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healthy_backКонспект самой диссертации: https://healthy-back.livejournal.com/458494.html (https://healthy-back.dreamwidth.org/444848.html)
https://healthy-back.livejournal.com/458785.html (https://healthy-back.dreamwidth.org/445070.html)
Имеются данные, указывающие на взаимозависимость между осанкой и стоматогнатической системой [175].
175. Cuccia A., Caradonna C. The relationship between the stomatognathic system and body posture / A. Cuccia, C. Caradonna // Clinics (Sao Paulo, Brazil). – 2009. – No 1 (64). – P. 61–66.
На эту статью была написана другая:
Correlations between the stomatognathic system and body posture: biological or clinical implications? Giuseppe Perinetti
https://pubmed.ncbi.nlm.nih.gov/19219310/
https://www.sciencedirect.com/science/article/pii/S1807593222026837?via%3Dihub
И источники 17 и 18, которые использовались в первоначальной статье:
17. https://www.tandfonline.com/doi/abs/10.1080/08869634.1996.11745978
The Journal of Craniomandibular & Sleep Practice Volume 14, 1996 - Issue 4
Relationship Between Posture and Occlusion: A Clinical and Experimental Investigation
Alessandro Nobili, M.D., D.D.S. & Riccardo Adversi, M.D. Pages 274-285 | Received 18 Jan 1996, Accepted 21 May 1996, Published online: 13 Jul 2016
ABSTRACT
Recently many postural diseases have been classified among occlusal-functional alterations, mostly on a clinical basis. However some anatomic and physiologic aspects are still unknown. The purpose of this study was to review the literature and to support the correlations by means of a balance platform on a group of 50 patients (30 males and 20 females, mean age 25.8 years) belonging to every Angle classification of malocclusion. The subjects were asked to stand on the balance platform and perform five different tests.
The results showed that
— subjects with a Class II malocclusion exhibit an anteriorly displaced posture, whereas
— subjects with a Class III malocclusion exhibit a posteriorly displaced posture.
18. https://www.scopus.com/record/display.uri?eid=2-s2.0-33748556536&origin=inward&txGid=c1d1e2b4d63b63e306509e58a28b739a
Angle OrthodontistVolume 76, Issue 5, 2006, Pages 779-785 Relationship between thoracic, lordotic, and pelvic inclination and craniofacial morphology in adults (Article) Lippold, C., Danesh, G., Schilgen, M., Drerup, B., Hackenberg, L.
Abstract
Objective: To analyze the correlation ratios between the spinal posture (thoracic, lordotic, and pelvic inclination) and the craniofacial morphology. Materials and Methods: The sample consisted of 53 healthy adults (32 women, 21 men; mean age 24.6 years). Six angular skeletal measurements (facial axis, mandibular plane angle, inner gonial angle, lower facial height, facial depth, and maxilla position) were determined based on the analysis of lateral head cephalographs.
Rasterstereography was used for a precise reconstruction of the back sagittal profile. From the profile parameters, the upper thoracic inclination, the thoracic angle, the lordotic angle, and the pelvic inclination were determined. The correlations to the craniofacial morphology were calculated by means of the Pearson and Mann-Whitney U-test.
Results: Significant correlations could be obtained with respect to the facial axis and the lordotic angle, the facial axis and the pelvic inclination, the inner gonial angle and the lordotic angle, the inner gonial angle and the pelvic inclination, the mandibular plane angle and the lordotic angle, the mandibular plane angle and the pelvic inclination, as well as the facial depth and the pelvic inclination.
Conclusions: In the case of postural disorders of the back shape, an interdisciplinary treatment approach seems to be of clinical value. Further prospective studies are necessary to prove how changes in craniofacial parameters can affect the postural balance of an individual.
129. https://link.springer.com/content/pdf/10.1007/s12548-009-0001-4.pdf
systematic topical review
J. Stomat. Occ. Med. (2009) 2: 2–10DOI 10.1007/s12548-009-0001-4Printed in Austria
Occlusion, orthodontics and posture:are there evidences? The example of scoliosis P. Amat
Received December 6, 2008; Accepted December 28, 2008
The relationship between posture and occlusion has been a constant source of interest to health care professionals. How-ever, a certain amount of confusion still beclouds in this connection because of the great variety of therapeutic approaches proposed for dealing with it as well as the lack of methodological rigor employed for most of the scientific studies published on it.
This presentation addresses the questions raised by the connections between posture and occlusion as well as their therapeutic implications. A review of the literature shows that there is a lack of reliable experimental publications devoted to this subject. The data that is available points to the existence of this correlation and also asserts the prevalence of associations between cranio-facial anomalies and idiopathic scoliosis in adolescents.
In presenting the interactions between dental occlusion and posture published data tends to lend comfortable support for the subjective convictions and clinical impressions wehave already formed. The physiological continuum tying occlusion to posture does not appear to be a univocal and linear relationship but instead a complex ensemble made up of numerous contributing factors.
To find more answers we need to undertake basic and clinical research projects that could eventually establish the validity of a cause and effect relationship between dental occlusion and posture that would put therapy on evidence-based foundation [23, 24].
Keywords: Evidence-based medicine, posture, dental occlusion, scoliosis, dento-facial orthopedics
Introduction
In dento-facial orthopedics, and in a more general way in all of dentistry, we live in an era in which postural considerations are being integrated into our therapy. It is probably fair to say that the inter-relationship be-tween occlusion and posture are of interest for a significant number of practitioners. However, a certain amount of confusion surrounds this connection because of the wide diversity of therapeutic approaches designed to deal with it and the weakness of methodological design in the scientific studies that have been published on it to date.
The interactions between posture and occlusion constitute a vast topic. With this presentation we hope to stimulate discussion and thinking about it and suggest that scientific study can often corroborate our original unsubstantiated convictions.
Occlusion and posture: a reciprocal inter-change
Definitions
Our subject is dental occlusion. The dictionary of orthognathics [21] published by the Société Française d’Orthopédie Dento-Faciale defines it as a phrase in current use employed to describe the reciprocal action of the dental arches.
The same tome offers a double definition of posture:
– The habitual stance of the body or parts of it supported by the action and constraints of tonic muscles that work to fix the body segments through joints designed to maintain equilibrium.
– Bodily stance derived from the interaction of body weight and the sensori-motor complex (derived from the labyrinth of the inner ear, the Pacini bodies, the Golgi apparatus, the joints, and the plantar surfaces of the feet).
Posture and dento-facial orthopedics
Orthodontists should take a consistent and on-going interestin the posture of their patients. In addition to the establish-ment of the dental objectives of their mechano-therapy they should also be attentive to the eventual relationship between occlusion and cephalic as well as overall bodily posture, taking into account physiological regulation of varying mandibulo-cranial positions. It is equally important that they consider the interaction between cranio-cervical posture and cranio-facial morphogenesis [79].
Clinically, orthodontists have to face with a number of questions. In the first place, they find that interest bearing on the relationship between occlusion and posture leads them into a battleground with at least two fronts. Patients consult them seeking occlusal treatment that they hope, or have been told by practitioners in allied fields, will help to improve their postural problems. How should we respond to these requests? Our patients have a right not to be deprived of effective treatment, no matter what it might be. They also have the right to benefit from true informed consent and we have the obligation to tell them exactly what medical benefit they can expect to derive from therapy, especially if that therapy isinvasive. In other words, they have a right to be presented with a clear cost/benefit/risk analysis.
Occlusion and posture: facts and beliefs
The indispensable evidence-based approach
Designed to help us achieve a global improvement in thequality of our treatment and to bridge the gap between clinicalresearch and the health care we deliver, the evidence-basedapproach [70, 71] has been widely accepted in the medicalcommunity.
Evidence-based dento-facial orthopedics [7, 8] describesthe application of factual data to our specialty. Let us empha-size that its three components, clinical experience, the bestavailable published data on clinical research, and the valuesand preferences of our patients, must be welded together sothat orthodontists and their patients can cooperate fully in adiagnostic and therapeutic alliance (Fig. 1). The most thoroughgoing review of the literature devoted to the postural approach will, unfortunately, deal with a limited number of controlledstudies carried out with methodological rigor.
Occlusion and posture: what does appear in the literature?
The questions
In addition to the simple issue of the existence of a relationshipbetween occlusion and posture, several other questions have been posed.
What are the criteria for normal posture of the body, the head and the spinal column, and the mandibulo-cranial complex? Are these criteria valid? How should malfunctions of posture be defined? What are the consequences of the malfunctions structurally, in causing pain, and can they beevaluated in terms of deficiency, of incapacity, or of handicap [4]? And have the results of postural treatment been confirmedby controlled studies?
Clinicians should also ask themselves about the nature of the mechanisms of the regulation of posture and the limits of postural adaptation. Is orthodontic treatment a contributing factor to the etiology of postural deformities or isn’t it? Canchanges in occlusion affect, in a clinically significant manner, global postural equilibrium? Can occlusion actually provoke postural disturbances or pathological ailments in sites far distant from the oral cavity?
Variations in dental occlusion are manifold and appear ina variety of ways; malformations, attrition due to function orfaulty habits, irregularities of teeth, and changes resultingfrom dental restorations, orthodontic care, and prostheticrehabilitation. What eventual influence does each of thesehave on postural balance?
Finally, another interrogation is based on the possible role that dento-facial orthopedic therapy could have in thetreatment of postural disorders.
The weakness of published data
Most publications devoted to the relations between postureand occlusion have been prepared with meager methodolog-ical rigor which makes it difficult to derive a clear answer fromthem to the questions that we have just outlined.
The aim of this article was to present a comprehensivereview of the literature. The literature survey was performedbyapplying theMedline database (Entrez PubMed, www.ncbi.nim.nih.gov). The survey covered the period from January1966 to December 2007. The headings sequence“Posture”[MeSH] OR“scoliosis”[MeSH] AND“Dental occlusion”[MeSH] was selected. Additionally, a search in the Cochrane Clinical Trials Register (www.cochrane.org/ reviews) was performed.
The titles and abstracts of all potentially relevant articleswere reviewed. Electronic searches were followed up with secondary searches. The search strategy resulted in 348 articles. 23 of them were reviews. Three RCTs were retrieved.
In any assessment it is quite clear that a great many of the articles dealing with the relationship between occlusion and posture are anecdotal reports of clinical cases that have little status as scientific evidence.
The scientific studies that have been devoted to the relationship of occlusion to posture suffer, as a group, from a variety off laws [37]. We can site the non-random separation of patients into groups to be studied, the failure, at theclose of the study, to measure all of the patients that had participated in the trial, or, to put it in another way, the omission of some of the participants. We should add thefrequent defect of poor definition of the criteria for inclusion or exclusion of subjects, the use of patient samples too small in size, and the failure to carefully define the validity of thetests employed with regard to their sensitivity, specificity, and reproducibility.
A few comments
The difficulties that participants in this field have had in obtaining experimental results that are clearly reliable should not prevent us from discerning in this bewildering jumble the existence of many suggestive implications. Some of the indications we might draw from them are:
— changes in the position of the mandible influence body posture [72];
— reciprocally, body posture seems to have an effect on the position of the mandible [72], with the exception of centric relation and occlusion with maximum intercuspation, the localization and reproducibility of both of which are not affected [20, 83];
— habitual mandibular position, or rest position, is tied to cephalic posture [88];
— head posture seems to influence occlusion [73, 74]. It does influence the trajectory of closing, and the position of the initial occlusal contacts [17, 22, 54, 79]. On the contrary, a forward inclined head posture does not appear to have any effect on initial occlusal contacts [52];
— can occlusion affect the way feet support weight? The conclusions of published studies on the point are contradictory. Ferrario et al. [29] have shown that adjustments of the centers of pressure in the feet are not influenced by the pain felt in the masticatory system, Class II subdivision malocclusions, or by variations in occlusal positioning. But other studies [14, 15] do assert that the occlusion exerts an influence on the pressures applied through the feet;
— many studies refer to a supposed correlation between malfunction of the masticatory apparatus and an anterior positioning of the head [16, 47, 48, 80]. These correlations should make clinicians consider the advisability of integrating the evaluation and treatment of postural defects at the same time they are correcting discrepancies in the masticatory system [16, 43, 45];
— but the results reported in another article [60] do not confirm the hypothesis that body posture provokes or aggravates masticatory discrepancies. Still this work should be evaluated with extreme caution because of the small size of the sample and the large number of postural variables it dealt with;
— the studies that Perinetti carried out using a stabilometric platform did not produce any evidence that there was a correlation between dental occlusion and bodily posture[63], nor that patients with TMJ problems had per force alterations in bodily posture [64];
— patients suffering from internal derangement of the temporo-mandibular joint do not necessarily hold their heads in an advanced position [39];
— pain felt in the masticatory apparatus is not associated with cephalic posture [85];
— a recent systematic review of the literature suggests that the hypothesis that there is a relationship between cervico-cephalic posture and disorders of the masticatory process remains uncertain [10];
— many articles claim to show that there is a relationship between cervico-cephalic posture and cranio-facial morphology. Cervical posture appears to be strongly correlated with structural variations in the sagittal and vertical dimensions of the face [11,26]. Positive correlations have also been demonstrated between cervico-cephalic posture and both mandibular and maxillary anterior dento-alveolar height as well as with the inclinations of the upper and lower occlusal planes [77]
— children with Class III skeletal malocclusions present asignificantly lower extent of cervical lordosis than those with skeletal Class I or II occlusions [26].
— on the contrary, children with Class II skeletal malocclusions have significantly increased cervical lordosis compared with children with Class I or II occlusions [26], and subjects in Class II keep their heads more forward to a significant extent [34];
— a study conducted using a posturographic platform showed that subjects in Class II had body posture projected forward and those with Class III malocclusions a bodily posture projected backward [61];
— a negative correlation exists between cervical lordosis and mandibular length [31];
— many studies seem to indicate that the afferent impulses of the trigeminal participate in the relationship of occlusion and postural regulation [35, 36]. They allege that there is an inter-dependence between the sensory and motor innervations of the trigeminal nerve and the cervical complex [18];
— there is a significant association between the dominant eye and homo-lateral rotation of the head. In patients suffering from discrepancies of the masticatory system there is also asignificant association between the side of the cephalic rotation and a contra-lateral deviation of the mandibular incisive midline [66];*In a study conducted by P. Gangloff of participants in riflery sports [35], the stabilization of sight was found to have an effect on postural control through mediation of the dental occlusion;
— Michelotti et al. [56] studied patients with posterior cross bites using a stabilometer platform and found in two modalities, occlusion at maximum inter-cuspation and a position with teeth held comfortably apart with cotton rolls.
They found the cross bites had no effect on the stability of bodily posture. They concluded that there would be no justification for correcting the cross bites if the objective were to prevent or treat a postural problem.
— in addition, another study found that posterior cross bites were not correlated with inequality in leg length of young adolescents [57];
— an excessive cranio-cervical angulation is associated with lower anterior crowding [3, 78]. This conclusion is in accord with a hypothesis about stretching of soft tissues accordingto which patients with extended cranio-cervical posturehave a blockage of the sagittal growth of their dental arches from the dorsal tension exerted on them;
— does muscular force vary with the occlusion? Maximalbiting force is greater when the head is extended than it is when the head is held in a natural position [41];
— a splint that places the mandible in a position determined by kinesiological tests would be likely to augment muscular force [1, 32, 33].
These results contradict those of another published article that avers that there is no correlation between biting force and cephalic posture [81];
— Kovero et al. also did not find any significant statistical correlation between maximal biting force and cervical posture [46];
— the neuromuscular activity of neck and face muscles seems to influence corporal or bodily posture according to many studies [25, 58, 59, 75], but, according to another one, do not[84];
— bruxism could be associated with a head posture that is inclined excessively downward and forward [86];
— a recent systematic review of the literature [40] surveys in 266 publications reporting on a relationship between the masticatory apparatus and disturbances of the spinal column. There is an inter-relation between the masticatory apparatus and head posture according to 216 articles, and an association between pelvic tilting and the oral cavity according to 53 studies. 131 articles conclude that the occlusion affects posture and 171 assert that posture affects occlusion.
These reports from the extensive literature suggest that our mechano-therapies can have an effect on the bodily posture of our patients. But because of the widespread lack of methodological rigor in these investigations, orthodontists should examine the results with prudence and circumspection, especially in view of their tendency to be mutually contradictory. By doing this we can avoid the risk of over-treating our patients by being scrupulously critical when we add postural considerations to our diagnoses [40].
The special case of the relationship between idiopathic scoliosis and occlusion in adolescents
When a diagnosis of idiopathic scoliosis is made, patients are confronted with the possibility that their spines will continue to develop in a deformed way until the end of the growth period. The best outcome for them would be merely to have to submit to regular check-up examinations about the state of the vertebral column. But some of them will have to endure especially grave orthopedic or surgical treatment. Because of the seriousness of the global effect of the disorder and its esthetic, psychological, and functional repercussions a close study of idiopathic scoliosis helps to answer many questions that arise about the interrelations between posture and occlusion.
Idiopathic scoliosis and adolescents
Scoliosis is a three-dimensional structural deformation of the spinal column, with rotation of some vertebrae that causes gibbosities. These deformations cannot be totally corrected, which differentiates them from simple tendencies toward scoliosis. Idiopathic scoliosis makes its appearance before the end of the growth period, unassociated with other pathologies, which also differentiates them from scolioses that are secondary to other problems such as malformations and neurological disorders.
Conventionally, idiopathic scoliosis is called infantile if it is detected before the child is three years old and juvenile if it appears clinically in children from three to ten.
When scoliosis appears in children between the age often and the time of skeletal maturation it is said to be adolescent, a category that embraces 80% of the ensemble of cases of idiopathic scolioses [87]. Affecting more girls than boys, the disorder [67] is seen in about 2 to 4% of adolescents between the ages of 10 and 16.
The etiology of idiopathic scoliosis is probably multi-factorial, with components that are hormonal, connected with growth, with genetics, with metabolic disturbances of collagens and proteoglycanes, with neurological disturbances especially of the proprioceptive and equilibration systems, and with biomechanical factors [19, 68].
With regular clinical and radiological examinations the progress of the malady can be observed. According to Lonstein and Carlson [51], the topography of the individual case of scoliosis, the patient’s age at the time it was discerned, the initial degree of angulation, the results of the Risser test, and, for girls, the date of the onset of menstruation, can all be evaluated as factors in the “prediction of curvature progression in untreated idiopathic scoliosis during growth”.
Treatment of evolving idiopathic scoliosis is usually conservative at first having the objective improving the appearance and the functioning of the spinal column and preventing any aggravation of the curvatures that have already occurred. Some patients are asked to wear braces that are adjusted to various degrees of correction. When the malady progresses unfavorably and the deformation becomes more serious, surgical treatment may be indicated. But, throughout, careful observation of the patients and their families is of primordial importance because the necessary procedures can be long, tedious, and extremely constraining. The primary goal with all patients is to limit the development of the scoliosis so that it does not become a serious impediment to a normal, active life when patients become adults.
Adolescents with idiopathic scoliosis and orthodontic treatment
How should orthodontists deal with patients who suffer from idiopathic scoliosis? Does the malady exert a pernicious effecton the patient’s occlusion? Will orthodontic treatment ameliorate or aggravate the patient’s overall health? These are the principal questions that must be answered when patients with scoliosis seek an orthodontic consultation.
Cases of idiopathic scoliosis often develop in unpredictable ways during growth periods. Not infrequently, the malady may become more grave or, in other cases, stabilize [38] during the time a patient is undergoing orthodontic treatment and the orthodontist’s mechano-therapy may be blamed or given credit. This, of course would affirm without a shred of proof that an association between two phenomena establishes a cause and effect relationship between them.
This calls to mind a parallel between another debate that caused a considerable stir in orthodontic circles during the 1980s when orthodontic treatment was alleged to have caused some patients tempero-mandibular disorders or so-called TMJ problems. During the epidemic of this unfortunate witch-hunt some patients actually obtained substantial financial awards [65] for alleged malpractice. Fortunately a series of subsequent clinical studies [55] was able to prove that dento-facial orthopedic treatment did not increase the risk of a patient’s developing tempero-mandibular maladies.
We have derived the answer to the series of questions we posed by means of a virtual dialogue between members of diverse health disciplines in an attempt to restore some unity to the evaluation of patients whose examinations are too often fragmented into studies of separate organs to fit the vision of a host of medical specialties and by a careful study of the literature.
The occlusion of adolescents with idiopathic scoliosis: what does the published data tell us?
Many studies have been carried out to try to determine if a scoliotic deformation can be associated not only with adaptive asymmetries of postural control but also with a particular type dento-skeletal formation.
Does treatment of scoliosis tend to affect a patient’s dento-facial equilibrium?
During the decades of the 60s and 70s many articles were published about the deleterious effects on facial growth that orthopedic treatment of scoliosis with a Milwaukee bracecould cause.
In a 1966 article Alexander [2] presented evidence that there was a significant reduction in facial height, an elevation of the palatal plane, a flattening of the palatal vault, a tilting,lower and forward, of the mandibular symphasis, intruding of molars, and labial tilting of maxillary and mandibular incisors during treatment of scoliosis with the Milwaukee brace.
Other authorities subsequently suggested that patients wear a variety of appliances, such as the monobloc, to counteract the adverse oro-facial effects of the Milwaukee brace [69].
Because of these studies the Milwaukee brace was then modified so that it would be less likely to provoke unwelcome iatrogenic side effects [49, 53]. More recently Huggare et al.[42] described the less substantial side effects of orthopedic treatment for scoliotic patients undertaken with a Boston brace. These patients were distinguished from a control group by an accentuation of the cranio-cervical angle, a rotation of the orbital plane, maxillary, and mandibular planes, a displacement of the mid-line of the mandibular arch, and a flattening of the posterior arch of the first cervical vertebra associated with a lengthening of the dent de l’axis.
Correlation between idiopathic scoliosis and dento-skeletal characteristics
Pecina et al. have classified orthodontic anomalies into two categories, hereditary and acquired. They show that in scoliotic patients [62] there is a higher rate of occurrence of hereditary orthodontic anomalies like hypodontia, which is 10 times more frequent and prognathic mandibles.
On the other hand, these authors did not find a higher incidence of acquired orthodontic anomalies in scoliosis patients.They suggest that early detection of hereditary orthodontic discrepancies would allow health care givers to identifya group of infants with a high risk of later developing scoliosis.
Lippold et al. found a statistically significant correlation between Class II malocclusion and scoliosis [50].
They recommend that all pre-school children with Class II malocclusions, no matter how slight, should be carefully watched for possible development of spinal abnormalities (Fig. 2a–c).
The authors of another article [44] conclude that there is a correlation between skeletal anomalies of Class I, II, or III,hypo or hyper-divergent, and scoliosis.
The study that Ben-Bassat et al. [12] published showed patients with scoliosis had more than an average amount of asymmetries in the sagittal and transverse dimensions. Other investigators have observed that patients with scoliosis have prevalence statistically greater than average of Class II sub-division malocclusions, lower incisal mid-line deviations, and, especially, mandibular deviations, as well as anterior and posterior cross bites. On the other hand, no significant correlation has been established between the side to which the spine is deformed and the side of the posterior cross bite or the side to which the mandibular midline is deviated.
Some authors do draw our attention to the possibility that the asymmetries of scoliosis and of malocclusion share a common etiology. Should this be true the global correction of a malocclusion, and its retention, could be more uncertain. They advise practitioners examining patients to look for underlying orthopedic problems when they have made a diagnosis [13] of early signs of dento-facial asymmetry.
Still other workers have studied the relationship between dental occlusion and posture in animals. Festa et al. [30] studied the effects in rats of unilaterally opening their bites by adding composite to posterior teeth. After one week a radiological examination showed a marked deviation of the animals’ vertebral columns. When researchers opened the bite similarly on the other side the spinal column straightened up. More recently D’Attilio et al. [27] also induced scoliotic curvature in the spinal columns of rats in a week’s time by unilaterally raising the occlusion. When the researchers re-stored occlusal harmony by elevating the contra-lateral side of the occlusion, vertebral alignment of 83% of the rats in the study returned to the original condition. This seems to make clear that spinal column alignment in rats can be influenced by dental occlusion.
So clinicians are faced with the question of determining to what extent experimental observations made in animal studies can be applied to daily practice. Even if the results of animal studies should not be extrapolated to apply to people but tested on humans first before they are accepted, their conclusions should, at the very least induce practitioners to conduct any mechanical adjustment that could lead to occlusal imbalance with extreme care.
Clinical implications
The strong prevalence of associations between scoliosis and cranio-facial anomalies argues persuasively for the related disciplines of general orthopedics and dento-facial orthopedics to work cooperatively in early diagnosis of patients and in increasing the effectiveness of the treatment of those patients.
In this way orthodontists could contribute to the orthopedist’s beginning early treatment of spinal cord deformities by suggesting an orthopedic consultation when orthodontic examinations have uncovered certain indicative dento-skeletal characteristics such as Class II malocclusion or dento-facial asymmetry.
It should be emphasized that when orthodontists do not include every facet of their patients’ health status in their examinations they may risk missing important diagnosticelements. When they are confronted with a polymorphous symptomology, they must endeavor to assess all of its dimensions including postural to avoid parceling treatment into isolated and ineffective components.
Certainly the achievement of a harmonious and esthetic smile for our patients (Fig. 3a and b) remains one of the objectives of our treatment, but the therapeutic perspectives of our specialty go far beyond that. Besides placing ourpatients’ faces (Fig. 4a and b), jaws, and dental arches in better esthetic and functional equilibrium we strive, especially, to re-establish optimal nasal breathing [82], and also to place the soft tissues of the face and the cranio-cervical complex in the best possible postural position.
We need to realize that our patients can be considered entities made of tightly connected psychic and somatic components whose complexity provoked Rudolph Slavicek [76] to propose a cybernetic concept of the mechanism of interreaction of the components of the masticatory system(Fig. 5). Instead of calling it an apparatus, which designates an ensemble of organs working together in the same func-tion, he prefers the term organism because the masticatory organism fulfills numerous functions.
In fact, this ensemble of organs working in a coordinated and hierarchal manner does more than just execute the activities of mastication and deglutition. It also participates in speech, breathing, maintenance of posture, esthetic appearance, and control of emotions and stress.
The Central Nervous System regulates these functions not only by neurological somatic control but also by conscious and unconscious psychic interference. R. Slavicekmakes a special point of stressing that the methods modern humans use to deal with the pressures and assaults they suffer in daily life often focus on the masticatory organism as an exhaust valve to relieve unconscious psychic charges or stress.
But it is not only desirable but also essential that we integrate a postural approach into the practice of dento-facial orthopedics by also including it as a component of education of patients [9].
This attitude of making patient participants in treatment not simple recipients of it, sometimes thought of as patient education but, in reality, of far wider scope than that, raises patients to the status of equal partners in the therapeutic enterprise [9]. This demarche can be broken down into three clinical entities that have routinely been described as [28]:
– information about the patient’s health;
– information about the patient’s malady;
– education about the patient’s therapy.
As specialists in caring for the health of children it is highly desirable that orthodontists disseminate all three of these types of information.
Because of the limited amount of space available for this article, we have not been able to discuss the therapeutic education of children in detail. But by at least formulating its three main aspects we wish to emphasize quite explicitly that education of patients is integral part of our treatment. We also strongly believe that instructing them about how to participate in their therapy, notably in myofunctional training, especially of breathing, is only one part (Fig. 6) of the pedagogical relationship between orthodontists and patients that should be a part of every visit. Centered on the patient, these sessions should be adapted to their age and the psycho-social context in which they live and should encompass all the educational aspects of preventive and curative treatment. The goal of this enterprise is to help patients, with the assistance of their families, to acquire the full competence for attaining, among other goals, the capacity for good nasal breathing.
Conclusions
In presenting the correlation between dental occlusion and posture published data tends to lend comfortable support for the convictions and clinical impressions we have already formed. The physiological continuum tying occlusion to posture does not appear to be a univocal and linear relationship but instead a complex ensemble made up of numerous contributing factors.
We must ask ourselves, then, is the frequent association between posture and facial deformities the result of pure coincidence or is it evidence of a real pathological development whose meaning is just beginning to be clarified? With what therapeutic techniques should we deal with these problems? Posing these questions and attempting to answer them is the indispensable pre-requisite for orthodontists to incorporate an evaluation of problems with posture and a consideration of their eventual repercussions in our dento-facial orthopedic treatment. And to find answers we need to undertake basic and clinical research projects that could eventually establish the validity of a cause and effect relationship between dental occlusion and posture without which there can be no sure indications for the directions orthodontic therapy for postural defects should take.
In the final analysis, by including postural considerations in our diagnoses, we shall be moving along the road that leads to a total corporal analysis of our patients. This approach will reinforce our communications with other health care deliverers and encourage us to treat our patients in a multi-disciplinary collaboration with our colleagues in other specialties. We are convinced that such a joint enterprise will be a key element in our common raison d’etre: caring for the overall health and well-being of our patients.
References
[1] Abdallah EF, Mehta NR, Forgione AG, Clark RE. Affecting upper extremity strength by changing maxillo-mandibular vertical dimension in deep bite subjects. Cranio 2004;22:268–75.
[2] Alexander RG. The effects on tooth position and maxillofacial vertical growth during treatment of scoliosis with the Milwaukee brace. Am JOrthod 1966;52:161–89.
[3] AlKofide EA, AlNamankani E. The association between posture of the head and malocclusion in Saudi subjects. Cranio 2007;25:98–105.
[4] Amat P, et al. Evaluation with World Health Organization criteriasof TMD and myofascial disorders. CED-IADR 35th Annual Meeting September 23–25, 1999 Montpellier, France. J Dent Res2001;80:1194–255.
[5] Amat P. Contribution of a functional and orthopaedic splint to the treatment of Class II malocclusions. 103rd Annual Session of theAmerican Association of Orthodontists; Honolulu, Hawaii, May 26,2006.
[6] Amat P. Apport d’une gouttière fonctionnelle et orthopédique autraitement des malocclusions de classe II. Orthod Fr 2003;74:71–81.
[7] Amat P. Orthopédie dento-faciale fondée sur les faits: marotted’universitaire ou indispensable outil clinique quotidien? RevOrthop Dento Faciale 2006;40:421–51.
[8] Amat P. What would you choose: evidence-based treatment or anexciting, risky alternative? Am J Orthod Dentofacial Orthop2007;132:724–5.
[9] Amat P. Stress et orthodontie. XXV Journées Internationalesdu Collège National d’Occlusodontologie. Stress, douleurs et dys-fonctionnements. Brest 13 et 14 mars, 2008.
[10] Armijo Olivo S, Bravo J, Magee DJ, Thie NMR, Major PW, Flores-Mir C. The association between head and cervical posture andtemporomandibular disorders: a systematic review. J Orofac Pain2006;20:9–23.
[11] Bacon W, Turlot JC, Blaise M. La reproductibilité de la posturenaturelledelatêteetsonimplicationdansl’organisation del’architecture cranio-faciale. Rev Orthop Dento-Faciale 1989;23:277–86.
[12] Ben-Bassat Y, Yitschaky M, Kaplan L, Brin I. Occlusal patterns inpatients with idiopathic scoliosis. Am J Orthod Dentofacial Orthop2006;130:629–33.
[13] Bodin CG, Duguet V, Hervé F. Diagnostic des latérognathies man-dibulaires. Intérêt de la butée occlusale d'Abjean. Rev Orthop DentoFaciale 1992;26:81–6.
[14] Bracco P, Deregibus A, Piscetta R, Ferrario G. Observations on thecorrelation between posture and jaw position: a pilot study. Cranio1998;16:252–8.
[15] Bracco P, Deregibus A, Piscetta R. Effects of different jaw relationson postural stability in human subjects. Neurosci Lett 2004;356:228–30.
[16] Braun BL. Postural differences between asymptomatic men andwomen and craniofacial pain patients. Arch Phys Med Rehabil1991;72:653–6.
[17] Brenman HS, Amsterdam M. Postural effects on occlusion. DentProg 1963;4:43–7.
[18] Browne PA, Clark GT, Kuboki T, Adachi NY. Concurrent cervicaland craniofacialpain. A review of empiric and basic science evidence.Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;86:633–40.
[19] Burwell RG. Aetiology of idiopathic scoliosis: current concepts.Pediatr Rehabil 2004;6:137–70.
[20] Campos AA, Nathanson D, Rose L. Reproducibility and condylarposition of a physiologic maxillomandibular centric relation inupright and supine body position. J Prosthet Dent 1996;76:282–7.
[21] Commission de terminologie. Dictionnaire d’orthognathodontie.Paris. SFODF, 2007.
[22] Chapman RJ, et al. Occlusal contact variation with changes in headposition. Int J Prosthodont 1991;4:377–81.
[23] Ciancaglini R. Proceedings of Research Forum. Posture, Occlusionand General Health. Milan, 1997.
[24] Ciancaglini R. Proceedings of Research Forum. Posture and Occlu-sion: hypothesis of correlation, Consensus Conference ten yearsafter. Milan 2008;(in press).
[25] De Mayo T, et al. Breathing type and body position effects onsternocleidomastoid and suprahyoid EMG activity. J Oral Rehabil2005;32:487–94.
[26] D’Attilio M, Caputi S, Epifania E, Festa F, Tecco S. Evaluation ofcervical posture of children in skeletal Class I, II, and III. Cranio2005;23:219–28.
[27] D’Attilio M, Filippi MR, Femminella B, Festa F, Tecco S. Theinfluence of an experimentally-induced malocclusion on vertebralalignment in rats: a controlled pilot study. J Craniomandibular Pract2005;23:119–29.
[28] Deccache A. Quelles pratiques et compétences en éducation dupatient? Recommandations de l’O.M.S. La Santé de l’homme1999;341:12–4.
[29] Ferrario VF, Sforza C, Schmitz JH, Taroni A. Occlusion and center offoot pressure variation: is there a relationship? J Prosthet Dent1996;76:302–8.
[30] Festa F, D’Attilio M, Vecchiet F. Effects of horizontal oscillation ofthe mandible on the spinal column of the rat in vivo using radio-graphic monitoring. Ortogntodonzia Ital 1997;6:539–50.
[31] Festa F, et al. Relationship between cervical lordosis and facialmorphology in Caucasian women with a skeletal Class II malocclu-sion: a cross-sectional study. Cranio 2003;21:121–9.
[32] Forgione AG, Mehta NR, Westcott WL. Strength and bite, Part 1: Ananalytical review. Cranio 1991;9:305–15.
[33] Forgione AG, Mehta NR, McQuade CF, Westcott WL. Strength andbite, Part 2: Testing isometric strength using a MORA set to afunctional criterion. Cranio 1992;10:13–20.
[34] Gadotti IC, Bérzin F, Biasotto-Gonzalez D. Preliminary rapport onhead posture and muscle activity in subjects with Class I and II.J Oral Rehabil 2005;32:794–9.
[35] Gangloff P, Louis JP, Perrin PP. Dental occlusion modifies gazeand posture stabilization in human subjects. Neurosci Lett2000;293:203–6.
[36] Gangloff P, Perrin PP. Unilateral trigeminal anaesthesia modifiespostural control in human subjects. Neurosci Lett 2002;330:179–82.
[37] Glenny AM, Harrison JE. How to interpret the orthodontic literature.J Orthod 2003;30:159–64.
[38] Guillaumat M. Scoliose idiopathique de l'enfant et de l’adulte jeune.Rev Rhum 2004;71:145–59.
[39] Hackney J, Bade D, Clawson A. Relationship between forward headposture and diagnosed internal derangement of the temporoman-dibular joint. J Orofac Pain 1993;7:386–90.
[40] Hanke BA, Motschall E, Türp JC. Association between orthopedic anddentalfindings: what level of evidence is available? J Orofac Orthop2007;68:91–107.
[41] Hellsing E, Hagberg C. Changes in maximum bite force related toextension of the head. Eur J Orthod 1990;12:148–53.
[42] Huggare J, Pirttiniemi P, Serlo W. Head posture and dentofacialmorphology in subjects treated for scoliosis. Proc Finn Dent Soc1991;87:151–8.
[43] Huggare JA, Raustia AM. Head posture and cervicovertebral andcraniofacial morphology in patients with craniomandibular dysfunc-tion. Cranio 1992;10:173–7.
[44] Ikemitsu H, Zeze R, Yuasa K, Izumi K. The relationship between jawdeformity and scoliosis. Oral Radiol 2006;22:14–7.
[45] Komiyama O, et al. Posture correction as part of behavioural therapyin treatment of myofascial pain with limited opening. J Oral Rehabil1999;26:428–35.
[46] Kovero O, et al. Maximal bite force and its associations with spinalposture and craniofacial morphology in young adults. Acta OdontolScand 2002;60:365–9.
[47] Kritsineli M, Shim YS. Malocclusion, body posture, and temporo-mandibular disorder in children with primary and mixed dentition.J Clin Pediatr Dent 1992;16:86–93.
[48] Lee WY, Okeson JP, Lindroth J. The relationship between forwardhead posture and temporomandibular disorders. J Orofac Pain1995;9:161–7.
[49] LinksPersky SL, Johnston LE. An evaluation of dentofacial changesaccompanying scoliosis therapy with a modified Milwaukee brace.Am J Orthod 1974;65:364–71.
[50] Lippold C, van den Bos L, Hohoff A, Danesh G, Ehmer U. Interdisci-plinary study of orthopedic and orthodonticfindings in pre-schoolinfants. J Orofac Orthop 2003;64:330–40.
[51] Lonstein JE, Carlson JM. The prediction of curve progression inuntreated idiopathic scoliosis during growth. J Bone Joint Surg1984;66:1061–71.
[52] Makofsky HW. The influence of forward head posture on dentalocclusion. Cranio 2000;18:30–9.
[53] Mathis R, Bacon W, Siffert B. Facial growth of children wearing amodified Milwaukee brace. Orthod Fr 1982;53:697–704.
[54] McLean LF, Brenman HS, Friedman MGF. Effects of changing bodyposition on dental occlusion. J Dent Res 1973;52:1041–5.
[55] McNamara J, Seligman DA, Okeson JP. Occlusion, orthodontictreatment, and temporomandibular disorders: a review. J OrofacialPain 1995;9:73–90.
[56] Michelotti A, et al. Postural stability and unilateral posterior cross-bite: is there a relationship? Neurosci Lett 2006;392:140–4.
[57] Michelotti A, et al. Is unilateral posterior crossbite associated with leglength inequality? Eur J Orthod 2007;29:622–6.
[58] Miralles R, et al. Body position effects on EMG activity of sternoclei-domastoid and masseter muscles in healthy subjects. Cranio1998;16:90–9.
[59] Miralles R, et al. Body position and jaw posture effects on supra- andinfrahyoid electromyographic activity in humans. Cranio 2006;24:98–103.
[60] Munhoz WC, Marques AP, de Siqueira JT. Evaluation of body posturein individuals with internal temporomandibular joint derangement. Cranio 2005;23:269–77.
[61] Nobili A, Adversi R. Relationship between posture and occlu-sion: a clinical and experimental investigation. Cranio 1996;14:274–85.
[62] Pe cina M, Luli c-Duki cO,Pe cina-Hrncevi c A. Hereditary ortho-dontic anomalies and idiopathic scoliosis. Int Orthop 1991;15:57–9.
[63] Perinetti G. Dental occlusion and body posture: no detectable corre-lation. Gait Posture 2006;24:165–8.
[64] Perinetti G. Temporomandibular disorders do not correlatewith detectable alterations in body posture. J Contemp Dent Pract2007;8:60–7.
[65] Pollack B. Cases of note: Michigan jury awards $ 850,000 inortho case: A tempest in a teapot. Am J Orthod Dentofacial Orthop1988;94:358–9.
[66] Pradham NS, White GE, Mehta N, Forgione A. Mandibular deviationsin TMD and non-TMD groups related to eye dominance and headposture. J Clin Pediatr Dent 2001;25:147–55.
[67] Roach JW. Adolescent idiopathic scoliosis. Orthop Clin North Am1999;30:353–65.
[68] Robin GC. The aetiology of idiopathic scoliosis. A review of a centuryof research. Boca Raton, Fla: Freund Publishing House, 1990.
[69] Roth NM. The modified monobloc appliance in scoliosis treatment.Am J Orthod 1969;55:506–9.
[70] Sackett D. Rules of evidence and clinical recommendations. Can JCardiol 1993;9:487–9.
[71] Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS.Evidence based medicine: what it is and what it isn’t. BMJ1996;312:71–2.
[72] Sakaguchi K, et al. Examination of the relationship between mandib-ular position and body posture. Cranio 2007;25:237–49.
[73] Salonen MA, Raustia AM, Huggare J. Head and cervical spinepostures in complete denture wearers. J Craniomandib Pract1993;11:30–3.
[74] Santander H, et al. Influence of stabilisation occlusal splint oncraniocervical relationships. Part II: Electromyographic analysis.J Craniomandib Pract 1994;12:227–33.
[75] Santander H, et al. Effects of head and neck inclination on bilateralsternocleidomastoid EMG activity in healthy subjects and in patientswith myogenic cranio-cervical-mandibular dysfunction. Cranio2000;18:181–91.
[76] Slavicek R. Approche cybernétique des structures et fonctionsde l'appareil manducateur. Communication aux IX JournéesInternationales du CNO, in Actes des journées. 13, 14 et 15 mars.Lyon, 1992.
[77] Solow B, Tallgren A. Dentoalveolar morphology in relation to cra-niocervical posture. Angle Orthod 1977;47:157–64.
[78] Solow B, Sonnesen L. Head posture and malocclusions. Eur J Orthod1998;20:685–93.
[79] Solow B, Sandham A. Cranio-cervical posture: a factor in the devel-opment and function of the dentofacial structures. Eur J Orthod2002;24:447–56.
[80] Sonnesen L, Bakke M, Solow B. Temporomandibular disordersin relation to craniofacial dimensions, head posture and bite forcein children selected for orthodontic treatment. Eur J Orthod2001;23:179–92.
[81] Sonnesen L, Bakke M. Molar bite force in relation to occlusion,craniofacial dimensions, and head posture in pre-orthodontic children. Eur J Orthod 2005;27:58–63.
[82] Talmant J, Deniaud J. Optimal nasal ventilation: a physiologicaldefinition. Arch Pediatr 2008;15:873–74.
[83] Tripodakis AP, Smulow JB, Mehta NR, Clark RE. Clinical studyof location and reproducibility of three mandibular positions inrelation to body posture and muscle function. J Prosthet Dent1995;73:190–8.
[84] Valenzuela S, et al. Does head posture have a significant effect on thehyoid bone position and sternocleidomastoid electromyographicactivity in young adults? Cranio 2005;23:204–11.
[85] Visscher CM, De Boer W, Lobbezoo F, Habets LL, Naeije M. Is therea relationship between head posture and craniomandibular pain?J Oral Rehabil 2002;29:1030–6.
[86] Vélez AL, et al. Head posture and dental wear evaluation of bruxistchildren with primary teeth. J Oral Rehabil 2007;34:663–70.
[87] Weinstein SL, Buckwalter JA, editors. Turek’s orthopedics, principlesand their application. 5th ed. Philadelphia: JB Lippincott, 1994.[88] Woda A, Pionchon P, Palla S. Regulation of mandibular postures:mechanisms and clinical implications. Crit Rev Oral Biol Med2001;12:166–78.
https://healthy-back.livejournal.com/458785.html (https://healthy-back.dreamwidth.org/445070.html)
Имеются данные, указывающие на взаимозависимость между осанкой и стоматогнатической системой [175].
175. Cuccia A., Caradonna C. The relationship between the stomatognathic system and body posture / A. Cuccia, C. Caradonna // Clinics (Sao Paulo, Brazil). – 2009. – No 1 (64). – P. 61–66.
https://pubmed.ncbi.nlm.nih.gov/19142553/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671973/
https://www.sciencedirect.com/science/article/pii/S1807593222027077?via%3Dihub
https://reader.elsevier.com/reader/sd/pii/S1807593222026837?token=10E09F5F73F66CFCFAD2664C8ECAFED95F63B30891A5A5EC2C683B8205D1A31A1915EDCF87535F8F629A82FA0BBBB9B1&originRegion=us-east-1&originCreation=20221020042836
The main disorders of the cranio-cervico-mandibular system, which often affect human posture, are the temporomandibular disorders (TMD).
Evidence continues to accumulate that untreated diseases of SS, in particular temporomandibular disorders and malocclusion, carry a risk of the development of postural disorders. Recent studies emphasize the potential role of dental occlusion and of trigeminal afferents in maintaining postural control.6–10 Several studies indicate that different mandibular positions induce variations in body posture. For example, a change in the mandibular position, which can lead to changes in the proprioceptive and periodontal afferents, may affect the center of foot pressure (COP) position and gait stability.11,12 Conversely, changes in body posture may affect mandibular position.13,14
An influence of periodontal receptors on body posture is hypothesized by Gangloff and Perrin (2002), who found a significant alteration of postural control after unilateral truncular anesthesia of the mandibular nerve.15 In fact, unilateral anesthesia of the trigeminous causes a shift in body weight onto the contralateral limb, which leads the homolateral inferior limb to contract. A more symmetric mandibular position also results in a more symmetric contraction pattern of the sternocleidomastoid muscle (SCM) and it reduces body sway.16 Other studies further suggest that dental occlusion may influence body posture and spine curvature (e.g., scoliosis and lordosis).
Positive correlations between different craniofacial morphologies and postural attitudes have been reported, such as an anteriorly displaced posture in class II malocclusion, and a posteriorly displaced posture in class III malocclusion.17
Lippold et al. (2006) have shown correlations between craniofacial parameters and back shape profiles: patients with distal and vertical craniofacial patterns present higher than normal upper thoracic, lumbar-lordotic, and pelvic angles (Figure 1).18 Furthermore, patients with idiopathic scoliosis show higher frequencies of malocclusion than control patients; these include Angle Class II malocclusions, lateral crossbites, lower midline deviations, and facial asymmetries.19–21
When the occlusal relationship is lost either unilaterally or bilaterally, the body posture may take on an unusual position, causing neck or shoulder pain. In these cases, a dental splint restores a balanced occlusion and determines a more symmetric maxillomandibular position and muscular activity, thereby reducing the range of body oscillation.22
Studies have also demonstrated a relationship between TMDs and posture. Patients with TMD show greater changes in the body’s center of gravity.25 Several studies have shown that patients with TMD present an excessively forward head position,26,27 usually associated with the shortening of the posterior cervical extensor muscles (suboccipital, semispinalis, splenii, and upper trapezius muscles), as well as shortening of the SCM.28 Anterior displacement of the head lowers the field of vision and, in the attempt to improve the field of vision, cervical lordosis increases.29,30
Associations also exist between TMD and oculomotor function. Recently, Monaco et al. (2003, 2004) suggested a much higher prevalence of ocular convergence defects in TMD adults presenting limited maximal opening, myofascial pain, and pain in the neck shoulder area, as well as in children with functional mandibular latero-deviation55,56 compared with healthy individual. In addition, TMD patients showed significantly lower binocular function, measured as convergence and positive fusional vergence, than did control healthy subjects.57
Changes in trigeminal stimulations can cause an imbalance in the vestibular and oculomotor systems. 15
An MFC is a group of muscles that are connected through the fasciae and are longitudinally positioned in the human body. They run in the same direction and overlap in a continuous chain, like tiles on a roof, which efficiently conducts tension.68,69 All of the muscles in the chain are mutually dependent and behave as if they were a single muscle. The existence of MFC may explain why disorders of the MM functions such as chewing and swallowing, can be transmitted to distal musculature.
CONCLUSION
According to the literature reviewed, we believe that there are real correlations between posture and the SS. However, due to the complexity of the factors involved, existing studies have left important gaps in understanding. Therefore, further controlled investigations of the long-term clinical effects of different stomatognathic inputs are necessary.
Postural alterations may reflect a general lack of equilibrium in the individual.2 Consequently, the various signals that reach the CNS, and the importance that each signal is given, will no longer be perfectly balanced with the motor responses, and the motor responses may no longer be adequate.74 In this way, an increase in postural swaying may indicate a general malaise caused by problems in the SS. Our clinical experience suggests that an interdisciplinary approach is reliable and sufficient for making diagnoses and developing treatment plans.
На эту статью была написана другая:
Correlations between the stomatognathic system and body posture: biological or clinical implications? Giuseppe Perinetti
https://pubmed.ncbi.nlm.nih.gov/19219310/
https://www.sciencedirect.com/science/article/pii/S1807593222026837?via%3Dihub
I am writing to comment on the review entitled “The relationship between the stomatognathic system and body posture” by Cuccia and Caradonna, which was recently published in Clinics.1 This is a narrative review that examines current evidence for correlations between any of the stomatognathic system (SS) morphological/ functional features and body posture. In particular, the authors concluded by saying that: “...there are real correlations between posture and the SS” and “...an increase in postural swaying may indicate a general malaise caused by problems in the SS.” At first glance, the review appears interesting, but after a more accurate analysis, one wonders if the conclusions can be considered as truly unbiased, or if the issues are addressed in a sufficiently accurate manner.
To consider this in more detail, two distinct aspects that must not be confused are the existence of correlations at a biological level and their potential clinical relevance. In other words, even though a correlation may be detected experimentally, this does not mean that it will have clinical relevance. Only if the biological correlations reach a clinically significant grade should the diagnosis and consequent treatment plan be required to take these aspects into account. This concept, however, has been missed in most of the published literature, including the above-mentioned review, with a few exceptions.2, 3, 4 Therefore, it is not possible at present to draw accurate conclusions on the real clinical (rather than statistical) significance of the correlation between the SS and body posture. For instance, data regarding the sensitivity and specificity of the posturographic assessment of body oscillation in healthy and temporomandibular disorder (TMD) patients has never been reported. Currently, there are results that both favor 5, 6, 7 and contradict3,8,9 the existence of detectable correlations.
There are additional concerns and comments regarding this paper.
First, a correlation between the SS and head and neck posture does not imply that whole body posture will be influenced as well, and the results from previous studies might be better analyzed considering this concept.
Second, most of the published literature on the correlation between the SS and body posture are of low quality by design, i.e., there is an absence of randomized clinical trials and most studies did not perform follow-up or include control groups, rendering it difficult to draw any definitive conclusion.
Third, a critical reappraisal of the previous data was not reported in the review by Cuccia and Caradonna;1 instead, the conclusions reported by the various authors were restated. Fourth, an exploration of the possibility that different results among the various studies might be linked to the different methodologies used to monitor body posture, e.g., electromyography or posturography, was not included (if a link exists, then major clinical implications can be derived).
Finally, in spite of the automatic key-word-based and manual searches used, the present review did not include several previous studies that did not support detectable correlations between the SS and body posture.2, 3, 4,8,9
In light of the considerations listed above, the conclusions presented in the review by Cuccia and Caradonna1 appear biased. In fact, current data on these correlations (both supportive and contradictory) should be interpreted with caution due to the complexity of the system under investigation and to the lack of studies with high-grade scientific evidence. Therefore, whether these correlations are limited to a biological level with no clinical implications remains an open question.
И источники 17 и 18, которые использовались в первоначальной статье:
17. https://www.tandfonline.com/doi/abs/10.1080/08869634.1996.11745978
The Journal of Craniomandibular & Sleep Practice Volume 14, 1996 - Issue 4
Relationship Between Posture and Occlusion: A Clinical and Experimental Investigation
Alessandro Nobili, M.D., D.D.S. & Riccardo Adversi, M.D. Pages 274-285 | Received 18 Jan 1996, Accepted 21 May 1996, Published online: 13 Jul 2016
ABSTRACT
Recently many postural diseases have been classified among occlusal-functional alterations, mostly on a clinical basis. However some anatomic and physiologic aspects are still unknown. The purpose of this study was to review the literature and to support the correlations by means of a balance platform on a group of 50 patients (30 males and 20 females, mean age 25.8 years) belonging to every Angle classification of malocclusion. The subjects were asked to stand on the balance platform and perform five different tests.
The results showed that
— subjects with a Class II malocclusion exhibit an anteriorly displaced posture, whereas
— subjects with a Class III malocclusion exhibit a posteriorly displaced posture.
18. https://www.scopus.com/record/display.uri?eid=2-s2.0-33748556536&origin=inward&txGid=c1d1e2b4d63b63e306509e58a28b739a
Angle OrthodontistVolume 76, Issue 5, 2006, Pages 779-785 Relationship between thoracic, lordotic, and pelvic inclination and craniofacial morphology in adults (Article) Lippold, C., Danesh, G., Schilgen, M., Drerup, B., Hackenberg, L.
Abstract
Objective: To analyze the correlation ratios between the spinal posture (thoracic, lordotic, and pelvic inclination) and the craniofacial morphology. Materials and Methods: The sample consisted of 53 healthy adults (32 women, 21 men; mean age 24.6 years). Six angular skeletal measurements (facial axis, mandibular plane angle, inner gonial angle, lower facial height, facial depth, and maxilla position) were determined based on the analysis of lateral head cephalographs.
Rasterstereography was used for a precise reconstruction of the back sagittal profile. From the profile parameters, the upper thoracic inclination, the thoracic angle, the lordotic angle, and the pelvic inclination were determined. The correlations to the craniofacial morphology were calculated by means of the Pearson and Mann-Whitney U-test.
Results: Significant correlations could be obtained with respect to the facial axis and the lordotic angle, the facial axis and the pelvic inclination, the inner gonial angle and the lordotic angle, the inner gonial angle and the pelvic inclination, the mandibular plane angle and the lordotic angle, the mandibular plane angle and the pelvic inclination, as well as the facial depth and the pelvic inclination.
Conclusions: In the case of postural disorders of the back shape, an interdisciplinary treatment approach seems to be of clinical value. Further prospective studies are necessary to prove how changes in craniofacial parameters can affect the postural balance of an individual.
129. https://link.springer.com/content/pdf/10.1007/s12548-009-0001-4.pdf
systematic topical review
J. Stomat. Occ. Med. (2009) 2: 2–10DOI 10.1007/s12548-009-0001-4Printed in Austria
Occlusion, orthodontics and posture:are there evidences? The example of scoliosis P. Amat
Received December 6, 2008; Accepted December 28, 2008
The relationship between posture and occlusion has been a constant source of interest to health care professionals. How-ever, a certain amount of confusion still beclouds in this connection because of the great variety of therapeutic approaches proposed for dealing with it as well as the lack of methodological rigor employed for most of the scientific studies published on it.
This presentation addresses the questions raised by the connections between posture and occlusion as well as their therapeutic implications. A review of the literature shows that there is a lack of reliable experimental publications devoted to this subject. The data that is available points to the existence of this correlation and also asserts the prevalence of associations between cranio-facial anomalies and idiopathic scoliosis in adolescents.
In presenting the interactions between dental occlusion and posture published data tends to lend comfortable support for the subjective convictions and clinical impressions wehave already formed. The physiological continuum tying occlusion to posture does not appear to be a univocal and linear relationship but instead a complex ensemble made up of numerous contributing factors.
To find more answers we need to undertake basic and clinical research projects that could eventually establish the validity of a cause and effect relationship between dental occlusion and posture that would put therapy on evidence-based foundation [23, 24].
Keywords: Evidence-based medicine, posture, dental occlusion, scoliosis, dento-facial orthopedics
Introduction
In dento-facial orthopedics, and in a more general way in all of dentistry, we live in an era in which postural considerations are being integrated into our therapy. It is probably fair to say that the inter-relationship be-tween occlusion and posture are of interest for a significant number of practitioners. However, a certain amount of confusion surrounds this connection because of the wide diversity of therapeutic approaches designed to deal with it and the weakness of methodological design in the scientific studies that have been published on it to date.
The interactions between posture and occlusion constitute a vast topic. With this presentation we hope to stimulate discussion and thinking about it and suggest that scientific study can often corroborate our original unsubstantiated convictions.
Occlusion and posture: a reciprocal inter-change
Definitions
Our subject is dental occlusion. The dictionary of orthognathics [21] published by the Société Française d’Orthopédie Dento-Faciale defines it as a phrase in current use employed to describe the reciprocal action of the dental arches.
The same tome offers a double definition of posture:
– The habitual stance of the body or parts of it supported by the action and constraints of tonic muscles that work to fix the body segments through joints designed to maintain equilibrium.
– Bodily stance derived from the interaction of body weight and the sensori-motor complex (derived from the labyrinth of the inner ear, the Pacini bodies, the Golgi apparatus, the joints, and the plantar surfaces of the feet).
Posture and dento-facial orthopedics
Orthodontists should take a consistent and on-going interestin the posture of their patients. In addition to the establish-ment of the dental objectives of their mechano-therapy they should also be attentive to the eventual relationship between occlusion and cephalic as well as overall bodily posture, taking into account physiological regulation of varying mandibulo-cranial positions. It is equally important that they consider the interaction between cranio-cervical posture and cranio-facial morphogenesis [79].
Clinically, orthodontists have to face with a number of questions. In the first place, they find that interest bearing on the relationship between occlusion and posture leads them into a battleground with at least two fronts. Patients consult them seeking occlusal treatment that they hope, or have been told by practitioners in allied fields, will help to improve their postural problems. How should we respond to these requests? Our patients have a right not to be deprived of effective treatment, no matter what it might be. They also have the right to benefit from true informed consent and we have the obligation to tell them exactly what medical benefit they can expect to derive from therapy, especially if that therapy isinvasive. In other words, they have a right to be presented with a clear cost/benefit/risk analysis.
Occlusion and posture: facts and beliefs
The indispensable evidence-based approach
Designed to help us achieve a global improvement in thequality of our treatment and to bridge the gap between clinicalresearch and the health care we deliver, the evidence-basedapproach [70, 71] has been widely accepted in the medicalcommunity.
Evidence-based dento-facial orthopedics [7, 8] describesthe application of factual data to our specialty. Let us empha-size that its three components, clinical experience, the bestavailable published data on clinical research, and the valuesand preferences of our patients, must be welded together sothat orthodontists and their patients can cooperate fully in adiagnostic and therapeutic alliance (Fig. 1). The most thoroughgoing review of the literature devoted to the postural approach will, unfortunately, deal with a limited number of controlledstudies carried out with methodological rigor.
Occlusion and posture: what does appear in the literature?
The questions
In addition to the simple issue of the existence of a relationshipbetween occlusion and posture, several other questions have been posed.
What are the criteria for normal posture of the body, the head and the spinal column, and the mandibulo-cranial complex? Are these criteria valid? How should malfunctions of posture be defined? What are the consequences of the malfunctions structurally, in causing pain, and can they beevaluated in terms of deficiency, of incapacity, or of handicap [4]? And have the results of postural treatment been confirmedby controlled studies?
Clinicians should also ask themselves about the nature of the mechanisms of the regulation of posture and the limits of postural adaptation. Is orthodontic treatment a contributing factor to the etiology of postural deformities or isn’t it? Canchanges in occlusion affect, in a clinically significant manner, global postural equilibrium? Can occlusion actually provoke postural disturbances or pathological ailments in sites far distant from the oral cavity?
Variations in dental occlusion are manifold and appear ina variety of ways; malformations, attrition due to function orfaulty habits, irregularities of teeth, and changes resultingfrom dental restorations, orthodontic care, and prostheticrehabilitation. What eventual influence does each of thesehave on postural balance?
Finally, another interrogation is based on the possible role that dento-facial orthopedic therapy could have in thetreatment of postural disorders.
The weakness of published data
Most publications devoted to the relations between postureand occlusion have been prepared with meager methodolog-ical rigor which makes it difficult to derive a clear answer fromthem to the questions that we have just outlined.
The aim of this article was to present a comprehensivereview of the literature. The literature survey was performedbyapplying theMedline database (Entrez PubMed, www.ncbi.nim.nih.gov). The survey covered the period from January1966 to December 2007. The headings sequence“Posture”[MeSH] OR“scoliosis”[MeSH] AND“Dental occlusion”[MeSH] was selected. Additionally, a search in the Cochrane Clinical Trials Register (www.cochrane.org/ reviews) was performed.
The titles and abstracts of all potentially relevant articleswere reviewed. Electronic searches were followed up with secondary searches. The search strategy resulted in 348 articles. 23 of them were reviews. Three RCTs were retrieved.
In any assessment it is quite clear that a great many of the articles dealing with the relationship between occlusion and posture are anecdotal reports of clinical cases that have little status as scientific evidence.
The scientific studies that have been devoted to the relationship of occlusion to posture suffer, as a group, from a variety off laws [37]. We can site the non-random separation of patients into groups to be studied, the failure, at theclose of the study, to measure all of the patients that had participated in the trial, or, to put it in another way, the omission of some of the participants. We should add thefrequent defect of poor definition of the criteria for inclusion or exclusion of subjects, the use of patient samples too small in size, and the failure to carefully define the validity of thetests employed with regard to their sensitivity, specificity, and reproducibility.
A few comments
The difficulties that participants in this field have had in obtaining experimental results that are clearly reliable should not prevent us from discerning in this bewildering jumble the existence of many suggestive implications. Some of the indications we might draw from them are:
— changes in the position of the mandible influence body posture [72];
— reciprocally, body posture seems to have an effect on the position of the mandible [72], with the exception of centric relation and occlusion with maximum intercuspation, the localization and reproducibility of both of which are not affected [20, 83];
— habitual mandibular position, or rest position, is tied to cephalic posture [88];
— head posture seems to influence occlusion [73, 74]. It does influence the trajectory of closing, and the position of the initial occlusal contacts [17, 22, 54, 79]. On the contrary, a forward inclined head posture does not appear to have any effect on initial occlusal contacts [52];
— can occlusion affect the way feet support weight? The conclusions of published studies on the point are contradictory. Ferrario et al. [29] have shown that adjustments of the centers of pressure in the feet are not influenced by the pain felt in the masticatory system, Class II subdivision malocclusions, or by variations in occlusal positioning. But other studies [14, 15] do assert that the occlusion exerts an influence on the pressures applied through the feet;
— many studies refer to a supposed correlation between malfunction of the masticatory apparatus and an anterior positioning of the head [16, 47, 48, 80]. These correlations should make clinicians consider the advisability of integrating the evaluation and treatment of postural defects at the same time they are correcting discrepancies in the masticatory system [16, 43, 45];
— but the results reported in another article [60] do not confirm the hypothesis that body posture provokes or aggravates masticatory discrepancies. Still this work should be evaluated with extreme caution because of the small size of the sample and the large number of postural variables it dealt with;
— the studies that Perinetti carried out using a stabilometric platform did not produce any evidence that there was a correlation between dental occlusion and bodily posture[63], nor that patients with TMJ problems had per force alterations in bodily posture [64];
— patients suffering from internal derangement of the temporo-mandibular joint do not necessarily hold their heads in an advanced position [39];
— pain felt in the masticatory apparatus is not associated with cephalic posture [85];
— a recent systematic review of the literature suggests that the hypothesis that there is a relationship between cervico-cephalic posture and disorders of the masticatory process remains uncertain [10];
— many articles claim to show that there is a relationship between cervico-cephalic posture and cranio-facial morphology. Cervical posture appears to be strongly correlated with structural variations in the sagittal and vertical dimensions of the face [11,26]. Positive correlations have also been demonstrated between cervico-cephalic posture and both mandibular and maxillary anterior dento-alveolar height as well as with the inclinations of the upper and lower occlusal planes [77]
— children with Class III skeletal malocclusions present asignificantly lower extent of cervical lordosis than those with skeletal Class I or II occlusions [26].
— on the contrary, children with Class II skeletal malocclusions have significantly increased cervical lordosis compared with children with Class I or II occlusions [26], and subjects in Class II keep their heads more forward to a significant extent [34];
— a study conducted using a posturographic platform showed that subjects in Class II had body posture projected forward and those with Class III malocclusions a bodily posture projected backward [61];
— a negative correlation exists between cervical lordosis and mandibular length [31];
— many studies seem to indicate that the afferent impulses of the trigeminal participate in the relationship of occlusion and postural regulation [35, 36]. They allege that there is an inter-dependence between the sensory and motor innervations of the trigeminal nerve and the cervical complex [18];
— there is a significant association between the dominant eye and homo-lateral rotation of the head. In patients suffering from discrepancies of the masticatory system there is also asignificant association between the side of the cephalic rotation and a contra-lateral deviation of the mandibular incisive midline [66];*In a study conducted by P. Gangloff of participants in riflery sports [35], the stabilization of sight was found to have an effect on postural control through mediation of the dental occlusion;
— Michelotti et al. [56] studied patients with posterior cross bites using a stabilometer platform and found in two modalities, occlusion at maximum inter-cuspation and a position with teeth held comfortably apart with cotton rolls.
They found the cross bites had no effect on the stability of bodily posture. They concluded that there would be no justification for correcting the cross bites if the objective were to prevent or treat a postural problem.
— in addition, another study found that posterior cross bites were not correlated with inequality in leg length of young adolescents [57];
— an excessive cranio-cervical angulation is associated with lower anterior crowding [3, 78]. This conclusion is in accord with a hypothesis about stretching of soft tissues accordingto which patients with extended cranio-cervical posturehave a blockage of the sagittal growth of their dental arches from the dorsal tension exerted on them;
— does muscular force vary with the occlusion? Maximalbiting force is greater when the head is extended than it is when the head is held in a natural position [41];
— a splint that places the mandible in a position determined by kinesiological tests would be likely to augment muscular force [1, 32, 33].
These results contradict those of another published article that avers that there is no correlation between biting force and cephalic posture [81];
— Kovero et al. also did not find any significant statistical correlation between maximal biting force and cervical posture [46];
— the neuromuscular activity of neck and face muscles seems to influence corporal or bodily posture according to many studies [25, 58, 59, 75], but, according to another one, do not[84];
— bruxism could be associated with a head posture that is inclined excessively downward and forward [86];
— a recent systematic review of the literature [40] surveys in 266 publications reporting on a relationship between the masticatory apparatus and disturbances of the spinal column. There is an inter-relation between the masticatory apparatus and head posture according to 216 articles, and an association between pelvic tilting and the oral cavity according to 53 studies. 131 articles conclude that the occlusion affects posture and 171 assert that posture affects occlusion.
These reports from the extensive literature suggest that our mechano-therapies can have an effect on the bodily posture of our patients. But because of the widespread lack of methodological rigor in these investigations, orthodontists should examine the results with prudence and circumspection, especially in view of their tendency to be mutually contradictory. By doing this we can avoid the risk of over-treating our patients by being scrupulously critical when we add postural considerations to our diagnoses [40].
The special case of the relationship between idiopathic scoliosis and occlusion in adolescents
When a diagnosis of idiopathic scoliosis is made, patients are confronted with the possibility that their spines will continue to develop in a deformed way until the end of the growth period. The best outcome for them would be merely to have to submit to regular check-up examinations about the state of the vertebral column. But some of them will have to endure especially grave orthopedic or surgical treatment. Because of the seriousness of the global effect of the disorder and its esthetic, psychological, and functional repercussions a close study of idiopathic scoliosis helps to answer many questions that arise about the interrelations between posture and occlusion.
Idiopathic scoliosis and adolescents
Scoliosis is a three-dimensional structural deformation of the spinal column, with rotation of some vertebrae that causes gibbosities. These deformations cannot be totally corrected, which differentiates them from simple tendencies toward scoliosis. Idiopathic scoliosis makes its appearance before the end of the growth period, unassociated with other pathologies, which also differentiates them from scolioses that are secondary to other problems such as malformations and neurological disorders.
Conventionally, idiopathic scoliosis is called infantile if it is detected before the child is three years old and juvenile if it appears clinically in children from three to ten.
When scoliosis appears in children between the age often and the time of skeletal maturation it is said to be adolescent, a category that embraces 80% of the ensemble of cases of idiopathic scolioses [87]. Affecting more girls than boys, the disorder [67] is seen in about 2 to 4% of adolescents between the ages of 10 and 16.
The etiology of idiopathic scoliosis is probably multi-factorial, with components that are hormonal, connected with growth, with genetics, with metabolic disturbances of collagens and proteoglycanes, with neurological disturbances especially of the proprioceptive and equilibration systems, and with biomechanical factors [19, 68].
With regular clinical and radiological examinations the progress of the malady can be observed. According to Lonstein and Carlson [51], the topography of the individual case of scoliosis, the patient’s age at the time it was discerned, the initial degree of angulation, the results of the Risser test, and, for girls, the date of the onset of menstruation, can all be evaluated as factors in the “prediction of curvature progression in untreated idiopathic scoliosis during growth”.
Treatment of evolving idiopathic scoliosis is usually conservative at first having the objective improving the appearance and the functioning of the spinal column and preventing any aggravation of the curvatures that have already occurred. Some patients are asked to wear braces that are adjusted to various degrees of correction. When the malady progresses unfavorably and the deformation becomes more serious, surgical treatment may be indicated. But, throughout, careful observation of the patients and their families is of primordial importance because the necessary procedures can be long, tedious, and extremely constraining. The primary goal with all patients is to limit the development of the scoliosis so that it does not become a serious impediment to a normal, active life when patients become adults.
Adolescents with idiopathic scoliosis and orthodontic treatment
How should orthodontists deal with patients who suffer from idiopathic scoliosis? Does the malady exert a pernicious effecton the patient’s occlusion? Will orthodontic treatment ameliorate or aggravate the patient’s overall health? These are the principal questions that must be answered when patients with scoliosis seek an orthodontic consultation.
Cases of idiopathic scoliosis often develop in unpredictable ways during growth periods. Not infrequently, the malady may become more grave or, in other cases, stabilize [38] during the time a patient is undergoing orthodontic treatment and the orthodontist’s mechano-therapy may be blamed or given credit. This, of course would affirm without a shred of proof that an association between two phenomena establishes a cause and effect relationship between them.
This calls to mind a parallel between another debate that caused a considerable stir in orthodontic circles during the 1980s when orthodontic treatment was alleged to have caused some patients tempero-mandibular disorders or so-called TMJ problems. During the epidemic of this unfortunate witch-hunt some patients actually obtained substantial financial awards [65] for alleged malpractice. Fortunately a series of subsequent clinical studies [55] was able to prove that dento-facial orthopedic treatment did not increase the risk of a patient’s developing tempero-mandibular maladies.
We have derived the answer to the series of questions we posed by means of a virtual dialogue between members of diverse health disciplines in an attempt to restore some unity to the evaluation of patients whose examinations are too often fragmented into studies of separate organs to fit the vision of a host of medical specialties and by a careful study of the literature.
The occlusion of adolescents with idiopathic scoliosis: what does the published data tell us?
Many studies have been carried out to try to determine if a scoliotic deformation can be associated not only with adaptive asymmetries of postural control but also with a particular type dento-skeletal formation.
Does treatment of scoliosis tend to affect a patient’s dento-facial equilibrium?
During the decades of the 60s and 70s many articles were published about the deleterious effects on facial growth that orthopedic treatment of scoliosis with a Milwaukee bracecould cause.
In a 1966 article Alexander [2] presented evidence that there was a significant reduction in facial height, an elevation of the palatal plane, a flattening of the palatal vault, a tilting,lower and forward, of the mandibular symphasis, intruding of molars, and labial tilting of maxillary and mandibular incisors during treatment of scoliosis with the Milwaukee brace.
Other authorities subsequently suggested that patients wear a variety of appliances, such as the monobloc, to counteract the adverse oro-facial effects of the Milwaukee brace [69].
Because of these studies the Milwaukee brace was then modified so that it would be less likely to provoke unwelcome iatrogenic side effects [49, 53]. More recently Huggare et al.[42] described the less substantial side effects of orthopedic treatment for scoliotic patients undertaken with a Boston brace. These patients were distinguished from a control group by an accentuation of the cranio-cervical angle, a rotation of the orbital plane, maxillary, and mandibular planes, a displacement of the mid-line of the mandibular arch, and a flattening of the posterior arch of the first cervical vertebra associated with a lengthening of the dent de l’axis.
Correlation between idiopathic scoliosis and dento-skeletal characteristics
Pecina et al. have classified orthodontic anomalies into two categories, hereditary and acquired. They show that in scoliotic patients [62] there is a higher rate of occurrence of hereditary orthodontic anomalies like hypodontia, which is 10 times more frequent and prognathic mandibles.
On the other hand, these authors did not find a higher incidence of acquired orthodontic anomalies in scoliosis patients.They suggest that early detection of hereditary orthodontic discrepancies would allow health care givers to identifya group of infants with a high risk of later developing scoliosis.
Lippold et al. found a statistically significant correlation between Class II malocclusion and scoliosis [50].
They recommend that all pre-school children with Class II malocclusions, no matter how slight, should be carefully watched for possible development of spinal abnormalities (Fig. 2a–c).
The authors of another article [44] conclude that there is a correlation between skeletal anomalies of Class I, II, or III,hypo or hyper-divergent, and scoliosis.
The study that Ben-Bassat et al. [12] published showed patients with scoliosis had more than an average amount of asymmetries in the sagittal and transverse dimensions. Other investigators have observed that patients with scoliosis have prevalence statistically greater than average of Class II sub-division malocclusions, lower incisal mid-line deviations, and, especially, mandibular deviations, as well as anterior and posterior cross bites. On the other hand, no significant correlation has been established between the side to which the spine is deformed and the side of the posterior cross bite or the side to which the mandibular midline is deviated.
Some authors do draw our attention to the possibility that the asymmetries of scoliosis and of malocclusion share a common etiology. Should this be true the global correction of a malocclusion, and its retention, could be more uncertain. They advise practitioners examining patients to look for underlying orthopedic problems when they have made a diagnosis [13] of early signs of dento-facial asymmetry.
Still other workers have studied the relationship between dental occlusion and posture in animals. Festa et al. [30] studied the effects in rats of unilaterally opening their bites by adding composite to posterior teeth. After one week a radiological examination showed a marked deviation of the animals’ vertebral columns. When researchers opened the bite similarly on the other side the spinal column straightened up. More recently D’Attilio et al. [27] also induced scoliotic curvature in the spinal columns of rats in a week’s time by unilaterally raising the occlusion. When the researchers re-stored occlusal harmony by elevating the contra-lateral side of the occlusion, vertebral alignment of 83% of the rats in the study returned to the original condition. This seems to make clear that spinal column alignment in rats can be influenced by dental occlusion.
So clinicians are faced with the question of determining to what extent experimental observations made in animal studies can be applied to daily practice. Even if the results of animal studies should not be extrapolated to apply to people but tested on humans first before they are accepted, their conclusions should, at the very least induce practitioners to conduct any mechanical adjustment that could lead to occlusal imbalance with extreme care.
Clinical implications
The strong prevalence of associations between scoliosis and cranio-facial anomalies argues persuasively for the related disciplines of general orthopedics and dento-facial orthopedics to work cooperatively in early diagnosis of patients and in increasing the effectiveness of the treatment of those patients.
In this way orthodontists could contribute to the orthopedist’s beginning early treatment of spinal cord deformities by suggesting an orthopedic consultation when orthodontic examinations have uncovered certain indicative dento-skeletal characteristics such as Class II malocclusion or dento-facial asymmetry.
It should be emphasized that when orthodontists do not include every facet of their patients’ health status in their examinations they may risk missing important diagnosticelements. When they are confronted with a polymorphous symptomology, they must endeavor to assess all of its dimensions including postural to avoid parceling treatment into isolated and ineffective components.
Certainly the achievement of a harmonious and esthetic smile for our patients (Fig. 3a and b) remains one of the objectives of our treatment, but the therapeutic perspectives of our specialty go far beyond that. Besides placing ourpatients’ faces (Fig. 4a and b), jaws, and dental arches in better esthetic and functional equilibrium we strive, especially, to re-establish optimal nasal breathing [82], and also to place the soft tissues of the face and the cranio-cervical complex in the best possible postural position.
We need to realize that our patients can be considered entities made of tightly connected psychic and somatic components whose complexity provoked Rudolph Slavicek [76] to propose a cybernetic concept of the mechanism of interreaction of the components of the masticatory system(Fig. 5). Instead of calling it an apparatus, which designates an ensemble of organs working together in the same func-tion, he prefers the term organism because the masticatory organism fulfills numerous functions.
In fact, this ensemble of organs working in a coordinated and hierarchal manner does more than just execute the activities of mastication and deglutition. It also participates in speech, breathing, maintenance of posture, esthetic appearance, and control of emotions and stress.
The Central Nervous System regulates these functions not only by neurological somatic control but also by conscious and unconscious psychic interference. R. Slavicekmakes a special point of stressing that the methods modern humans use to deal with the pressures and assaults they suffer in daily life often focus on the masticatory organism as an exhaust valve to relieve unconscious psychic charges or stress.
But it is not only desirable but also essential that we integrate a postural approach into the practice of dento-facial orthopedics by also including it as a component of education of patients [9].
This attitude of making patient participants in treatment not simple recipients of it, sometimes thought of as patient education but, in reality, of far wider scope than that, raises patients to the status of equal partners in the therapeutic enterprise [9]. This demarche can be broken down into three clinical entities that have routinely been described as [28]:
– information about the patient’s health;
– information about the patient’s malady;
– education about the patient’s therapy.
As specialists in caring for the health of children it is highly desirable that orthodontists disseminate all three of these types of information.
Because of the limited amount of space available for this article, we have not been able to discuss the therapeutic education of children in detail. But by at least formulating its three main aspects we wish to emphasize quite explicitly that education of patients is integral part of our treatment. We also strongly believe that instructing them about how to participate in their therapy, notably in myofunctional training, especially of breathing, is only one part (Fig. 6) of the pedagogical relationship between orthodontists and patients that should be a part of every visit. Centered on the patient, these sessions should be adapted to their age and the psycho-social context in which they live and should encompass all the educational aspects of preventive and curative treatment. The goal of this enterprise is to help patients, with the assistance of their families, to acquire the full competence for attaining, among other goals, the capacity for good nasal breathing.
Conclusions
In presenting the correlation between dental occlusion and posture published data tends to lend comfortable support for the convictions and clinical impressions we have already formed. The physiological continuum tying occlusion to posture does not appear to be a univocal and linear relationship but instead a complex ensemble made up of numerous contributing factors.
We must ask ourselves, then, is the frequent association between posture and facial deformities the result of pure coincidence or is it evidence of a real pathological development whose meaning is just beginning to be clarified? With what therapeutic techniques should we deal with these problems? Posing these questions and attempting to answer them is the indispensable pre-requisite for orthodontists to incorporate an evaluation of problems with posture and a consideration of their eventual repercussions in our dento-facial orthopedic treatment. And to find answers we need to undertake basic and clinical research projects that could eventually establish the validity of a cause and effect relationship between dental occlusion and posture without which there can be no sure indications for the directions orthodontic therapy for postural defects should take.
In the final analysis, by including postural considerations in our diagnoses, we shall be moving along the road that leads to a total corporal analysis of our patients. This approach will reinforce our communications with other health care deliverers and encourage us to treat our patients in a multi-disciplinary collaboration with our colleagues in other specialties. We are convinced that such a joint enterprise will be a key element in our common raison d’etre: caring for the overall health and well-being of our patients.
References
[1] Abdallah EF, Mehta NR, Forgione AG, Clark RE. Affecting upper extremity strength by changing maxillo-mandibular vertical dimension in deep bite subjects. Cranio 2004;22:268–75.
[2] Alexander RG. The effects on tooth position and maxillofacial vertical growth during treatment of scoliosis with the Milwaukee brace. Am JOrthod 1966;52:161–89.
[3] AlKofide EA, AlNamankani E. The association between posture of the head and malocclusion in Saudi subjects. Cranio 2007;25:98–105.
[4] Amat P, et al. Evaluation with World Health Organization criteriasof TMD and myofascial disorders. CED-IADR 35th Annual Meeting September 23–25, 1999 Montpellier, France. J Dent Res2001;80:1194–255.
[5] Amat P. Contribution of a functional and orthopaedic splint to the treatment of Class II malocclusions. 103rd Annual Session of theAmerican Association of Orthodontists; Honolulu, Hawaii, May 26,2006.
[6] Amat P. Apport d’une gouttière fonctionnelle et orthopédique autraitement des malocclusions de classe II. Orthod Fr 2003;74:71–81.
[7] Amat P. Orthopédie dento-faciale fondée sur les faits: marotted’universitaire ou indispensable outil clinique quotidien? RevOrthop Dento Faciale 2006;40:421–51.
[8] Amat P. What would you choose: evidence-based treatment or anexciting, risky alternative? Am J Orthod Dentofacial Orthop2007;132:724–5.
[9] Amat P. Stress et orthodontie. XXV Journées Internationalesdu Collège National d’Occlusodontologie. Stress, douleurs et dys-fonctionnements. Brest 13 et 14 mars, 2008.
[10] Armijo Olivo S, Bravo J, Magee DJ, Thie NMR, Major PW, Flores-Mir C. The association between head and cervical posture andtemporomandibular disorders: a systematic review. J Orofac Pain2006;20:9–23.
[11] Bacon W, Turlot JC, Blaise M. La reproductibilité de la posturenaturelledelatêteetsonimplicationdansl’organisation del’architecture cranio-faciale. Rev Orthop Dento-Faciale 1989;23:277–86.
[12] Ben-Bassat Y, Yitschaky M, Kaplan L, Brin I. Occlusal patterns inpatients with idiopathic scoliosis. Am J Orthod Dentofacial Orthop2006;130:629–33.
[13] Bodin CG, Duguet V, Hervé F. Diagnostic des latérognathies man-dibulaires. Intérêt de la butée occlusale d'Abjean. Rev Orthop DentoFaciale 1992;26:81–6.
[14] Bracco P, Deregibus A, Piscetta R, Ferrario G. Observations on thecorrelation between posture and jaw position: a pilot study. Cranio1998;16:252–8.
[15] Bracco P, Deregibus A, Piscetta R. Effects of different jaw relationson postural stability in human subjects. Neurosci Lett 2004;356:228–30.
[16] Braun BL. Postural differences between asymptomatic men andwomen and craniofacial pain patients. Arch Phys Med Rehabil1991;72:653–6.
[17] Brenman HS, Amsterdam M. Postural effects on occlusion. DentProg 1963;4:43–7.
[18] Browne PA, Clark GT, Kuboki T, Adachi NY. Concurrent cervicaland craniofacialpain. A review of empiric and basic science evidence.Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;86:633–40.
[19] Burwell RG. Aetiology of idiopathic scoliosis: current concepts.Pediatr Rehabil 2004;6:137–70.
[20] Campos AA, Nathanson D, Rose L. Reproducibility and condylarposition of a physiologic maxillomandibular centric relation inupright and supine body position. J Prosthet Dent 1996;76:282–7.
[21] Commission de terminologie. Dictionnaire d’orthognathodontie.Paris. SFODF, 2007.
[22] Chapman RJ, et al. Occlusal contact variation with changes in headposition. Int J Prosthodont 1991;4:377–81.
[23] Ciancaglini R. Proceedings of Research Forum. Posture, Occlusionand General Health. Milan, 1997.
[24] Ciancaglini R. Proceedings of Research Forum. Posture and Occlu-sion: hypothesis of correlation, Consensus Conference ten yearsafter. Milan 2008;(in press).
[25] De Mayo T, et al. Breathing type and body position effects onsternocleidomastoid and suprahyoid EMG activity. J Oral Rehabil2005;32:487–94.
[26] D’Attilio M, Caputi S, Epifania E, Festa F, Tecco S. Evaluation ofcervical posture of children in skeletal Class I, II, and III. Cranio2005;23:219–28.
[27] D’Attilio M, Filippi MR, Femminella B, Festa F, Tecco S. Theinfluence of an experimentally-induced malocclusion on vertebralalignment in rats: a controlled pilot study. J Craniomandibular Pract2005;23:119–29.
[28] Deccache A. Quelles pratiques et compétences en éducation dupatient? Recommandations de l’O.M.S. La Santé de l’homme1999;341:12–4.
[29] Ferrario VF, Sforza C, Schmitz JH, Taroni A. Occlusion and center offoot pressure variation: is there a relationship? J Prosthet Dent1996;76:302–8.
[30] Festa F, D’Attilio M, Vecchiet F. Effects of horizontal oscillation ofthe mandible on the spinal column of the rat in vivo using radio-graphic monitoring. Ortogntodonzia Ital 1997;6:539–50.
[31] Festa F, et al. Relationship between cervical lordosis and facialmorphology in Caucasian women with a skeletal Class II malocclu-sion: a cross-sectional study. Cranio 2003;21:121–9.
[32] Forgione AG, Mehta NR, Westcott WL. Strength and bite, Part 1: Ananalytical review. Cranio 1991;9:305–15.
[33] Forgione AG, Mehta NR, McQuade CF, Westcott WL. Strength andbite, Part 2: Testing isometric strength using a MORA set to afunctional criterion. Cranio 1992;10:13–20.
[34] Gadotti IC, Bérzin F, Biasotto-Gonzalez D. Preliminary rapport onhead posture and muscle activity in subjects with Class I and II.J Oral Rehabil 2005;32:794–9.
[35] Gangloff P, Louis JP, Perrin PP. Dental occlusion modifies gazeand posture stabilization in human subjects. Neurosci Lett2000;293:203–6.
[36] Gangloff P, Perrin PP. Unilateral trigeminal anaesthesia modifiespostural control in human subjects. Neurosci Lett 2002;330:179–82.
[37] Glenny AM, Harrison JE. How to interpret the orthodontic literature.J Orthod 2003;30:159–64.
[38] Guillaumat M. Scoliose idiopathique de l'enfant et de l’adulte jeune.Rev Rhum 2004;71:145–59.
[39] Hackney J, Bade D, Clawson A. Relationship between forward headposture and diagnosed internal derangement of the temporoman-dibular joint. J Orofac Pain 1993;7:386–90.
[40] Hanke BA, Motschall E, Türp JC. Association between orthopedic anddentalfindings: what level of evidence is available? J Orofac Orthop2007;68:91–107.
[41] Hellsing E, Hagberg C. Changes in maximum bite force related toextension of the head. Eur J Orthod 1990;12:148–53.
[42] Huggare J, Pirttiniemi P, Serlo W. Head posture and dentofacialmorphology in subjects treated for scoliosis. Proc Finn Dent Soc1991;87:151–8.
[43] Huggare JA, Raustia AM. Head posture and cervicovertebral andcraniofacial morphology in patients with craniomandibular dysfunc-tion. Cranio 1992;10:173–7.
[44] Ikemitsu H, Zeze R, Yuasa K, Izumi K. The relationship between jawdeformity and scoliosis. Oral Radiol 2006;22:14–7.
[45] Komiyama O, et al. Posture correction as part of behavioural therapyin treatment of myofascial pain with limited opening. J Oral Rehabil1999;26:428–35.
[46] Kovero O, et al. Maximal bite force and its associations with spinalposture and craniofacial morphology in young adults. Acta OdontolScand 2002;60:365–9.
[47] Kritsineli M, Shim YS. Malocclusion, body posture, and temporo-mandibular disorder in children with primary and mixed dentition.J Clin Pediatr Dent 1992;16:86–93.
[48] Lee WY, Okeson JP, Lindroth J. The relationship between forwardhead posture and temporomandibular disorders. J Orofac Pain1995;9:161–7.
[49] LinksPersky SL, Johnston LE. An evaluation of dentofacial changesaccompanying scoliosis therapy with a modified Milwaukee brace.Am J Orthod 1974;65:364–71.
[50] Lippold C, van den Bos L, Hohoff A, Danesh G, Ehmer U. Interdisci-plinary study of orthopedic and orthodonticfindings in pre-schoolinfants. J Orofac Orthop 2003;64:330–40.
[51] Lonstein JE, Carlson JM. The prediction of curve progression inuntreated idiopathic scoliosis during growth. J Bone Joint Surg1984;66:1061–71.
[52] Makofsky HW. The influence of forward head posture on dentalocclusion. Cranio 2000;18:30–9.
[53] Mathis R, Bacon W, Siffert B. Facial growth of children wearing amodified Milwaukee brace. Orthod Fr 1982;53:697–704.
[54] McLean LF, Brenman HS, Friedman MGF. Effects of changing bodyposition on dental occlusion. J Dent Res 1973;52:1041–5.
[55] McNamara J, Seligman DA, Okeson JP. Occlusion, orthodontictreatment, and temporomandibular disorders: a review. J OrofacialPain 1995;9:73–90.
[56] Michelotti A, et al. Postural stability and unilateral posterior cross-bite: is there a relationship? Neurosci Lett 2006;392:140–4.
[57] Michelotti A, et al. Is unilateral posterior crossbite associated with leglength inequality? Eur J Orthod 2007;29:622–6.
[58] Miralles R, et al. Body position effects on EMG activity of sternoclei-domastoid and masseter muscles in healthy subjects. Cranio1998;16:90–9.
[59] Miralles R, et al. Body position and jaw posture effects on supra- andinfrahyoid electromyographic activity in humans. Cranio 2006;24:98–103.
[60] Munhoz WC, Marques AP, de Siqueira JT. Evaluation of body posturein individuals with internal temporomandibular joint derangement. Cranio 2005;23:269–77.
[61] Nobili A, Adversi R. Relationship between posture and occlu-sion: a clinical and experimental investigation. Cranio 1996;14:274–85.
[62] Pe cina M, Luli c-Duki cO,Pe cina-Hrncevi c A. Hereditary ortho-dontic anomalies and idiopathic scoliosis. Int Orthop 1991;15:57–9.
[63] Perinetti G. Dental occlusion and body posture: no detectable corre-lation. Gait Posture 2006;24:165–8.
[64] Perinetti G. Temporomandibular disorders do not correlatewith detectable alterations in body posture. J Contemp Dent Pract2007;8:60–7.
[65] Pollack B. Cases of note: Michigan jury awards $ 850,000 inortho case: A tempest in a teapot. Am J Orthod Dentofacial Orthop1988;94:358–9.
[66] Pradham NS, White GE, Mehta N, Forgione A. Mandibular deviationsin TMD and non-TMD groups related to eye dominance and headposture. J Clin Pediatr Dent 2001;25:147–55.
[67] Roach JW. Adolescent idiopathic scoliosis. Orthop Clin North Am1999;30:353–65.
[68] Robin GC. The aetiology of idiopathic scoliosis. A review of a centuryof research. Boca Raton, Fla: Freund Publishing House, 1990.
[69] Roth NM. The modified monobloc appliance in scoliosis treatment.Am J Orthod 1969;55:506–9.
[70] Sackett D. Rules of evidence and clinical recommendations. Can JCardiol 1993;9:487–9.
[71] Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS.Evidence based medicine: what it is and what it isn’t. BMJ1996;312:71–2.
[72] Sakaguchi K, et al. Examination of the relationship between mandib-ular position and body posture. Cranio 2007;25:237–49.
[73] Salonen MA, Raustia AM, Huggare J. Head and cervical spinepostures in complete denture wearers. J Craniomandib Pract1993;11:30–3.
[74] Santander H, et al. Influence of stabilisation occlusal splint oncraniocervical relationships. Part II: Electromyographic analysis.J Craniomandib Pract 1994;12:227–33.
[75] Santander H, et al. Effects of head and neck inclination on bilateralsternocleidomastoid EMG activity in healthy subjects and in patientswith myogenic cranio-cervical-mandibular dysfunction. Cranio2000;18:181–91.
[76] Slavicek R. Approche cybernétique des structures et fonctionsde l'appareil manducateur. Communication aux IX JournéesInternationales du CNO, in Actes des journées. 13, 14 et 15 mars.Lyon, 1992.
[77] Solow B, Tallgren A. Dentoalveolar morphology in relation to cra-niocervical posture. Angle Orthod 1977;47:157–64.
[78] Solow B, Sonnesen L. Head posture and malocclusions. Eur J Orthod1998;20:685–93.
[79] Solow B, Sandham A. Cranio-cervical posture: a factor in the devel-opment and function of the dentofacial structures. Eur J Orthod2002;24:447–56.
[80] Sonnesen L, Bakke M, Solow B. Temporomandibular disordersin relation to craniofacial dimensions, head posture and bite forcein children selected for orthodontic treatment. Eur J Orthod2001;23:179–92.
[81] Sonnesen L, Bakke M. Molar bite force in relation to occlusion,craniofacial dimensions, and head posture in pre-orthodontic children. Eur J Orthod 2005;27:58–63.
[82] Talmant J, Deniaud J. Optimal nasal ventilation: a physiologicaldefinition. Arch Pediatr 2008;15:873–74.
[83] Tripodakis AP, Smulow JB, Mehta NR, Clark RE. Clinical studyof location and reproducibility of three mandibular positions inrelation to body posture and muscle function. J Prosthet Dent1995;73:190–8.
[84] Valenzuela S, et al. Does head posture have a significant effect on thehyoid bone position and sternocleidomastoid electromyographicactivity in young adults? Cranio 2005;23:204–11.
[85] Visscher CM, De Boer W, Lobbezoo F, Habets LL, Naeije M. Is therea relationship between head posture and craniomandibular pain?J Oral Rehabil 2002;29:1030–6.
[86] Vélez AL, et al. Head posture and dental wear evaluation of bruxistchildren with primary teeth. J Oral Rehabil 2007;34:663–70.
[87] Weinstein SL, Buckwalter JA, editors. Turek’s orthopedics, principlesand their application. 5th ed. Philadelphia: JB Lippincott, 1994.[88] Woda A, Pionchon P, Palla S. Regulation of mandibular postures:mechanisms and clinical implications. Crit Rev Oral Biol Med2001;12:166–78.