CRANIO®

The Journal of Craniomandibular & Sleep Practice

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Relationship Between Posture and Occlusion: A

Clinical and Experimental Investigation

Alessandro Nobili & Riccardo Adversi

To cite this article: Alessandro Nobili & Riccardo Adversi (1996) Relationship Between Posture
and Occlusion: A Clinical and Experimental Investigation, CRANIO®, 14:4, 274-285, DOI:
10.1080/08869634.1996.11745978

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 • OCCLUSION

Relationship Between Posture and Occlusion: A Clinical

and Experimental Investigation
Alessandro Nobili, M.D., D.D.S.; Riccardo Adversi, M.D.

ABSTRAGT: Recently many postural diseases have been classified among occlusal-functional
alterations, mostly on a clinical basis. However sorne anatomie and physiologie 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) belong-
ing 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 Glass Il malocclusion
0886-9634/1404- exhibit an anteriorly displaced posture, whereas subjects with a Glass Ill malocclusion exhibit a posteri-
274$03.00/0, THE
JOURNAL OF orly displaced posture.
CRANIOMANDIBULAR
PRACTICE,
Copyright© 1996
by CHROMA, lnc.
roblems linked to posture, as the position of differ-

Manuscript received
January 18, 1996; revised
manuscrtpt received
April 22, 1996; accepted
May 21, 1996.
Address for reprint requests:
Dr. Alessandro Nobili
Via S.Vitale, 21
40125 Bologna
ltaly
Dr. Alessandro Nobili was born in
Balogna, Italy. He received his MD.
degree in 1983 and his D.D.S. degree in
1986. Dr. Nobili is in private practice in
Balogna and is part-time assistant profes-
sorat the Balogna University School of
Dentistry. His main field ofinterest and
research is clinical orthodonties, TMJ
disorders, relationship between orthodon-
ties and periodontics, and relationship
between occlusion and posture.
Dr. Riccardo Adversi was born in
Pesaro, ltaly. He received his M.D.
degree in 1993 and is apprenticed in
orthodonties at the Balogna University
School of Dentistry. Dr. Adversi 's main
field of interest and research is clinical
orthodonties, pediatrie dentistry, and the
relationship between occlusion and
posture.
occlusal Interference. Their results showed that EMG
could ~e.either "balanced" or "unbalanced" depending on
the acttvtty of the controlateral muscles.
tromyographic activity bilaterally; when unbalanced an
P
ent body segments, raised interest since the early
60s. In 1966 Robinson1 studied the influences of
the head and body posture on TMJ fonction. He con-
cluded that the postural position affected the neuromus-
cular function of the individual.
Review of the Literature
In the 70s Solow e Tallgren 2. 3 and later Opdebeek, et
al. 4 and Catalbiano5 detected sorne correlations between
craniocervical posture and dentoalveolar height. These
studies indicated that postural head position was predic-
tive for facial development. ln addition a positive rela-
tionship between upper and lower occlusal plane canting
and the relative dentoalveolar height level was evident.
In 1973 Mc Lean, et al. 6 studied the effects of changes
in body position on dental occlusion using electromyo-
graphic (EMG) detection of the masseter muscle impulses
taken while gradually changing the body position of
every subject from a supine to an upright position. Results
showed that with the shift from a supine to an upright
position, graduai changes of the first contact points to a
more mesial location were recorded. The authors stated
that the position of the body in space influences the neu-
romuscular activity of the position of the mandible at rest.
In 1976, Funakoshi, et a}.7 studied the effect of head
po~tu~e alteration on chewing muscular activity and the
extstmg _correlation between muscular activity and
values varied according to head position. EMG activity
When balanced there was an equal amount of elec-

274
NOBIU AND ADVERSI
unequal amount. Funakoshi points out that occlusal inter-
ference could be one of the reasons for unbalanced activ-
ity of the chewing musculature, because the balanced
type of electromyographic responses of participants with
normal occlusion changed to the unbalanced type after
creating a premature contact artificially and returned to
the balanced type after removing it. The unbalanced type
of EMG responses of participants with occlusal interfer-
ence turned to the balanced type after occlusal adjust-
ment.
In 1981 Marcotte8 discovered a direct relationship
between head posture and dento-facial dimensions,
observing that patients with a concave profile show a
high tendency to keep their heads bent towards the
ground, whereas patients with a distal relationship and a
convex profile tended to keep their heads upwards.
Friedman and Weisberg9 in 1982 studied different fac-
tors often related to TMJ dysfunction. These authors
believed thatjoints near the TMJ, especially the occlusal
articulation between the mandibular and the maxillary
teeth, played an important role in determining TMJ
symptoms.
A year later Tallgren, et al. 10 noted great changes in the
mandibular position in full denture patients observed for
one year. According to their report, an altered head and
neck position is often the cause ofTMJ problems. Patients
with a malocclusion compensate by altering the normal
masticatory muscular relation, perhaps facilitating cervi-
cal spine disorders. Further investigations of individual
changes, revealed that a marked decrease in mandibular
inclination, due to alveolar resorption, was associated
with a retroclination of the cervical spine and a decrease
of cranio-cervical angulation.
Solow, et al. 11 in 1984 concluded that there were corre-
lations among craniofacial morphology, craniocervical
angle and upper airway resistance, and they were impor-
tant for craniofacial development.
During the same year, Goldstein, et al.l 2 showed a pos-
sible influence of cervical posture on mandibular move-
ments. They found that a change in anterior-posterior
plane in head and neck position bad an immediate effect
on the mandibular closure path in a normal population
sample. He also showed that the forward head position
was the more comrnon head posture that could affect the
neuromuscular function on the masticatory system.
Goldstein believed that an altered head posture influ-
enced the mandibular closing path causing abnormal ini-
tial tooth contact.
Tallgren and Solow 13 studied variation in position of
the hyoid bone in relation to changes in mandibular incli-
nation and craniocervical posture in a sample of long time
full denture patients. The authors discovered that hyoid
OCTOBER 1996, VOL. 14, NO. 4
POSTURE AND OCCLUSION
bone position was controlled by two postural systems:
changes of mandibular inclination and changes of cervi-
cal and craniocervical posture.
In 1984 Darling, et al. 14 noted that mandibular vertical
dimension at rest was affected by head position. Later
Archer and Vig 15 evaluated head position effects on intra-
oral pressures in adults with an Angle Class 1 and Class II
malocclusion. The authors claimed that posture could be
an important factor in skeletal morphology development
and in dental position. This can be important for a better
understanding of malocclusions etiology and orthodontie
treatment prognosis.
In 1987 Root, et al. 16 found no significant change in
normal subject head and neck position with an increase in
vertical dimension of the occlusion.
Darlow et al. 17 in the same year were unable to confrrm
the relation between posture and algico-dysfunctional
syndrome of craniomandibular muscles.
In 1988 Korn 18 stated that functional balance in the
craniomandibular system is influenced by dental mutila-
tion, growth pattern, parafunctional habits and breathing.
Rocabadol9 showed that the observation of association
between dentomaxillofacial alterations and cran-
iomandibular dysfunctions is quite comrnon. He demon-
strated that sorne malocclusions cao facilitate or determine
craniomandibular dysfunction and vice versa. Even if
occlusal contact variation is at first a simple adaptation to
an altered posture, long lasting abnormal posture cao
induce a permanent change in occlusion.
Schellhas2° using magnetic resonance imaging demon-
strated that TMJ pathology is quite common in patients
with malocclusions.
Capurso, et al.21 showed that in patients with a severe
malocclusion, the forward head and neck posture was by
far the most comrnon postural alteration. Head and neck
in a forward position was correlated significantly with a
skeletal Class II and hyperdivergent pattern.
Southard, et al.2 2 discovered that the intensity of
occlusal contacts in segments varied according to posture
which was less significant in supine subjects than in
standing subjects. Southard suggested that postural effect
on contact intensity should be taken into consideration in
fixed prothesis or dental restorations.
Urbanowicz 23 resolved that a change in mandibular
posture, specifically an increase in vertical dimension
contributes to craniovertical extension leading to suboc-
cipital compression and upsetting the postural balance
between the head and neck. This craniovertical angle can
be taken by measuring, using a protector and plumb line.
Two small dots are positioned on the zygomatic promi-
nence of the cheek, one anterior to the tragus of the ear
and the other six cm anteriorly toward the eye. The cran-
THE JOURNAL OF CRANIOMANDIBULAR PRACTICE 275
POSTURE AND OCCLUSION
iovertical angle is the angle between the gravity true ver-
tical and the line passing through the two ink dots on the
patient's face.
Hirschfielder24 observed that, as an average, head pos-
ture was more proclined in a natural position rather than
in a standardized one such as in a craniostate. Moreover
subjects with a Class III malocclusion tended to have a
more extended head position compared to patients with a
Class 1 or a Class ll malocclusion.
Huggare25 compared 22 patients treated for scoliosis to
normal patients in order to find out any possible relation-
ship between postural head position and dento-facial
morphology. The authors found that in patients treated
for scoliosis there was an increase in the craniocervical
angle, a rotation of mandibular and maxillary planes and
a flattening of the atlas dorsal arch. These patients showed
also a high prevalence of lateral malocclusions.
Solow26 showed that certain patients with a backward
inclined upper cervical column and a small craniocervical
angle were associated with a horizontal facial develop-
ment, characterized by a reduced backward displacement
of the TMJ, large maxillary growth in length, and an
increased facial prognathism, and larger than average
true forward rotation of the mandible. On the contrary, a
large craniocervical angle and an upright position of the
upper cervical column was associated with vertical facial
development characterized by large backward displace-
ment of the TMJ, reduced growth in length of the maxilla,
reduced facial prognathism, and less than average true
forward rotation of the mandible. The craniovertical
angulation (that is, the position of the head in relation to
the true vertical) was expressed by the angles between the
craniofacial reference lines, NSL, FH and NL, and the
true vertical, VER. The craniocervical angulation (the
position of the head in relation to the cervical column)
was expressed by the angles between the craniofacial ref-
erence lines, OPT and CVT. Cervical inclination in rela-
tion to the true horizontal was expressed by variables
OPTIHOR and CVTIHOR.
Kritsineli, et al. 27 demonstrated that tooth eruption and
growth seem to cause great changes on the TMJ and
occlusion. Forward head position had a significant rela-
tionship with clickings, deviation of the mandible while
opening and posterior condyle displacement in the mixed
dentition, whereas head position did not influence the
TMJ in the primary dentition. This study also supports a
significant relationship between many of the occlusal
conditions and TMJ dysfonctions. History of injury and
oral habits such as finger sucking bad a significant rela-
tionship to signs and symptoms of TMJ disorders.
Adamidis, et al. 28 evidenced a statistically significant
difference in the position and inclination of the hyoid
276 THE JOURNAL OF CRANIOMANDIBULAR PRACTICE
NOBIU AND ADYERSI
bone between patients with a Class III and a Class 1 mal-
occlusion. Class rn patients, especially the boys, showed
a more anterior position of the hyoid bone and also a
reverse inclination. This might have an implication of the
fonction of the suprahyoid and infrahyoid muscle and
thus on the direction of mandibular growth.
In 1992 Martensmeier, et al. 29 showed that, before
treatment, nearly half of Class 1 and II patients bad a
marked cervical lordosis, whereas Class rn patients bad
abnormal kyphosis. The former group benefited from the
orthodontie treatment, but Class rn patients did not.
Materials and Methods
The test panel consisted of 50 subjects, 30 males and
20 females aged 18 to 32 years (mean age of 25.8). For
each patient alginate impressions were taken. The sub-
jects were divided into three different groups according
to the Angle classification: 1. 20 Class 1 cases; 2. 20 Class
II cases; and 3. 10 Class III cases. Any major postural
pathology in each subject was excluded by a medical his-
tory and a physiotherapy exam. Each subject received a
postural evaluation by a "balance platform" formed by:
1. Dynamometric platform to record postural oscillation
with three vertical force transducers with a Ioading
range 10-150 Kg, resolution 2%,48 cm wide, 48 cm
long, and 7 cm high. The platform bas references for
the right positioning of the patient and is connected
to a persona! computer unit that grants the system
fonction.
2. Personal computer
3. Software made by:
a. Feedback program with dynamic and static exer-
cise to different difficulty levels. Duration of exer-
cise is adjustable in one to thirty minutes range.
Monitoring graphie of therapy progress.
b. Evaluation test of postural control. Test duration is
in the 5 to 10 second range with the chance to per-
form different further tests without intermediate
calibration (joint feet, divaricated feet, open eyes,
closed eyes). Patients' files were stored on hard
disk.
c. Evaluation test of force and speed distribution.
W e paid attention to the body baricentrum coordinates
that were recorded by the balance platform. Once each
subject was on the balance platform, they were asked to
stay in a natural position. During the postural evaluation,
they bad to look continuously at the same point of refer-
ence in front of them in order to keep a constant natural
head position. Each postural measurement, considered as
measurement error and reproducibility of subject posi-
tioning, bas been evaluated as +/- 1 mm. Postural evalua-
OCTOBER 1996, VOL 14, NO. 4
NOBILI AND ADVERSI POSTURE AND OCCLUSION

tion consisted of five different tests of one minute each,

taken with different mandibular spatial positions, suppos- Table 1
ing that a different orientation of the neuromuscular Body Postural Data of Group 1
apparatus can generate corresponding postural changes of (values in mm.)
ali the body. Angle Glass 1 Group Shows, on the Average,
A Baricentrum Close to Zero
Test 1 Subject Group Test 1 Test2 Test 3 Test4 Tests
Open eyes, free mandible. Aim of this test was to A 1 7 5 2 5 6
determinate the coordinates of the baricentrum in every B 1 28 24 23 18 19
subject.
c 1 31 24 20 14 23
D 1 -15 -18 -22 -25 -26
It represents the global posture freely gained by every E 1 -2 -2 0 -4 -5
individual and is the hypothetical result of the sum of all F 1 23 22 28 27 29
the factors (even from the stomatognatic apparatus) able G 1 38 46 42 34 23
to modify it. This is the most important test because it is H 1 0 2 -2 -6 -8
1 1 -22 -23 -24 -23 -27
the only one freely gained, and it describes the postural J 1 -7 -8 -1 1 11
attitude that the subject keeps in everyday life. K 1 -33 -36 -27 -27 -19
M 1 13 12 6 11 -1
Test 2 N 1 -6 -4 7 4 1
Closed eyes, mandible in a natural position: Romberg 0 1 -7 -12 -8 -6 -5
p 1 7 13 7 12 0
test. This test aimed to determine each individual's pos- Q 1 -16 -17 -19 -20 -23
ture without any esteroceptive influence from the retina R 1 -15 -17 -20 -13 -21
and the so-called visual uprighting reflex. The postural s 1 -15 -24 -23 -21 -23
position is kept by labyrinthic proprioceptive impulses by T 1 -4 -4 -3 3 2
neck and feet receptors necessary to keep harmonie and u 1 7 8 1 -8 -6
Average 0.6 -0.45
reciprocal position of every single part of the body.
Data applies to anterior-posterior coordinates
Positive value indicates an anteriorly displaced
Test 3 baricentrum
Open eyes, clenched teeth, assuming that impulses Negative value indicates a posteriorly displaced
coming from dento-alveolar propioceptors might produce baricentrum
postural changes. In this case there is a maximum fonc-
tion of the elevator muscles. Results

Test4
Open eyes, mouth full open. Here depressor muscles
are full y working. Mandibular movement is composed by
a forward translation combined with a rotation. This test
aims to verify if the mandibular changes correspond to
body postural changes.
Test 5
Open eyes, maximum mandibular protrusion. Here the
purpose is to see if an anterior condyle repositioning and
new arrangements of the TMJ correspond to a postural
change.
The data is shown in Tables 1, 2, and 3.
We decided to examine only the sagittal plane coordi-
nates as we observed that the body baricentrum lateral
displacement ranged +1- 2 mm only.
After data collection statistical evaluation of each sub-
ject's postural fonctions was done trying to find any
common characteristics among subjects of the same
group.
The data of the five different postural tests have been
examined separately at two different times, first consider-
ing tests 1 and 2, then 3, 4 and 5. This was done because
it was supposed from the beginning that the first two tests
were the most reliable to analyze the postural attitude of
the subjects. In fact, in tests number 3, 4, 5, the subjects
were asked to keep a particular spatial mandibular posi-
tion. In tests 1 and 2 the postural attitude adopted on the
balance platform was the most spontaneous, due to indi-
vidual sensitivity.
In particular test 2, with eyes closed, was considered
important to verify the reliability of test 1, since the pos-
ture of the subject was independent from any vi suai and
externat influence.
For the remaining tests 3, 4, and 5, we tried to study the
postural state variation compared to the first test follow-
ing the different mandibular positions. (Tables 4, 5, 6)
Data evaluation has been done with the Microsoft®
Excel™ program on a personal computer.
Two main elaborations were made:

OCTOBER 1996, VOL. 14, NO. 4 THE JOURNAL OF CRANIOMANOIBULAR PRACTICE 277
POSTURE AND OCCLUSION NOBILI AND ADVERSI

Table 2 Table4
Body Postural Data of Group 2 Body Posture Variation During Tests
(values in mm.) 3, 4, and 5 Performance
Angle Glass Il Group Shows, on the Average, Subject Group Test (3-1) Test(4-1) Test (5-1)
An Anteriorly Displaced Baricentrum A 1 -5 -2 -1
Subject Group Test 1 Test2 Test 3 Test4 Test 5 B 1 -5 -10 -9
A 2 4 14 10 12 12
c 1 -11 -17 -8
D 1 -7 -10 -11
B 2 34 31 32 23 15
E 1 2 -2 -3
c 2 12 12 21 18 18
F 1 5 4 6
D 2 16 13 25 23 20
G 1 4 -4 -15
E 2 23 12 1 1 4
-12 H 1 -2 -6 -8
F 2 4 14 -5 -19
1 1 -2 -1 -5
H 2 -10 -7 -16 -9 -15
-12 -6 -14 -13 -13
J 1 6 8 18
1 2
K 1 6 6 14
J 2 -2 -11 -12 -11 5
M 1 -7 -2 -14
K 2 32 45 43 44 48
N 1 13 10 7
L 2 1 3 -8 -6 -1
-8 -6 -12
0 1 -1 1 2
M 2 1 3
p 1 0 5 -7
N 2 8 8 2 3 0
Q 1 -3 -4 -7
0 2 20 18 15 17 14
p R 1 -5 2 -6
2 7 7 2 -1 1
Q 2 13 10 9 9 15
s 1 -8 -6 -8
T 1 1 7 6
R 2 -12 -13 -16 -11 -9
s 2 -5 -10 -23 -12 -9 u 1 -6 -15 -13
Average -1.25 -1.8 -3.1
u 2 5 9 2 -3 2
v 2 14 15 12 14 11 Data is calculated by substracting data of tests
Average 7.65 8.35 3, 4, and 5 to data of test 1
Data applies to anterior-posterior coordinates
Positive value indicates an anteriorly displaced
baricentrum
Negative value indicates a posteriorly displaced
baricentrum Table 5
Body Posture Variation During Tests
3, 4, and 5 Performance
Subject Group Test (3-1) Test (4-1) Test(S-1)
Table 3 A 2 6 8 8
Body Postural Data of Group 3 B 2 -2 -11 -19
(values ln mm.) c 2 9 6 6
D 2 9 7 4
Angle Glass Ill Group Shows, on the Average, E 2 -22 -22 -19
An Posteriorly m:?placed Baricentrum F 2 -9 -16 -23
Subject Group Test 1 Test 2 Test 3 Test 4 Test 5 H 2 -6 1 -5
A 3 -23 -21 -24 -25 -27 1 2 -2 -1 -1
B 3 -3 2 -2 1 -5 J 2 -10 -9 7
c 3 -10 -6 -9 -9 -3 K 2 11 12 16
D 3 -1 -1 -4 -1 -2 L 2 -9 -7 -2
E 3 0 -8 -1 0 -11 M 2 -9 -7 -13
F 3 -12 -18 -11 -19 -22 N 2 -6 -5 -8
G 3 -12 -12 -16 -14 -13 0 2 -5 -3 -6
H 3 1 -5 -8 -6 -5 p 2 -5 -8 -6
1 3 0 6 -5 -9 -10 Q 2 -4 -4 2
J 3 -6 -10 -7 -12 -15 R 2 -4 1 3
Average -6.6 -7.3 s 2 -18 -7 -4
Data applies to anterior-posterior coordinates u 2 -3 -8 -3
Positive value indicates an anteriorly displaced v 2 -2 0 -3
baricentrum Average -4.05 -3.65 -3.3
Negative value indicates a posteriorly displaced Data is calculated by substracting data of tests
baricentrum 3, 4, and 5 to data of test 1

278 THE JOURNAL OF CRANIOMANDIBULAR PRACTICE OCTOBER 1996, VOL 14, NO. 4
NOBILI AND ADVERSI POSTURE AND OCCLUSION

The mean value in Group 1 (Angle C1ass 1) in test one

Table 6 was 0.6, and in test two -0.45 showing a baricentric pos-
Body Posture Variation During Tests ture in this population (Figures 1, 4).
3, 4, and 5 Performance Mean value in Group 2 (Angle Class Il) in test one was
Subject Group
Test(3-1) Test(4-1) Test (5-1) 7.65, and in test two 8.35, showing an anterior displaced
A 3 -1 -2 -4 posture (Figures 2, 5).
8 3 1 4 -2 Mean value in Group 3 (Angle Class III) in test one
c 3 1 1 7 was -6.6, and in test two -7.3 showing a posteriorly dis-
D 3 -3 0 -1
E 3 -1 0 -11
p1aced posture (Figures 3, 6).
F 3 1 -7 -10 The inferential evaluation calculated for each test a
G 3 -4 -2 -1 matrix i-j; "j" represented groups, "i" represented the
H 3 -9 -7 -6 observed data. We calculated "r" value (i.e., verisimili-
1 3 -5 -9 -10 tude ratio or F ratio) by the following expression:
J 3 -1 -6 -9
Average -2.1 -2.8 -4.7 k -
Data is calculated by substracting data of tests Ln/ xj.- x )2/(k-1)
3, 4, and 5 to data of test 1 j=l

r=
n
1. Statistical evaluation of the data observed in tests 1 3 j

and 2 of each group including: L L (xji- x) 2 l(n-k)

j=l i=l
a. mean value and evaluation of the frequency distri-
bution around it (Figures 1-6); j = 1~3
b. variance of this distribution compared to a normal i = 1~ ni
distribution 3

2. Variance inferential evaluation of the observed data n=I.ni

j=l
in tests 1 and 2.
ni = observed data in j-groups

Group 1

50

40
0 Posture1
rJil Posture2
30

20

Ê
.§. 10 Figure 1
Graphical depiction of the

-
1!!
;:,
Ill
0
a.
0
data of tests 1 and 2.

-10

-20

-30

-40 ·.~.
A 8 c D E F G H J K M N 0 p a R s T u

OCTOBER 1996, VOL. 14, NO. 4 THE JOURNAL OF CRANIOMANDIBULAR PRACTICE 279
POSTURE AND OCCLUSION NOBILI AND ADVERSI

Group 2

50
0 Posture1
40
~ Posture2

30

Ê 20 Figure 2
.§. Graphical depiction of the
data of tests 1 and 2.

-
!
:::1
I ll
0
Il.
10

-10

-20 If 1
A B C 0 E F H J K L M N 0 P Q R S U V

Elaborated data for tests 1 and 2 with the intermediate
computation and the final results are reported in Appendix.
"r"* values are respectively:
test 1 r = 4.0183 0,05>P>O,O 1
test 2 r = 4.7379 0,05>P>O,Ol
The inferential evaluation let us affirm that the mean
values of the three different groups significantly differ
from each other, as a consequence a statistically signifi-
cant correlation between body posture and occlusion is
found with a hazard "P" 0.05 > P > 0,01.
Discussion
It is necessary to specify that our research was a popu-
lation study intended to document parameters within a
group of dental students. The individual analysis of sub-
jects including "persona!" details was not intended. We
excluded any gross anomalies in our sample group that
could affect the overall postural results.
Results of this research could be considered as evi-
dence of a generic tendency in our sample group to show
* "r"' values reported are calculated taking away two border values
in group 1 (one positive, one negative) related to subjects with
opposite data repeated in tests 1 and 2. lncluding these two subjects
O.l>P>0.05. We believe that the introduced correction does not
invalidate the veracity of our conclusions.
specifie postural attitudes in relation to different occlusal
characteristics.
It must be pointed out that in every group there are
very different values (i.e., Group 2 +34 mm, Group 3 -23
mm). An explanation for these differences within the
same group could be that head position was not a fixed
parameter for everyone because each subject could
choose a comfortable head position simply staring at a
reference Iine; the variability of this parameter within
the subjects could have influenced the body posture.
Otherwise, these situations lend themselves to further
investigations of individual factors able to increase the
"group" postural attitude.
The postural data display for the three groups is even
more interesting when related to the different occlusions.
Opposing occlusal Classes of malocclusion correspond to
opposing postural attitudes (Class II anterior posture,
Class III posterior posture).
We cannot say if the "group body posture" was influ-
enced by the stomatognatic apparatus or if that particular
occlusion was the result itself of that particular body
posture.
In our experience we found a correlation between the
Class III malocclusion and a posterior body posture, and
in opposition, between Class II malocclusion and an ante-
rior body posture. These results could be explained by a
forward and a more extended head position that are

280 THE JOURNAL OF CRANIOMANDlBULAR PRACTlCE OCTOBER 1996, VOL. 14, NO. 4
NOBILI AND ADVERSI POSTURE AND OCCLUSION

Group 3

10
D Posture1
5
I'JJ Posture2
0
Ê Figure3
.§. -5 Graphical depiction of the
! data from tests 1 and 2.
i 0
-10
D..
-15
-20
-25
A B c D E F G H J

Group 1

25

--
20
0~

>(,)- 15 Figure4
c Relative frequency distribu-
Q)
:::s tion of Group 1 postural
C" data. The mean value is
...
Q)

LL
10 zero .

0
x<-16 -15<x<-8 -7<x<O 1<x<7 8<x<15 x>16
Gaps

Group 2

25

--
~
0 20
Figure 5
>-
u 15 Relative frequency distribu-
cQ) tion of Group 2 postural
:::s 10 data. A positive shi ft of the
C"
...
Q)

LL 5
values is noticeable.

0
x<-8 -7<x<O 1<x<7 8<x<15 16<x<23 x>24

Gaps

OCTOBER 1996, VOL. 14, NO. 4 THE JOURNAL OF CRANlOMANDlBULAR PRACTlCE 281
POSTURE AND OCCLUSION NOBILI AND ADVERSI

Group 3

50
45
~ 40
0
-35
~ 30
Figure6
Relative frequency distribu-
c
Q) 25 tion of Group 3 postural
:::s
g- 20
data. A negative shi ft of the
values is noticeable .
.t 15
10
5
0
x<-15 -14<x<-8 -7<x<O 1<x<7 x>8

Gaps

linked respectively to Class II and Class III malocclusion
as demonstrated by other authors 21 -24 and could be even
reconciled with other previous studies.l4-23
The balance platform could record the coordinates of
the baricentrum of the body and describe it in the five
tests, therefore it showed the who le amount of ali the fac-
tors able to influence it, but this postural unit could not
give any more detailed information regarding single body
districts (i.e., head posture).
Results of tests 3, 4, and 5 with the mandible in an
extreme position show a tendency to posterior displace-
ment of the body's center of gravity especially for test 5
(mandibular protrusion) (Figures 7-9). This is evidence
that the spatial position of the condyles can influence pos-
ture which suggests new and more detailed research to
find out possible correlations between posture and dys-
functional syndromes of the TMJ.
Conclusions
This study supports the hypothesis that a relationship
exists between occlusion and posture.
After a review of literature dealing with postural-
occlusal correlations, we studied a group of 50 subjects.
These patients, classified by malocclusion according to
Angle, were examined by means of a balance platform
which included 5 different tests.
During the tests a constant tendency towards a
backward repositioning of the baricentrum was ob-
served. Subjects with a Class II malocclusion showed

Group 1 --o-- Post.(3-1)

20 --a-- Post.(4-1) Figure 7

Body posture variation

-E
15
10
---tr-- Post.(S-1) during tests 3, 4, and 5
(Group 1) performance

-E
Q)
(J
5
compared to data of test 1.
Tests with the mandible in
extreme position show a

.
c 0 general tendency to poste-

-c
Q)
rior displacement of bari cen-
Q) -5 trum, particularly test 5
-10 (mandibular protrusion).

-15

-20

282 THE JOURNAL OF CRANIOMANDIBULAR PRACTICE OCTOBER 1996, VOL. 14, NO. 4
NOBILI AND ADVERSI POSTURE AND OCCLUSION

Group 2 - - o - - Post.(3-1)

20 --o-- Post.(4-1)
FigureS
..-. 15 ----{;--- Post.(S-1) Body posture variation
E 10 during tests on 3, 4, and 5
E
.._. (Group 2) performance
5 compared to data test 1.
CD
u 0 Tests with the mandible in
c
...
Cl) extreme position show a

-
ë
Cl)

-10
-15
-5 general tendency to poste-
rior displacement of bari cen-
trum, particularly test 5
(mandibular protrusion).
-20
-25

Group 3
- - o - - Post.(3-1)

8 --o-- Post.(4-1)

6 -----fr-- Post.(5-1)
Figure 9
4
Body posture variation
during tests 3, 4, and 5
..-. 2
(Group 3) performance
E compared to data of test 1.
E
.._. 0
Tests with the mandible in
Cl) H extreme position show a
u -2
c general tendency to poste-
...
-
Cl)
-4 rior displacement of baricen-
Cl)
trum, particularly test 5
(mandibular protrusion).
ë -6

-8

-10

-12

an anteriorly displaced posture, whereas subjects with a

Class III malocclusion showed a posteriorly displaced Appendix A (Cont.)
posture. Subject Group Test 1 Results
Results of this study could be considered as evidence D 1 -15 236.8179
of a generic tendency in our sample group to show spe- E 1 -2 5.70679
cifie postural attitudes in relation to different occlusal F 1 23 511.2623
characteristics and opens the door for further investiga- H 1 0 0.151235
1 1 -22 501.2623
tions on a larger scale. -7
J 1 54.59568
M 1 13 159.0401
N 1 -6 40.8179
AppendixA
0 1 -7 54.59568
Subject Group Test 1 Results p 1 7 43.70679
A 1 7 43.70679 Q 1 -16 268.5957
B 1 28 762.3735 R 1 -15 236.8179
c 1 31 937.0401 s 1 -15 236.8179

OCTOBER 1996, VOL. 14, NO. 4 THE JOURNAL OF CRANIOMANDIBULAR PRACTICE 283
POSTURE AND OCCLUSION NOBILI AND ADVERSI

Appendix A (Cont.) Appendix B (Cont.)

Subject Group Test 1 Results Subject Group Test 2 Results
T 1 -4 19.26235 H 1 2 9.33642
u 1 7 43.70679 1 1 -23 481.5586
------A-------2---------4------------13~3225 __ _ J 1 -8 48.22531
B 2 34 694.3225 M 1 12 170.4475
c 2 12 18.9225 N 1 -4 8.669753
D 2 16 69.7225 0 1 -12 119.7809
E 2 23 235.6225 p 1 13 197.5586
F 2 4 13,3225 Q 1 -17 254.2253
H 2 -10 311.5225 R 1 -17 254.2253
1 2 -12 386.1225 s 1 -24 526.4475
J 2 -2 93.1225 T 1 -4 8.669753
K 2 32 592.9225 u 1 8 82.00309
L 2 1 44.2225 ------A-------2--------14------------31~9225 __ _
M 2 1 44.2225 B 2 31 513.0225
N 2 8 0.1225 c 2 12 13.3225
0 2 20 152.5225 D 2 13 21.6225
p 2 7 0.4225 E 2 12 13.3225
Q 2 13 28.6225 F 2 14 31.9225
R 2 -12 386.1225 H 2 -7 235.6225
s 2 -5 160.0225 1 2 -6 205.9225
u 2 5 7.0225 J 2 -11 374.4225
v 2 14 40.3225 K 2 45 1343.223
------A-------3--------:23-------------268~6--- L 2 3 28.6225
B 3 -3 12.96 M 2 3 28.6225
c 3 -10 11.56 N 2 8 0.1225
D 3 -1 31.36 0 2 18 93.1225
E 3 0 43.56 p 2 7 1.8225
F 3 -12 29.16 Q 2 10 2.7225
G 3 -12 29.16 R 2 -13 455.8225
H 3 1 57.76 s 2 -10 336.7225
1 3 0 43.56 u 2 9 0.4225
J 3 -6 0.36 v 2 15 44.2225
------A-------3--------:21-------------187~69--
Number Average N*(tot-grpr2 B 3 2 86.49
Group 1 18 0.388889 44.33681 c 3 -6 1.69
Group 2 20 7.65 647.9014 D 3 -1 39.69
Group 3 10 -6.6 732.4507 E 3 -8 0.49
Total 48 1.9583333 F 3 -18 114.49
Sig"2T 712.3444 G 3 -12 22.09
K= 3 sig"2R 177.2717 H 3 -5 5.29
F* 4.018376 1 3 6 176.89
F* = r = Final result J 3 -10 7.29
Matrix achieved using Microsoft'-' ExcelrM software for the
calculation of "r'' value. Number Average N*(tot-grpr2
The "r'' values reported are calculated taking away two Group 1 18 -1.05556 123.3759
border values in Group 1 (one positive, one negative) Group 2 20 8.35 921.4031
related to subjects with opposite data repeated in tests 1 Group 3 10 -7.3 785.4391
and 2. lncluding these two subjects 0.1 >P>0.05. We Total 48 1.5625
believe the introduced correction does not invalidate the Sig"2T 915.109
veracity of our conclusions. K= 3 sig"2R 193.1465
F* 4.7379
F* = r = Final result
Appendix B Matrix achieved using Microsoft® ExcelrM software for the
Subject Group Test 2 Results calculation of "r'' value.
A 1 5 36.66975 The "r'' values reported are calculated taking away two
B 1 24 627.7809 border values in Group 1 (one positive, one negative)
c 1 24 627.7809 related to subjects with opposite data repeated in tests 1
D 1 -18 287.1142 and 2. lncluding these two subjects 0.1 >P>0.05. We
E 1 -2 0.891975 believe the introduced correction does not invalidate the
F 1 22 531.5586 veracity of our conclusions.

284 THE JOURNAL OF CRANIOMANDIBULAR PRACTICE OCTOBER 1996, VOL. 14, NO. 4
 NOBILI AND ADVERSI POSTURE AND OCCLUSION

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