Orthodontic Treatment and Craniocervical Posture in Patients with Temporomandibular Disorders: An Observational Study

Abstract

Orthodontic treatment acts through the application of forces and/or by stimulating and redirecting the functional forces within the craniofacial complex. Considering the interrelationship between craniomandibular and craniocervical systems, this intervention may alter craniocervical posture. Thus, our aim is to (a) compare craniocervical posture, hyoid bone position, and craniofacial morphology before, after, and also in the contention phase at least one year after the orthodontic treatment, in patients with temporomandibular disorders and (b) to verify whether the presence of condylar displacement, the skeletal class, or the facial biotype interferes with the abovementioned outcomes. To do so an observational, analytical, longitudinal, and retrospective design study was carried out. A non-probabilistic convenience sampling method was applied. The sample consisted of clinical records of patients diagnosed with temporomandibular disorders in order to compare pre-orthodontic treatment with post-orthodontic treatment (n = 42) and contention phase data (n = 26). A cephalometric analysis of several variables was performed. The p-value was set as 0.05. When the pre- and post-orthodontic treatment data were analyzed, there were statistically significant changes in variables concerning craniocervical posture (CV angle, C0-C1, and AA-PNS) and also concerning hyoid bone position (C3-Rgn). When pre- and post-orthodontic treatment and contention phase data were analyzed the variables concerning craniocervical posture (C0-C1, CVT/Ver, NSL/OPT, NSL/CVT, NSL/Ver; OPT/CVT, OPT/Ver) and facial biotype had statistically significant changes. This allowed us to conclude that in the sample studied, there were significant differences regarding hyoid bone position (pre- versus post-orthodontic treatment) and craniocervical posture (pre- versus post-orthodontic versus contention), with the craniocervical posture being prone to return to basal values. The presence of condylar displacement was found to significantly increase the H-H1 distance in the three moments of evaluation. Facial biotype was found to significantly increase the NSL/Ver angle on hypodivergent compared to hyperdivergent in the contention phase.

Neural Basis of Etiopathogenesis and Treatment of Cervicogenic Orofacial Pain

“…Moreover, in experimental animals with unilateral occlusal interference, condylar bone resorption of the contralateral side has been observed 1 week later [ 49 ]. This finding has been directly and indirectly verified in human patients [ 50 , 51 , 55 , 56 , 57 , 58 , 59 , 60 ] and the amount of scientific evidence of this phenomenon is rapidly increasing. Of note, when such conditions occur, a change in the occlusal (axilla-mandibular) relationship often leads to misalignment of teeth (malocclusion).…”

“…The relationship to body posture is critical. Many studies have provided evidence of a direct connection between body posture and vertebro-cranio-mandibular system [ 50 , 51 , 55 , 56 , 57 , 58 , 59 , 60 ]. For example, in children with unilateral crossbite, increased occurrence of postural problems such as oblique shoulder, scoliosis, oblique pelvis, and functional leg length differences have been observed [ 55 ].…”

Effectiveness of Physiotherapy in the Treatment of Temporomandibular Joint Dysfunction and the Relationship with Cervical Spine

“…Balancing TMJs through exercise corrects the dysfunctions and changes the position of the center of gravity, which has effects on the mobility of the spine and the stability of the limbs [ 38 , 39 ].…”

Disorders of the statics of the body and the temporomandibular joint

“…In the case of TMD, the position of the hyoid bone is important, and Paco and Ekici paid special attention to this in their research. The results provided evidence that TMD is not associated with craniocervical dysfunction, but with the position of the hyoid bone and craniofacial morphology, and the reduction of this pathology may be due to appropriately selected orthodontic treatment [46,47,76]. The shoulder girdle may also have an indirect influence on the temporomandibular joint.…”