Size and shape measurement in contemporary cephalometrics

The traditional method of analysing cephalograms - conventional cephalometric analysis (CCA) - involves the calculation of linear distance measurements, angular measurements, area measurements, and ratios. Because shape information cannot be determined from these 'size-based' measurements, an increasing number of studies employ geometric morphometric tools in the cephalometric analysis of craniofacial morphology. Most of the discussions surrounding the appropriateness of CCA, Procrustes superimposition, Euclidean distance matrix analysis (EDMA), thin-plate spline analysis (TPS), finite element morphometry (FEM), elliptical Fourier functions (EFF), and medial axis analysis (MAA) have centred upon mathematical and statistical arguments. Surprisingly, little information is available to assist the orthodontist in the clinical relevance of each technique. This article evaluates the advantages and limitations of the above methods currently used to analyse the craniofacial morphology on cephalograms and investigates their clinical relevance and possible applications.