Evaluating the effect of digital technology on the learning of orthodontic cephalometric measurement

Background: This study aimed to evaluate the effect of applying digital technology in cephalometric measurement teaching and students’ acceptance towards it. 

Methods: In total, 94 undergraduates of stomatology were recruited and randomly allocated to two groups. According to the cross-over design, both groups completed cephalometric measurements through the traditional hand-drawn method and digital technology (the Dolphin software) in different orders. By traditional hand-drawn method, students need to depict the outlines of the craniofacial anatomical structures on the sulfuric transfer paper first, then marked the measurement points and completed the measurement of line spacings and angles. By digital technology, they should mark the points in the software and adjust the automatically generated outlines of the structures and obtained the results. Besides, an online questionnaire was designed to investigate students' attitudes toward the digital technology. Two professional orthodontists were invited as instructors. They measured a lateral cranial radiograph by two methods with one week’s interval, and their intra- and inter-class correlation coefficient were measured. The means of their measurements were set as standards. 

Results: The inter- and intra-ICC of two instructors surpassed 90%, and there were no significant differences between their measurements, and the measurements by two methods. There were significant differences of students’ measurements (P _1-SNA<0.01, P _1-SNB=0.01 and P _{1-L1-NB (mm)}<0.01; SNA: sella-nasion-subspinale angle, SNB: sella-nasion-supramental angle, L1-NB (mm): the distance from the lower central incisor tip to the nasion-supramental plane) between the traditional method and digital technology. Besides, the most results of digital technology were closer to the standards than those of traditional method, including five items with statistical significance (P _2-SNB<0.05, P _{2-L1-NB (mm)}<0.01, P _2-FMA<0.05, P _2-FMIA<0.05, P _2-IMPA<0.01), while three items were the opposite (P _2-SNA<0.05, P _{2-ANB (mm)}<0.01, P _2-NA-PA<0.01). The questionnaire showed more students preferred digital technology (33%) compared with traditional method (2%) and 72% of participants mastered 50-80% of cephalometric knowledge after the course.