ORIGINAL ARTICLE

Reliability of 2 methods in maxillary

transverse deficiency diagnosis
Chun-xi Zhang,a,b Xiao-ming Tan,b Wei Wu,c,d Hong Liu,b Yi Liu,b Xiao-ru Qu,b and Dong-xu Liub
Qingdao, Jinan, and Weifang, Shandong, China

Introduction: The objective of this research was to evaluate the reliability of 2 methods (Andrews’ Element III
analysis and Yonsei transverse analysis) in maxillary transverse deficiency diagnosis. Methods: Plaster casts
and cone-beam computed tomography images of 80 outpatients with skeletal Class I malocclusion (29 males
and 51 females, mean age, 20.16 6 8.22 years) were selected. Maxillary and mandibular width were
measured, respectively, and independently by 2 examiners at an interval of 2 weeks, using Andrews'
Element III analysis and Yonsei transverse analysis. Intraclass correlation coefficients and Bland-Altman
plots of intraexaminer and interexaminer reliability were evaluated. After diagnosis, Cohen's kappa statistics
were calculated to evaluate the diagnostic agreement. Results: The intraclass correlation coefficients were
all above 0.85, indicating good to excellent reliability. Compared with Andrews' Element III analysis, Yonsei
transverse analysis had higher intraexaminer and interexaminer reliability in both maxillary and mandibular width
measurements. Thirty-one to 42 of the patients were diagnosed with maxillary transverse deficiency by 2
examiners using 2 methods. The intraexaminer and interexaminer Cohen's kappa values of Yonsei
transverse analysis were all higher than those of Andrews' Element III analysis. Conclusions: Both Andrews'
Element III analysis and Yonsei transverse analysis had good to excellent reliability and substantial diagnostic
agreement. Yonsei transverse analysis had higher reliability in maxillary and mandibular width measurements
and higher diagnostic agreement, compared with Andrews’ Element III analysis. (Am J Orthod Dentofacial
Orthop 2021;159:758-65)

A
harmonious maxilla-mandibular transverse transverse deficiency (MTD) is pervasive in patients with
relationship is crucial for the function and sta- malocclusion.1 It is often accompanied by crossbites,
bility of the dentition; the ideal transverse rela- dental crowding, and wide buccal corridors, and it is
tionship is that the molars are centered and upright in often compensated with the buccal tipping of the maxil-
the alveolar house and well-intercuspated. The maxillary lary molars and lingual inclination of the mandibular
molars2 leading to an exaggerated curve of Wilson, in-
clined force transition, and potential periodontal disad-
a
Center of oral medicine, Qingdao Municipal Hospital, Qingdao, Shandong, vantage. The transverse discrepancy is more easily to be
China.
b ignored than the sagittal and vertical discrepancies,3
Department of Orthodontics, Shandong Provincial Key Laboratory of Oral Tissue
Regeneration, Shandong Engineering Laboratory for Dental Materials and Oral therefore, selecting an accurate and reliable MTD diag-
Tissue Regeneration, School and Hospital of Stomatology, Shandong University, nostic method is essential before treatment planning be-
Jinan, Shandong, China.
c gins.
Qingdao University, Qingdao, Shandong, China.
d
Department of Stomatology, Weifang People's Hospital, Weifang, Shandong, Studies have found that dental arch width deficiency
China. was one of the primary causes of dental crowding,2 and
All authors have completed and submitted the ICMJE Form for Disclosure of Po-
crowding was a major consideration in MTD diagnosis in
tential Conflicts of Interest, and none were reported.
This work was supported by the National Natural Science Foundation of China, the last century. By measuring plaster casts, Pont4 estab-
China (Nos. 81571010 and 81701008); Natural Science Foundation of Shandong lished an ideal relationship between maxillary incisor
Province, China (Nos. 2018GSF118199 and ZR2017BH116); and Key Research
width and dental arch width; Schwarz and Gratzinger5
and Development Program of Shandong Province, China (No. 2019GSF108187).
Address correspondence to: Dong-xu Liu, Department of Orthodontics, School presented a method of dental arch width estimation ac-
and Hospital of Stomatology, Shandong University, and Shandong Provincial cording to different facial types, and Howe et al6 set a
Key Laboratory of Oral Tissue Regeneration, and Shandong Engineering Labora-
series of arch width normative data. However, at that
tory for Dental Materials and Oral Tissue Regeneration, No. 44-1, Wenhua Rd W,
Jinan 250012, Shandong, China; e-mail, liudongxu@sdu.edu.cn. time, most studies merely took the maxillary expansion
Submitted, August 2019; revised and accepted, February 2020. as a means of space acquisition. The relationship be-
0889-5406/$36.00
tween maxillary and mandibular widths had been rarely
Ó 2021 by the American Association of Orthodontists. All rights reserved.
https://doi.org/10.1016/j.ajodo.2020.02.019 evaluated.

758
Zhang et al
In recent years, Andrews and Andrews7 proposed The
six elements of orofacial harmony. According to the au-
thors, the mandibular width is naturally optimal in most
patients; the maxillary width should be 5 mm greater
than the mandibular width when the first permanent
molars centered and upright in the alveolus. If the differ-
ence between maxillary and mandibular width was less
than 5 mm, the patient was diagnosed with MTD. To
calculate maxillary and mandibular widths after decom-
position, distance and angular measurements of plaster
casts were made.
Radiographs are also commonly used as an aid in
MTD diagnosis. Ricketts8,9 introduced a transverse diag-
nosis method using anteroposterior cephalometrics and
determined a series of age-determined normative data.
However, because of the image superimposition of ante-
roposterior cephalometrics and head rotation during ra-
diographing,10-12 higher landmark identification errors
and less reliability of this method were reported than
those of the cone-beam computed tomography (CBCT)
images.13 Recent studies reported multiple ways in
MTD diagnosis using CBCT images. Miner et al14,15
analyzed the transverse dimension using the cone-
beam transverse method. By measuring maxillary and
mandibular width at the palatal and lingual cortex,
normative data were determined, and this method was
proved to be valid. Shewinvanakitkul16 developed a
method to measure buccolingual inclinations of poste-
rior teeth using CBCT; afterward, the Case Western
Reserve University's transverse analysis was developed.17
Yehya Mostafa et al18 indicated that the Case Western
Reserve University's transverse analysis could signifi-
cantly improve the orthodontic results. Koo et al19 intro-
duced Yonsei University's transverse analysis. The
authors stated that the centers of resistance (CR) of the
first permanent molars were not readily affected by the
tipping of the teeth; thus, the CR could enable evalua-
tion of the transverse dimension at the basal bone level.
By measuring the maxillary and mandibular width at the
estimated CR of first permanent molars, the authors pro-
vided the Yonsei Transverse Index of normal occlusions,
which is 0.39 6 1.87 mm.
As with any diagnostic test, the most important fac-
tors are validity and reliability.20 Reliability represents
the repeated measurements by the same or different
raters yielding the same results, and a diagnostic method
with high reliability is crucial in orthodontic clinical
practice. As far as we know, the reliability of Andrews’
Element III analysis and Yonsei transverse analysis has
American Journal of Orthodontics and Dentofacial Orthopedics
759
not been evaluated yet. Therefore, in this study, we
aimed to evaluate the reliability of 2 methods in MTD
diagnosis.
MATERIAL AND METHODS
This cross-sectional study was accepted by the
Research Ethics Committee of Shandong University
Dental School (Protocol No. 20190505). Among the out-
patients who visited the Department of Orthodontics of
School of Stomatology, Shandong University in 2018, 80
were included in this study. The inclusion criteria were as
follows: (1) the subjects were aged at least 12 years with
full permanent dentitions; (2) all maxillary and mandib-
ular first permanent molars had fully erupted to the
occlusal plane; and (3) skeletal Class I relationship
(ANB angle was greater than 1 and less than 4 ). The
exclusion criteria were as follows: (1) subjects with any
of the first permanent molars have abnormal root
morphology, restoration, fracture, or cavity; (2) peri-
odontal disease; and (3) previous orthodontic treatment.
CBCT scans (NewTom 5G; NewTom, Verona, Italy) at
a 0.30-mm voxel resolution with the scanning parameter
of 110 kV, 5 mA, were selected from the past orthodontic
records. They were not specifically taken for this research
but to evaluate other craniofacial patterns, for example,
the impacted third molars. The corresponding plaster
casts were also selected. All the CBCT data and plaster
casts were coded and randomized to blind the investiga-
tors who made the measurements.
Andrews' Element III analysis was based on the plas-
ter casts measurements. The facial axis (FA) points were
defined as the midpoint of the buccal groove of the first
permanent molars. The WALA ridge was defined as the
most prominent portion of a mandible's mucogingival
junction. First, distances and angles were measured. A
digital caliper with an accuracy of 0.01 mm was used
to measure the distance between the maxillary FA-FA
points of the bilateral first molars, as well as the distance
between the WALA-WALA ridge at the side of mandib-
ular first molars. An Andrews ruler was used to measure
the angulation between the FA of maxillary first molars
and the occlusal plane. The plastic rod was placed paral-
lel to the FA of the crown; thus, the angulation could be
read on the ruler (Fig 1). Second, researchers estimated
the amount of horizontal change that would occur be-
tween the FA-FA distances when the molars were opti-
mally angulated. According to Andrews' Element III
analysis,7 every 5 molar inclination change indicates
1-mm difference in maxillary width. Then, the estimated
June 2021  Vol 159  Issue 6
760
Fig 1. A, Maxillary FA-FA distance measured by the digital caliper. B, Mandibular WALA-WALA dis-
tance measured by the digital caliper. C and D, The angulation of the bilateral first permanent molars
measured by the Andrews ruler.
amount of change was subtracted from the original FA-
FA distances; the result represents the maxillary width
after decompensation. The mandibular width was the
WALA-WALA distance minus 4 mm. Finally, we sub-
tracted the mandibular width from the maxillary width,
and if the difference is less than 5 mm, the patient was
diagnosed with MTD.7
Yonsei transverse analysis was based on the measure-
ments of CBCT images. The Digital Imaging and Com-
munications in Medicine format CBCT data were
transferred into Materialise's Interactive Medical Image
Control System (MIMICS) (version 19.0; Materialise,
Leuven, Belgium) software package. The estimated CR
points were located at the middle of the root furcation
of the first permanent molars.19 To make the procedure
more precise, the location of the points was checked on
different cutting slices in 3 planes of space, including the
sagittal, coronal, and transverse views. Then the distance
between the estimated CR points could be calculated
automatically in MIMICS (Fig 2). Then we subtracted
the mandibular width from the maxillary width. Accord-
ing to Yonsei Transverse Index, if the difference was less
than 2.26 mm, the patient was diagnosed with
MTD.1,19
All the measurements were carried out by 2 practiced
researchers (C.Z. and X.T.) independently at a 2-week
June 2021  Vol 159  Issue 6 American Journal of Orthodontics and Dentofacial Orthopedics
Zhang et al
interval. The researchers used the same computer, digital
caliper, and Andrews ruler to prevent performance
bias.21 The agreement of dichotomous diagnosis MTD
and harmonious was evaluated with kappa statistics.
Statistical analysis
Sample size calculation for the kappa agreement
evaluation was performed using PASS (version 15.0;
NCSS, LLC, Kaysville, Utah) software, with an alpha of
0.05, power of 0.8, k1 of 0.9, and k0 of 0.7,22 the num-
ber of the subjects should be at least 79. Thus, 80 sub-
jects were included. Statistical analysis was performed
using SPSS (version 21.0; IBM, Armonk, NY) and Mad-
Calc (version 18.11.3; MadLogic, Ostend, Belgium)
software package. The mean of the 2 measurements
of the same examiner at different times was calculated
to represent the final measurement of the examiner.
First, the intraclass correlation coefficients (ICC; 2-
way random, single measurements) were used to assess
the intraexaminer and interexaminer reliability of the
maxillary and mandible width measurements. The
agreement was classified according to the following
ICC values: excellent (.0.9), good (0.75-0.9), moderate
(0.5-0.75), or poor (\0.5).23 A P value less than 0.05
indicated statistical significance. Second, the Bland-
Altman plots were drawn, in which the 95% limits of
Zhang et al 761

Fig 2. A, B, and C, The location of the estimated CR points on the coronal, transverse, and sagittal
view. D, The distance between the points could be calculated digitally in MIMICS.

Table I. Intraexaminer and interexaminer reliability of Andrews’ Element III analysis and Yonsei transverse analysis
Intraexaminer

Examiner A Examiner B Interexaminer

Diagnostic methods ICC 95% CI ICC 95% CI ICC 95% CI

Andrews' Element III analysis Mx 0.94 0.907-0.961 0.894 0.839-0.931 0.937 0.901-0.960
Md 0.916 0.872-0.945 0.871 0.805-0.915 0.918 0.871-0.948
Yonsei transverse analysis Mx 0.988 0.981-0.992 0.986 0.976-0.992 0.989 0.973-0.995
Md 0.991 0.987-0.994 0.966 0.948-0.978 0.985 0.969-0.992
CI, confidence of intervals; Mx, maxillary width; Md, mandibular width.

agreement were defined as the mean difference plus RESULTS

and minus 1.96 times the standard deviation of the dif-
ferences. The bias should ideally be near zero, and the
values between the limits of the agreement lines were
considered to be acceptable. The smaller range between
these 2 limits, the better the agreement.24 Third, after
diagnosis, Cohen's kappa coefficients were calculated
to evaluate the clinical determination of harmonious
vs MTD of the 2 methods. The levels of agreement re-
flected by the kappa values were considered 0-0.20 as
slight, 0.21-0.40 as fair, 0.41-0.60 as moderate, 0.61-
0.80 as substantial, and 0.81-1 as almost perfect
agreement.25
Twenty-nine males and 51 females were included in
this study, with a mean age of 20.16 6 8.22 years. The
clinical examination showed that only 19 of the 80 pa-
tients had posterior crossbites.
The ICC with 95% confidence intervals for intraexa-
miner and interexaminer reliability of the 2 methods
are presented in Table I. The ICC values were all above
0.85, indicating good to excellent reliability. Compared
with Andrews’ Element III analysis, Yonsei transverse
analysis had higher intraexaminer and interexaminer
reliability in both maxillary and mandibular measure-
ments.

American Journal of Orthodontics and Dentofacial Orthopedics June 2021  Vol 159  Issue 6
762 Zhang et al

Fig 3. Bland-Altman plots for evaluating the interexaminer reliability of both methods. For each plot, the
x-axis was set as the mean of both examiners' measurements. The y-axis represents the absolute dif-
ference between the 2 measurements. The blue line represents the bias, and the red dotted lines repre-
sent the upper and lower limits of agreement. The top row shows the interexaminer reliability of
Andrews' Element III analysis for maxillary and mandibular measurements. The bottom row shows
the interexaminer reliability of Yonsei transverse analysis for maxillary and mandibular measurements.

Fig 4. Bland-Altman plots for evaluating the intraexaminer reliability of Andrews' Element III analysis.
For each plot, the x-axis was set as the mean of measurements at different times of 1 examiner. The
y-axis represents the absolute difference between the 2 measurements at different times. The blue line
represents the bias, and the red dotted lines represent the upper and lower limits of agreement. The top
row shows the intraexaminer reliability of examiner A in maxillary and mandibular measurements. The
bottom row shows the intraexaminer reliability of examiner B in maxillary and mandibular measure-
ments.

Figures 3-5 report the Bland-Altman plots of inter- measurements and 6 outliers in mandibular width mea-
examiner and intraexaminer reliability. Figure 3 shows surements. In Yonsei transverse analysis, there were 4
the interexaminer reliability. In Andrews' Element III outliers in maxillary width measurements and only 1 in
analysis, there were 4 outliers in maxillary width mandibular width measurements. Figures 4 and 5

June 2021  Vol 159  Issue 6 American Journal of Orthodontics and Dentofacial Orthopedics
Zhang et al 763

Fig 5. Bland-Altman plots for evaluating the intraexaminer reliability of Yonsei Transverse analysis.
For each plot, the x-axis was set as the mean of measurements at different times of 1 examiner.
The y-axis represents the absolute difference between the 2 measurements at different times. The
blue line represents the bias, and the red dotted lines represent the upper and lower limits of agree-
ment. The top row shows the intraexaminer reliability of examiner A in maxillary and mandibular mea-
surements. The bottom row shows the intraexaminer reliability of examiner B in maxillary and
mandibular measurements.

demonstrate the intraexaminer reliability. For examiner Table II. 2 3 2 kappa agreement table of Andrews
A, there were 4 outliers in maxillary measurements and Element III analysis
3 outliers in mandibular measurements in both methods,
respectively. For examiner B, there were 3 outliers in Examiner B
both methods respectively in maxillary measurements; Examiner A MTD Not MTD Total
4 outliers were in Andrews' Element III analysis and MTD 36 6 42
only 1 outlier in Yonsei transverse analysis in mandibular Not MTD 6 32 38
measurements. Compared with Andrews’ Element III Total 42 38 80
analysis, Yonsei transverse analysis had biases closer to
0 and smaller ranges between the limits.
Using Andrews' Element III analysis, 42 patients were Table III. 2 3 2 kappa agreement table of Yonsei
diagnosed as MTD by examiner A and by examiner B. transverse analysis
Thirty-one patients were diagnosed as MTD by examiner
Examiner B
A and 39 patients were diagnosed as MTD by examiner
B, using Yonsei transverse analysis (Tables II and III). Examiner A MTD Not MTD Total
For Andrews' Element III analysis, the intraexaminer MTD 30 1 31
kappa value was 0.62 in examiner A and 0.67 in exam- Not MTD 9 40 49
Total 39 41 80
iner B; for Yonsei transverse analysis, the intraexaminer
kappa value was 0.82 in examiner A and 0.80 in exam-
iner B. The interexaminer agreements of both methods reliability; furthermore, Yonsei transverse analysis had
reflected by the kappa values were substantial, with higher ICC values. However, studies have shown that
the value of 0.70 in Andrews’ Element III analysis and the ICC values report merely the strength of the relation-
the value of 0.75 in Yonsei transverse analysis (Table IV). ship between 2 variables. To report the actual agreement
in reliability evaluation, the Bland-Altman plots were
DISCUSSION recommended to assist.26 The Bland-Altman plots of
According to the ICC values in Table I, both methods our study, shown in Figures 3-5, indicate high
had good to excellent interexaminer and intraexaminer interexaminer and intraexaminer reliability of both

American Journal of Orthodontics and Dentofacial Orthopedics June 2021  Vol 159  Issue 6
764
Table IV. Kappa values of Andrews’ Element III analysis and Yonsei transverse analysis
Kappa values
Methods Intraexaminer A
Andrews' Element III analysis 0.62
Yonsei transverse analysis 0.82
methods, with biases near zero and few outliers outside
the limits of agreement. Furthermore, Yonsei transverse
analysis had smaller biases, equal or fewer outliers, and
smaller ranges between the 95% limits, indicating
higher reliability. The result was coincident with that
of the ICC values. The higher reliability of Yonsei
transverse analysis may attribute to the precise
location of the CR points on CBCT images using
digital software. By observing sagittal, coronal, and
transverse cross-sectional slices, researchers could be
able to locate and calibrate the estimated CR points in
3-dimensional space on a 2-dimensional computer
screen.19,27 Furthermore, after the location of the points,
the distance between them was calculated digitally by
MIMICS, which could avoid human error to a large
extent. Previous studies have demonstrated that the dis-
tance and angular measurements using 3-dimensional
software have higher reliability than manual plaster
model measurements,28,29 which is in accordance with
the results of our study.
In Andrews' Element III analysis, both intraexaminer
and interexaminer reliability of the mandibular width
measurements was lower than that of the maxillary
width measurements in our study. This finding may be
due to the measuring locations of the WALA ridge at
both sides of the mandibular first permanent molars.
Although the examiners were well trained, the WALA
ridge is inherently a curve in 3 dimensions; the location
of the measuring points on this curve may have greater
variation. However, in maxillary width measurements,
the location of the FA points could have more reproduc-
ibility. Therefore, to increase reliability in mandibular
width measurements in Andrews’ Element III analysis,
clinicians could define the location of the measuring
points more specifically.
In our study, 31-42 patients were diagnosed as MTD
in the 80 patients with skeletal Class I malocclusion, with
only 19 of them have posterior crossbites. At present, no
“gold standard” in MTD diagnosis is available.30 There-
fore, we were unable to determine whether maxillary
transverse deficiency had been overlooked or because
of the systematic bias of the methods. In addition, the
number of subjects in our study is too limited to estimate
June 2021  Vol 159  Issue 6 American Journal of Orthodontics and Dentofacial Orthopedics
Zhang et al
Intraexaminer B Interexaminer
0.67 0.7
0.8 0.75
the prevalence rate in the general population. Previously,
Proffit and White Jr31 claimed that 30% of adult patients
had transverse discrepancy; Kurol and Berglund,32
together with Kisling33 reported a prevalence rate of
13%-23% of posterior crossbites in European children.
Considering the relatively high prevalence rate and
dental compensation, attention should be paid to trans-
verse dimension routinely, even in patients with skeletal
Class I malocclusion. It should be noticed that posterior
crossbites may not be the only reference in MTD diag-
nosis. If plaster casts are available, Andrews’ Element
III analysis can be performed; if the outpatient has
already taken CBCT image because of the impacted teeth
or other dentofacial diseases on their first visit, Yonsei
transverse analysis is also an option.
When evaluating diagnostic methods, validity is
another major factor apart from reliability. In our study,
more patients were diagnosed as MTD in Andrews’
Element III analysis by both examiners. However, it is
unclear which method is more accurate. A “gold stan-
dard” in MTD diagnosis needs to be established. Further
studies about the validity of the 2 methods are needed,
and the sensitivity and specificity shall be calculated.
Although Yonsei transverse analysis had higher reli-
ability and agreement in diagnosis, it is still a
radiation-exposing and relatively expensive method,
compared with making the impressions and measuring
plaster models. Orthodontists ought to choose the diag-
nostic methods wisely with regard to reliability, effi-
ciency, and validity.
CONCLUSIONS
1. Both Andrews' Element III analysis and Yonsei trans-
verse analysis had good to excellent reliability and
substantial kappa agreements. Yonsei transverse
analysis had higher reliability in maxillary and
mandibular width measurements and higher kappa
agreement than Andrews' Element III analysis.
2. Posterior crossbites may not be the only reference in
MTD diagnosis. Cautions need to be paid to the
transverse dimension routinely in orthodontic diag-
nosis.
Zhang et al
AUTHOR CREDIT STATEMENT
Dong-xu Liu contributed to the research design,
manuscript review and revision, and manuscript
approval and submission; Chun-xi Zhang contributed
to the conduction of research, data measurement and
analysis, and discussion of results; Xiao-ming Tan
contributed to the conduction of research and data mea-
surement and analysis; Wei Wu contributed to data
measurement and analysis; Hong Liu contributed to
data analysis and discussion of results; Yi Liu contrib-
uted to data collection and measurement; Xiao-ru Qu
contributed to the discussion of results.
REFERENCES
1. Lee KJ, Choi SH, Choi TH, Shi KK, Keum BT. Maxillary transverse
expansion in adults: rationale, appliance design, and treatment
outcomes. Semin Orthod 2018;24:52-65.
2. McNamara JA. Maxillary transverse deficiency. Am J Orthod Den-
tofacial Orthop 2000;117:567-70.
3. Tamburrino R, Shah S, Fishel D. Periodontal rationale for trans-
verse skeletal normalization. Orthod Pract 2014;5:50-3.
4. Pont A. Der zahn-index in der orthodontie. Zahnartzliche Orthopa-
die 1909;3:306-21: German.
5. Schwarz AM, Gratzinger M. Removable orthodontic appliances.
Philadelphia: Saunders; 1966. p. 64.
6. Howe RP, McNamara JA Jr, O’Connor KA. An examination of
dental crowding and its relationship to tooth size and arch dimen-
sion. Am J Orthod 1983;83:363-73.
7. Andrews LF. The six elements of orofacial harmony. Andrews J
2000;1:13-22.
8. Ricketts RM. Introducing Computerized Cephalometrics. Los An-
geles: Rocky Mountain Data Systems; 1969.
9. Ricketts RM. Perspectives in the clinical application of cephalomet-
rics. The first fifty years. Angle Orthod 1981;51:115-50.
10. Leonardi R, Annunziata A, Caltabiano M. Landmark identification
error in posteroanterior cephalometric radiography. A systematic
review. Angle Orthod 2008;78:761-5.
11. El-Mangoury NH, Shaheen SI, Mostafa YA. Landmark identifica-
tion in computerized posteroanterior cephalometrics. Am J Orthod
Dentofacial Orthop 1987;91:57-61.
12. Malkoc S, Sari Z, Usumez S, Koyuturk AE. The effect of head rota-
tion on cephalometric radiographs. Eur J Orthod 2005;27:
315-21.
13. Tai B, Goonewardene MS, Murray K, Koong B, Islam SMS. The reli-
ability of using postero-anterior cephalometry and cone-beam CT
to determine transverse dimensions in clinical practice. Aust Or-
thod J 2014;30:132-42.
14. Miner RM, Al Qabandi S, Rigali PH, Will LA. Cone-beam computed
tomography transverse analysis. Part I: normative data. Am J Or-
thod Dentofacial Orthop 2012;142:300-7.
15. Miner RM, Al Qabandi S, Rigali PH, Will LA. Cone-beam computed
tomography transverse analyses. Part 2: measures of performance.
Am J Orthod Dentofacial Orthop 2015;148:253-63.
American Journal of Orthodontics and Dentofacial Orthopedics
765
16. Shewinvanakitkul W. A new method to measure buccolingual
inclination using CBCT [thesis]. Cleveland: Case Western Reserve
University; 2009.
17. Kapila SD. Cone beam computed tomography in orthodontics: in-
dications, insights, and innovations. John Wiley & Sons; 2014.
18. Yehya Mostafa R, Bous RM, Hans MG, Valiathan M, Copeland GE,
Palomo JM. Effects of Case Western Reserve University’s transverse
analysis on the quality of orthodontic treatment. Am J Orthod
Dentofacial Orthop 2017;152:178-92.
19. Koo YJ, Choi SH, Keum BT, Yu HS, Hwang CJ, Melsen B, et al. Max-
illomandibular arch width differences at estimated centers of resis-
tance: comparison between normal occlusion and skeletal Class III
malocclusion. Korean J Orthod 2017;47:167-75.
20. Beglin FM, Firestone AR, Vig KW, Beck FM, Kuthy RA, Wade D. A
Comparison of the reliability and validity of 3 occlusal indexes of
orthodontic treatment need. Am J Orthod Dentofacial Orthop
2001;120:240-6.
21. Pannucci CJ, Wilkins EG. Identifying and avoiding bias in research.
Plast Reconstr Surg 2010;126:619-25.
22. de Moraes ME, Hollender LG, Chen CS, Moraes LC, Balducci I. Eval-
uating craniofacial asymmetry with digital cephalometric images
and cone-beam computed tomography. Am J Orthod Dentofacial
Orthop 2011;139:e523-31.
23. Portney LG, Watkins MP. Foundations of Clinical Research: Appli-
cations to Practice. 3rd ed. Upper Saddle River: Prentice Hall; 2009.
24. Bland JM, Altman DG. Statistical methods for assessing agreement
between two methods of clinical measurement. Lancet 1986;1:
307-10.
25. Landis JR, Koch GG. The measurement of observer agreement for
categorical data. Biometrics 1977;33:159-74.
26. Donatelli RE, Lee SJ. How to report reliability in orthodontic
research: part 1. Am J Orthod Dentofacial Orthop 2013;144:
156-61.
27. de Oliveira AEF, Cevidanes LHS, Phillips C, Motta A, Burke B,
Tyndall D. Observer reliability of three-dimensional cephalometric
landmark identification on cone-beam computerized tomography.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:
256-65.
28. Costalos PA, Sarraf K, Cangialosi TJ, Efstratiadis S. Evaluation of
the accuracy of digital model analysis for the American Board of
Orthodontics objective grading system for dental casts. Am J Or-
thod Dentofacial Orthop 2005;128:624-9.
29. Nouri M, Abdi AH, Farzan A, Mokhtarpour F, Baghban AA. Mea-
surement of the buccolingual inclination of teeth: manual tech-
nique vs 3-dimensional software. Am J Orthod Dentofacial
Orthop 2014;146:522-9.
30. Sawchuk D, Currie K, Vich ML, Palomo JM, Flores-Mir C. Diag-
nostic methods for assessing maxillary skeletal and dental trans-
verse deficiencies: a systematic review. Korean J Orthod 2016;
46:331-42.
31. Proffit WR, White RP Jr. Who needs surgical-orthodontic treat-
ment? Int J Adult Orthodon Orthognath Surg 1990;5:81-9.
32. Kurol J, Berglund L. Longitudinal study and cost-benefit analysis
of the effect of early treatment of posterior cross-bites in the pri-
mary dentition. Eur J Orthod 1992;14:173-9.
33. Kisling E. Occlusal interferences in the primary dentition. ASDC J
Dent Child 1981;48:181-91.
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