Effects of changes in the frankfort horizontal plane definition on the three-dimensional cephalometric evaluation of symmetry

Utkarsh Mangal, Jae Joon Hwang, Heon Jo, Sung Min Lee, Yun Hoa Jung, Bong Hae Cho, Jung Yul Cha, Sung Hwan Choi

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The plane formed by the intersection of bilateral porions (PoR and PoL) and left orbitale (OrL) is conventionally defined as the Frankfort horizontal (FH) plane. We aim to test the influence of the FH plane definition on a 3D cephalometric assessment. We selected 38 adult patients (20 males, 18 females; average age: 22.87 ± 5.17 years) without any gross asymmetry from retrospective records and traced and analyzed their cone-beam computed tomographic images. The findings were categorized into the following four groups: FH1: conventional; FH2: PoR, PoL, right orbitale (OrR); FH3: OrR, OrL, PoL; FH4: OrR, OrL, PoR. The average menton (Me) deviation from the MSP was statistically significant for the FH1 group (0.56 ± 0.27 mm; p < 0.001), compared to the FH3 (1.37 ± 1.23 mm) and FH4 (1.33 ± 1.16 mm) groups. The spatial orientation level (SOL) of the FH plane showed a marked difference (p < 0.05) between the FH2 (0.602 ± 0.503) and FH4 (0.944 ± 0.778) groups. The SOL of the MSP was comparatively small (p < 0.001) for FH2 (0.015 ± 0.023) in comparison to both FH 3 (0.644 ± 0.546) and FH 4 (0.627 ± 0.516). Therefore, the FH plane definition can significantly influence the interpretation of cephalometric findings. Future studies should focus on standardization to improve the reliability and reproducibility of 3D cephalometry.

Original languageEnglish
Article number7956
Pages (from-to)1-12
Number of pages12
JournalApplied Sciences (Switzerland)
Issue number22
Publication statusPublished - 2020 Nov 2

Bibliographical note

Funding Information:
Funding: This research was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, the Republic of Korea (grant number: HI20C0611).

Publisher Copyright:
© 2020 by the authors. Licensee MDPI, Basel, Switzerland.

All Science Journal Classification (ASJC) codes

  • Materials Science(all)
  • Instrumentation
  • Engineering(all)
  • Process Chemistry and Technology
  • Computer Science Applications
  • Fluid Flow and Transfer Processes


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