Reliability of Artificial Intelligence-Assisted Cephalometric Analysis. A Pilot Study

Recently, Artificial Intelligence (AI) has spread in orthodontics, in particular within cephalometric analysis, where computerized digital software is able to provide linear-angular measurements upon manual landmark identification. A step forward is constituted by fully automated AI-assisted cephalometric analysis, where the landmarks are automatically detected by software. The aim of the study was to compare the reliability of a fully automated AI-assisted cephalometric analysis with the one obtained by a computerized digital software upon manual landmark identification. Fully automated AI-assisted cephalometric analysis of 13 lateral cephalograms were retrospectively compared to the cephalometric analysis performed twice by a blinded operator with a computerized software. Intra- and inter-operator (fully automated AI-assisted vs. computerized software with manual landmark identification) reliability in cephalometric parameters (maxillary convexity, facial conicity, facial axis angle, posterior and lower facial height) was tested with the Dahlberg equation and Bland–Altman plot. The results revealed no significant difference in intra- and inter-operator measurements. Although not significant, higher errors were observed within intra-operator measurements of posterior facial height and inter-operator measurements of facial axis angle. In conclusion, despite the small sample, the cephalometric measurements of a fully automated AI-assisted cephalometric software were reliable and accurate. Nevertheless, digital technological advances cannot substitute the critical role of the orthodontist toward a correct diagnosis.