Craniocervical posture in patients with skeletal malocclusion and its correlation with craniofacial morphology during different growth periods

The association between craniocervical posture and craniofacial structures in the various sagittal skeletal malocclusion during different growth stages has been the focus of intense interest in fields of orthodontics, but it has not been conclusively demonstrated. Thus, this study aimed to investigate the association between craniofacial morphology and craniocervical posture in patients with sagittal skeletal malocclusion during different growth periods. A total of 150 from a large pool of cephalograms qualified for the inclusion and exclusion were evaluated and classified into three groups according to the Cervical Vertebral Maturation (CVM) by examining the morphological modifications of the second through fourth cervical vertebrae, each group consisted of 50 cephalograms. In each growth period, for the comparison of head and cervical posture differences among various skeletal classes, the radiographs were further subdivided into skeletal Class I (0° < ANB < 5°, n = 16), skeletal Class II (ANB ≥ 5°, n = 18), and skeletal Class III (0° ≤ ANB, n = 16) on the basis of their ANB angle. There was no significant difference in gender (P > 0.05). Some variables were found to be significant during pubertal growth and later in patients with sagittal skeletal malocclusion (P < 0.05). Most indicators describing craniocervical posture were largest in skeletal Class II and smallest in skeletal Class III during the peak growth periods and later. Cervical inclination variables were greater in skeletal Class III than in skeletal Class II. Variables of craniofacial morphology and craniocervical posture are more correlated during the pubertal growth period and later in patients with sagittal skeletal malocclusion. A tendency is an indication of the close interrelationship that a more extended head was in skeletal Class II while a flexed head was in skeletal Class III. Nevertheless, with the considerations of some limitations involved in this study, further longitudinal studies with large samples are required to elucidate the relationship clearly.

Photometric analysis of the relationship between craniovertebral angle and facial profile in children aged 10-12 years

Background

Head posture deviation is seen in 52.5 % of children aged 6-15 years. Studies have shown that poor posture habits can impair muscle function during craniofacial growth and development. A muscle imbalance causes abnormal positioning of dental and skeletal structures, a condition that exerts negative impacts, such as changes in facial morphology.

Objective

To determine through photometric analysis the relationship between craniovertebral angle as a function of head posture and glabella-subnasale-pogonion (G-Sn-Pg) angle as a function of facial profile in 10-12-year-old children, and the results will help to avoid facial development issues.

Methods

Thirty-three subjects met the inclusion criteria. Their craniovertebral angles and facial profiles were measured using lateral photometry and ImageJ. The craniovertebral angle was determined by connecting the tragus and C7 with a horizontal line, whereas the facial profile angle was determined by connecting the glabella, subnasale, and pogonion. The relationship between the craniovertebral and G-Sn-Pg angle values was analyzed using the Pearson correlation test.

Results

A significant relationship was observed between the craniovertebral angle and the G-Sn- Pg angle (p < 0.05), although such a relationship was weak (r = 0.373).

Conclusion

A more forward head posture is associated with a more convex facial profile, and this relationship is useful for the early prevention and treatment.

Comparative Evaluation of the Relationship Between Airway Inadequacy, Head Posture, and Craniofacial Morphology in Mouth-Breathing and Nasal-Breathing Patients: A Cephalometric Observational Study

BACKGROUND

The process of respiration is the primary factor of the posture of the jaws and tongue. Thus, a changed respiratory form like mouth breathing can change the posture of the head, jaw, and tongue. This, in turn, could change the equilibrium of pressure on the jaws and teeth thus affecting jaw growth and teeth positions. The influence of nasorespiratory function on craniofacial growth has stimulated interest and debate for more than a century. Mouth breathing is the reason for numerous orthodontic glitches such as a mouth breather's face evolving aberrantly because of of functional disruptions triggered by chronic airway obstruction. The relationship between nasorespiratory function and dentofacial development remains controversial despite the long-standing clinical concern of orthodontists, so there was a need to evaluate and compare the relationship between head posture, airway inadequacy, and craniofacial morphology in mouth breathers and nasal breathers.

METHODOLOGY

Forty patients were selected and divided equally into two groups: mouth breathers and nasal breathers. Patients were diagnosed as mouth breathers based on physical examination and a history of chronic allergic rhinitis, adenoid, and tonsil enlargement. Lateral cephalograms were taken for all patients in the natural head position (NHP) with the Planmeca Proline XC Dimax3 x-ray machine (Planmeca, Helsinki-Uusimaa, Finland). All lateral cephalograms were traced and analysis was done to check airway, head posture, and craniofacial morphology. Descriptive statistics were performed to obtain the means and standard deviation of all the sample sizes. Unpaired t test was performed between nasal breathers and mouth breathers to check and evaluate the relationship.

RESULT

Mouth-breathing patients varied from nasal-breathing patients in airway adequacy and craniofacial morphology. A little, but not statistically significant, difference was seen in head posture between the two groups.

CONCLUSIONS

Early interception of mouth breathing in patients could be very helpful, as the postural changes in the mouth-breathing patients, if continued for a longer period of time, could be the reason for severe skeletal deformities as well as dental malocclusion.

Differences in the effects of orthodontic treatment on airway-craniocervical functional environment in adult and adolescent patients with skeletal class II high-angle: a retrospective pilot study

INTRODUCTION

This retrospective cohort study aimed to compare the change in upper airway and craniocervical posture after orthodontic treatment between adolescent and adult patients with Class II high-angle malocclusion.

METHODS

A total of 12 adolescent (mean ± standard deviation age = 13.0 ± 2.0 years) and 12 adult patients with Class II high-angle malocclusion (mean ± standard deviation age = 23.7 ± 6.4 years) were selected in this study. The lateral cephalograms and cone beam computed tomography images of adolescent and adult patients were taken before and after treatment, which can be employed to evaluate the variables of craniofacial morphology, upper airway, and craniocervical posture through paired t tests, respectively. An independent sample t test was performed to observe the differences between two groups after orthodontic intervention. For adults and adolescents, the correlation between craniofacial morphology, upper airway, and craniocervical posture was determined through Pearson correlation analysis.

RESULTS

In all subjects, the improvements in vertical and sagittal facial morphology after treatment were observed. Anterior and inferior movements of the hyoid bone, an increase of upper airway dimension, posterior tipping of the head and a reduction of cervical inclination in the lower and middle segments post-treatment were identified in adolescence (P < 0.05). Adults displayed anterior movements of the hyoid bone, whereas no significant difference was observed in upper airway dimension and craniocervical posture (P < 0.05). Notable differences were identified in the change of hyoid position and airway volume between two groups (P > 0.05). Mandibular plane inclination, growth pattern, occlusal plane inclination, and chin position were all significantly correlated with craniocervical posture in adolescent patients. Besides, the mandibular growth pattern and chin position in adult patients were significantly correlated with craniocervical posture (P < 0.05).

CONCLUSIONS

Orthodontic treatment is capable of enhancing the facial profile of patients with skeletal class II high-angle while improving their upper airway morphology and craniocervical posture, where adolescents and adults differ substantially in that the former exhibit a more favorable alteration in the airway-craniocervical functional environment.

Effects of Different Head Positioning Methods on Facial Soft Tissue Analysis Using Stereophotogrammetry

PURPOSE

The purpose of this study was to compare the sagittal tilt of the head in different head positioning techniques using an inclinometer and facial stereophotogrammetric measurements.

MATERIALS AND METHODS

The study was carried out in 45 participants (26 female, 19 male). Participants' head positioning was obtained with dynamic walking, Frankfort horizontal plane (FHP'), self-balance plus mirror, and subjective photographic positioning methods. All pitch values were recorded by an inclinometer and stereophotogrammetric images were obtained. Facial analysis included distances of the glabella (G'), pronasale (Pn), soft tissue A point (A'), upper lip (Ls), lower lip (Li), soft tissue B point (B)', and soft tissue pogonion (Pog') to the true vertical line (TVL) and face height and lip length measurements.

RESULTS

Participants' head positions were observed to be more forward in the FHP' head positioning technique compared with other methods, whereas a more backward head position was recorded with subjective head positioning, and the difference was significant (P < .001). There were no relevant differences in pitch values between the self-balance plus mirror and dynamic walking methods. G'-TVL (P < .000), Pn-TVL (P < .029), A'-TVL (P < .039), Ls-TVL (P < .001), Li-TVL (P < .037), B'-TVL (P < .003), and Pog'-TVL (P < .000) in the profile view and face height, lower face height, and lower lip length values in the frontal view (P < .001) differed significantly by head positioning method.

CONCLUSIONS

The dynamic walking and self-balance plus mirror head positioning methods offered similar and advisable natural head position results, whereas FHP' head positioning was questionable for an accurate determination of natural head position. Facial soft tissue measurements, such as face height, lower face height, lower lip length, and projection of structures such as the G', Pn, lips, and chin, varied based on head positioning method.

Relationships of vertical facial pattern, natural head position and craniocervical posture in young Chinese children

OBJECTIVE

To investigate relationships of vertical facial patterns, natural head position (NHP), and craniocervical posture in young Chinese children with skeletal Class I relationship.

METHODS

Ninety-four patients with skeletal Class I relationship were classified into low, average, and high angle groups according to their mandibular plane angle (NSL/ML). Cephalometric radiographs in NHP were taken. Variables representing vertical and sagittal craniofacial morphology, head posture, and craniocervical posture were measured and compared.

RESULTS

Inclinations of the mandible to the true vertical and cervical column were smallest in the high angle group and largest in the low angle group. Other variables representing head posture and craniocervical posture were largest in the high angle group, smallest in the low angle group. Inclinations of ramus to cervical column were largest in the high angle group and smallest in the low angle group.

DISCUSSION

Subjects with large NSL/ML angles showed extended head and craniocervical posture, while subjects with small NSL/ML angles exhibited flexed head and craniocervical posture.

Natural head position and lower incisor irregularity: Is there a relationship?

OBJECTIVE

The aim of this study was to assess the relationship between dynamic measurements of natural head position (NHP) and lower incisor irregularity to identify potential gender differences.

MATERIALS AND METHODS

A total of 103 plaster models and dynamic NHP measurements were taken from 51 male (mean age: 14.20 ± 2.51 years) and 52 female (mean age: 15.02 ± 2.67 years) subjects. The dynamic NHP data were gathered by using an inclinometer device and a portable data logger. Lower incisor irregularity was measured with Little's irregularity index. The Mann-Whitney U and Kruskal-Wallis rank tests were used at a significance level of p < 0.05. To evaluate the correlation between NHP and lower incisor irregularity, Spearman correlation coefficients (r) were calculated.

RESULTS

There were significant gender differences in the sagittal measurements of NHP (p = 0.031) and incisor irregularity (p = 0.023). A Kruskal-Wallis test revealed no significant difference in NHP measurements between subjects presenting different levels of irregularity. Females displayed no significant correlation between incisor irregularity and any NHP measurement. However, in the males high correlation coefficients between incisor irregularity and sagittal NHP measurements (r = 0.369; p = 0.008) were noted.

CONCLUSION

Significant correlations between lower incisor irregularity and sagittal NHP measurements in males were observed. Females had a more forwardly inclined NHP than males. Moreover, male subjects displayed greater incisor irregularity than female subjects.

Relationships between Malocclusion, Body Posture, and Nasopharyngeal Pathology in Pre-Orthodontic Children

BACKGROUND

Malocclusion, body posture, and breathing pattern may be correlated, but this issue is still controversial. The aim of the study was to examine the relationship between the type of malocclusion, body posture, and nasopharyngeal obstruction in children aged 7-14 years.

MATERIAL AND METHODS

The study group comprised 94 patients aged 7-14 years (mean±SD: 11.9±2.1 years); 44 (46.8%) males and 50 (53.2%) females. All patients passed an examination performed by the same orthodontist (study model and cephalometric radiograph analysis), orthopedic surgeon (body posture examined from the front, side, and back), and otorhinolaryngologist (anterior and posterior rhinoscopy and pharyngoscopy) in a blind manner.

RESULTS

Postural disorders were observed in 72 (76.6%) patients. Hypertrophy of the adenoids was diagnosed in 54 (57.4%) patients, hypertrophy of the tonsils in 85 (90.3%), nasal septum deviation in 51 (54.3%), and allergic rhinitis in 19 (20.2%) patients. There was a statistically significant correlation between presence of kyphotic posture and a reduction in the SNB angle, representing sagittal position of the mandible. Also, there was a statistically significant association between kyphotic posture and nasopharyngeal obstruction (54.1% of patients with nasopharyngeal obstruction were kyphotic, compared with 25% of patients with no nasopharyngeal obstruction; p=0.02). Kyphotic posture and reduced SNB angle were more common among males.

CONCLUSIONS

We concluded that: 1) there was a significant association between the sagittal position of the mandible (SNB angle) and a kyphotic posture; 2) kyphotic posture was significantly more common among patients with nasopharyngeal obstruction.

Relationships of sagittal skeletal discrepancy, natural head position, and craniocervical posture in young Chinese children

OBJECTIVE

The aim of this study was to investigate the relationships of sagittal skeletal discrepancy, natural head position (NHP), and craniocervical posture in young Chinese children with average vertical facial pattern.

METHODS

Ninety patients with average Frankfort mandibular plane angle (FH/ML) were classified into skeletal class I, II, and III relationships according to their ANB angle. Cephalometric radiographs in NHP were taken. Variables representing sagittal and vertical craniofacial morphology, head posture, and craniocervical posture were measured and compared.

RESULTS

Subjects in the skeletal class II group showed the largest craniovertical angles and craniocervical angles, while subjects in the skeletal class III group exhibited the smallest craniovertical angles and craniocervical angles, though not all the measurements showed significant differences. The angle formed by the nasion-sella line and the tangent to the posterior border of the mandibular ramus (NSL/RL) was largest in the skeletal class II group and smallest in the skeletal class III group (p = 0.05).

DISCUSSION

Significant differences exist in NHP and craniocervical posture among skeletal class I, II, and III relationships in young Chinese children. Subjects with skeletal class II relationship tended to exhibit more extended head, and children with skeletal class III relationship often exhibited flexed head.

Morphometric analysis of cervical vertebrae morphology and correlation of cervical vertebrae morphometry, cervical spine inclination and cranial base angle to craniofacial morphology and stature in an adult skeletal class I and class II population

Objective:

The study was carried out to compare the morphometry of the cervical column between adult Class I and Class II individuals and between gender and to analyze the correlation between the cervical column morphology, the cranial base angle, the craniocervical inclination with craniofacial morphology and stature of Angles Class I and Class II individuals.

Materials and Methods:

The data for this institutional retrospective study were systematically selected according to the specified inclusion and exclusion criteria from the pretreatment cephalometric radiographs of 19 male and 30 female patients visiting the Department of Orthodontics, Manipal College of Dental Sciences, Mangalore, Manipal University, based on their ANB angle. The radiographs were traced and digitized. The reliability of the variables describing the cranial base and vertical and sagittal craniofacial dimensions was assessed.

Conclusions:

Our results showed that there was no statistically significant variation in the cervical vertebrae dimensions between Class I and Class II patients. There was found to be a definite sexual dimorphism, which was not statistically significant. Correlation exists between sagittal skeletal patterns, especially mandibular length and cervicovertebral morphology, but its use to classify the subjects in different sagittal classes is questionable.

[Dental spacing problems and associated factors among Brazilian adolescents]

The scope of this study was to estimate the prevalence of dental spacing problems and associated factors among adolescents using data from the SB Brazil 2010 survey. The outcomes evaluated were dental spacing problems: space deficit (crowding and misalignment) and excess space (diastema and spacing) obtained using the DAI index. The association of independent variables with outcomes was assessed using a hierarchical model with four levels: contextual, socioeconomic and demographic characteristics, access to services and dental morbidity. Statistical analysis was performed using the chi-square test and univariate and multivariate Poisson distribution to estimate prevalence ratios (PR). The overall prevalence of space problems was 71.43%, with misalignment being the most common type (56.4%). The following aspects were significantly associated with excess space: age of 16, 18 and 19 years; being non-Caucasian (PR = 1.75), perception of speech problems (PR = 1.72) and periodontal pockets 4-5mm (RP = 1.56). For space deficit: family income up to 3 minimum wages, dental visit 1 year or more previously (PR = 1.19) and having one or more decayed teeth on average (PR = 1.32). There was a prevalence of spacing problems, especially with socioeconomic and demographic variables and morbidity as potential risk factors.

[Dento-facial orthopedics and osteopathy]

Osteopathy has grown rapidly. Given their common action on children and adolescents, the collaboration between dentofacial orthopedics and osteopathy is increasingly common. It therefore becomes necessary and urgent to investigate whether, based on data acquired from science, there is evidence of possible interrelations between the two disciplines. After reviewing the literature, very few scientific publications demonstrate the utility of osteopathy and its relationships with other disciplines. However, the relationship between occlusion and posture seem relatively proven, especially in the sagittal direction. On the other hand, although the mobility of the cranial bones is established, the primary respiratory motion is still subject to controversy, even among osteopaths. This, even as orthodontics has long been accused of countering the primary respiratory motion of cranial bones (PRM). Today osteopaths do not reject orthodontics anymore, because the return to a physiological bite situation is considered beneficial. According to expert opinion (without proof, however), some orthodontic devices (like headgears) which block the sutures are still to be avoided and require appropriate monitoring osteopathy. The controversy over the adverse effects of orthodontic treatment is becoming more nuanced by osteopaths, and modern orthodontics claiming a «global» approach of patient, collaboration may be possible in future year.

Postura de cabeça nas deformidades dentofaciais classe II e classe III

OBJETIVO: este estudo investiga se existe diferença entre grupos com diferentes deformidades dentofaciais (padrão classe II e classe III) e o grupo sem a deformidade em relação à postura de cabeça. MÉTODO: participaram deste estudo, voluntariamente, 25 pacientes (entre 16 e 40 anos). Dez pacientes com diagnóstico de deformidade dentofacial classe II e 15 pacientes com o diagnóstico de classe III esquelética e 15 voluntários sadios, com equivalência em sexo e idade ao grupo de deformidade, formando o grupo controle. Primeiramente foi realizada a inspeção da postura de cabeça. Logo em seguida foi realizada a avaliação postural de cabeça por meio da fotografia postural (fotogrametria). RESULTADOS: não houve diferença significante (p>0,05) entre os grupos em relação à avaliação postural utilizando-se a fotogrametria. Já em relação à avaliação postural pela inspeção clínica, observou-se uma postura anterior de cabeça nos indivíduos com a deformidade dentofacial padrão classe II, comparados ao padrão classe III (p = 0,001) e ao grupo controle (p = 0,001). Foi visto também que o grupo deformidade classe II apresentou um percentual inferior de indivíduos com posição neutra de cabeça comparado ao grupo deformidade classe III (p = 0,008) e ao grupo controle (p = 0,001). CONCLUSÃO: indivíduos com deformidade dentofacial classe II podem apresentar uma anteriorização de cabeça. Não há influência da deformidade no aumento ou na redução do ângulo cabeça-pescoço, analisado por meio da fotogrametria.