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

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.