Cephalometric Methods of Prediction in Orthognathic Surgery

  • Olga-Elpis Kolokitha
  • Nikolaos Topouzelis


Over the past decade the growing number of adult patients seeking for orthodontic treatment made orthognathic surgery popular. Surgical and orthodontic techniques have developed to the point where combined orthodontic and surgical treatment is now feasible to manage dentofacial deformity problems very satisfactorily. The prediction of orthognathic treatment outcome is an important part of orthognathic planning and the process of patient’ inform consent. The predicted results must be presented to the patients prior to treatment in order to assess the treatment’s feasibility, optimize case management and increase patient understanding and acceptance of the recommended treatment. Cephalometrics is a routine part of the diagnosis and treatment planning process and also allows the clinician to evaluate changes following orthognathic surgery. Traditionally cephalometry has been employed manually; nowadays computerized cephalometric systems are very popular. Cephalometric prediction in orthognathic surgery can be done manually or by computers, using several currently available software programs, alone or in combination with video images. Both manual and computerized cephalometric prediction methods are two-dimensional and cannot fully describe three-dimensional phenomena. Today, three-dimensional prediction methods are available, such as three-dimensional computerized tomography (3DCT), 3D magnetic resonance imaging (3DMRI) and surface scan/cone-beam CT. The aim of this article is to present and discuss the different methods of cephalometric prediction of the orthognathic surgery outcome.


Orthognathic surgery Orthodontics Prediction 2D cephalometry 3D cephalometry 


  1. 1.
    Tucker MR (1995) Orthognathic surgery versus orthodontic camouflage in the treatment of mandibular deficiency. J Oral Maxillofac Surg 53:572–578PubMedCrossRefGoogle Scholar
  2. 2.
    Bailey LJ, Haltiwanger LH, Blakey GH, Proffit WR (2001) Who seeks surgical-orthodontic treatment: a current review. Int J Adult Orthod Orthognath Surg 16:280–292Google Scholar
  3. 3.
    Proffit WR, Turvey TA, Phillips C (2007) The hierarchy of stability and predictability in orthognathic surgery with rigid fixation: an update and extension. Head Face Med 30:3–21Google Scholar
  4. 4.
    Proffit WR, White RP Jr (1990) Who needs surgical-orthodontic treatment? Int J Adult Orthod Orthognath Surg 5:81–89Google Scholar
  5. 5.
    Musich DR (1994) Orthodontics orthognathic surgery: Principles of combined treatment. In: Graber TM, Vanarsdall RL (eds) Orthodontics: current principles and techniques. Mosby Year Book, St Louis, pp 838–841Google Scholar
  6. 6.
    Proffit WR, Turvey TA, Phillips C (1996) Orthognathic surgery: a hierarchy of stability. Int J Adult Orthod Orthognath Surg 11:191–204Google Scholar
  7. 7.
    Olson RE, Laskin DM (1980) Expectations of patients from orthognathic surgery. J Oral Surg 38:283–295PubMedGoogle Scholar
  8. 8.
    Mayo KH, Vig KD, Vig PS, Kowalski CJ, Mayo KH (1991) Attitude variables of dentofacial deformity patients: demographic characteristics and associations. J Oral Maxillofac Surg 49:594–602PubMedCrossRefGoogle Scholar
  9. 9.
    Finlay PM, Atkinson JM, Moos KF (1995) Orthognathic surgery: patient expectations; psychological profile and satisfaction with outcome. Br J Oral Maxillofac Surg 33:9–14PubMedCrossRefGoogle Scholar
  10. 10.
    Athanasiou AE, Melsen B, Eriksen J (1989) Concerns, motivation and experience of orthognathic surgery patients: A retrospective study of 152 patients. Int J Adult Orthod Orthognath Surg 4:47–55Google Scholar
  11. 11.
    Ostler S, Kiyak HA, Ostler S (1991) Treatment expectations versus outcomes among orthognathic surgery patients. Int J Adult Orthodon Orthognath Surg 6:247–255PubMedGoogle Scholar
  12. 12.
    Rivera SM, Hatch JP, Dolce C, Bays RA, Van Sickels JE, Rugh JD (2000) Patients’ own reasons and patient-perceived recommendations for orthognathic surgery. Am J Orthod Dentofacial Orthop 118:134–140PubMedCrossRefGoogle Scholar
  13. 13.
    Williams DM, Bentley R, Cobourne MT, Gibilaro A, Good S, Huppa C, Matthews NS, O’Higgins E, Patel S, Newton JT (2009) Psychological characteristics of women who require orthognathic surgery: comparison with untreated controls. Br J Oral Maxillofac Surg 47:191–195PubMedCrossRefGoogle Scholar
  14. 14.
    Kiyak HA, Bell R (1991) Psychosocial considerations in surgery and orthodontics. In: Proffit WR, White RP (eds) Surgical-orthodontic treatment. Mosby Year Book, St Louis, pp 71–89Google Scholar
  15. 15.
    Scott AA, Hatch JP, Rugh JD, Hoffman TJ, Rivera SM, Dolce C, Bays RA (2000) Psychosocial predictors of satisfaction among orthognathic surgery patients. Int JAdult Orthod Orthognath Surg 15:7–15Google Scholar
  16. 16.
    Gerzanic L, Jagsch R, Watzke IM (2002) Psychologic implications of orthognathic surgery in patients with skeletal class II or class III malocclusion. Int J Adult Orthod Orthognath Surg 17:75–81Google Scholar
  17. 17.
    Lazaridou-Terzoudi T, Kiyak HA, Moore R, Athanasiou AE, Melsen B (2003) Long term assessment of psychologic outcomes of orthognathic surgery. J Oral Maxillofac Surg 61:545–552PubMedCrossRefGoogle Scholar
  18. 18.
    Hugo B, Becker S, Witt E (1996) Assessment of the combined orthodontic- surgical treatment from the patients’ point of view. J Orofac Orthop 57:88–101PubMedCrossRefGoogle Scholar
  19. 19.
    Hatch JP, Rugh JD, Clark GM, Keeling SD, Tiner BD, Bays RA (1998) Health-related quality of life following orthognathic surgery. Int J Adult Orthod Orthognath Surg 13:67–77Google Scholar
  20. 20.
    Proffit WR, Sarver DM (2003) Treatment planning: Optimizing benefit to the patient In: Proffit WR, White RP Jr, Sarver DM (eds) Contemporary treatment of dentofacial deformity. Mosby Inc, St Louis, pp 172–244Google Scholar
  21. 21.
    Esperao PT, de Oliveira BH, de Oliveira Almeida MA, Kiyak HA, Miguel JA (2010) Oral health-related quality of life in orthognathic surgery patients. Am J Orthod Dentofacial Orthop 137:790–795PubMedCrossRefGoogle Scholar
  22. 22.
    Sarver DM (1998) Videocephalometric treatment prediction. In: Sarver DM (ed) Estetics orthodontics and orthognathic surgery. Mosby Inc, St Louis, pp 61–89Google Scholar
  23. 23.
    Cohen MI (1965) Mandibular prognathism. Am J Orthod 51:368–379PubMedCrossRefGoogle Scholar
  24. 24.
    McNeill RW, Proffit WR, White RP (1972) Cephalometric prediction for orthodontic surgery. Angle Orthod 42:154–164PubMedGoogle Scholar
  25. 25.
    Henderson D (1974) The assessment, management of bony deformities of the middle, lower face. Br J Plast Surg 66:378–396Google Scholar
  26. 26.
    Worms FW, Isaacson RJ, Spiedel TM (1976) Surgical orthodontic treatment planning: Profile analysis and mandibular surgery. Angle Orthod 46:1–25PubMedGoogle Scholar
  27. 27.
    Hohl TH, Wolford LM, Epker BN, Fonseca RJ (1978) Craniofacial osteotomies: A photocephalometric technique for the prediction and evaluation of tissue changes. Angle Orthod 48:114–125Google Scholar
  28. 28.
    Fish LC, Epker BN (1980) Surgical-orthodontic cephalometric prediction tracing. J Clin Orthod 14:36–52PubMedGoogle Scholar
  29. 29.
    Bench RW, Gugino CF, Hilgers JJ (1977) Bioprogressive therapy: Part 2-principles of the therapy. J Clin Ortodod 11:661–668Google Scholar
  30. 30.
    Bench RW, Gugino CF, Hilgers JJ (1977) Bioprogressive therapy: Part 2-principles of the therapy. J Clin Ortodod 11:744–763Google Scholar
  31. 31.
    Moshiri F, Jung ST, Sclaroff A, Marsh JL, Gay DW (1982) Orthognathic and craniofacial surgical diagnosis and treatment planning: A visual approach. J Clin Orthod 16:37–59PubMedGoogle Scholar
  32. 32.
    Harris MC (1972) Soft tissue effects of surgical anterior maxillary retraction, thesis. University of Kentaki, LouisvilleGoogle Scholar
  33. 33.
    Wolford LM, Hilliard FW, Dugan DJ (1985) Surgical treatment objective. A systematic approach to the prediction tracing. Mosby Year Book, St Louis, pp 54–74Google Scholar
  34. 34.
    Proffit WR (1991) Treatment planning: The search for wisdom. In: Proffit WR, White RP (eds) Surgical orthodontic treatment. Mosby Year Book, St Louis, pp 142–191Google Scholar
  35. 35.
    Jensen AC, Sinclair PM, Wolford LM (1992) Soft tissue changes associated with double jaw surgery. Am J Orthod Dentofac Orthop 101:266–275CrossRefGoogle Scholar
  36. 36.
    Gossett CB, Preston CB, Dunford R, Lampasso J (2005) Prediction accuracy of computer-assisted surgical visual treatment objectives as compared with conventional visual treatment objectives. J Oral Maxillofac Surg 63:609–617PubMedCrossRefGoogle Scholar
  37. 37.
    Sarver DM (1998) The technology and mechanics of videocephalometrics. In: Sarver DM (ed) Estetics orthodontics and orthognathic surgery. Mosby Inc, St Louis, pp 89–134Google Scholar
  38. 38.
    Athanasiou AE, Kragskov J (1995) Computerized cephalometric systems. In: Athanasiou AE (ed) Orthodontic cephalometry. Mosby-Wolfe, London, pp 231–239Google Scholar
  39. 39.
    Bhatia SN, Sowray JH (1984) A computer-aided design for orthognathic surgery. Br J Oral Maxillofac Surg 22:237–253PubMedCrossRefGoogle Scholar
  40. 40.
    Engel GA, Quan RE, Chaconas ST (1979) Soft tissue change as a result of maxillary surgery. A preliminary study. Am J Orthod 75:291–300PubMedCrossRefGoogle Scholar
  41. 41.
    Harradine NWT, Burnie DJ (1985) Computerized prediction of the results of orthognathic surgery. J Maxillofac Surg 13:245–249PubMedCrossRefGoogle Scholar
  42. 42.
    Walters H, Walters HD (1986) Computerized planning of maxillofacial osteotomies: The program and its clinical applications. Br J Oral Maxillofac Surg 24:178–189PubMedCrossRefGoogle Scholar
  43. 43.
    Freihofer HPM (1984) Latitude and limitations of midface movements. Br J Oral Maxillofac Surg 22:393–413PubMedCrossRefGoogle Scholar
  44. 44.
    Kaipatur N, Al-Thomali Y, Flores-Mir C (2009) Accuracy of computer programs in predicting orthognathic surgery hard tissue response. J Oral Maxillofac Surg 67:1628–1639PubMedCrossRefGoogle Scholar
  45. 45.
    Seeholzer H, Walker R (1991) Orthodontic and oral surgical treatment planning by computer, for example, the dentofacial planners (I). Quintessenz 42:59–67PubMedGoogle Scholar
  46. 46.
    Seeholzer H, Walker R (1991) Orthodontic and oral surgical treatment planning by computer, for example, the dentofacial planners (II). Quintessenz 2:257–262Google Scholar
  47. 47.
    Coursley RRJ, Grant E (2004) The accuracy of preoperative orthognathic predictions. Br J Oral Maxillofac Surg 42:96–104CrossRefGoogle Scholar
  48. 48.
    Power G, Breckon J, Sherriff M, McDonald F (2005) Dolphin imaging software: An analysis of the accuracy of cephalometric digitization and orthognathic prediction. Int J Oral Maxillofac Surg 34:619–626PubMedCrossRefGoogle Scholar
  49. 49.
    Kusnoto B (2007) Two-dimensional cephalometry and computerized orthognathic surgical treatment planning. Clin Plast Surg 34:417–422PubMedCrossRefGoogle Scholar
  50. 50.
    Sarver DM, Johnston MW, Matukas VJ (1988) Video imaging for planning and counseling in orthognathic surgery. J Oral Maxillofac Surg 46:939–945PubMedCrossRefGoogle Scholar
  51. 51.
    Talahashi I, Talahashi T, Hamada M, Kawamoto T, Kinoshita Z, Kubo Y, Kakudo K, Shirasu R (1989) Application of video surgery to orthodontic diagnosis. Int j Orthod Orthogn Surg 4:219–222Google Scholar
  52. 52.
    Sarver DM, Johnston MW (1990) Video imaging: techniques for superimposition of cephalometric radiography and profile images. Int J Adult Orthodon Orthognath Surg 5:241–248PubMedGoogle Scholar
  53. 53.
    Grubb JE (1992) Computer assisted orthognathic surgical treatment planning: a case report. Angle Orthod 62:227–234PubMedGoogle Scholar
  54. 54.
    Sarver DM (1998) Videocephalometric treatment prediction. In: Sarver DM (ed) Estetics orthodontics and orthognathic surgery. Mosby Inc, St Louis, pp 89–134Google Scholar
  55. 55.
    Sarver DM (1993) Video imaging, a computer facilitated approach to communication and planning in orthognathic surgery. Br J Orthod 20:187–191PubMedGoogle Scholar
  56. 56.
    Phillips C (1984) Photocephalometry: errors of projection and landmark location. Am J Orthod 86:233–243PubMedCrossRefGoogle Scholar
  57. 57.
    Rakosi T (2010) Therapeutic diagnosis. In: Racosi T, Graber TM (eds) Orthodontic and dentofacial orthopedic treatment. Thieme, New York, pp 1–17Google Scholar
  58. 58.
    Pospisil OA (1987) Reliability and feasibility of prediction tracing in orthognathic surgery. J Craniomaxillofac Surg 15:79–83PubMedCrossRefGoogle Scholar
  59. 59.
    Konstiantos KA, O’Reilly MT, Close J (1994) The validity of the prediction of soft tissue profile changes after Le Fort I osteotomy using the dentofacial planner (computer software). Am J Orthod Dentofac Orthop 105:241–249CrossRefGoogle Scholar
  60. 60.
    Eales EA, Newton C, Jones ML, Sugar A (1994) The accuracy of computerized prediction of the soft tissue profile: a study of 25 patients treated by means of the Le Fort I osteotomy. Int J Adult Orthod Orthognath Surg 9:141–152Google Scholar
  61. 61.
    Eales EA, Jones ML, Newton C, Sugar AW (1995) A study of the accuracy of predicted soft tissue changes produced by a computer software package (COG 3.4) in a series of patients treated by the Le Fort I osteotomy. Br J Oral Maxillofac Surg 33:362–369PubMedCrossRefGoogle Scholar
  62. 62.
    Sameshima GT, Kawakami RK, Kaminishi RM, Sinclair PM (1997) Predicting soft tissue changes in maxillary impaction surgery: A comparison of two video imaging systems. Angle Orthod 67:347–354PubMedGoogle Scholar
  63. 63.
    Csaszar GR, Brüker-Csaszar B, Niederdellmann H (1999) Prediction of soft tissue profiles in orthodontic surgery with the dentofacial planner. Int J Adult Orthod Orthognath Surg 14:285–290Google Scholar
  64. 64.
    Jones RM, Khambay BS, McHugh S, Ayoub AF (2007) The validity of a computer-assisted simulation system for orthognathic surgery (CASSOS) for planning the surgical correction of class III skeletal deformities: single-jaw versus bimaxillary surgery. Int J Oral Maxillofac Surg 36:900–908PubMedCrossRefGoogle Scholar
  65. 65.
    Kolokitha OE, Athanasiou AE, Tuncay O (1996) Validity of computerized predictions of dentoskeletal and soft tissue profile changes after mandibular setback and maxillary impaction osteotomies. Int J Adult Orthod Orthognath Surg 11:137–154Google Scholar
  66. 66.
    Curtis TJ, Casko JS, Jakobsen JR, Southard TE (2000) Accuracy of a computerized method of predicting soft tissue changes from orthognathic surgery. J Clin Orthod 34:524–530PubMedGoogle Scholar
  67. 67.
    Jacobson R, Sarver DM (2001) The predictability of maxillary repositioning in Le Fort I orthognathic surgery. Am J Orthod Dentofac Orthop 122:142–154CrossRefGoogle Scholar
  68. 68.
    Kolokitha OE (2007) Validity of a manual soft tissue profile prediction method following mandibular setback osteotomy. Eur J Dent 1:202–211PubMedGoogle Scholar
  69. 69.
    Donatsky O, Bjørn-Jørgensen J, Hermund NU, Nielsen H, Holmqvist-Larsen M, Nerder PH (2010) Immediate postoperative outcome of orthognathic surgical planning, and prediction of positional changes in hard and soft tissue, independently of the extent and direction of the surgical corrections required. Br J Oral Maxillofac Surg (in press)Google Scholar
  70. 70.
    Kaipatur NR, Flores-Mir C (2009) Accuracy of computer programs in predicting orthognathic surgery soft tissue response. J Oral Maxillofac Surg 67:751–759PubMedCrossRefGoogle Scholar
  71. 71.
    Harrell WE Jr, Hatcher DC, Bolt RL (2002) In search of anatomic truth: 3-dimensional digital modelling and the future. Am J Orthod Dentofac Orthop 122:325–330CrossRefGoogle Scholar
  72. 72.
    Popat H, Richmond ST (2010) New developments in: three-dimensional planning for orthognathic surgery. J Ortho 37:62–71CrossRefGoogle Scholar
  73. 73.
    Gateno J (2011) New 3-dimensional cephalometric analysis for orthognathic surgery. J Oral Maxillofac Surg 69:606–622PubMedCrossRefGoogle Scholar
  74. 74.
    Bergensen EO (1980) Enlargement and distortion in cephalometric radiography: compensation tables fro linear measurements. Angle Orthod 50:230–244Google Scholar
  75. 75.
    Ahlqvist J, Eliasson S, Welander U (1983) The cephalometric projection: part II. Principles of image distortion in cephalography. Dentomaxillofac Radiol 12:101–108PubMedGoogle Scholar
  76. 76.
    Hwang H-S, Hwang CH, Lee K-H, Kang B-C (2006) Maxillofacial 3- dimensional image for the diagnosis of facial asymmetry. Am J Dentofacial Orthop 130:779–785CrossRefGoogle Scholar
  77. 77.
    Cutting CC, Bookstein FL, Crayson B, Fellingham L, McCarthy JG (1986) Three-dimensional computer assisted design of craniofacial surgical procedures: optimization and interaction with cephalometric and CT-based models. Plast Reconstr Surg 77:877–887PubMedCrossRefGoogle Scholar
  78. 78.
    Moss JP, Grindrod SR, Linney AD, Janes D (1988) A computer system for the interactive planning and prediction of maxillofacial surgery. Am J Orthod Dentofac Orthop 94:469–475CrossRefGoogle Scholar
  79. 79.
    Plooij JM, Maal TJ, Borstlap WA, Kuijpers-Jagtman AM, Berge SJ (2010) Digital three-dimensional image fusion processes for planning and evaluating orthodontics and orthognathic surgery. A systematic review. Int J Oral Maxillofac Surg. doi:  10.1016/j.ijom.2010.10.013
  80. 80.
    Groeve PD, Schutyser F, Cleynen–Breugel JV, Suetens P (2001) Registration of 3D photographs with spiral CT images for soft tissue simulation in maxillofacial surgery. Lect Notes Comput Sci 2208:991–996CrossRefGoogle Scholar
  81. 81.
    Khambay B, Nebel JC, Bowman J, Walker F, Hadley DM, Ayoub A (2002) 3D stereophotogrammetric image superimposition onto 3DCT scan images: the future of orthognathic surgery. A pilot study. Int J Adult Orthodon Orthognath Surg 17:331–341PubMedGoogle Scholar
  82. 82.
    Maal TJ, Plooij JM, Rangel FA, Mollemans W, Schutyser FA, Berge SJ (2008) The accuracy of matching three-dimensional photographs with skin surfaces derived from cone-beam computed tomography. Int J Oral Maxillofac Surg 37:641–646PubMedCrossRefGoogle Scholar
  83. 83.
    Swennen GR, Mollemans W, De Clercq C, Abeloos J, Lamoral P, Lippens F, Neyt N, Casselman J, Schutyser F (2009) A cone-beam computed tomography triple scan procedure to obtain a three-dimensional augmented virtual skull model appropriate for orthognathic surgery planning. J Craniofac Surg 20:297–307PubMedCrossRefGoogle Scholar
  84. 84.
    Swenner GR, Mollemans W, Schutyser F (2009) Three-dimensional treatment planning of orthognathic surgery in the era of virtual imaging. J Oral Maxillofac Surg 67:2080–2092CrossRefGoogle Scholar
  85. 85.
    Swennen GR, Schutyser FAC (2006) Three-dimensional virtual approach to diagnosis and treatment planning of maxillofacial deformity. In: Bell WH, Guerrero CA (eds) Distraction osteogenesis of the facial skeleton. BC Decker Inc, HamiltonGoogle Scholar
  86. 86.
    Mavili ME, Canter HI, Saglam-Aydinatay B, Kamaci S, Kocadereli I (2007) Use of three-dimensional medical modeling methods for precise planning of orthognathic surgery. J Craniofac Surg 18:740–747PubMedCrossRefGoogle Scholar
  87. 87.
    Ayoub AF, Xiao Y, Khambay B, Siebert JP, Hadley D (2007) Towards building a photo–realistic virtual human face for craniomaxillofacial diagnosis and treatment planning. Int J Oral Maxillofac Surg 36:423–428PubMedCrossRefGoogle Scholar
  88. 88.
    Nakasima A, Terajima M, Mori N, Hoshino Y, Tokumori K, Aoki Y, Hashimoto S (2005) Three-dimensional computer-generated head model reconstructed from cephalograms, facial photographs, and dental cast models. Am J Orthod Dentofacial Orthop 127:282–292PubMedCrossRefGoogle Scholar
  89. 89.
    Van Vlijmen OJ (2010) A comparison between 2D and 3D cephalometry on CBCT scans of human skulls. Int J Oral Maxillofac Surg 39:156–160PubMedCrossRefGoogle Scholar
  90. 90.
    Kragskov J, Bosch C, Gyldensted C, Sindet-Pedersen S (1997) Comparison of the reliability of craniofacial anatomic landmarks based on cephalometric radiographs and three-dimensional CT scans. Cleft Palate Craniofac J 34:111–116PubMedCrossRefGoogle Scholar
  91. 91.
    Bianchi A, Muyldermans L, Di Martino M, Landellotti L, Amadori S, Sarti A, Marchetti C (2010) Facial soft tissue esthetic predictions: validation in craniomaxillofacial surgery with cone-beam computed tomography. J Oral Maxillofac Surg 68:1471–1479PubMedCrossRefGoogle Scholar
  92. 92.
    Mollemans W, Schutyser F, Nadjmi N, Maes F, Suetens P (2007) Predicting soft tissue deformations for a maxillofacial surgery planning system: from computational strategies to a complete clinical validation. Med Image Anal 11:282–301PubMedCrossRefGoogle Scholar
  93. 93.
    Proffit WR (2000) The soft tissue paradigm in orthodontic diagnosis and treatment planning: a new view for a new century. J Esthet Dent 12:46–49PubMedCrossRefGoogle Scholar

Copyright information

© Association of Oral and Maxillofacial Surgeons of India 2011

Authors and Affiliations

  1. 1.Department of Orthodontics, School of DentistryAristotle University of ThessalonikiThessalonikiGreece

Personalised recommendations