The aim of this study was to compare and evaluate the reliability of three different cephalometric assessment methods: Smartphone Application Tracing Method CephNinja (SATM), Web Based Artificial Intelligence (AI) Driven Tracing Method WebCeph (WATM) and Conventional Hand Tracing Method (CHTM).

110 lateral cephalometric radiographs were enrolled in the study and 4 linear and 7 angular parameters were traced and measured by one examiner using CephNinja, WebCeph and conventional hand tracing methods. Independent-samples Kolmogorov-Smirnov and Shapiro Wilks tests were used to compare the mean values of intra-examiner differences. Both intra-method and inter-method correlations were evaluated.

There were statistically significant differences between the methods in terms of SNA (p:0.003; p < 0.05); SNB measurements (p:0.001; p < 0.05); SN-MP angle (p:0.001; p < 0.05); U1-SN angle (p:0.001; p < 0.05); L1-NB(mm) (p:0.007; p < 0.05) and E Line-Upper Lip(mm) measurements (p:0.013; p < 0.05). All intra-method correlation coefficients are 80% and above. In terms of inter-method coefficients the lowest coefficient of agreement is 0.170 and it is the coefficient of agreement between CHTM and SATM for measurement of U1-NA. The highest coefficient of agreement is 0.884 which is between WBTM and SATM for SNB measurement.

The null hypothesis was rejected. There were statistically and clinically significant differences in various measurements among groups.