## 4 Discussion
Even though automatic tracing software can identify precise anatomical landmarks, the accuracy of proportions, angles, and correlations between points may be compromised due to head positioning in the NHP (natural head position). Whetherutilizing manual or automatic/computer-enhanced tracing methods, as well as AI software, the NHP and patient posture during the examination are crucial factors. Both the experience and expertise of clinicians, as well as the proficiency and knowledge of younger clinicians, can greatly influence cephalometric tracings and their accuracy [13]. While manual tracings rely on the clinician's experience and knowledge to utilize cranometric reference points, automatic or AI-driven software evaluates images based on algorithms or other automated tools. It seems, however, that the issue of correct patient positioning remains outside the area that can be optimized with computer programs. Regardless of the method used, the most crucial factor is to establish the most accurate, comprehensive, and sufficient analysis for each patient's case. The precise placement of anatomical cephalometric landmarks to enhance the linear, angular, and planar comparison of selected landmarks is pivotal for planning both orthodontic and orthognathic surgery procedures [20]. Numerous authors, such as [PERSON] et al. [23], [PERSON] et al. [40] and others, have studied the skill of placing anatomical and cephalometric points and concluded that a skilled specialist with more years of active clinical practice demonstrates greater proficiency in accurately placing the necessary reference points for conducting a precise cephalometric analysis [19]. Furthermore, it is important to note that clinicians, dentists, surgeons, and orthodontists who perform such analyses routinely possess more experience compared to those who perform them sporadically or infrequently. With the advancements in 3D software and the computer-enhanced evaluation of radiographs, CBCT studies, and facial photographs, new techniques used in both orthodontics and orthognathic surgery are being widely embraced for their rapid and precise analysis. Similar studies conducted by [PERSON] et al. [39], [PERSON] et al. [42], [PERSON] et al. [43], [PERSON] et al. [45], [PERSON] et al. [46], and [PERSON] et al. [50], among others, tend to corroborate these findings. Today's software aims not only for precise and accurate measurements but also to mitigate any potential human errors or inaccuracies in cranometric evaluation [1, 61]. From the author's perspective, this situation is quite evident, but when patients' head positioning in NHP during radiographs, facial photographs, and CBCT evaluation is misaligned, even with numerous new devices and software, the results may not be accurate. This situation holds particular importance in planning surgical interventions, such as in orthognathic surgery, where establishing the full scope of the soft and hard tissue contour and balance is imperative without any disruptions. When this criterion is not met, numerous disturbances in measurements are observed, irrespective of the computed-enhanced/AI or classic manual evaluation methods utilized in various studies. This aspect is considered one of the most crucial parts of each cephalometric evaluation and has been well-documented [19, 20, 70]. From the author's perspective, regardless of the anthropometric reference points and techniques used, some cases of severe skeletal malocclusion surpass the capabilities of standard planning methods, necessitating a combined manual-approach and 3D/AI-driven software. The discussion regarding the comparison between manual classic cephalometric evaluation and those conducted by AI-computed assisted software is steadily gaining traction in the existing literature. Both methods possess their respective advantages and disadvantages, and it is particularly noteworthy that some very complex and challenging cases still require traditional manual hand-made evaluation, cephalometric measurements, and estimation.