The purpose of this study was to identify the potential projection errors of posteroanterior cephalometric radiographs due to head rotation in the vertical Z-axis. For this investigation, 20 human dry skull samples with permanent dentition were collected from the Department of Anatomy in the College of Medicine, Chosun University, Korea. They had no gross asymmetries and were well preserved. Each dry skull was rotated from 0 degrees to +/- 10 degrees at 1 degrees intervals. A vertical axis, the Z-axis, was used as a rotational axis for the exposure of 420 posteroanterior cephalometric radiographs. Most of the abscissa values of each landmark showed statistically significant differences in the head rotation from each rotational angle (P.05), whereas the ordinate values were almost the same in all rotational angles regardless of the head rotation. The abscissa values of each landmark anterior to the vertical rotational axis displaced in the same direction as the head rotation, whereas those of other landmarks posterior to the vertical rotational axis displaced in the opposite direction. The mean differences of the abscissa values, per 1 degrees of head rotation, were larger as the landmark was located further anteroposteriorly from the vertical rotational axis and smaller as the landmark was located nearer the vertical rotational axis. In view of the projection error, a posteroanterior cephalometric radiograph is a more valuable diagnostic tool when it is exposed with no head rotation about the vertical Z-axis.
