Influence of Lateral Cephalometric Radiographs on Orthodontic Treatment Planning of Class II Patients

Irina Stupar1, Enver Yetkiner2, *, Daniel Wiedemeier3, Thomas Attin4, Rengin Attin5
1 Private Practice, Schulzahnklinik Nord, Hofwiesenstrasse 379, 8050Zürich, Switzerland
2 Faculty of Dentistry, Ege University, Bornova 35100 Izmir, Turkey
3 Department of Statistics, University of Zurich, Zürich, Switzerland
4 Department of Preventive, Periodontology, Cariology University of Zurich, Zürich, Switzerland
5 Department of Orthodontics, Faculty of Dentistry, University of Zurich, Zürich, Switzerland

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© 2018 Stupar et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Faculty of Dentistry, Ege University, Bornova 35100 Izmir, TURKEY, Tel: +90 (555)4297430, E-mails:,



Lateral Cephalometric Radiographs (LCR) are a common decision-making aid in orthodontic treatment planning and are routinely used in clinical practice. The aim of this present study was to test the null hypothesis that LCR evaluation does not alter specific components of orthodontic treatment planning in Class II patients.

Materials and Methods:

Records of 75 patients, who had been treated at the Department of Orthodontics, Centre of Dental Medicine, University of Zurich comprised the study material. Inclusion criteria were: (1) adolescents between the age of 12-15, (2) permanent dentition with Class II buccal segment relationship (3) absence of craniofacial and dento-alveolar malformations. Fifteen orthodontists from the dental faculties of Istanbul University, Istanbul and Ege University, Izmir filled out Likert-type linear scale questionnaires without knowing that they would repeat the same procedure with and without LCRs at two different time points. Equivalence and clinical relevance were assessed using (%95 CI) Wilcoxon signed rank tests.


Extraction decision did not differ between groups (p=0.68). Preference of functional appliance use (p=0.006) and inter-maxillary fixed functional appliance (p=0.043) was different among groups.


LCR evaluation has minor influence on treatment planning procedure of Class II patients. It might be beneficial to consider its prescription not in a routine manner but as a supplementary tool considering possible reduction of radiation exposure.

Keywords: Cephalometric radiographs, Orthodontic treatment, Class II patients, Tooth extraction, Linear Likert-type scale, Dento-alveolar malformations.