Associations of Digital Measurements: Analysis of Orthopantomography Versus Lateral Cephalograms for Evaluation of Facial Asymmetry

<b>Background/Objectives</b>: This study aimed to compare the associations of digital measurements obtained from orthopantomographies (OPGs) or panoramic radiographs and lateral cephalograms in evaluating facial asymmetry in patients with different skeletal classes. The sample consisted of 128 Romanian patients (67 females, 61 males) who sought orthodontic treatment. These measurements are an essential diagnostic tool for evaluating facial asymmetry in order to treat them. <b>Methods</b>: Lateral cephalograms and OPGs were obtained for each patient, and digital tracing was performed using the WebCeph program. Angular measurements (ANB, FMA, gonial angles) and linear measurements (ramus height, mandibular body length) were assessed on both imaging modalities. <b>Results</b>: Strong positive correlations were found between the gonial angle and ramus height measurements obtained from lateral cephalograms and OPGs (rs range: 0.800-0.946; <i>p</i> < 0.001). However, the mandibular body length showed weaker correlations between the two methods. Significant sex differences were observed, with males exhibiting larger craniofacial measurements compared to females (<i>p</i> < 0.05). The study population was quite young, as seen by the cohort's median age of 21 years and interquartile range (IQR) of 16 to 29 years. Lateral Ceph: the FMA angle median value of 22° (IQR: 17-25), gonial angle median of 121° (IQR: 116-127), mandibular ramus height median value of 44 mm (IQR: 41-48 mm), and mandibular body length median value of 70 mm (IQR of 65 to 76 mm). OPG: gonial angles on the right and left sides yield medians of 121° (IQR: 116-127) and 122° (IQR: 117-127); the mandibular ramus height on the right and left sides shows medians of 44.0 mm (IQR: 40.0-47.0 mm) and 43 mm (IQR: 40-48 mm); and the mandibular body on the right side presents a median of 71 mm (IQR: 67-76 mm) and the left side has a median of 71 mm (IQR: 67-75 mm). <b>Conclusions</b>: The findings suggest that OPGs can be reliably used to measure the gonial angle and ramus height, providing results comparable to lateral cephalograms. However, caution should be exercised when predicting horizontal measurements from OPGs. The standardization of the OPG recording process and further research with larger sample sizes are required to establish standard panoramic norms for OPG parameters in the assessment of facial asymmetry.