Conventional Manual Versus Desktop, Web-Based, and Mobile Application Cephalometric Analysis: A Systematic Review and Meta-Analysis of Measurement Agreement, Reliability, and Efficiency

This systematic review and meta-analysis will compare conventional manual, desktop-based, web-based, and mobile application-based cephalometric analysis methods applied to the same two-dimensional lateral cephalograms. Methods will be classified by platform and by degree of automation (manual on-screen, semi-automated, or fully automated/AI-based). The primary outcome will be the between-method measurement difference for six core parameters: SNA, SNB, ANB, IMPA, SN-MP, and FMA. For primary comparisons against conventional manual tracing, measurement differences will be expressed as digital minus manual. Secondary outcomes will include between-method agreement (ICC/CCC and Bland–Altman analysis), intra- and inter-examiner reliability, analysis time, clinical acceptability, usability, and landmark-identification error within otherwise eligible studies. Pairwise random-effects meta-analysis will be performed where at least three independent, sufficiently comparable studies are available. Network meta-analysis will be considered only where methodologically justified.