NCS)
Nasal width            0.270 (0.033-0.528)    0.874 (0.777-0.930)
Nostril floor width    0.977 (0.958-0.988)    0.820 (0.690-0.899)
(CS)
Nostril floor width    0.793 (0.647-0.883)    0.370 (0.078-0.604)
(NCS)
Nasal tip protrusion   0.790 (0.642-0.881)    0.590 (0.352-0.757)
Nostril height (CS)    0.841 (0.724-0.912)    0.704 (0.512-0.829)
Nostril height         0.930 (0.873-0.962)    0.680 (0.477-0.815)
(NCS)
Medial nostril         0.722 (0.538-0.840)    0.636 (0.415-0.787)
height (CS)
Medial nostril         0.753 (0.584-0.859)    0.415 (0.127-0.639)
height (NCS)
Lateral nostril        0.954 (0.916-0.975)    0.380 (0.089-0.611)
height (CS)
Lateral nostril        0.887 (0.800-0.938)    0.245 (0.060-0.508)
height (NCS)
Nostril diameter       0.982 (0.967-0.990)    0.866 (0.764-0.926)
(CS)
Nostril diameter       0.806 (0.666-0.891)    0.686 (0.486-0.818)
(NCS)
COPYRIGHT 2019 AVES
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2019 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:ORIGINAL ARTICLE
Author:Nur Yilmaz, R. Burcu; Cakan, Derya Germec; Altay, Merve; Canter, Halil Ibrahim
Publication:Turkish Journal of Orthodontics
Article Type:Report
Date:Jun 1, 2019
Words:5279
Previous Article:Does Gender Have an Effect on Craniofacial Measurements?
Next Article:Comparison of Two Retention Appliances with Respect to Clinical Effectiveness.
Topics:

Terms of use | Privacy policy | Copyright © 2020 Farlex, Inc. | Feedback | For webmasters