Marcello M. | January 30, 2026
Cephalometric analysis is a powerful diagnostic tool in orthodontics. However, when misused or oversimplified, it can easily lead to incorrect diagnoses and inappropriate treatment plans. Most errors do not originate from the cephalometric method itself, but from how measurements are selected, interpreted, or integrated into the clinical context.
Below are nine common cephalometric errors, illustrated with clinical examples, to highlight how misinterpretation can affect real-world orthodontic decision-making.
The error: Interpreting a single value without considering the rest of the cephalometric analysis.
Clinical example: A patient presents with an increased MMPA and is diagnosed as having a vertical growth pattern. However, FMA and SN–GoGn values are within normal limits, and facial analysis shows balanced vertical proportions.
Key lesson: Vertical diagnosis must be based on multiple indicators, not one isolated angle.
The error: Attempting to force measurements into normative ranges.
Clinical example: A patient with a naturally low mandibular plane angle and strong musculature shows stable occlusion. Treatment aims to increase vertical dimension to match norms, resulting in instability and relapse.
Key lesson: Norms are references, not mandatory treatment goals.
The error: Relying primarily on cephalometric tracings for diagnosis.
Clinical example: ANB suggests skeletal Class II, but the patient presents with a harmonious profile, balanced lips, and a functional mandibular shift.
Key lesson: Cephalometric findings must always be confirmed clinically.
The error: Inconsistent or imprecise landmark placement.
Clinical example: Minor variations in Gonion or Menton placement lead to significant changes in mandibular plane angle and vertical classification.
Key lesson: Precision and consistency in landmark identification are essential, especially in digital analysis.
The error: Assuming cranial base morphology is uniform across patients.
Clinical example: A low ANB suggests Class III, but cranial base length and inclination are atypical. Wits appraisal and facial analysis indicate a milder discrepancy.
Key lesson: Cranial base–related measurements should be interpreted cautiously and supported by additional indicators.
The error: Confusing dental adaptations with skeletal relationships.
Clinical example: ANB appears normal, but incisor inclinations reveal severe dental compensation masking an underlying skeletal Class III pattern.
Key lesson: Dental and skeletal analyses must always be interpreted together.
The error: Using cephalometric values to predict growth outcomes.
Clinical example: A patient with a high mandibular plane angle is expected to develop severe vertical growth, yet growth slows and mandibular rotation stabilizes over time.
Key lesson: Cephalometrics describe current relationships; they do not reliably predict future growth.
The error: Relying on a single cephalometric record.
Clinical example: Post-treatment changes in facial height cannot be attributed confidently to growth or mechanics without pre-treatment and interim comparisons.
Key lesson: Longitudinal analysis is essential for accurate interpretation.
The error: Accepting automated results without critical interpretation.
Clinical example: Software reports normal sagittal values, yet clinical examination reveals functional shifts and asymmetry.
Key lesson: Digital tools support diagnosis, but clinical judgment remains indispensable.
Most cephalometric errors are not technical but interpretative. They occur when numerical values are isolated from facial analysis, clinical examination, and longitudinal assessment.
When used critically and contextually, digital cephalometry remains an essential diagnostic resource, supporting precise, individualized, and stable orthodontic treatment planning.
