Occlusion, orthodontics and posture: are there evidences? The example of scoliosis

The effect of temporomandibular joint dysfunction on the craniocervical mandibular system: A retrospective study

BACKGROUND

Temporomandibular disorders are the most common condition affecting the orofacial region, resulting in pain and dysfunction.

OBJECTIVE

This study aimed to elucidate the ambiguous association between cervical features and temporomandibular disorders by measuring the rotations between the skull-atlas, atlas-axis and mandible-atlas and examining the relationship between these rotations and temporomandibular disorders.

METHODS

Cone-beam computed tomography (CBCT) images from 176 patients, 97 females and 79 males with an average age of 25.7 years were used in this study. The patients were divided into two groups: those with joint dysfunction (n = 88) and those without (n = 88). The study employed various methods to determine rotations in the skull-atlas, atlas-axis and mandible atlas based on anatomical landmarks and measurements. These methods include the use of specific planes, angles and distances to identify and measure rotation. Data analysis was performed using the TURCOSA statistical software (Turcosa Analytics Ltd Co, Turkey, www.turcosa.com.tr).

RESULTS

The results showed that the degree of rotation between the skull and the atlas was higher in the TMD group than in the control group (p < .001). Similarly, Atlas-axis rotation was significantly higher in the TMD group (p < .001). However, no significant difference was found between mandible atlas rotations in the two groups (p = .546). The study also found a significant difference between the direction of rotation between the atlas and axis and the direction of mandible atlas rotation (p < .001) as well as between skull and atlas rotations and mandible-atlas rotations (p < .001).

CONCLUSION

Overall, the study suggests that there is a relationship between the skeletal structures of the cranio-cervico-mandibular system and TMD. Skull-atlas and atlas-axis rotations may play an important role in the aetiology of TMD in individuals with TMD. Therefore, it is important to evaluate rotations in the skull-atlas-axis region for the treatment of TMD.

Influence of the mandibular position on various postural anatomical segments

OBJECTIVE

To determine postural changes in relation to mandibular position in maximum intercuspation and at rest in adult patients of both sexes.

METHODS

: A descriptive observational clinical study was carried out in 76 patients. Using an analyzer and the Meersseman test, the necessary dermal points for postural analysis were located.

RESULTS

: The authors found significant differences in the posture adopted by the patient between maximum intercuspation and mandibular rest in the frontal, sagittal, and dorsal planes. Foot support in the right foot went from cavus to normal in 6% of the sample, and from flat to normal in 2.5% of the sample in the jaw rest position.

CONCLUSION

Postural changes were observed in various segments, with clinical and statistical significance at cervical level in the frontal plane, in the biscapular variable in the dorsal plane, and at the level of the lower limbs in the bipopliteal and bimalleolar variables.

Spinal disorders and mastication: the potential relationship between adolescent idiopathic scoliosis and alterations of the chewing patterns

OBJECTIVE

to evaluate mastication in a group of patients with Adolescent Idiopathic Scoliosis (AIS) with a control group, by means of the prevalence of reverse chewing cycles (RCC).

MATERIAL AND METHODS

this study included a group of patients (N=32; F=24; M=8; mean age ± SD = 14±3 years) with a confirmed diagnosis of Adolescent Idiopathic Scoliosis and a group of control subjects (N=32; F=24; M=8; mean age ± SD = 13±6 years) without spinal disorders. Mastication was recorded with both a hard and a soft bolus, following a standardized protocol, and the prevalence of reverse chewing cycles was compared between the groups.

RESULTS

The prevalence of reverse chewing cycles was significantly higher in the Adolescent Idiopathic Scoliosis group, with both a soft and a hard bolus, compared to the control group (p<0,001).

CONCLUSION

the results of this study indicate that the presence of Adolescent Idiopathic Scoliosis influences mastication, i.e. one of the main functions of the stomatognathic system. A multidisciplinary approach to these patients may be relevant in providing the best possible treatment outcomes.

Temporomandibular Joint Disorders in Females with Adolescent Idiopathic Scoliosis: Long-Term Effects of Milwaukee Brace Treatment

Patients with adolescent idiopathic scoliosis (AIS) more frequently suffer dysfunctions of dento-skeletal complex. To our knowledge, no study has ever evaluated the temporomandibular joint disorders (TMD) of AIS patients at least 23 years after the completion of Milwaukee brace treatment. We aimed to provide a complex assessment of TMD and AIS patients treated with a Milwaukee brace, in a minimum 23-year follow-up, using radiological, clinical, and socio-demographical data, and to adapt the TMD Disability Index Questionnaire (TMDQ) and Fonseca’s questionnaire (FQ) to Polish conditions. In total, 42 healthy females and 30 AIS patients with a minimum of 23 years after a completed Milwaukee brace treatment were asked to complete the Polish version of (TMDQ-PL) and (FQ-PL). AIS patients present higher TMD levels than healthy controls. Significant differences exist between TMDQ-PL and FQ-PL (both in total scores and particular sub-sections), and AIS patients. Clinical and radiological factors affected the TMDQ-PL and FQ-PL results. Adult patients with scoliosis treated conservatively present limitations in everyday activities connected with the temporomandibular joint (TMJ). The variety of curve-related factors in a long-term follow-up of wearing the Milwaukee brace influence TMJ.

Effects of unilateral posterior missing-teeth on the temporomandibular joint and the alignment of cervical atlas

Cervical atlas alignment changes are associated with craniofacial development. Disturbance of craniofacial development may be associated with temporal mandibular joint function. Therefore, we examined the possibility of a correlation between unilateral missing teeth and morphologic changes of the spine and posture. We collected eighty-nine patients (38 men and 51 women) with unilateral posterior missing teeth and twenty patients without previous orthodontic treatment or missing posterior teeth by tracing and analyzing their panoramic and cephalometric film. We measured the angulations of articular eminence, cranio-cervical angle, and the percentage of the occlusal plane passing through the first and second cervical vertebrae with other morphologic geometric data. The angle of articular eminence inclination was higher in the non-missing teeth group than the missing teeth group (46.66° and 42.28°, respectively). The cranio-cervical angle was smaller in the missing posterior teeth group than the non-missing posterior teeth group (99.81° and 103.27°, respectively). The missing teeth group also showed fewer occlusal planes passing through the intersection of the first and second cervical vertebrae compared to the non-missing teeth group (28.9% and 65%, respectively). Individuals with unilateral missing teeth had lower articular eminence inclination, smaller cranio-cervical angle, and a lower percentage of the occlusal plane passing through the intersection of the first and second cervical vertebrae.

The correlation between back posture and sagittal jaw position in adult orthodontic patients

Objective

A debate remains in evidence-based medicine about the reciprocal interchange between dental occlusion and body postural therapy. Back posture deformity has been found to be related to trunk asymmetry as one characteristic of scoliosis that is commonly reported in occlusal development issue. This study aims to determine the correlation between back posture and sagittal jaw position in adult orthodontic patients treated at the dental hospital of Universitas Sumatera Utara.

Methods

This observational study was conducted on orthodontic patients who had routine orthodontic control between October 2019 and February 2020. The sagittal jaw relationship on pre-treatment cephalometry lateral-based on Steiner analysis was done with OrthoVision software. The back posture that related to cervical, thoracic, and lumbar measurement was performed using scoliometer plastic economy (Baseline®).

Results

From 128 patients, aged between 18 and 30 years, we found 72 patients with Class I, 41 patients with Class II, and 15 patients with Class III skeletal malocclusion. There were no significant differences of trunk asymmetry based on sagittal jaw relationship (p = 0.651). Additionally, there was no significant correlation between back posture and sagittal jaw position in Class II and Class III patients (r = 0.112, p > 0.05).

Conclusion

In this study, the sagittal jaw relationship had poor correlation to back posture in orthodontic adult patients due to a compensatory mechanism. The presence of temporomandibular dysfunction, sella-nasion-B point, and head posture are specific variables in a particular dento-skeletal type that should be considered in further studies.