History of Orthodontics in Brazil - Postgraduate Education.

Orthodontics in Brazil underwent significant transformations in the 1950s when several dentists returned to the country after completing advanced education courses in the specialty abroad. The first two orthodontic associations, in Rio de Janeiro and São Paulo, were constituted in 1955 and 1959. The specialty's first event with characteristics of a professional meeting occurred in São Paulo in 1957, and Postgraduate Orthodontic education became available. This paper aims to describe the central insights of the constitution and evolving of the education of Orthodontics in Brazil.

Cone-beam computed tomography use in postgraduate orthodontic programs in North America and Europe.

OBJECTIVES: Cone-beam computed tomography (CBCT) has emerged over recent decades as a rapid acquisition technology that allows practitioners to view the craniofacial complex in high spatial detail. This study aimed to assess the latest trend of CBCT use in postgraduate orthodontic programs in North America and Europe/Australia. METHODS: An electronic multiple-choice survey was sent via email requesting anonymous participation of postgraduate orthodontic program directors: 73 in North America (as listed on the American Association of Orthodontists website) and 189 in Europe/Australia (as listed on the European Orthodontic Society website). Survey collection was over a 2-month period with two follow-up emails sent 2 weeks and 1 month after the initial email to each program director who had not responded. Responses were collected directly on Qualtrics for analysis. RESULTS: The response rate was 46.6% (34 responses) for North America and 11.1% (21 responses) for Europe/Australia. Results revealed that 100% of respondents from North America had access to a CBCT scanner, while 90.48% of respondents (19 responses) from Europe/Australia had access. Most North American postgraduate orthodontic programs have CBCT scanners within their clinic, while most European/Australian programs do not, and they refer patients to the radiology department. Although there is a higher percentage of programs in North America compared to Europe/Australia that use CBCT as part of routine orthodontic records for all patients, most programs in both regions use CBCT imaging for specific diagnostic purposes and not for routine records. CONCLUSION: Overall, North American programs have more access to CBCT scanners in postgraduate clinics and use CBCT imaging more routinely than European/Australian programs.

Orthodontic clinicians' attitudes and knowledge of dentogingival aesthetics: A cross-sectional survey of BOS members.

OBJECTIVE: To assess orthodontic clinicians' knowledge and attitudes towards dentogingival aesthetics and to explore characteristics that predict the knowledge of dentogingival aesthetics. DESIGN: Cross-sectional questionnaire. SETTING: On-line survey of members of the British Orthdontic Society. MATERIALS AND METHODS: An 11-item online questionnaire was sent to orthodontic practitioners for completion. The questionnaire covered respondent demographics and questions relating to both knowledge and attitudes towards dentogingival aesthetics (six parameters). Descriptive statistics were calculated for study characteristics and summary values for the survey items. Responses to the eight knowledge-based questions were converted to a binary outcome (correct and incorrect answer). The maximum score that could be achieved was eight. Multivariable modelling was used in order to examine associations between the study characteristics and the aggregate score. RESULTS: A total of 252 responses were obtained resulting in a response rate of 17%. Within this cohort, the respondents were primarily women (52.8%) and aged 30-40 years (35.7%). The mean score for the eight knowledge-based questions was 3.8 ± 1.8 (range = 0-8). Knowledge of the ideal gingival margin position of the anterior teeth was high (92.4%). Knowledge of the other five dentogingival aesthetic parameters was variable. In the multivariable analysis, lower knowledge scores were predicated by respondents who did not have a special interest in dental aesthetics (-0.54; 95% confidence interval [CI] = -1.01 to -0.07; P = 0.02), who could not recall attending courses, lectures or seminars on dental aesthetics in the past five years (-0.80; 95% CI = -1.43 to -0.17; P = 0.01) and with increasing age (-0.43; 95% CI = -0.62 to -0.23; P < 0.001). CONCLUSION: Knowledge of ideal dentogingival parameters is generally suboptimal among orthodontists in the UK. The reported lack of knowledge of the ideal dentogingival parameters may also influence respondents' attitudes towards the importance of dentogingival aesthetics. Further teaching or courses related to dentogingival aesthetics is desired by orthodontic clinicians.

Royal London Space Planning as a learning tool for postgraduate Orthodontic students. A mixed methods study.

OBJECTIVE: To assess the effectiveness of the Royal London Space Planning (RLSP) as a learning tool among postgraduate orthodontic students as well as investigate students' attitudes to its use. The RLSP tool is a structured method of orthodontic case assessment and treatment planning. DESIGN: A prospective cohort study of first year postgraduate orthodontic students who attended teaching of the RLSP. SETTING: Postgraduate teaching institute. PARTICIPANTS: First year postgraduate orthodontic students. METHODS: The outcome measured was the accuracy in assessment and planning of a standardised orthodontic simulated case before and after teaching. Qualitative assessment was conducted through focus group and a semi-structured format after the teaching. RESULTS: Nineteen students were included in the study. There was an overall improvement in assessment and planning of 20% after the teaching intervention (P < 0.05). Assessment improved by 34% in comparison to treatment planning, which improved by 17% (P < 0.05). The impact of the RLSP was most noticeable on the assessment of crowding in the lower arch which improved by 37% after teaching (P < 0.05). Students felt using the RLSP tool made them more confident and was advantageous to use in training; most felt they would not use the tool after qualification. CONCLUSION: The RLSP tool is an effective method of teaching assessment and treatment planning to postgraduate orthodontic students. The effect of the RLSP is greater at assessments and less significant for treatment planning. The participant students felt the RLSP improved their confidence in assessment and treatment planning.

Current status of undergraduate orthodontic education in Canada.

PURPOSE: This study evaluated teaching hours and mode of instruction of undergraduate orthodontic education dental students in Canada receive, changes implemented by each educational dental institution (EDI) in response to the COVID-19 pandemic, and plans for mode of orthodontic education delivery post-COVID-19. METHODS: An electronic survey was administered to the program directors of undergraduate orthodontics at each EDI to reveal details regarding the (i) time and details of didactic, preclinical, and clinical experience provided to students and (ii) perceptions of undergraduate program directors about the adequacy of the current curricula. RESULTS: All 10 Canadian EDIs participated in the survey during the year 2021. Most EDIs deliver their orthodontic curricula beginning in the second year of the program (7, 70.0%), continuing through third (7, 70.0%) and fourth (6, 60.0%) years. The number of hours of didactic, preclinical, and clinical instruction varied by as much as 50 h per academic year across different EDIs. In response to the COVID-19 pandemic, almost all EDIs (9, 90.0%) maintained the same amount of didactic lecture time yet most switched to synchronous (5, 50.0%) or asynchronous (3, 30.0%) online delivery format. Most EDIs (8, 80.0%) indicated the quality of education was maintained during the pandemic. CONCLUSIONS: There exists significant variation in undergraduate orthodontic time allotment among Canadian EDIs. During the COVID-19 pandemic, most Canadian EDIs maintained a consistent amount of teaching hours while transitioning to some form of online course delivery. Most program directors indicated they believed students received the same quality of education after the change in mode of course delivery. The future of undergraduate orthodontic education will likely continue the accelerated trend toward online education.

Making competency-based predoctoral orthodontics fun: Introducing Dealodontics.

OBJECTIVES: Dealodontics is a card game developed at New York University College of Dentistry for dental students to reinforce and apply basic orthodontic concepts. Dealodontics incorporates clinical photographs and questions to assess students' skills in diagnosis and patient management. The game was designed to be an enjoyable, interactive, and collaborative learning experience, supplementing competency-based instruction. The purpose of this project was to present this novel educational method and to evaluate dental students' engagement and game-playing experience. METHODS: The survey was modeled after the "Game Experience Questionnaire" and followed the same methodology collapsing 16 survey questions into eight categories. The 5-point Likert scale was collapsed into a 3-point graduated scale (negative, neutral, and positive). Results were tabulated and scored using methods developed by IJsselsteijn et.al. Comparisons were made between two years: 2019 (N = 385) and 2021 (N = 245). Additionally, students were asked an open-ended question, to list three words to describe the game-playing experience. RESULTS: Response rates declined from 72% in 2019 to 50.2% in 2021. Response trends were similar: Positive gameplay experiences (competence, positive affect, immersion, challenge, and learning) and lack of negative experiences (tension/annoyance, negative affect). In the category of flow, 2021 responses were more positive (42.68%) when compared to the responses in 2019 (38.3%). Open-ended responses were similar with "fun" being the most commonly occurring word. CONCLUSIONS: Dealodontics is an effective and engaging tool for learning which can be used to supplement traditional methods.

Generational perspectives of orthodontists in the U.S. and Canada: A survey study.

INTRODUCTION: The objectives of this study were to identify differences between generations of orthodontists in the United States and to evaluate the perspective of each generation on widely debated topics in orthodontics. METHODS: A 22-item Institutional Review Board-approved survey was randomly distributed to orthodontists in the United States and Canada. Participants were asked questions about the use of technology, the future of clear aligner therapy, orthodontic education, student debt, marketing, and corporate orthodontics, among other topics. RESULTS: Significant increase in female orthodontists over generations and a decrease in orthodontic educators were found (P <0.001). Among generations, differences were found regarding the amount of student debt, use of specific diagnostic tools, marketing preferences, and their opinion on the future of clear aligner therapy. Most of the silent generation did not have student debt, whereas millennials reported paying off their debt in 1 year to >20 years and being most heavily burdened by student debt. Younger generations appeared more likely to use cone-beam computed tomography and intraoral imaging, whereas older generations preferred traditional diagnostic tools such as hand-wrist radiographs and alginate impressions. Most of the silent generation indicated not marketing their practices, whereas millennials rely heavily on social media and e-mails for marketing. CONCLUSIONS: Clear distinctions exist between different generations of orthodontists. Issues such as increasing student debt load and a decrease in orthodontic educators over generations should be addressed to preserve the future of the orthodontic specialty.

Dental students' interest in orthodontic careers: do orthodontic-related experiences and faculty and practitioner role models matter?

OBJECTIVES: To assess the percentage of dental students interested in orthodontics and likely to apply to orthodontic residency programs, the role of orthodontic-related experiences, and of orthodontic faculty and practitioner role models for student career decision-making. MATERIALS AND METHODS: This study had a cross-sectional design. A total of 335 students from seven U.S. dental schools responded to an anonymous web-based survey. RESULTS: 35% were much/very much interested in becoming orthodontists and 26% were likely to apply for this specialty training. A total of 80.1% had orthodontic treatment, 58.7% knew an orthodontist in their community, 44% had shadowed an orthodontist, and 10.8% had worked in an orthodontic practice before dental school. Respondents evaluated orthodontic practitioners more positively than orthodontic faculty. They considered practitioners as more compassionate providers than faculty members (5-point scale with 5 = agree strongly: mean = 4.25 vs 3.83; P < .001), making more of a difference in their patients' lives (4.44 vs 4.05; P < .001), and as better role models (4.21 vs 3.94; P < .001) who encouraged students more to pursue orthodontics (4.03 vs 3.65; P < .001). Their interest in becoming an orthodontist and in applying for an orthodontic residency program correlated with educational experiences (r = 0.35; P < .001 / r = 0.34; P < .001) and positive impressions of orthodontic faculty (r = 0.23; P < .001 / r = 0.22; P < .001) and practicing orthodontists (r = 0.29; P < .001 / r = 0.27; P < .001). CONCLUSIONS: Better understanding of factors motivating dental students to pursue orthodontics is crucial. Orthodontic practitioners and faculty play an important role in this context.

History of Orthodontics in Brazil - First Brazilian Specialist.

At the beginning of the 20th century science was beginning to transform the world, including Brazil. All aspects of dentistry were considered essential to the welfare of the people and that may also have included orthodontics. It is possible then to assume that the manufacturing of some orthodontic appliances was already being taught in the educational courses. However, the lack of didactic orthodontic texts in Portuguese was a problem, when considering literature as one of the pillars that would support advancements in the science and practice of orthodontics. This difficulty, however, was solved in 1910, when the third edition of the Odontological Manual by Coelho e Souza was published including a chapter on orthodontics. Some years later Carlos Lustosa became interested in this subject after reading the paper by Angle that presented the ribbon arch appliance. He went to Pasadena (CA) and convinced Angle to accept him as a student. In 1923 he completed the course at the Angle School of Orthodontia, becoming the first Brazilian specialist in orthodontics. He treated patients with the ribbon arch until his death in 1937. However, did his search for knowledge outside the country influence the course of Brazilian orthodontics?

Postgraduate student perceptions of face-to-face and distance education in orthodontics: A cross-sectional qualitative study.

OBJECTIVE: To investigate postgraduate student perceptions of face-to-face and distance education on a three-year programme in orthodontics. DESIGN: Cross-sectional qualitative study. SETTING: UCL Eastman Dental Institute, London. PARTICIPANTS: A total of 25 current postgraduate orthodontic students in the first, second and third years of training were included in this study. METHODS: Postgraduate student perceptions were obtained by conducting online focus groups on Zoom Video Communications Inc. A focus group topic guide was developed, and a facilitator was trained to host the focus groups. There were separate focus groups for each year group, with a maximum of five participants in each group. The focus groups were audio recorded and transcribed verbatim. The transcripts were assessed by all members of the research team and analysed using a thematic content analysis, with a framework approach to identify themes and subthemes regarding perceptions of distance and face-to-face education. RESULTS: A total of 25 students participated. Six key themes were identified relating to student perceptions of face-to-face and distance education: (1) social support network; (2) technology; (3) learning experience; (4) education environment; (5) interpersonal interactions; and (6) effective teaching/learning. There were perceived benefits and drawbacks for both modes of teaching delivery. In particular, students highlighted the importance of reliable technology, peer support and accessibility of educational resources for their academic learning. Students favoured a blended approach to learning where practical skills were taught in person and some theoretical aspects taught remotely. CONCLUSION: The results aid the understanding of how educational tools and digital technology can enrich the student academic experience. The results provide important information for the future development and delivery of orthodontic postgraduate education.

Knowledge of evidence-based research methodology amongst orthodontic postgraduate residents in four universities: An international survey.

AIM: The aim of this international survey was to assess knowledge concerning the design, conduct, critical appraisal and synthesis of clinical studies among senior orthodontic postgraduate residents. MATERIALS AND METHODS: Senior postgraduate residents from four universities in Europe and the United States were invited to complete a custom questionnaire. The overall correct answer score and proportion of residents correctly answering each of the 10 questions within the survey were analysed with descriptive statistics, analysis-of-variance, chi-squares test and linear regression at 5%. RESULTS: A total of 46 residents with mean age of 30.4 years scored an overall % correct score of 48.8%±13.8%, with the % of correct answers to each question ranging from 7 to 89%. The worst-answered questions pertained to correctly characterizing sensitivity and specificity (7%), number needed to treat (9%), credibility of trial synthesis in meta-analysis (35%) and publication bias (37%). The vast majority of postgraduate students could correctly identify entities that can be blinded in a randomized trial (89%), statistical power of a trial (74%) and proper methods for random allocation sequence (67%). No statistically significant differences were found among the four included universities, while residents having obtained another degree apart from dentistry scored better than others (+9.5%; 95% confidence interval: 0.6% to 18.5%; P=0.04). CONCLUSIONS: Postgraduate residents in orthodontics possessed moderate knowledge on evidence-based methodology. Efforts should be reinforced to assimilate research methodology perspectives in the postgraduate curricula of universities, in order to further augment critical training of orthodontic specialists.

3-Dimensional simulations and student learning in orthodontic education.

INTRODUCTION: The electronic dental model (e-model) is an example of a digital 3-dimensional technology to support inquiry-based learning in undergraduate dental education. As student perceptions of and engagement with e-models vary, it is uncertain whether these perceptions have implications for their learning processes and outcomes. MATERIALS AND METHODS: Third-year dental students (N = 40) completed a questionnaire to identify their perceptions of and preferences for model modalities. They were divided into three groups based on their preference: Preferring plaster models (Group 1); Preferring e-models (Group 2); No preference (Group 3). Students from three groups (N = 9) attended a hands-on digital occlusion evaluation workshop, and then completed a case-based diagnostic evaluation test using digital occlusion evaluation software. Camtasia Studio™ recorded real-time and on-screen data of the number of mouse-clicks and time spent. RESULTS: Students reported positive feedbacks on the use of e-models, and 72.5% of the students preferred combination use of e-models and plaster models. After attending the hands-on digital dental occlusion evaluation workshop, Group 2 scored higher on the diagnostic evaluation test (p < .05) and registered more mouse-clicks than Group 1 when evaluating the arch symmetry (p < .05). Group 2 registered fewer mouse-clicks than Group 3 during tooth size measurement (p < .05). There was no significant difference regarding the time used to answer the knowledge questions amongst the three groups. CONCLUSION: Undergraduate dental students indicated a generally high acceptance of e-models for their learning in orthodontics, and more prefer a blended approach. Students preferring e-models presented higher performance outcomes, which supports cognitive load theory regarding prior exposure to simulation-based environments.

Los entornos virtuales de enseñanza aprendizaje y las habilidades en la especialidad de Ortodoncia / Teaching-learning virtual environments and skills in the specialty of orthodontics

Introducción: Los diferentes tipos de educación en el trabajo y sus modalidades para la formación y el desarrollo de habilidades en la especialidad Ortodoncia, desde los entornos virtuales de enseñanza aprendizaje, constituyen todo un reto para los docentes. Objetivo: Proponer una alternativa para el desarrollo de habilidades en la especialidad de Ortodoncia desde un entorno virtual de enseñanza aprendizaje. Desarrollo: Se propone para el primer año de la especialidad Ortodoncia una alternativa que incluye las diferentes habilidades a formar y desarrollar, según formas de organización de la enseñanza, las que transitan por actividades (base de datos, foro, tarea) y recursos virtuales (archivo, carpeta o tarea) divididas en momentos, así como el tipo de evaluación. En todas estas actividades docentes, a excepción de la educación en el trabajo, se usa la modalidad de clase invertida. Conclusiones: En la especialidad Ortodoncia el residente debe desarrollar diferentes habilidades que también pudieran alcanzarse desde los entornos virtuales de enseñanza aprendizaje. Algunas de las vías para esto pudieran ser las propuestas en el presente artículo(AU)

Introduction: The different types of education at work and their modalities for training and development of skills in the specialty of Orthodontics, from virtual teaching-learning environments, constitute a challenge for professors. Objective: To propose an alternative for developing skills in the specialty of Orthodontics from a virtual teaching-learning environment. Development: An alternative is proposed for the first academic year of the Orthodontics specialty, which includes the different skills to be taught and developed, according to forms of teaching organization, those that go through activities (database, forum, task) and virtual resources (file, folder or task) divided into moments, as well as the type of evaluation. In all these teaching activities, with the exception of education at work, the inverted class modality is used. Conclusions: In the specialty of Orthodontics, the resident must develop different skills that could also be achieved from virtual teaching-learning environments. Some of the ways for achieving this could be those proposed in this article(AU)

Virtualización de la formación posgraduada para la especialidad de Ortodoncia durante la COVID-19. Experiencia en Santiago de Cuba / Virtualization of postgraduate training for the specialty of Orthodontics during Covid-19. Experience in Santiago de Cuba

La continuidad de la formación del especialista de Ortodoncia, en tiempos de pandemia por la COVID-19, constituye todo un reto para los docentes. Por ello, este ensayo reflexiona y presenta, tomando como referencia el primer año de la mencionada especialidad (debido a su complejidad), la experiencia con la virtualización de la formación posgraduada durante este periodo en Santiago de Cuba. Durante esta experiencia, las alternativas que se han propuesto incluyen a las diferentes habilidades a desarrollar según formas de organización de la enseñanza, las cuales abarcan desde actividades (base de datos, foro, tarea), recursos virtuales (archivo, carpeta o tarea) hasta tipos de evaluación. En todas estas clases, a excepción de la Educación en el Trabajo, se implementó la modalidad de clase invertida. Finalmente, se consideró que esta modalidad se configuró como una alternativa para darle continuidad al proceso de enseñanza aprendizaje y favorecer la adquisición de habilidades de manera independiente y creadora.

Continuing the training of the Orthodontic specialist in times of a COVID-19 pandemic constitutes a challenge for teachers. For this reason, this essay reflects and presents, taking as a reference the first year of the aforementioned specialty (due to its complexity), the experience with the virtualization of postgraduate training during this period in Santiago de Cuba. During this experience, the alternatives that have been proposed include the different skills to be developed according to forms of teaching organization, which range from activities (database, forum, task), virtual resources (file, folder or task) to types of evaluation. In all these classes, with the exception of education at work, the inverted class modality was implemented. Finally, it was considered that this modality was configured as an alternative to give continuity to the teaching-learning process and favor the acquisition of skills in an independent and creative way.

Evaluation of dental school student's satisfaction regarding their own smile esthetics and facial profile

Introduction: Facial aesthetics is especially important in a person's life. However,what is considered aesthetic by the orthodontist does not always correspond withthe patient's opinion, since aesthetics is very subjective. Thus, the aim of this studyis to evaluate the perception of dentalgraduate students in relation to their ownsmile and facial profile, analyzing if there would be any difference between thisself-evaluation associated with the year students are attending in dental schooland the technical knowledge progressively acquired. Materials and methods: Atransverse observational study was performed, in which a questionnaire wasapplied to all dentistry students at the State University of Rio de Janeiro. Thequestionnaire inquired about: student's current semester, age, gender, nationality,and previous history of orthodontic treatment. It also contained a Likert scale ofsatisfaction about their smile, the aesthetic component of the Index of OrthodonticTreatment Need (IOTN) for students to compare with their smile, and a scale forfacial profile comparison. The chi-squared test was applied using the SPSS 13.0software and all analyzes were performed with 95% confidence (p < 0.05). Results:A total of 253 questionnaires were distributed and 166 were filled out. Amongthose, 103 people reported having had orthodontic treatment before. The level ofsatisfaction with their own smile was high, reaching 78% in the first year of thecourse, 63% in the second, 87% in the third, and 72% in the fourth year. There wasa preference for a slightly convex profile for both genders. It is observed that 62%of the sample reported having been submitted to orthodontic treatment beforeand the percentage of white students who had received previous orthodontictreatment was substantially higher than other ethnicities. The qui-square testfound a significant statistical difference in ethnicity among students that hadreceived previous orthodontic treatment (p=0.008). Conclusion: There was nodifference in the aesthetic perception of the smile and profile in relation to theyear attended by dental school students, with the level of satisfaction with theirown smile being high.

Introdução: A estética facial apresenta grande importância na vida dos indivíduos. Entretanto, nem sempre o considerado estético pelo ortodontista corresponde com a opinião do paciente, visto que a estética é subjetiva. Assim,objetivou-se avaliar a percepção de graduandos da faculdade de Odontologia, em relação ao próprio sorriso e perfil facial, analisando se haveria diferença nesta percepção em relação ao período que cursariam e à medida que os conhecimentos são adquiridos. Materiais e Métodos: Desenvolveu-se este estudo observacional transversal, no qual distribuiu-se um questionário para todos os alunos do curso de Odontologia da Universidade do Estado do Rio de Janeiro. O questionário continha perguntas sobre o período cursado, idade, sexo, naturalidade, história prévia de tratamento ortodôntico, satisfação com o sorriso, índice de Necessidade de Tratamento Ortodôntico (IOTN) para ser comparado com o sorriso, além de escala para comparação do perfil facial. O teste do qui-quadrado foi aplicado no software SPSS 13.0 e todas as análises foram realizadas com 95% de confiança (p<0,05). Resultados: Foram preenchidos 166 dos 253 questionários distribuídos. Destes, 103 alunos relataram tratamento ortodôntico prévio. O grau de satisfação com o próprio sorriso foi alto, sendo de 78% no primeiro ano de faculdade, 63% no segundo, 87% no terceiro e 72% no quarto ano. Houve preferência pelo perfil levemente convexo para ambos os gêneros. Foi observado que 62% da amostra já havia feito tratamento ortodôntico, sendo a maioria da etnia branca. O teste qui-quadrado encontrou diferença estatisticamente significativa na etnia dos estudantes que receberam tratamento ortodôntico prévio (p=0,008). Conclusão: Não houve diferença na percepção estética do próprio sorriso e perfil em relação ao período cursado, sendo o grau de satisfação com o próprio sorriso bastante alto.

Influence of type of radiograph and levels of experience and training on reproducibility of the cervical vertebral maturation method.

INTRODUCTION: The objective of this study was to assess the reproducibility of cervical vertebral maturation (CVM) method based on the type of radiographic image and the level of experience and level of training of the evaluator. METHODS: Ten evaluators (5 orthodontic residents and 5 faculty members) were randomly divided into 2 groups: trained and untrained. All participants evaluated 80 radiographic images previously acquired in 4 different formats: (1) 2-dimensional (2D) digital (2D-digital), (2) 2D digitized hard copy from the Iowa Facial Growth Study (American Association of Orthodontists Foundation Craniofacial Growth Legacy Collection), (3) 2D digital reconstructed from a 3-dimensional (3D) radiograph (2D-from 3D), and (4) 3D cone-beam computerized tomographic (3D-CBCT) images. Agreement among evaluators on the morphology of the cervical vertebrae (CV) and the CVM stage of each radiographic image was assessed using Randolph's kappa statistic and Kendall's W coefficient of concordance. RESULTS: Interobserver agreement on the determination of a curvature on the inferior border of the CV was substantial to perfect, whereas agreement on shape was fair to moderate. Overall, the level training in all image types, except 3D-CBCTs, but not the level of experience affected the agreement for shape and curvature of the CVs. Interobserver agreement on CVM staging for all combined images was substantial at 0.72. Faculty had a higher level of agreement than residents except for 2D-digital and 3D-CBCT images, whereas trained evaluators had an overall higher level of agreement than untrained evaluators except for 3D-CBCT images. CONCLUSIONS: Interobserver agreement in determining CVM stage was substantial for all images evaluated; experience and training resulted in higher level of agreement for some image types. The 3D-CBCT images did not provide increased interobserver agreement over current 2D-digital lateral cephalograms in determining CVM staging or shape of the CV. The highest agreement in CVM staging was obtained on 2D-digital lateral cephalograms with training.