Response to: Cardinal L, da Silva TR, Andujar ALF, Gribel BF, Dominguez GC, Janakiraman N. Evaluation of the three-dimensional (3D) position of cervical vertebrae in individuals with unilateral posterior crossbite. Clin Oral Investig. 2021 Jul 13. doi: 10.1007/s00784-021-04020-5

Neural Basis of Etiopathogenesis and Treatment of Cervicogenic Orofacial Pain

“…A patient may not be aware of this change because the central visual cortex and visual connectomes “re-count” the information such as the head would be in a perfectly horizontal position (for review see Wei, 2018 [ 47 ]). This vertebro-cranio-mandibular relation has been repeatedly verified both in experimental animals [ 48 , 49 ] and human patients [ 50 , 51 , 52 , 53 , 54 ]. Elegant experimental study has been provided by D’Attilio et al [ 48 ], who investigated the impact of occlusal interference on the spine of rats creating composite interferences on the right molar of each rat in the experimental group, observing that all such rats developed scoliotic curvature.…”

“…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).…”

“…If this mechanism, and increased attrition/abrasion of the teeth is insufficient, particular teeth (or dental work such as crowns or bridges) are overloaded (traumatic articulation/occlusal trauma) and can suffer from periodontal breakdown and fractures. Moreover, if this malocclusion is fixed, such as in a case of functional unilateral posterior crossbite, it increases the discrepancy of maximum intercuspation and temporomandibular centric relation to pathologic level, which, if not treated properly, can affect further growth and development of the jaws and occlusion, leading to significant skeletal asymmetry, which may require surgical correction [ 50 , 51 , 62 ]. Moreover, concomitant abnormal mandibular movements may lead to adverse effects both on TMJ and other structures of the stomatognathic system, causing pain and various symptoms [ 50 , 51 , 63 , 64 ].…”

“…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 ].…”

“…Although, we can perform CT with classical medical CT scan, it might be better to perform cone-beam CT (CBCT), to minimize the radiation dose [ 128 ]. Moreover, CBCT offers the acquisition of an image with high accuracy, reducing the evaluation (measurement) bias and improving the reliability, including the evaluation of data from scientific studies [ 50 , 51 , 129 ]. To date, CBCT is available in an increasing number of ambulatory offices, becoming the standard examination modality in ENT, dentistry, and cranio-maxillofacial surgery [ 129 ].…”