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Objective This study aimed to evaluate the reproducibility of nine reference planes used in orientation of as-received cone-beam computed tomography (CBCT) images in all three dimensions. Materials and Methods The study was conducted on CBCT images of 15 adult subjects (mean age 21.2 ± 5.8 years). The anonymized CBCT images were oriented using five different methods created from nine reference planes by two experienced orthodontists. For each subject, pitch, yaw, and roll changes with five orientation methods were recorded twice by each observer. Statistical Analysis The inter- and intraobserver agreement was tested using intraclass correlation (ICC) and Bland–Altman plot. The intra- and interobserver error was analyzed using paired t-test. Analysis of variance and paired t-test were used to analyze the differences among the various pitch, roll, and yaw orientation planes. Results Inter- and intraobserver agreement (ICC, 0.9) was excellent for all the nine reference planes. The interobserver reliability showed statistically significant differences for four planes namely Frankfort horizontal plane constructed on right side (p = 0.014) and left side (p = 0.000), transorbital plane (p = 0.001), and midsagittal plane on top view (p = 0.036); however, the mean differences were clinically insignificant. Conclusion The landmark-based nine reference planes used in this study to orient CBCT images showed good reproducibility. Therefore, these reference planes can be used to orient CBCT images and can be incorporated into automated software.

Orientation of Cone-Beam Computed Tomography Image: Pursuit of Perfect Orientation Plane in Three Dimensions—A Retrospective Cross-Sectional Study