Spinal deformity and malocclusion association is not supported by high-quality studies: results from a systematic review of the literature

Improving Therapy for Children with Scoliosis through Reducing Ionizing Radiation by Using Alternative Imaging Methods-A Study Protocol

BACKGROUND

Patients with scoliosis often require multiple imaging modalities. The aim of this study was to find out whether primary diagnosis, including surgical planning, could be carried out entirely without computed tomography (CT) scans and whether follow-up could be replaced with alternative methods without the use of X-rays. In order to reduce the radiation exposure in the diagnosis and treatment of severe scoliosis, we expect to replace X-rays with radiation-free or less-intensive radiation examinations. This study protocol is interdisciplinary.

METHODS

A total of 50 male and female patients (children and adolescents, aged 7-18 years) treated for scoliosis will be analyzed. In addition to routine projection radiographs, preoperative CT, and/or X-ray stereoradiography (EOS) examinations, thin-slice 3D magnetic resonance imaging (MRI) sequences will be retrospectively reformatted during the preoperative MRI examination. A three-dimensional back scan (video-raster stereography) and an intraoral scan will also be obtained. The following questions should be answered at the end of the project: (1) Can MRI examination with additional thin-slice 3D reconstruction answer all relevant questions for preoperative planning instead of CT? (2) Are EOS or whole-spine X-ray examinations in combination with MRI data sufficient for the evaluation of the pedicles and spinal deformity? (3) Does the Cobb angle in the radiograph correlate with the calculations from the back scanner image and can follow-up checks be replaced? (4) Are there any correlations between dental anomalies and scoliosis?

CONCLUSIONS

Until now, pediatric patients with scoliosis have been diagnosed, monitored, and treated with numerous independent specialist disciplines, such as pediatricians, orthopedic surgeons, neurosurgeons, and general practitioners with different radiological issues. The aim of this project is to reduce radiation and lower perioperative risks by creating a preoperative and follow-up-related standard protocol in close interdisciplinary and targeted cooperation between all the specialist disciplines involved. In line with the holistic examination approach, the associated accompanying diseases and developmental disorders such as dental and neuronal malformations will also be examined. On the one hand, CT-based questions could be replaced with the reconstruction of thin-slice MRI sequences. In addition, it may be possible to use the three-dimensional back scan as an intermediate diagnostic procedure instead of X-rays in the monitoring of severe scoliosis. Insofar as correlations or causalities between scoliosis and occlusal anomalies, early orthodontic intervention could positively benefit the duration of therapy at a later stage.

Craniocervical posture in patients with skeletal malocclusion and its correlation with craniofacial morphology during different growth periods

The association between craniocervical posture and craniofacial structures in the various sagittal skeletal malocclusion during different growth stages has been the focus of intense interest in fields of orthodontics, but it has not been conclusively demonstrated. Thus, this study aimed to investigate the association between craniofacial morphology and craniocervical posture in patients with sagittal skeletal malocclusion during different growth periods. A total of 150 from a large pool of cephalograms qualified for the inclusion and exclusion were evaluated and classified into three groups according to the Cervical Vertebral Maturation (CVM) by examining the morphological modifications of the second through fourth cervical vertebrae, each group consisted of 50 cephalograms. In each growth period, for the comparison of head and cervical posture differences among various skeletal classes, the radiographs were further subdivided into skeletal Class I (0° < ANB < 5°, n = 16), skeletal Class II (ANB ≥ 5°, n = 18), and skeletal Class III (0° ≤ ANB, n = 16) on the basis of their ANB angle. There was no significant difference in gender (P > 0.05). Some variables were found to be significant during pubertal growth and later in patients with sagittal skeletal malocclusion (P < 0.05). Most indicators describing craniocervical posture were largest in skeletal Class II and smallest in skeletal Class III during the peak growth periods and later. Cervical inclination variables were greater in skeletal Class III than in skeletal Class II. Variables of craniofacial morphology and craniocervical posture are more correlated during the pubertal growth period and later in patients with sagittal skeletal malocclusion. A tendency is an indication of the close interrelationship that a more extended head was in skeletal Class II while a flexed head was in skeletal Class III. Nevertheless, with the considerations of some limitations involved in this study, further longitudinal studies with large samples are required to elucidate the relationship clearly.

Malocclusion and Scoliosis: Is There a Correlation?

INTRODUCTION

Scoliosis is a complex three-dimensional malformation of the spine. Although its etiology is still being investigated, it is clear that a number of factors can influence this syndrome. The spinal deformity of idiopathic scoliosis can be viewed from an etiopathogenetic perspective as a symptom of a complicated condition with a multifactorial etiology. Numerous studies have established its relationship with malocclusion, but it is still unclear how these factors interact. Malocclusion is a change in the physiological alignment of the upper and lower teeth that can be either dental or skeletal in origin. This study's objective is to assess the relationship between scoliosis and malocclusion.

MATERIAL AND METHODS

A total of 646 patients were enrolled (554 females and 92 males), 447 with scoliosis and 199 without, from private dental and orthopedic practices, to answer an anonymous questionnaire. They were selected in private dental and orthopedic practices where they had dental and orthopedic examinations. Twenty-two patients were excluded because of a lack of answers. Participants were given a bilingual survey, in English and Italian, composed of 13 questions formulated specifically for this study, using Google Forms (Google LLC, Mountain View, CA, USA).

RESULTS

Univariate analysis of the question "Do you have scoliosis?" shows a significant correlation with the following questions: "Was scoliosis a family issue?" (p < 0.05 OR 7.30 IC: 3.05-17.46) "Do you have malocclusion?" (p < 0.05, OR: 1.19 IC:1.0-1.34) and "Was mal-occlusion a family issue?" (p < 0.01, OR: 1.39 IC 1.10-1.77). Performing a multivariate analysis for the same variables, the best predictors of scoliosis were "Was scoliosis a family issue?" (p < 0.001) and "Was malocclusion a family issue?" (p < 0.05), while the question "Do you have malocclusion" lost significance.

CONCLUSION

This study adds further confirmation that there might be an important connection between malocclusion and scoliosis; it suggests that dentists and orthopedists have to check, as early as possible, for the probable presence of both pathologies to avoid a severe progression which, in most cases, may require significant therapy and even surgery.

Are Craniofacial Asymmetries Related to Trunk Asymmetries?

OBJECTIVE

The aim of this study was to investigate whether craniofacial asymmetries could be a predictor of spine asymmetries or not.

METHODS

Female individuals aged between 18 and 25 years participated in this cross-sectional descriptive-analytic study. The angle of trunk rotation was measured by a scoliometer in conjunction with the Adams forward-bending test. Individuals in the control group (n = 57) had spinal curvature of 0 to 3 degrees, and individuals in the study group (n = 53) had spinal curvature of between 4 and 6 degrees. Facial anthropometric measurements of individuals were evaluated by referencing anatomical landmarks determined on the face with 2-dimensional photogrammetry using ImageJ (Version 1.53q) program.

RESULTS

Both groups were similar in terms of facial measurements (P > 0.05). Axial trunk rotation values of the mid-thoracic and thoraco-lumbar regions were significantly higher on both sides of the asymmetry group (P < 0.05). The distances between facial landmarks are not associated with asymmetries of spine regions (P > 0.05).

CONCLUSION

Although the sensitivity and predictive value of facial asymmetries in determining trunk asymmetries and sagittal spinal posture were low, it was concluded that comparative studies are needed, especially in individuals with asymmetry at the level of scoliosis, as the asymmetries of the individuals in our study were not at the level of scoliosis.

Association between constitution, axiography, orthodontic cast analysis, and upper body posture in women aged 31 to 40 years

OBJECTIVE

Whether it is primarily the spine that reacts with pain to the negative consequences of everyday stress and possibly the temporomandibular system as a result (ascending chain), or whether incorrect stress in the dental area has an influence on body geometry (descending chain), is still a controversially discussed topic. The aim of this study is to investigate possible relationships between constitutional, axiographic, and dental parameters with upper body posture.

MATERIAL AND METHODS

A total of 106 subjectively healthy women between 31 and 40 years of age voluntarily participated in this study. Data collection was done by filling out a questionnaire with constitutional and anamnestic parameters and by evaluating orthodontic casts, axiographic measurements, and video raster stereographic measurements. These data were analyzed using correlations and group comparisons, with the significance level set at p ≤ 0.05.

RESULTS

Positive correlations were shown between the constitutional factors of body weight and BMI and the lumbar bending angle (p = 0.01), the kyphosis angle (p = 0.001), and lordosis angle (weight p = 0.05; BMI p = 0.03). In the cast analysis, regardless of the direction of the midline shift (left/right/none), a left lateral tilt can be seen which is greatest at 2.12° with a left midline shift. In addition, the elevated pelvic side correlates with the side of the displacement of the jaw, with the stronger manifestation being on the left side. With a vertical anterior bite in the normal range, the kyphosis angle is 48.09°, while with a deep bite, it is 60.92°, and with an open bite, it is 62.47°; thus, the group in the normal range differs significantly (p = 0.01) from the other two. The greater the protrusion, the smaller the sagittal plane angles (kyphosis angle, lumbar bending angle, each p = 0.03), and the more dorsal the posture (p = 0.04). The lordosis angle differs significantly (p = 0.001) between the group of subjects with a protrusion in the normal range (52.34°) and the group with an increased advancement of the mandible (41.79°).

CONCLUSION

There is a correlation between body weight, BMI, midline shift, and protrusion, as well as the vertical anterior step and upper body posture in women between 31 and 40 years of age. Interdisciplinary functional examinations of the temporomandibular musculature, and also sustained orthodontic treatment, can contribute to an improvement in upper body posture.

"Association between posterior unilateral functional crossbite and asymmetrical spinal flexion: A prospective study"

Background

Unilateral posterior crossbite (UPC) with functional shift is a malocclusion that may have the potential to affect the masticatory function and the flexibility of the spine due to intrinsic occlusal, structural and functional asymmetries sustained by marked asymmetrical muscular activation.

Research question

To investigate whether the presence of UPC with functional shift is associated with reverse chewing pattern and altered spine flexion.

Methods

Patients with UPC and a control group of patients with normal occlusion were recorded when chewing soft and hard boluses using a Kinesiograph (Myotronics-Noromed Inc., USA) and spine alignment was assessed with an electronic inclinometer Spinal Mouse® system (Idiag AG, Switzerland).

Results

There were 87 children with UPC in the patients' group among whom 38, with median (IQR) age 8.0 (7.3-9.3) years, had measurements before and after treatment. The UPC patients showed a higher percentage of anomalous/reverse chewing patterns on the crossbite side compared with a control group (p < 0.001). Moreover, a clear difference was observed between left and right flexion angles of the spine in the patients' group (p < 0.001 and p = 0.001, paired t-test) with the crossbite side being more flexible compared to the non-crossbite side. No such differences were seen in the control group, nor post-treatment for right and left crossbite (p = 0.44 and p = 0.15 respectively, paired t-test).

Significance

This study suggests an association between UPC, asymmetrical chewing patterns and asymmetrical flexion of the spine. These results may help improve understanding of any association between dental malocclusions and spine posture and hence aid diagnosis and treatment strategies.

Effects of an Interdisciplinary Approach in the Management of Temporomandibular Disorders: A Scoping Review

Temporomandibular disorders (TMD) is an umbrella term that encompasses many musculoskeletal problems that include the masticatory muscles, the temporomandibular joint, and other associated structures. TMD can be divided into two large groups: those that affect the musculature and those that affect the joint. The treatment of TMD requires the combined skills of physiotherapists and dentists, as well as sometimes psychologists and other medical specialists. This study aims to examine the effectiveness of the interdisciplinary approach using physiotherapy and dental techniques on pain in patients with temporomandibular disorders (TMDs). This is a Scoping Review of studies investigating the effects of combined therapy on patients with TMD. PRISMA guidelines were followed during this review's design, search, and reporting stages. The search was carried out in the MEDLINE, CINHAL, and EMBASE databases. A total of 1031 studies were detected and analyzed by performing the proposed searches in the detailed databases. After removing duplicates and analyzing the titles and abstracts of the remaining articles, six studies were ultimately selected for this review. All the included studies showed a positive effect on pain decreasing after a combined intervention. The interdisciplinary approach characterized by the combination of manual therapy and splint or electrotherapy can positively influence the perceived symptoms; positively decrease pain; and reduce disability, occlusal impairments, and perception of change.

Spinal disorders and mastication: the potential relationship between adolescent idiopathic scoliosis and alterations of the chewing patterns

OBJECTIVE

to evaluate mastication in a group of patients with Adolescent Idiopathic Scoliosis (AIS) with a control group, by means of the prevalence of reverse chewing cycles (RCC).

MATERIAL AND METHODS

this study included a group of patients (N=32; F=24; M=8; mean age ± SD = 14±3 years) with a confirmed diagnosis of Adolescent Idiopathic Scoliosis and a group of control subjects (N=32; F=24; M=8; mean age ± SD = 13±6 years) without spinal disorders. Mastication was recorded with both a hard and a soft bolus, following a standardized protocol, and the prevalence of reverse chewing cycles was compared between the groups.

RESULTS

The prevalence of reverse chewing cycles was significantly higher in the Adolescent Idiopathic Scoliosis group, with both a soft and a hard bolus, compared to the control group (p<0,001).

CONCLUSION

the results of this study indicate that the presence of Adolescent Idiopathic Scoliosis influences mastication, i.e. one of the main functions of the stomatognathic system. A multidisciplinary approach to these patients may be relevant in providing the best possible treatment outcomes.

Juvenile/Adolescent Idiopatic Scoliosis and Rapid Palatal Expansion. A Pilot Study

The question of whether orthodontic therapy by means of rapid palatal expansion (RPE) affects the spine during development is important in clinical practice. RPE is an expansive, fixed therapy conducted with heavy forces to separate the midpalatal suture at a rate of 0.2–0.5 mm/day. The aim of the study was to evaluate the influence of RPE on the curves of the spine of juvenile/adolescent idiopathic scoliosis patients. Eighteen patients under orthopedic supervision for juvenile/adolescent idiopathic scoliosis and independently treated with RPE for orthodontic reasons were included in the study: Group A, 10 subjects (10.4 ± 1.3 years), first spinal radiograph before the application of the RPE, second one during the orthodontic therapy with RPE; Group B, 8 patients (11.3 ± 1.6 years), first radiograph during the use of RPE second one after the removal. Group A showed a significant worsening of the Cobb angle (p ≤ 0.005) at the second radiograph after RPE. Group B showed a significant improvement of the Cobb angle (p = 0.01) at the second radiograph after removal of RPE. Based on the results, the use of RPE during adolescence might influence the spinal curves of patients with idiopathic scoliosis.

Relationship between back posture and early orthodontic treatment in children

Background

The purpose of this study was to analyze the relationship between body posture and sagittal dental overjet in children before and after early orthodontic treatment with removable functional orthodontic appliances.

Methods

Angle Class II patients (mean age 8.2 ± 1.2 years; 29 males and 25 females) with a distinctly enlarged overjet (> 9 mm) were retrospectively examined regarding body posture parameters before and after early orthodontic treatment. In addition, changes in overjet were investigated with the aid of plaster models. Forms of transverse dysgnathism (crossbite, lateral malocclusions) and open bite cases were excluded. Body posture parameters kyphosis, lordosis, surface rotation, pelvic tilt, pelvic torsion and trunk imbalance were analyzed by means of rasterstereographical photogrammetry to determine, if the orthodontic overjet correction is associated with specific changes in posture patterns.

Results

In nearly all patients an overjet correction and an improvement regarding all body posture and back parameters could be noted after early orthodontic treatment. Overjet reduction (− 3.9 mm ± 2.1 mm) and pelvic torsion (− 1.28° ± 0,44°) were significantly (p < 0.05) and moderately correlated (R = 0.338) with no significant associations found for the other posture and back parameters (p > 0.05).

Conclusion

Overjet reduction during early orthodontic treatment may be associated with a detectable effect on pelvic torsion.

The correlation between back posture and sagittal jaw position in adult orthodontic patients

Objective

A debate remains in evidence-based medicine about the reciprocal interchange between dental occlusion and body postural therapy. Back posture deformity has been found to be related to trunk asymmetry as one characteristic of scoliosis that is commonly reported in occlusal development issue. This study aims to determine the correlation between back posture and sagittal jaw position in adult orthodontic patients treated at the dental hospital of Universitas Sumatera Utara.

Methods

This observational study was conducted on orthodontic patients who had routine orthodontic control between October 2019 and February 2020. The sagittal jaw relationship on pre-treatment cephalometry lateral-based on Steiner analysis was done with OrthoVision software. The back posture that related to cervical, thoracic, and lumbar measurement was performed using scoliometer plastic economy (Baseline®).

Results

From 128 patients, aged between 18 and 30 years, we found 72 patients with Class I, 41 patients with Class II, and 15 patients with Class III skeletal malocclusion. There were no significant differences of trunk asymmetry based on sagittal jaw relationship (p = 0.651). Additionally, there was no significant correlation between back posture and sagittal jaw position in Class II and Class III patients (r = 0.112, p > 0.05).

Conclusion

In this study, the sagittal jaw relationship had poor correlation to back posture in orthodontic adult patients due to a compensatory mechanism. The presence of temporomandibular dysfunction, sella-nasion-B point, and head posture are specific variables in a particular dento-skeletal type that should be considered in further studies.

Systematic changes of the static upper body posture with a symmetric occlusion condition

Background

Temporary occlusal changes and their influence on the upper body statics are still controversially discussed. Furthermore, concrete statements on whether age- or gender-specific differences in neurophysiological reactions exist are missing. Therefore, it is the aim of this study to evaluate the immediate effects of a symmetrical occlusion blocking on the upper body posture. These effects shall be investigated for both genders and for a larger age range.

Methods

In this study, 800 (407f/393 m) subjects volunteered aged from 21 to 60 years. Both genders were divided into four age groups according to decades. The three-dimensional upper body posture was measured by using the rasterstereography (ABW-Bodymapper). The habitual static posture was measured in two dental occlusion conditions (a) in rest position and (b) symmetrical blocking in the bicuspid region by cotton rolls.

Results

A significant reduction of the trunk length (0.72 mm; p <  0.001), an increase of the lumbar (0.30°; p <  0.001) and the thoracic bending angle (0.14°; p = 0.001), a reduction of the spinal forward decline (0.16°; p <  0.001) and a reduction of the scapular distance (0.36 mm; p = 0.001) was found. Gender-specific reactions can only be recorded in scapular distance, in that regard men reduce this distance while over all age groups women did not show a significant change.

Discussion

Slight gender- and age-independent reactions due to a symmetric occlusion blockade are shown: A gender independent reaction of the spinal related variables in the sagittal plane (thoracic and lumbar flexion angle, trunk length, spinal forward decline). In addition, a gender specific change of the shoulder blade distance could be observed, where men reduced the distance while female did not show a change. However, since these reactions are of a minimum amount, it can be concluded that neurophysiological compensation mechanisms work equally well regardless of age and sex, and the upper body posture of healthy people changes only very slightly due to a temporarily symmetrical altered bite position.