Although digital radiographs and cephalometric analysis software are becoming increasingly popular in orthodontic offices, there is little information concerning their reliability of measurement of soft tissue or concerning comparison with conventional techniques. Our study shows good reliability of each imaging system (conventional and storage phosphor digital) and cephalometric analysis modality (manual tracing, Dolphin Imaging v. 7.0 and Vistadent Image Management system v. 8.0) with no statistical differences in reliability among the modalities. In the second part of our research comparing the means of the modalities using different subjects, there was no difference in mean Dolphin scanned values when compared with manual traced values whereas the other imaging modalities (Dolphin digital, Vistadent scanned, and Vistadent digital) were significantly different from the manual traced values. Dolphin digital was significantly different from Vistadent scanned and Vistadent digital, although there were no differences between Vistadent scanned and digital. In general, except for facial angle, these differences in modalities do not appear to be clinically significant.
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