Relationship Between Skeletal Malocclusion and Craniocervical Structure of Head Posture Using CBCT
Abstract
Objective: Skeletal malocclusion may influence head posture and craniocervical balance in addition to facial aesthetics. Altered head posture has been associated with cervical muscle strain, airway compromise, and musculoskeletal imbalance. Cone Beam Computed Tomography (CBCT) allows more accurate evaluation of craniofacial–cervical relationships than conventional two-dimensional radiography. This preliminary exploratory study assessed the association between skeletal malocclusion and craniocervical posture using CBCT imaging.
Material and Methods: This preliminary exploratory analytic cross-sectional study used a limited sample of 16 CBCT radiographs of patients with skeletal Class I, II, and III malocclusions. Measurements were performed on nine cephalometric variables of head posture using OnDemand3D and CorelDRAW software. Statistical analysis was performed using Pearson and Spearman correlation tests.
Results: In skeletal Class I, OPT/CVT showed a strong positive correlation (r=0.893, p-value=0.041). In skeletal Class III, NL/VER showed a very strong negative correlation (r=−0.959, p-value=0.003), whereas NSL/OPT, NSL/CVT, NL/OPT, and NL/CVT showed very strong positive correlations (r=0.820–0.974, p-value≤0.046). No statistically significant correlations were observed for the remaining variables (p-value>0.05).
Conclusion: Within the limitations of this small preliminary sample and cross-sectional design, selected craniocervical and cervical postural parameters showed significant correlations, whereas craniovertical angles and cervical column inclination did not. These findings should be interpreted cautiously and considered preliminary, hypothesis-generating evidence to inform future studies with larger samples.
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Šidlauskienė M, Smailienė D, Lopatienė K, Čekanauskas E, Pribuišienė R, Šidlauskas M. Relationships between malocclusion, body posture, and nasopharyngeal pathology in pre-orthodontic children. Med Sci Monit 2015;21:1765-73.
D’Attilio M, Caputi S, Epifania E, Festa F, Tecco S. Evaluation of cervical posture of children in skeletal class I, II, and III. Cranio 2005;23:219-28.
Sandoval C, Díaz A, Manríquez G. Relationship between craniocervical posture and skeletal class: a statistical multivariate approach for studying class II and class III malocclusions. Cranio 2021;39:133–40.
Solow B, Tallgren A. Head posture and craniofacial morphology. Am J Phys Anthropol 1976;44:417–35.
Peng H, Liu W, Yang L, Zhong W, Yin Y, Gao X, et al. Does head and cervical posture correlate to malocclusion? A systematic review and meta-analysis. PLoS One 2022;17:1–16.
Tankhiwale A, Rahalkar JS, Agarkar S, Deshmukh S, Manerikar R. Relationship between extended head posture and malocclusion. IP Indian J Orthod Dentofac Res 2020;4:35–40.
Rhiyanthy F, Lubis MM, Yusuf M, Sofyanti E, Bahirrah S. Relationship head posture in class II skeletal malocclusion against canal width breath and hyoid bone position. J Int Dent Med Res 2023;17:247–52.
Tauheed S, Shaikh A, Fida M. Cervical posture and skeletal malocclusions – is there a link? J Coll Med Sci 2019;15:5–9.
Daryanani JD, Vijay N, Shetty KS, Chawla R. Changes in pharyngeal airway after mandibular setback surgery: a retrospective cephalometric study. J Indian Orthod Soc 2019;53:256–63.
Bindayel NA, Bindayel NA. The impact of postural changes on dental occlusion. Pak Oral Dent J 2017;37:583–8.
Navarro R de L, Oltramari-Navarro PVP, Fernandes TMF, de Oliveira GF, Conti AC de CF, de Almeida MR, et al. Comparison of manual, digital and lateral CBCT cephalometric analyses. J Appl Oral Sci 2013;21:167–76.
Harrell WE. Limitations of two-dimensional cephalometric analysis in orthodontic diagnosis and treatment planning: the future of three-dimensional analysis. ResearchGate [homepage on the Internet]. 2005 [cited 2025 Sep 3]. Available from: https://www.researchgate.net/publication/259707627
Chung EJ, Yang BE, Park IY, Yi S, On SW, Kim YH, et al. Effectiveness of cone-beam computed tomography-generated cephalograms using artificial intelligence cephalometric analysis. Sci Rep 2022;12:1–8.
Kaasalainen T, Ekholm M, Siiskonen T, Kortesniemi M. Dental cone beam CT: an updated review. Phys Med 2021;88:193–217.
Singh D. Cone-beam computed tomography: a new era in clinical orthodontics. Int J Health Sci 2021;5:411–27.
Mohamad Y, Rani MAB, Gaballah K, Badran S, Manila N, Shetty SR, et al. A study on the association between skeletal malocclusion, upper airway cross-sectional area, and upper airway volume using CBCT scans. Eur J Gen Dent 2026;15:89–98.
Anagnostopoulos I, Pattanaik S, Zaky A, El-motayam A, Shetty SR, Sadek MM. Assessment of upper airway and temporomandibular joint changes in growing patients with Class II Division 1 malocclusion, treated with the twin block appliance: a retrospective cone-beam computed tomography study. Arch Craniofacial Surg 2025;26:92–101.
Wani MA, Amir M, Siddiqui S, Shukla D. Significance of natural head position (NHP) in orthodontic diagnosis: a review. J Dent Panacea 2023;5:149–54.
Meiyappan N, Tamizharasi S, Senthilkumar KP, Janardhanan K. Natural head position: an overview. J Pharm Bioallied Sci 2015;7:424-7.
Verma SK, Maheshwari S, Gautam SN, Prabhat KC, Kumar S. Natural head position: key position for radiographic and photographic analysis and research of craniofacial complex. J Oral Biol Craniofac Res 2012;2:46–9.
Tecco S, Festa F. Cervical spine curvature and craniofacial morphology in an adult caucasian group: a multiple regression analysis. Eur J Orthod 2007;29:204–9.
Peng L, Cooke MS. Fifteen-year reproducibility of natural head posture: a longitudinal study. Am J Orthod Dentofacial Orthop 1999;116:82–5.
Hassan MM, Alfaifi WH, Qaysi AM, Alfaifi AA, AlGhafli ZM, Mattoo KA, et al. Comparative evaluation of digital cephalometric tracing applications on mobile devices and manual tracing. Med Sci Monit 2024;30:1–12.
Narkhede S, Rao P, Sawant V, Sachdev SS, Arora S, Pawar AM, et al. Digital versus manual tracing in cephalometric analysis: a systematic review and meta-analysis. J Pers Med 2024;14:1–23.
Sikandar S, Chaudhry NA, Rahbar MI, Riaz A, Kamal MM, Ali F. Relationship between craniocervical posture and vertical face pattern in class II division 1 malocclusion. Esculapio J Serv Inst Med Sci 2023;19:241–6.
Bjork A. Some biological aspects of prognathism and occlusion of the teeth. Acta Odontol Scand 1950;9:1-40.
Alexa VT, Fratila AD, Szuhanek C, Jumanca D, Lalescu D, Galuscan A. Cephalometric assessment regarding craniocervical posture in orthodontic patients. Sci Rep 2022;12:1-15.
Dipalma G, Inchingolo AD, Pezzolla C, Sardano R, Trilli I, Di Venere D, et al. Head and cervical posture in sagittal skeletal malocclusions: insights from a systematic review. J Clin Med 2025;14:1-21.
Khalil N, Bizdikian AJ, Bakouny Z, Salameh M, Bou Zeid N, Yared F, et al. Cervical and postural strategies for maintaining horizontal gaze in asymptomatic adults. Eur Spine J 2018;27:2700-9.
Solow B, Siersbaek-Nielsen S. Growth changes in head posture related to craniofacial development. Am J Orthod 1986;89:132-40.
Peng H, Liu W, Yang L, Yan P, Zhong W, Gao X, et al. Craniocervical posture in patients with skeletal malocclusion and its correlation with craniofacial morphology during different growth periods. Sci Rep 2024;14:1-11.
Cassi D, De Biase C, Tonni I, Gandolfini M, Di Blasio A, Piancino MG. Natural position of the head: review of two-dimensional and three-dimensional methods of recording. Br J Oral Maxillofac Surg 2016;54:233-40.
Straker LM, O’Sullivan PB, Smith A, Perry M. Computer use and habitual spinal posture in Australian adolescents. Public Health Rep 2007;122:634-43.
Fathi H, Mohammad-Rabei E, Kabiri S, Baghban A, Soheilifar S, Nouri M. Craniofacial and airway growth in 9-11 years old normal dental occlusion in Iranian adolescents: a longitudinal cephalometric study. Dent Hypotheses 2017;8:8-16.
Goodarzi F, Rahnama L, Karimi N, Baghi R, Jaberzadeh S. The effects of forward head posture on neck extensor muscle thickness: an ultrasonographic study. J Manipulative Physiol Ther 2018;41:34-41.
Kadioglu O, Currier GF. Craniofacial 3D imaging. Cham: Springer; 2019.
Polizzi A, Serra S, Leonardi R. Use of CBCT in orthodontics: a scoping review. J Clin Med 2024;13:1-18.
Hajeer MY, Al-Homsi HK, Alfailany DT, Murad RMT. Evaluation of the diagnostic accuracy of CBCT-based interpretations of maxillary impacted canines compared to those of conventional radiography: an in vitro study. Int Orthod 2022;20.
van Vlijmen OJC, Maal T, Bergé SJ, Bronkhorst EM, Katsaros C, Kuijpers-Jagtman AM. A comparison between 2D and 3D cephalometry on CBCT scans of human skulls. Int J Oral Maxillofac Surg 2010;39:156-60.
Wen J, Liu S, Ye X, Xie X, Li J, Li H, et al. Comparative study of cephalometric measurements using 3 imaging modalities. J Am Dent Assoc 2017;148:913-21.
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