ORIGINALARTICLE

COMPARISON OF ORTHOPANTOMOGRAM AND LATERAL CEPHALOGRAM IN ASSESSING

GONIAL ANGLE, RAMAL HEIGHT, RAMAL HEIGHT AND BODY LENGTH

Farheen Sajid¹, Nabila Anwar², Multazam Ahmad¹, Muhammad Uzair¹, Aneela Baseer¹, Asad-ur-Rehman¹

How to cite this article

ABSTRACT

OBJECTIVES

This study aimed to obtain an orthopantomogram (OPG) and a lateral

Sajid F, Anwar N, Ahmad M, Uzair

cephalogram to measure the gonial angle, ramus height, and mandibular

M, Baseer A, Rehman AU.

body length.

METHODOLOGY

Comparison of Orthopantomogram

and Lateral Cephalogram in Assessing

This cross-sectional comparative study was conducted at Rehmat Hospital,

Abbottabad, and Peshawar, and included 160 participants selected through

nonprobability consecutive sampling. Patients aged 16 to 40 years, of

Pakistani nationality, with both OPG and lateral cephalogram in their

orthodontic records were included. Radiographs of poor quality or patients

with craniofacial anomalies, facial asymmetry, trauma, cancer, or previous

head radiotherapy were excluded. Ramus height was measured from

condylion to gonion, body length from gonion to menton, and the gonial

angle was determined by the intersection of tangents along the lower and

posterior borders of the mandible. Data were analyzed using a paired t-test

to compare measurements between the two radiographic techniques.

RESULTS

Gonial Angle, Ramal Height, Ramal

Height and Body Length. J Gandhara

Med Dent Sci. 2026;13(2):45-49

https://doi.org/10.37762/jgmds.13-2.817

Date of Submission: 03-11-2025

Date Revised:

12-03-2026

14-03-2026

Date Acceptance:

²Supervisor and HOD, Department of

Orthodontics, Rehmat Memorial

Hospital Abbottabad

The mean age of participants was 24.93 ± 7.18 years, with 82 females (51.3

percent) and 78 males (48.8 percent). Signicant dierences were foun d

between OPG and cephalogram measurements. The mean ramus height was

65.46 ± 10.40 mm on OPG and 50.21 ± 7.96 mm on cephalogram (p <

0.001). The mean body length was 95.99 ± 11.41 mm on OPG and 64.75 ±

7.85 mm on cephalogram (p < 0.001). The mean gonial angle was smaller on

OPG (116.73 ± 6.85°) compared with the cephalogram (119.10 ± 8.31°, p <

0.001).

Correspondence

¹Farheen Sajid, Trainee Medical

Ofcer, Department of Orthodontics,

Rehmat Memorial Hospital

Abbottabad

CONCLUSION

Panoramic radiographs tend to overestimate linear measurements but

underestimate angular values compared with lateral cephalograms.

KEYWORDS: Lateral Cephalograms, Ramus Height, Body Length, Gonial

Angle, Mandible

+92-336-9918701

farheensajid97@gmail.com

INTRODUCTION

trauma, to abnormal growth such as unilateral condylar

hyperplasia.⁵Proper diagnosis can help achieve an

The lateral cephalogram is an important tool in

orthodontics for diagnosis and treatment planning. It

oers a reproducible view of the craniofacial structures,

helping in the assessment of skeletal relationships,

dental angulations, and the soft-tissue prole.¹

Clinicians can evaluate anteroposterior and vertical

accurate diagnosis and plan treatment, and select

adequate options among orthodontic correction,

orthognathic surgery, or distraction osteogenesis.⁶

Accurate evaluation of the mandibular morphology is

important in orthodontics and maxillofacial practice.

Measurements such as the gonial angle, ramal height,

and mandibular body length can provide information on

facial balance, skeletal development, and any

asymmetry. Lateral cephalograms have been the most

commonly used radiographs for these assessments.

However, one limitation of lateral cephalograms is that

they superimpose the mandibular halves, making it

difficult to accurately assess dierences between the

right and left sides. Orthopantomograms (OPGs)

provide a broad view of the entire mandible, allowing

both the right and left sides to be seen clearly and

separately. This makes them useful for assessing

discrepancies,

growth

patterns,

and

occlusal

relationships, all of which are crucial for creating

tailored

treatment plans

through cephalometric

analysis.²It can also allow the monitoring of

craniofacial development and treatment progress.³

Mandibular asymmetry is when the two sides of the

lower jaw dier in size, shape, or position. Mandibular

asymmetry can aect facial appearance, occlusal

alignment, and jaw function.⁴Its etiology is

multifactorial, ranging from developmental issues,

congenital conditions like hemifacial microsomia,

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J Gandhara Med Dent Sci

Comparison of Orthopantomogram and Lateral Cephalogram

mandibular measurements without the superimposition length was measured from the gonion (Go) to the

issue that occurs in lateral cephalograms.⁷Though menton (Me), which is the lowest point on the

OPGs are commonly used in clinical practice, their mandibular symphysis. The mandibular gonial angle

accuracy for linear and angular measurements has been was determined by the intersection of two tangents, one

questioned due to possible magnication and distortion drawn along the lower border of the mandible and the

errors.⁸OPGs are also valuable for assessing other along the posterior border of the ramus, and

mandibular asymmetry. Because they record both sides recorded in degrees. Measurements were taken only on

of the mandible in a single view, OPGs make it easier the right side. Data were analyzed using R software

to compare the right and left sides without requiring version 4.3.3. The mean and standard deviation were

additional radiation exposure.⁹This makes them a calculated for numerical variables, such as age and

convenient and widely available option in everyday mandibular measurements (ramus height, body length,

clinical practice. Considering the advantages and and gonial angle), on both sides and for both

limitations of both OPGs and lateral cephalograms, it is radiographs. Frequencies and percentages were

important to assess whether OPGs can provide

measurements that are as reliable as those from lateral

cephalograms. This study aimed to compare the two

radiographic methods in measuring the gonial angle,

ramal height, and mandibular body length.

determined for the qualitative variable, gender. A paired

t-test was used to compare mandibular measurements

between the orthopantomogram (OPG) and lateral

cephalogram. Gender was treated as an eect modier

and controlled for by stratification, followed by a post-

stratication paired t-test. A p-value of ≤0.05 was

considered statistically signicant. Reliability was

tested with Pearson‘s correlation coecient. An R

value of 0.80 or higher was considered excellent

agreement between the observations.

METHODOLOGY

This cross-sectional comparative study was conducted

at Orthodontics, Rehmat Hospital, Abbottabad, and

Peshawar, on 160 cases using a non-probability,

consecutive sampling technique. Written informed

consent had already been obtained from all orthodontic

patients or their guardians, allowing the use of their

anonymized records for research purposes. Ethical

approval was obtained from the hospital‘s ethical

review committee. Using the WHO sample size

calculator, the required sample size was determined to

be 160 at a 95% condence level, with a population

mean of 126.107¹⁰, a population standard deviation of

7.034, and an absolute precision of 1. The study

included patients aged 16-40 years who were Pakistani

nationals, conrmed by their ‗Form B‘ or CNIC. Both

male and female patients were eligible to participate.

Only clear and high-quality radiographs were included,

and both an orthopantomogram (OPG) and a lateral

cephalogram were required as part of the orthodontic

records. Patients with any craniofacial malformations or

RESULTS

A total of 160 participants were included in the study,

with a mean age of 24.93 ± 7.18 years. Of these, 82

(51.3%) were females, and 78 (48.8%) were males.

Most participants (60.0%) were in the 16–25-year age

group, while 40.0% were between 26 and 40 years of

age. (Table 1). A signicant dierence was found

between

measurements

obtained

from

lateral

cephalograms and orthopantomogram (OPGs). The

mean ramus height was 50.21 ± 7.96 mm on

cephalograms and 65.46 ± 10.40 mm on OPGs (p <

0.001). Similarly, the mean mandibular body length

was 64.75 ± 7.85 mm on cephalograms compared with

95.99 ± 11.41 mm on OPGs (p < 0.001). In contrast, the

mean gonial angle was slightly smaller on OPGs

(116.73 ± 6.85°) than on cephalograms (119.10 ± 8.31°,

p < 0.001). (Table 2 & Fig 1). Among females, the

mean ramus height and body length measured on OPG

(63.22 ± 7.79 mm and 91.98 ± 10.26 mm, respectively)

were signicantly greater than those on cephalogram

(47.88 ± 6.22 mm and 62.56 ± 5.67 mm; p < 0.001 for

both). Similarly, in males, OPG showed higher mean

values for ramus height (67.82 ± 12.19 mm vs. 52.67 ±

8.85 mm) and body length (100.21 ± 11.08 mm vs.

67.05 ± 9.11 mm), both of which were statistically

significant (p < 0.001). For the gonial angle, females

showed a signicantly lower mean value on OPG

compared with cephalogram (115.34 ± 6.61 mm vs.

119.66 ± 8.56 mm; p < 0.001), whereas in males, the

dierence between the two methods was not

facial

asymmetry,

identied

through

clinical

examination, were excluded. Those with a history of

facial trauma, cancer, or radiotherapy to the head region

were also not included in the study. Data on the

inclusion and exclusion criteria, as well as demographic

information such as age and gender, were collected

from

the

patients‘

were

record

taken

les.

from

Mandibular

both the

measurements

orthopantomogram (OPG) and lateral cephalogram. The

mandibular ramus height was measured as the distance

between the condylion (Co), which is the highest point

on the mandibular condyle, and the gonion (Go),

located where the posterior border of the ramus meets

the lower border of the mandible. The mandibular body

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J Gandhara Med Dent Sci

Comparison of Orthopantomogram and Lateral Cephalogram

Table 4: Reliability Score

statistically signicant (118.18 ± 6.83 mm vs. 118.51 ±

R-value

P-value

8.04 mm; p = 0.8). (Table 3). Excellent inter- and intra-

Inter-observer

Intra-observer

0.82

0.85

0.000

reliability was observed (R value> 0.8). (Table 4)

Table 1: Descriptive Statistics of Age and Gender of the

Participants

DISCUSSION

Characteristic

Age (years)

Gender

N = 160

24.93 ± 7.18

This study assessed mean mandibular ramus height,

body length, and gonial angle using panoramic

radiographs (OPG) and lateral cephalograms. We found

statistically signicant dierences in ramus height and

body length between the two imaging methods. These

dierences should be interpreted with caution, as

panoramic radiography is known to be aected by

magnication and geometric distortion inherent to its

imaging technique. Although several studies have

evaluated gonial angle measurements between these

Female

82 (51.25)

78 (48.75)

Male

Age group(years)

26-40

Mean ± SD; n (%)

64 (40.00)

Table 2: Comparison of Mandibular Measurements between

Cephalogram and Orthopantomogram (OPG)

Characteristic

Lateral

Panoramic

Cephalogram Radiograph

value

modalities, only

few have compared linear

Mean ± SD

50.21 ± 7.96

64.75 ± 7.85

119.10 ± 8.31

Mean ± SD

65.46 ± 10.40

95.99 ± 11.41

116.73 ± 6.85

Ramus height(mm)

Body length(mm)

Gonial Angle(mm)

<0.001

mandibular parameters such as ramus height and body

length. Panoramic radiographs are produced by

rotational imaging, in which the X-ray source and

detector rotate around the patient. Because of this

geometry, the magnication factor is not uniform

across the image and varies with the position of

anatomical structures within the focal trough. The

rotation center determines the horizontal projection,

while the vertical projection is determined by the X-ray

source.¹¹Both horizontal and vertical dimensions may

be aected by distortion, particularly when the object is

positioned outside the optimal focal layer or when

slight variations in head positioning occur. The

horizontal dimension is aected by both projection

geometry and motion, leading to variations in image

size and shape.¹²These characteristics may partly

explain the larger linear measurements observed on

OPG in the present study. Therefore, the observed

dierences between the two modalities likely reect

methodological and projection-related factors rather

than true anatomical variation. Our ndings align with

those of Zulfiqar et al.¹³, who evaluated the gonial

angle, ramus height, and mandibular body length in a

sample of 195 Pakistani individuals aged 16-35 years.

Their study also found signicantly greater values for

ramus height and body length on orthopantomograms

(OPGs) than on lateral cephalograms, whereas the

gonial angle showed no statistically signicant

dierence between the two imaging modalities.

Similarly, Kumar et al.¹⁴investigated 100 Indian

subjects and observed no signicant dierences in the

gonial angle or ramus height; however, signicant

variation was noted in mandibular body length. These

findings support the notion that horizontal linear

measurements are more prone to distortion in

panoramic radiography, due to the inherent projection

geometry, and should be interpreted cautiously. In

*Paired t-test

Figure 1: Comparison of Mandibular Measurements between

Cephalogram and Orthopantomogram (OPG)

Table 3: Comparison of Mandibular Measurements between

Cephalogram and Orthopantomogram (OPG) Stratified by

Gender

Character Female

Male

istic

Cephalo OPG

Cephal OPG

N = 82 val

ue^*

gram

N = 82

47.88

N = 82 valu ogram

e^*

N = 82

Ramus

63.22 ± <0.0 52.67 ± 67.82

<0.

height(m 6.22

7.79

8.85

Body

12.19

62.56

length(m 5.67

91.98 ± <0.0 67.05 ± 100.2

<0.

10.26

9.11

11.08

118.1

Gonial

Angle(m

119.66± 115.34 <0.0 118.51

8.56 ± 6.61 01 ± 8.04

0.8

6.83

*Paired t-test

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J Gandhara Med Dent Sci

Comparison of Orthopantomogram and Lateral Cephalogram

contrast, Khan et al.⁷evaluated 100 subjects aged 13-20

years and reported nearly identical gonial angle

measurements on both orthopantomograms and lateral

cephalograms (mean values of 122.4° and 122.6°,

CONCLUSIONS

This study found signicant dierences in mandibular

measurements between lateral cephalograms and

orthopantomograms. The values for ramus height and

body length were consistently higher on panoramic

radiographs, while the gonial angle was slightly

smaller. These results indicate that panoramic images

may exaggerate linear dimensions but show lower

angular measurements compared with cephalograms.

respectively).

They

concluded

that

panoramic

radiographs provide reliable estimates for angular

assessment. This observation partially concurs with our

results in male participants, in which the dierence in

gonial angle between the two radiographic techniques

was not statistically significant, suggesting that gender-

anatomical

variation

and

mandibular

CONFLICT OF INTEREST: None

FUNDING SOURCES: None

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AUTHORS CONTRIBUTION

Farheen Sajid - Concept & Design; Data Acquisition; Data

Rawalpindi

Med

Coll.

2024;28(2):225-230.

https://doi.org/10.37939/jrmc.v28i2.2389.

Analysis/Interpretation;

Revision; Final Approval

Drafting

Manuscript;

Critical

14. Kumar SS, Thailavathy V, Srinivasan D, Loganathan D, Yamini

J. Comparison of orthopantomogram and lateral cephalogram

Nabila Anwar - Concept & Design; Data Acquisition; Drafting

Manuscript; Supervision; Final Approval

for mandibular measurements.

2017;9(Suppl

Pharm Bioallied Sci.

1):S92-S96.

Multazam Ahmad- Concept & Design; Data Acquisition; Data

Analysis/Interpretation; Drafting Manuscript; Final Approval

Muhammad Uzair - Concept & Design; Data Acquisition;

Drafting Manuscript; Final Approval

Aneela Baseer - Concept & Design; Data Acquisition; Drafting

Manuscript; Critical Revision; Final Approval

Asad-ur-Rehman - Concept & Design; Data Acquisition;

Drafting Manuscript; Critical Revision; Final Approval

https://doi.org/10.4103/jpbs.JPBS_98_17 PMID: 29284977

PMCID: PMC5735477.

15. Pillai JP, Shah RJ, Darji B, Banker A, Pillai RJ. Association of

the gonial angle with age, gender, and dental status:

radiographic study using lateral cephalogram and

orthopantomogram. J Forensic Radiol Imaging. 2018;15:8-13.

https://doi.org/10.1016/j.jofri.2018.11.002.

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