Original Article

Comparison of Panoramic Radiography and Lateral Cephalometry for Angular Measurements in Different Skeletal Classes

Abstract

Objectives: This study evaluated the reliability of panoramic radiography in comparison with lateral cephalometry for angular measurements in different skeletal classes.

Materials and Methods: In this retrospective study, the gonial angle, the angle formed between the palatal plane and the Frankfort plane (palatal plane inclination), and the angle formed between the incisal edge of the upper incisor and the Frankfort plane (upper incisor vertical index) were measured on panoramic and lateral cephalometric radiographs of 278 patients in three skeletal classes. Intraclass correlation coefficient (ICC) was calculated to compare panoramic and lateral cephalometric radiographs. Paired t-test was used for comparison of the right- and left-side angles on panoramic radiographs.

Results: The ICCs were 0.941, 0.927, and 0.954 for the gonial angle, 0.650, 0.605, and 0.320 for the palatal plane inclination, and 0.812, 0.810, and 0.758 for the maxillary incisor vertical index in skeletal Class I, II and III patients, respectively. The ICCs were all statistically significant (P<0.05) except for the palatal plane inclination in Class III patients (P>0.05). There was a significant difference in the gonial angle of Class II patients between the right and left sides (P<0.05). The upper incisor vertical index in the right and left sides showed significant differences in all three skeletal classes (P<0.05). The difference between the right and left sides in other angles and skeletal classes was not statistically significant (P>0.05).

Conclusion: Skeletal class does not affect the reliability of panoramic radiographs for angular measurements, except for the palatal plane inclination in Class III patients.

1. Fields HW Jr, Larson BE, Sarver DM, Proffit WR. Contemporary Orthodontics. 7th ed. St. Louis (MO): Elsevier; 2025. Chapter 6, Orthodontic Diagnosis; p. 139.
2. Piedra I. The Levandoski Panoramic Analysis in the diagnosis of facial and dental asymmetries. J Clin Pediatr Dent. 1995 Fall;20(1):15-21.
3. Graber TM. Panoramic radiography in orthodontic diagnosis. Am J Orthod. 1967 Nov;53(11):799-821.
4. Bruks A, Enberg K, Nordqvist I, Hansson AS, Jansson L, Svenson B. Radiographic examinations as an aid to orthodontic diagnosis and treatment planning. Swed Dent J. 1999;23(2-3):77-85.
5. Friedland B. Clinical radiological issues in orthodontic practice. Semin Orthod. 1998 Jun;4(2):64-78.
6. Cobourne MT, DiBiase AT. Handbook of Orthodontics. 3rd ed. Edinburgh: Elsevier; 2024. Chapter 7, The Orthodontic Patient: Examination and Diagnosis; p. 193–224.
7. Mattila K, Altonen M, Haavikko K. Determination of the gonial angle from the orthopantomogram. Angle Orthod. 1977 Apr;47(2):107-10.
8. Tenti FV. Cephalometric analysis as a tool for treatment planning and evaluation. Eur J Orthod. 1981;3(4):241-5.
9. Araki M, Kiyosaki T, Sato M, Kohinata K, Matsumoto K, Honda K. Comparative analysis of the gonial angle on lateral cephalometric radiographs and panoramic radiographs. J Oral Sci. 2015;57(4):373-8.
10. Zangouei-Booshehri M, Aghili HA, Abasi M, Ezoddini-Ardakani F. Agreement between panoramic and lateral cephalometric radiographs for measuring the gonial angle. Iran J Radiol. 2012 Nov;9(4):178-82.
11. Ongkosuwito EM, Dieleman MM, Kuijpers-Jagtman AM, Mulder PG, van Neck JW. Linear mandibular measurements: comparison between orthopantomograms and lateral cephalograms. Cleft Palate Craniofac J. 2009 Mar;46(2):147-53.
12. Nohadani N, Ruf S. Assessment of vertical facial and dentoalveolar changes using panoramic radiography. Eur J Orthod. 2008 Jun;30(3):262-8.
13. Alhaija ES. Panoramic radiographs: determination of mandibular steepness. J Clin Pediatr Dent. 2005 Winter;29(2):165-6.
14. Fischer-Brandies H, Fischer-Brandies E, Dielert E. Der Unterkieferwinkel auf dem Orthopantomogramm [The mandibular angle in the orthopantomogram]. Radiologe. 1984 Dec;24(12):547-9.
15. Okşayan R, Aktan AM, Sökücü O, Haştar E, Ciftci ME. Does the panoramic radiography have the power to identify the gonial angle in orthodontics? ScientificWorldJournal. 2012;2012:219708.
16. Mallya S, Lam EWN. White and Pharoah's Oral Radiology: Principles and Interpretation. 8th ed. St. Louis (MO): Elsevier; 2019. Chapter 8, Cephalometric and Skull Imaging, p. 119–131; Chapter 9, Panoramic Imaging, p. 132–150.
17. Akcam MO, Altiok T, Ozdiler E. Panoramic radiographs: a tool for investigating skeletal pattern. Am J Orthod Dentofacial Orthop. 2003 Feb;123(2):175-81.
18. Portney LG, Watkins MP. Foundations of Clinical Research: Applications to Practice. Norwalk (CT): Appleton & Lange; 1993. p. 505–528.
19. Türp JC, Vach W, Harbich K, Alt KW, Strub JR. Determining mandibular condyle and ramus height with the help of an Orthopantomogram--a valid method? J Oral Rehabil. 1996 Jun;23(6):395-400.
20. Larheim TA, Svanaes DB. Reproducibility of rotational panoramic radiography: mandibular linear dimensions and angles. Am J Orthod Dentofacial Orthop. 1986 Jul;90(1):45-51.
21. Faryal A, Shaikh A. Reliability of orthopantomogram in comparison to lateral cephalogram for linear mandibular measurements. J Ayub Med Coll Abbottabad. 2022 Oct-Dec;34(Suppl 1)(4):S957-63.
22. de Mora EP, Caleya-Zambrano AM, Martin-Vacas A, Ginés-Pérez A, de Nova-Garcia J, Gallardo-López NE. Panorametric study in a paediatric population in Madrid. J Clin Pediatr Dent. 2023 Sep;47(5):103-15.
23. Wyatt DL, Farman AG, Orbell GM, Silveira AM, Scarfe WC. Accuracy of dimensional and angular measurements from panoramic and lateral oblique radiographs. Dentomaxillofac Radiol. 1995 Nov;24(4):225-31.
24. Shahabi M, Ramazanzadeh BA, Mokhber N. Comparison between the external gonial angle in panoramic radiographs and lateral cephalograms of adult patients with Class I malocclusion. J Oral Sci. 2009 Sep;51(3):425-9.
25. Radhakrishnan PD, Sapna Varma NK, Ajith VV. Dilemma of gonial angle measurement: Panoramic radiograph or lateral cephalogram. Imaging Sci Dent. 2017 Jun;47(2):93-7.
26. Kumar SS, Thailavathy V, Srinivasan D, Loganathan D, Yamini J. Comparison of orthopantomogram and lateral cephalogram for mandibular measurements. J Pharm Bioallied Sci. 2017 Nov;9(Suppl 1):S92-5.
27. Bhullar MK, Uppal AS, Kochhar GK, Chachra S, Kochhar AS. Comparison of gonial angle determination from cephalograms and orthopantomogram. Indian J Dent. 2014 Jul;5(3):123-6.
28. Srii R, Koju S, Mahanta SK, Marla V, Niroula D, Upadhyaya C, et al. Digital radiographic study of gonial angle in forensic odontology in a tertiary care centre: A descriptive cross-sectional study. JNMA J Nepal Med Assoc. 2021 Apr;59(236):350-5.
29. Kaya D. Is there any difference between gonial angle values measured on digital lateral cephalograms and orthopantomograms? Turk J Orthod. 2020 May;33(2):72-6.
30. Goyal D, Kumar P, Jain S. Digital evaluation and correlation of facial growth patterns assessed on lateral CEPH and orthopantomogram through ONECEPH mobile application. J Orthod Sci. 2023 Apr;12:29.
31. Dahan J, Jesdinsky HJ. Evaluation of the orthopantomogram for cephalometric studies in orthodontics. Stoma. 1968 Aug;21(3):200-6.
IssueVol 23 (Continuously Published Article-Based) QRcode
SectionOriginal Article
Keywords
Cephalometry Radiography Malocclusion Panoramic

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Panjnoush M, Ebrahimi S. Comparison of Panoramic Radiography and Lateral Cephalometry for Angular Measurements in Different Skeletal Classes. Front Dent. 2026;23.