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Original Research

Open Access

Commercial artificial intelligence lateral cephalometric analysis: part 1—the possibility of replacing manual landmarking with artificial intelligence service

  • Jaesik Lee1,†
  • Seong-Ryeol Bae2,†
  • Hyung-Kyu Noh2,*,

1Department of Pediatric Dentistry, School of Dentistry, Kyungpook National University, 41940 Daegu, Republic of Korea

2Department of Orthodontics, School of Dentistry, Kyungpook National University, 41940 Daegu, Republic of Korea

DOI: 10.22514/jocpd.2023.085 Vol.47,Issue 6,November 2023 pp.106-118

Submitted: 10 April 2023 Accepted: 12 May 2023

Published: 03 November 2023

*Corresponding Author(s): Hyung-Kyu Noh E-mail:

† These authors contributed equally.


Artificial intelligence (AI) technology has recently been introduced to dentistry. AI-assisted cephalometric analysis is one of its applications, and several commercial AI services have already been launched. However, the performance of these commercial services is still unclear. This study aimed to determine whether commercially available AI cephalometric analysis can replace manual analysis by human examiners. Eighty-four pretreatment lateral cephalograms were traced and examined by two orthodontists and four commercial AIs, and 13 commonly used cephalometric variables were calculated. Then, the Bland-Altman analysis was conducted to evaluate systematic and random errors between examiners. The interchangeability of an AI was determined if the random errors of the AI were smaller than the clinically acceptable limits derived from the random errors between human examiners. Finally, the inter-examiner reliability index was calculated, and Cohen’s kappa was determined to assess the actual classification reliability of each examiner. The systematic errors of the AIs were clinically insignificant in general. However, the random errors of the AIs were approximately twice those of human examiners, which did not satisfy the interchangeability condition. Furthermore, even though the reliability indices of the AIs were in the good-to-excellent range, their classification reliability was unacceptable. Commercial AI is still at a level that makes it challenging to replace manual landmarking by human experts. Thus, a human examiner’s landmark position review is mandatory when using commercial AIs.


Cephalometric; Artificial intelligence; Accuracy; Precision; Reliability

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Jaesik Lee,Seong-Ryeol Bae,Hyung-Kyu Noh. Commercial artificial intelligence lateral cephalometric analysis: part 1—the possibility of replacing manual landmarking with artificial intelligence service. Journal of Clinical Pediatric Dentistry. 2023. 47(6);106-118.


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