It’s important that data be gathered to test the efficacy of the various methods of correction, including anything that you are trying yourself. There is collection of objective evidence, objective ways to analyse the evidence, and ways to share it.
Evidence Collection
It is important to have before and after evidence. Often times treatment uses hard-evidence scans before treatment and then downgrades to soft evidence like photos or ancedotes after. Get hard evidence scans before, during (if feasible), and after treatment
Cephalometric Radiographs (Normal XRay)
This is essentially an X-Ray of the head, in most cases done with a side view down the centerline of the skull so that you can conduct a cepholemetric analysis or superimposition (see below)
Pros:
- Standardized and widely used in orthodontics.
- Relatively low radiation exposure.
- Cost-effective and accessible in most clinical settings.
Cons:
- Two-dimensional, lacking depth information.
- Distortion and magnification errors are possible.
- Limited in ability to see soft tissue (non-bone) structures.
Cone-Beam Computed Tomography (CBCT)
CBCT is a large step up in terms of evidence collection: Instead of capturing a single slice of the skull / body, many slices are taken - each individual slice can be used for analysis (including cephelometric analysis, see below)
Pros:
- Provides three-dimensional visualization of craniofacial structures.
- Lower radiation dose compared to conventional CT.
- Allows volumetric analysis of skeletal structures, airway, and temporomandibular joints.
- Useful for precise surgical and orthodontic treatment planning.
Cons:
- Higher radiation dose than standard radiographs.
- Not ideal for repeated use in young patients.
- Limited capacity for soft tissue evaluation.
Conventional Computed Tomography (CT)
Conventional CT scans provide highly detailed cross-sectional and volumetric images of both bone and soft tissue. While CT offers superior resolution compared to CBCT, it has a substantially higher radiation dose.
Pros:
- High-resolution images of both hard and soft tissues.
- Accurate cross-sectional and volumetric data.
- Valuable for complex craniofacial anomalies, trauma cases, and surgical planning.
Cons:
- Substantially higher radiation exposure than CBCT or radiographs.
- Expensive and less accessible in non-hospital settings.
Magnetic Resonance Imaging (MRI)
MRI represents a non-radiographic modality capable of generating high-resolution images of soft tissue structures. MRIs do not provide as much bone information as CT or CBCT, older methods only display bone as void. Yet newer methods do get a good amount of bone position information, and new techniques like full body MRI can be very valuable to assess wholistic changes. MRI also does not have ionizing radiation, makes it a valuable option for repeated assessments.
Pros:
- No radiation exposure.
- Superior imaging of soft tissues, including muscles, cartilage, and temporomandibular joints.
- Suitable for repeated evaluations without health risks.
Cons:
- Limited resolution for bony structures.
- More costly and less accessible than X-ray–based methods.
- Longer scan times; may be challenging for children or uncooperative patients.
Ultrasound Imaging
Ultrasound offers a radiation-free method for evaluating superficial craniofacial structures. It has been applied in the assessment of soft tissue thickness, muscle dynamics, and certain aspects of temporomandibular joint function. While non-invasive and widely accessible, its limited penetration and operator dependency constrain its utility for comprehensive craniofacial evaluation.
Pros:
- Completely radiation-free and safe for all ages.
- Portable, accessible, and cost-effective.
- Effective for superficial soft tissues and certain aspects of joint assessment.
Cons:
- Operator-dependent, requiring skill for reliable results.
- Limited penetration into deeper skeletal structures.
- Not comprehensive for full craniofacial analysis.
Three-Dimensional Surface Scanning
Advances in optical scanning technologies, such as laser and structured-light systems, have enabled the capture of detailed three-dimensional representations of the external face. These scans are particularly effective for analyzing symmetry, contour, and soft tissue changes following growth or treatment. However, surface scanning does not provide information about skeletal structures, and is therefore most effective when combined with radiographic modalities.
Pros:
- Non-invasive and radiation-free.
- High accuracy for facial symmetry, contour, and soft tissue evaluation.
- Useful for documenting aesthetic outcomes and growth-related changes.
- Quick and comfortable for patients.
Cons:
- Provides no information about underlying skeletal structures.
- Accuracy may be affected by lighting or patient movement.
- Requires integration with radiographic imaging for comprehensive analysis.
Dental Casts and Digital Models
These are physical or digital impressions taken of the teeth, palate, jaws, and anywhere else the cast or scanner can reach. Physical impressions taken using plaster or other methods are a good snapshot of the inside of the mouth, while digital models can be extremely high resolution and show the colour/health of the soft tissue/gums as well. Physical impressions have to be taken skillfully, digital impressions are more full-proof
Pros:
- Provide precise documentation of dental arches, occlusion, and tooth alignment.
- Allow direct measurement of arch width, tooth size, and spacing.
- Digital models facilitate storage, replication, and superimposition for longitudinal comparisons.
- Enable virtual treatment planning and simulation of orthodontic outcomes.
Cons:
- Focus limited to dentoalveolar changes; do not capture craniofacial skeletal structures.
- Physical casts require storage space and are prone to damage or loss.
- Digital models require specialized equipment and software.
- Accuracy may vary depending on impression or scanning technique.
Bite Records (Occlusal Records)
The image above is a home version of a bite registered on paper, but dental/orthodontic/clinical practices will also have bite registration paper for one or more areas of the teeth. Though not the best method, it’s better than nothing.
Pros:
- Easy to do, even at home
- Provide a reference for occlusal changes during or after treatment.
Cons:
- Do not provide information on craniofacial skeletal or soft tissue structures.
- Accuracy is highly dependent on material properties and operator technique.
- Records may distort or wear over time if not stored properly.
- Limited usefulness as a standalone tool; should be integrated with casts, scans, or other scans.
Photographic Records
Be careful with this one! It’s good to take these as evidence, but both for yourself and when reviewing the evidence/results of others, be very very critical of photographic evidence. There are a huge amount of factors that make this very unreliable, including things invisible to someone looking at the picture : A different lense or field of view can make a huge difference, as can lighting or slight adjustments in the angle of the camera or person. It’s very, very difficult to take comparable photographs and virtually no photo proof would be considered scientifically acceptable do to how large the virtually uncontrollable variation is between pictures taken months apart.
Pros:
- Non-invasive and radiation-free.
- Useful for evaluating facial aesthetics, symmetry, and soft tissue changes over time.
- Easy to obtain, repeat, and store.
- Valuable for patient communication and treatment documentation.
Cons:
- Soft tissue changes can be mistaken for bone changes.
- Provide external surface information only; skeletal structures cannot be assessed.
- Lots of hard to control variability in lighting, head positioning, camera angle, lense etc.
- Limited clinical value without integration with skeletal and dental records.
Analysis
2D Cephalometric Analysis
Whole Body Breathing Offers Cephelometric and Face analysis. Click here
Cephalometric analysis is a standardized method of evaluating craniofacial morphology using lateral and, less commonly, posteroanterior radiographs. By identifying and measuring anatomical landmarks on skeletal, dental, and soft tissue structures, clinicians and researchers can assess craniofacial growth patterns, diagnose malocclusions, and plan orthodontic or surgical interventions.
Cephalometric analysis is a standardized method of evaluating craniofacial morphology using lateral and, less commonly, posteroanterior radiographs. By identifying and measuring anatomical landmarks on skeletal, dental, and soft tissue structures, clinicians and researchers can assess craniofacial growth patterns, diagnose malocclusions, and plan orthodontic or surgical interventions.
The analysis typically involves tracing craniofacial landmarks, constructing reference planes, and calculating angular and linear measurements. These measurements allow for the evaluation of relationships between the maxilla, mandible, cranial base, dentition, and facial profile. Serial cephalograms enable longitudinal studies of growth and treatment outcomes, providing insight into both natural developmental processes and treatment-induced changes.
Although cephalometric analysis remains a cornerstone of orthodontics and craniofacial research, its accuracy is influenced by radiographic technique, patient positioning, and the inherent limitations of two-dimensional imaging.
Pros
- Standardization: Provides a reproducible and widely accepted method for assessing craniofacial relationships.
- Growth assessment: Enables longitudinal monitoring of skeletal and dental changes over time.
- Treatment planning: Critical for orthodontic diagnosis, surgical evaluation, and prediction of treatment outcomes.
- Accessibility: Radiographs are relatively inexpensive, quick to obtain, and widely available.
- Educational value: Serves as an effective teaching and communication tool for clinicians, students, and patients.
Cons
- Two-dimensional imaging: Lacks depth information, leading to distortion and superimposition of bilateral structures.
- Magnification and distortion errors: Accuracy depends on precise patient positioning and equipment calibration.
- Radiation exposure: Though relatively low, repeated imaging contributes to cumulative exposure, particularly in young patients.
- Soft tissue limitations: Provides limited accuracy in assessing facial soft tissue compared to three-dimensional methods.
- Population-specific norms: Standard reference values may not be universally applicable across diverse populations.
3D Cephalometric Analyis
Three-dimensional (3D) cephalometric analysis, most commonly performed with Cone-Beam Computed Tomography (CBCT), allows volumetric evaluation of craniofacial structures without the distortion or superimposition inherent in two-dimensional radiographs. By identifying landmarks directly in three planes of space, clinicians can assess skeletal relationships, asymmetry, airway dimensions, and soft tissue contours with greater precision, making it a valuable tool in complex orthodontic and surgical cases.
Pros
- Provides true three-dimensional visualization of craniofacial structures.
- Eliminates distortion and landmark superimposition found in 2D radiographs.
- Allows assessment of asymmetry, volumetric airway analysis, and soft tissue integration.
- Enhances precision in orthodontic diagnosis and surgical planning.
Cons
- Higher radiation exposure than conventional cephalometric radiographs.
- More costly and less widely available than 2D imaging.
- Requires advanced software and technical expertise for analysis.
- Not always necessary for routine orthodontic assessment.
2D Superimposition
In conventional cephalometry, 2D superimposition is performed on serial lateral or posteroanterior radiographs. Landmarks and reference planes (such as the sella–nasion line or palatal plane) are used to align images. Changes in skeletal or dental position are then interpreted from traced overlays.
Pros:
- Established and widely used in orthodontics.
- Relatively simple, inexpensive, and fast.
- Allows visualization of growth or treatment effects over time.
- Supported by well-documented reference standards.
Cons:
- Superimposition accuracy limited by distortion, magnification, and patient positioning.
- Overlapping bilateral structures obscure detail.
- Provides only projected changes, lacking depth information.
- Less accurate for assessing asymmetry or complex three-dimensional changes.
3D Superimposition
With CBCT or 3D surface scans, superimposition can be performed volumetrically using stable craniofacial regions (e.g., cranial base) as reference structures. Advanced software aligns scans in three planes of space, enabling visualization and quantification of skeletal, dental, and soft tissue changes without projection errors.
Pros:
- Provides true spatial assessment of changes in all three dimensions.
- Eliminates distortion and landmark superimposition found in 2D.
- Allows precise evaluation of asymmetry, rotations, and volumetric changes.
- Useful for complex cases, surgical planning, and airway or soft tissue analysis.
Cons:
- Requires CBCT or similar imaging, which involves higher radiation than 2D.
- More costly and less accessible than traditional cephalometry.
- Demands specialized software and technical expertise.
- Increased data complexity may lengthen analysis time.
Photo LandMark Analysis
Photographic facial landmark analysis involves the identification of reproducible soft tissue reference points on standardized two-dimensional facial photographs. These landmarks—such as the nasion, subnasale, labiale superius, pogonion, and gonion—are used to calculate linear distances, angles, and proportional indices. The method allows clinicians and researchers to evaluate facial symmetry, soft tissue balance, and aesthetic changes associated with growth or treatment. Photographic analysis is widely applied in orthodontics, maxillofacial surgery, and anthropometry due to its non-invasive and accessible nature.
Pros
- Non-invasive and radiation-free: Safe for all ages and suitable for repeated use.
- Accessible and cost-effective: Requires only standardized photography equipment.
- Soft tissue focus: Captures aesthetic outcomes and facial balance, which skeletal imaging alone cannot provide.
- Longitudinal tracking: Enables comparison of facial changes over time when standardized protocols are followed.
- Patient communication: Provides a visual tool to discuss treatment goals and outcomes.
Cons
- Two-dimensional projection: Lacks depth and cannot capture three-dimensional spatial changes.
- Technique-sensitive: Accuracy depends on consistent head positioning, lighting, and camera calibration.
- No skeletal detail: Limited to external morphology; cannot assess underlying bone changes.
- Variability: Expressions, posture, or slight head tilts can alter landmark positions and reduce reliability.
- Reduced precision: Less accurate than 3D surface scans for detailed symmetry or contour analysis.
Sharing
Much of the profesionally taken evidences/scans will come in the form of a DICOM file. The following resource will let you upload your DICOMs, they will become anonymous, and you can then share the DICOMs with anyone.
https://www.dicomlibrary.com/
https://www.dicomlibrary.com/
The Whole Body Breathing Integrated Health Project is currently exploring ways to further ease (optionally) anonymous sharing of the results of various treatments.