Artificial Intelligence Methods in Cephalometric Image Analysis—A Systematic Narrative Review

TL;DR

This paper reviews how artificial intelligence is being used to analyze cephalometric images in orthodontics, showing that AI tools can match expert accuracy and improve efficiency.

Contribution

The paper systematically reviews recent AI methods applied to cephalometric analysis, highlighting their clinical accuracy and potential for workflow improvement.

Findings

AI models like CNN and YOLO achieve clinically acceptable accuracy in landmark detection with 1-2 mm errors.

ANN models for cervical vertebral maturity classification reach up to 95% accuracy.

Semi-automated AI systems significantly reduce analysis time while maintaining expert-level agreement.

Abstract

Background: The dynamic development of information technologies, particularly in the fields of computer image analysis and artificial intelligence (AI) algorithms, plays an increasingly important role in orthodontic diagnostics. Cephalometric images constitute a fundamental element in orthodontic treatment planning. They contain encoded information related to the assessment of craniofacial growth and development, which is the focus of algorithms employing machine learning and process automation. Objectives: The aim of this paper is to present the current state of knowledge regarding the application of artificial intelligence methods in cephalometric image analysis, with particular emphasis on studies published between 2020 and 2025 in the Scopus and Web of Science databases. Results: Twenty key studies were included. The most commonly used models were convolutional neural networks (CNN), You Only Look Once (YOLO), Bayesian convolutional neural networks (BCNN), artificial neural networks (ANN), stacked hourglass networks, and Deep Neural Patchworks (DNP). In landmark detection tasks, the average location errors ranged from 1 to 2 mm compared to expert annotations, remaining within clinically acceptable limits. YOLO- and CNN-based systems achieved accuracy comparable to that of experienced orthodontists, while BCNN models additionally provided uncertainty estimates that improved clinical interpretability. In classification tasks, artificial neural network (ANN) models assessing cervical vertebral maturity (CVM) achieved an accuracy of up to 95%. In screening studies prior to orthognathic surgery, a multilayer perceptron combined with a regional convolutional neural network achieved 96.3% agreement with expert decisions. Conclusions: AI-based tools provide clinically acceptable accuracy in cephalometric analysis, with landmark detection errors typically ranging from 1 to 2 mm compared to expert assessment. These systems improve repeatability and significantly reduce analysis time, especially when used in semi-automated workflows. AI-based assessment of cervical vertebral maturity and surgical eligibility shows high agreement with expert decisions, confirming their role as reliable tools to support clinical decision-making. Nevertheless, broader validation in different patient populations is necessary before routine clinical implementation.