Comparative reliability and agreement of CBCT-based measurement approaches for assessing maxillary transverse deficiency

Cone-beam computed tomography (CBCT) enables three-dimensional evaluation of maxillary transverse relationships; however, no consensus exists regarding which CBCT-based diagnostic approach should be used, and the reliability and diagnostic consistency of available systems remain unclear. In this study, the reproducibility and diagnostic agreement of four established CBCT-based transverse assessment methods were compared. Ninety-eight patients (mean age: 21.57 years) underwent CBCT. Four diagnostic systems—Penn transverse analysis (PTA), Miner CBCT transverse analysis (CBTA), Yonsei transverse analysis (YTA), and Case Western Reserve University transverse analysis (CWRUTA)—were applied. Two calibrated examiners performed all the measurements twice with a two-week interval. Reliability was assessed using intraclass correlation coefficients (ICCs), Dahlberg’s error, and Bland–Altman analyses. Diagnostic agreement was evaluated using Cohen’s kappa and cross-method comparisons across skeletal subtypes. All four methods demonstrated acceptable reproducibility (ICC > 0.75), but variation existed across measurements. Compared with inclination-dependent parameters, skeletal width measurements were more repeatable. YTA demonstrated the highest overall reliability and the smallest systematic and random errors, whereas the inclination variables in CWRUTA exhibited the greatest variability and systematic bias. Diagnostic agreement varied across systems and was not interchangeable. YTA and CBTA showed the strongest agreement, whereas CWRUTA classified the greatest proportion of patients as deficient. Agreement increased in skeletal Class III and was lowest in Class II. CBCT-based transverse diagnostic systems differ in both measurement reproducibility and diagnostic output. YTA demonstrated the most consistent performance and may serve as a reliable primary assessment tool, whereas inclination-based analyses should be interpreted cautiously and in a clinical context. Because no single method fully captures skeletal and dentoalveolar dimensions, a combined diagnostic approach may be more appropriate until standardized criteria and automated CBCT analysis tools become available.