Chinese Journal of Tissue Engineering Research ›› 2026, Vol. 30 ›› Issue (10): 2459-2465.doi: 10.12307/2026.624

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Accuracy of a real-time registration system based on orthodontic landmarks

Huang Juneng1, Zeng Jingjie2, Peng Ying1, Lu Wenrong3, Tang Min2, Zhang Xuejun1   

  1. 1Guangxi University, Nanning 530004, Guangxi Zhuang Autonomous Region, China; 2Guangxi Medical University Stomatological Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China; 3First People’s Hospital of Hechi City, Hechi 547000, Guangxi Zhuang Autonomous Region, China
  • Received:2025-03-14 Accepted:2025-06-18 Online:2026-04-08 Published:2025-08-28
  • Contact: Tang Min, MD, Chief physician, Guangxi Medical University Stomatological Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China Co-corresponding author: Zhang Xuejun, MD, Professor, Guangxi University, Nanning 530004, Guangxi Zhuang Autonomous Region, China
  • About author:Huang Juneng, MS, Guangxi University, Nanning 530004, Guangxi Zhuang Autonomous Region, China Zeng Jingjie, MS, Physician, Guangxi Medical University Stomatological Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China Huang Juneng and Zeng Jingjie contributed equally to this work.
  • Supported by:
    Guangxi Medical and Healthcare Appropriate Technology Development and Promotion Application Project, No. S2023094 (to TM); National Clinical Key Specialty Construction Project, No. CZ000037 (to TM)

Abstract: BACKGROUND: The superimposition of consecutive cephalometric lateral radiographs is commonly used in orthodontics to assess the outcomes of orthodontic/orthopedic treatments and changes in growth and development. The key factors affecting the accuracy of cephalometric superimposition are landmark localization errors and registration methods. Currently, there is no highly accurate registration system. 
OBJECTIVE: To study a real-time registration system that guides the adjustment of landmark localization on cephalometric lateral radiographs to assist in improving registration accuracy and evaluate the precision of this registration method. 
METHODS: Pre- and post-treatment cephalometric lateral radiographs of 40 adult patients were selected according to the inclusion criteria. Landmark localization on the pre- and post-treatment radiographs was performed using Labelme software. Real-time visualized registration software was developed using Python, Opencv, and PyQT. Registration was performed using the SellaNasion (SN) superimposition method, the Least Squared Averaged 5 Landmarks (LS-5) method, and the Real-time Least Squared Averaged 5 Landmarks (LS-5R) method. The distance errors and the success detection rate of landmarks anterior nasal spine (ANS), posterior nasal spine (PNS), upper alveolar seat point (A), lower alveolar seat point (B), point of anterior chin (Pog) were measured and compared to evaluate the registration accuracy.
RESULTS AND CONCLUSION: The LS-5R method exhibited the smallest landmark distance errors. Compared with the SN method, all landmark distance errors showed statistically significant differences (P < 0.05). The distance errors of PNS, A, B, and Pog landmarks with the LS-5R method were statistically different from those with the LS-5 method (P < 0.05), and the differences increased in sequence. The success detection rate of automatic landmark detection within 1mm, 2mm, and 3mm accuracy ranges was higher for the LS-5R method than for the SN superimposition method. The LS-5R method has smaller superimposition errors compared with the traditional SN method, making it a potentially more reliable method for superimposing consecutive cephalometric lateral radiographs in clinical practice.

Key words: lateral cephalogram, superimposition, multi-point registration, real-time registration, accuracy

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