progress in orthodontics 1 3 ( 2 0 1 2 ) 273–280

Available online at www.sciencedirect.com

journal homepage: www.elsevier.com/locate/pio

Original article

Is postural platform suited to study correlations between

the masticatory system and body posture? A study of
repeatability and a meta-analysis of reported variations

Giuseppe Perinetti a,∗ , Luisa Marsi b , Attilio Castaldo a , Luca Contardo a

a Department of Medical, Surgical and Health Sciences, School of Dentistry, University of Trieste, Italy
b Private practice, Treviso, Italy

a r t i c l e i n f o a b s t r a c t

Article history: Aim: To evaluate the repeatability of different static posturographic parameters with regard
Received 26 November 2011 to the analysis of correlations between the masticatory system and body posture.
Accepted 13 December 2011 Materials and methods: In 15 healthy subjects (26.4 ± 3.7 years, 9 females and 6 males) with
no malocclusion, posturographic recordings were carried out by vertical force platform
Keywords: under mandibular rest position (RP) and dental intercuspidal position (ICP). Six different
Body posture posturographic parameters were recorded at baseline, 30 min, 1 day and 7 days. Repeata-
Masticatory system bility analysis was based on the method of the moment estimator (as percentage over the
Method error baseline scores, i.e. method error) and interclass correlation coefficients (ICC). Moreover,
Posturographic platform a meta-analysis of the variations in posturographic recordings between different occlusal
Reliability conditions, i.e. RP vs. ICP, from previous studies was also performed.
Results: Only the sway area and velocity yielded acceptable errors and ICCs up to 14.8%
and 0.94, respectively. The spatial parameters, i.e. displacement of the centre of pressure
from the theoretical point, performed poorly with lowest errors and greatest ICCs of 149.0%
and 0.64, respectively. At the meta-analysis, ten studies were included and a total of 281
variation scores were calculated, with most of the greater and significant variations seen
for the spatial parameters.
Conclusions: The sway area and velocity show acceptable reliability, but a threshold of 25%
should be used as a true variation between two different recording conditions, i.e. RP vs.
ICP. Considering that most of the previous results on the relevant correlations between the
masticatory system and body posture are based on spatial parameters, with the poorest
repeatability, corresponding conclusions should be interpreted with caution.
© 2012 Società Italiana di Ortodonzia SIDO. Published by Elsevier Srl. All rights reserved.

popular both in clinical practice and in clinical research;1 this

1. Introduction
is achieved by monitoring the displacement of the body cen-
tre of pressure (COP) and other postural parameters using
Assessing postural coordination through measuring the sway a vertical force platform (posturography). This approach has
of the human body in an upright posture has become also been widely used in the dental field to investigate on

∗
Corresponding author. Struttura Complessa di Clinica Odontoiatrica e Stomatologica, Ospedale Maggiore, Piazza Ospitale 1, 34129 Trieste,
Italy.
E-mail address: G.Perinetti@fmc.units.it (G. Perinetti).
1723-7785/$ – see front matter © 2012 Società Italiana di Ortodonzia SIDO. Published by Elsevier Srl. All rights reserved.
doi:10.1016/j.pio.2011.12.003
274 progress in orthodontics 1 3 ( 2 0 1 2 ) 273–280
correlations between the masticatory system and body
posture2 even though, an analysis of the reliability of these
measurements, with regard to dental occlusion, is still
missing.2 Therefore, whether significant differences seen in
previous investigations are due to true correlations or method-
ological errors remains an open issue.3
This study assessed the repeatability of postural plat-
form according to different occlusal states, and compared the
present results with variability seen in previous studies, with
an attempt to assess whether previously reported differences
were due to true biological correlations or were within the
errors in recording.
2. Materials and methods
Fifteen subjects, 9 females and 6 males (mean age 26.4 ± 3.7
years, ages 21.2-32.8 years), were enrolled in the study after
a signed informed consent, and the protocol was reviewed
and approved by the local Institutional Review Board. The fol-
lowing inclusion criteria were followed: i) good general health
according to medical history and clinical judgment; ii) neg-
ative history of vertigo through central nervous disease; iii)
negative for symptoms caused by any previous trauma or
surgery; iv) absence of any neurological, vestibular and lower
leg sensory functions; v) absence of any particular episode
of psychosocial and psychological stress profile in the last
month; vi) presence of a natural dentition and a bilateral molar
support and canine Class I relationship;4 vii) absence of any
cross-, open- or depth-bite;5 viii) absence of cast restorations
and extensive occlusal restoration; and ix) absence of any
temporo-mandibular dysfunction.6 Posturographic recordings
were repeated at baseline, 30-min, 1-day and 7-day time
points.
2.1. Posturographic recordings
Posturographic recordings were performed as previously
described.7 Briefly, a 10-Hz sampling frequency vertical force
platform (Bio Postural System, AXA S.r.l., Vimercate [Mi], Italy)
was employed with subjects placed in a quiet stance. The sub-
jects were required to remain as stable as possible, but relaxed
with their arms hanging free beside their trunk and facing the
wall (150 cm away). Moreover, all of the subjects were asked
to avoid alcohol and heavy exercise during the 24 h before the
clinical recordings.
Two different occlusion states (conditions) with eyes open
were used during the static posturography: mandibular rest
position (RP) and intercuspidal position (ICP). The RP is defined
as the habitual postural position of the mandible when at
rest; the ICP (without clenching) is defined as the most closed,
static position which the mandible can assume through the
full interdigitation of the opposing teeth.8
Each recording lasted 30 s, and six posturographic param-
eters were recorded: i) lateral (X) and ii) antero-posterior
(Y) COP displacements from the theoretical point (in mm);
iii) right-left (lateral) and iv) antero-posterior load differ-
ences, v) sway velocity (in mm/s) and vi) area (in mm2 ). In
particular, the load differences were calculated by using right-
left/anterior-posterior loads as percentage of the total body
height,7 whereby zero represents a perfect balance between
the distribution of the two loads. Only the body center of pres-
sure projections within the ellipse of 90% of the projected
points were considered in the final estimation of each of the
outcomes, while each recording was repeated three consec-
utive times with the mean value representing the statistical
unit.
2.2. Data analysis
Parametric/non-parametric methods were used for data anal-
ysis after having tested each data set for the required
assumptions. A Friedman test and a Wilcoxon test were used
to assess the significance of the differences in X and Y COP
displacements and lateral and antero-posterior loads over
time points (within each condition) and between the recording
conditions (within each time point), respectively. A repeated
measure analysis of variance and a paired t-test were used in
the same manner for the sway velocity and area. A p value
<0.05 was considered as being statistically significant.
Intraclass correlation coefficients (ICCs) along the 95% con-
fidence intervals (CIs) were calculated for each posturographic
parameter at each 30 min, 1-day and 7-day time points with
regard to the corresponding baseline scores. An ICC >0.75 indi-
cates ‘excellent’ reliability, and between 0.40 and 0.75 stands
for ‘fair to good’ reliability.9 The coefficient of variance (CV),
defined as the ratio of the standard deviation (SD) over the
mean value (mean/SD), was also calculated for each time point
and condition recording. Generally, no larger values than 0.33
are considered acceptable.10 The ICC considers both the vari-
ability between individuals and between test–retest record-
ings and the CV shows consistency between the test–retest.
However, in a homogenous group, with a small variability
between individuals, the ICC may show a false low value. That
is if the variability between individuals is smaller than the
variability between tests.11 Therefore, high ICCs associated to
low CVs are more indicative of a reliable measurement.
With the aim of quantifying the variability of the differ-
ent recordings for each parameter, the method of moments
(MME) variance estimator (i.e. method error) was used.12 Sub-
sequently, for each posturographic parameter, the mean error
and 95% confidence intervals (CIs) between recordings at
30-min, 1-day and 7-day time points with respect to those
at baseline have been calculated by using the MME variance
estimator. Method errors were finally expressed as percentage.
2.3. Meta-analysis of reported variations
All the studies investigating on the correlations between the
masticatory system and body posture through the use of static
vertical force postural platform, and already included in a
recent systematic review2 were re-included herein. The study
re-included had, however, made use of at least one of the pos-
turographical parameters analysed in the present study. In
the end, seven studies4,6,13–17 were retrieved to which three
more articles,7,18,19 meeting the same criteria and published
thereafter, were also added.
For each posturographic parameter used in these reports,
the variations between different recording conditions/groups
were calculated as the difference between the means of two
 progress in orthodontics 1 3 ( 2 0 1 2 ) 273–280 275

Table 1 – Descriptive and inferential statistics for the posturographic parameters under the different recording conditions
over the time points (n = 15).
Parameter Condition Baseline 30 min 1 day 7 days Diff.
X COP displacement (mm) RP -0.02 ± 0.3 0.08 ± 0.37 -0.09 ± 0.41 0.02 ± 0.44 NS
ICP 0.04 ± 0.62 0.05 ± 0.21 0.2 ± 0.3 0.13 ± 0.28 NS
Diff. NS NS * NS

Y COP displacement (mm) RP 0.04 ± 0.54 -0.14 ± 0.47 0.11 ± 0.35 0.15 ± 0.69 NS
ICP 0.11 ± 0.22 0.05 ± 0.31 0.07 ± 0.31 0.10 ± 0.18 NS
Diff. NS NS NS NS

Lateral load difference (%) RP 4.1 ± 3.1 3.8 ± 3.7 4.9 ± 3.6 6.6 ± 3.6 NS
ICP 3.5 ± 2.8 2.9 ± 2.6 5.0 ± 3.0 5.5 ± 3.5 *
Diff. NS NS NS **

Antero-posterior load difference (%) RP -1.5 ± 7.2 -1.1 ± 6.1 0.4 ± 6.0 0.7 ± 5.6 *
ICP -2.1 ± 7.4 -1.4 ± 6.3 0.3 ± 6.3 0.2 ± 5.8 NS
Diff. NS NS NS NS

Sway velocity (mm/s) RP 0.46 ± 0.06 0.45 ± 0.06 0.44 ± 0.07 0.49 ± 0.08 **
ICP 0.43 ± 0.05 0.45 ± 0.10 0.41 ± 0.06 0.45 ± 0.08 NS
Diff. ** NS ** **

Sway area (mm2 ) RP 1925.4 ± 263.8 1854.8 ± 254.9 1819.4 ± 291.4 2039.8 ± 376.8 ***
ICP 1808.2 ± 306.4 1820.3 ± 320.1 1662.6 ± 267.7 1895.3 ± 350.0 *
Diff. ** NS ** *
Data are presented as mean ± SD. COP, projection of the body centre of pressure; ICP, intercuspidal position; RP, rest position. Diff., difference
among the experimental conditions or time points. Levels of significance: *p < 0.05, **p < 0.01.

recordings divided by the smaller mean, and expressed as per-
centages. According to this procedure, the largest variation
per comparison was calculated. The studies were then sorted
according to the highest variation obtained for each of the
posturographic parameters analysed herein. Finally, the effect
size (ES) coefficients2,20,21 in the posturographic recordings
corresponding to the highest variations were also calculated.
The ES coefficient is the ratio of the difference between the
means of two recordings divided by the within-subject/group
SD.20 Generally, values of at least 1.0 are considered associated
to a clinically relevant correlation and to a reliable diagnostic
tool.22–24
3. Results
Descriptive and inferential statistics are shown in Table 1.
The lateral load difference (ICP condition), antero-posterior
load difference (RP condition), sway velocity (RP condition)
and sway area (both, RP and ICP condition) yielded statisti-
cally significant differences over time. Most of the significant
differences between the RP and ICP conditions, within each
time point, were seen for the sway velocity and area (base-
line, 1-day and 7-day time point) with lower values for the ICP.
Significant lower and greater values for the ICP as compared
to the RP condition, were seen for the lateral load difference
(7-day time point) and X COP displacement (1-day time point),
respectively.
Results on the repeatability analysis are shown in Table 2.
The X and Y COP displacements yielded the worst perfor-
mance with very low ICCs ranging from 0.0 to 0.64 along
with very high CVs ranging from 1.84 to 15.50. The lateral
and antero-posterior load differences yielded ICCs generally
around or above 0.75, with a better repeatability seen for the
latter. However, even for these two parameters, the corre-
sponding CVs were also notably large ranging from 0.55 to
29.00. The remaining sway velocity and area yielded the best
results in terms of repeatability. While the ICCs were gener-
ally around or above 0.75, the corresponding CVs were all low
with the highest value being 0.22. However, at 30-min time
point and for the ICP condition, both the sway velocity and
area showed lower ICCs of 0.38 and 0.42, respectively.
Results on the method error are shown in Table 3. As for
the ICCs, the X and Y COP displacements yielded the worst
performance with very high errors ranging from 149.0% to
1,789.6%. The lateral and antero-posterior load differences
yielded notably smaller errors with a better repeatability for
the former. The errors ranged from 35.2% and 66.6% and from
130.9% and 230.2%, for the lateral and antero-posterior load
differences, respectively. The sway velocity and area showed
again the best results in terms of repeatability with no relevant
differences between their behaviours. The overall mean errors
for both ranged from 4.5% to 17.1%. However, mean errors were
generally below 10% while, even considering the upper limit
of the 95% CIs, these were no greater than 25.6%.
Results on the re-appraisal of reported highest variations
are shown in Table 4. A total of 281 variations/ES coefficients
were calculated from eleven studies (including the present).
For the X and Y COP displacement and lateral and antero-
posterior load differences, all the variations reported are well
below or within the method errors reported herein, even when
the differences showed statistically significant differences.
The sway velocity and area were the parameters most used,
and in about half of the cases the variations were below 15%,
reaching up to 38.1%16 and 122.2%,19 respectively. The ES coef-
ficient associated to these highest variation were mostly below
or equal to 0.5 (23 out of 29), the only cases above 1.0, reached
1.0419 and 1.29.14
276 progress in orthodontics 1 3 ( 2 0 1 2 ) 273–280

Table 2 – The repeatability of the posturographic parameters, for the different recording conditions and according to the
corresponding baseline recording scores (n = 15).
Parameter Condition Coefficient Baseline 30 min 1 day 7 days
X COP Displacement RP ICC 1 0.31 (0-0.77) 0.64 (0.01-0.88) 0.16 (0-0.72
CV 15.00 4.63 4.56 22.00
ICP ICC 1 0.00 (0-0.64) 0.49 (0-0.83) 0.00 (0-0.59)
CV 15.50 4.20 1.50 2.15

Y COP Displacement RP ICC 1 0.41 (0-0.80) 0.00 (0-0.57) 0.00 (0-0.00)

CV 12.10 3.48 3.16 4.57
ICP ICC 1 0.45 (0-0.82) 0.20 (0-0.73) 0.55 (0-0.85)
CV 2.07 6.00 4.64 1.84

Lateral load difference RP ICC 1 0.90 (0.70-0.97) 0.77 (0.31-0.92) 0.51 (0-0.83)
CV 0.76 0.97 0.73 0.55
ICP ICC 1 0.68 (0.05-0.89 0.70 (0.10-0.90) 0.71 (0.14-0.90)
CV 0.80 0.90 0.60 0.64

Antero-posterior load difference RP ICC 1 0.94 (0.83-0.89) 0.89 (0.68-0.96) 0.84 (0.53-0.95)
CV 4.80 5.55 15.00 8.00
ICP ICC 1 0.91 (0.75-0.97) 0.89 (0.68-0.96) 0.83 (0.51-0.94)
CV 3.52 4.50 21.00 29.00

Sway velocity RP ICC 1 0.90 (0.69-0.96) 0.83 (0.49-0.94) 0.73 (0.21-0.91)

CV 0.13 0.13 0.16 0.16
ICP ICC 1 0.38 (0.02-0.79) 0.68 (0.05-0.89) 0.84 (0.52-0.95)
CV 0.12 0.22 0.15 0.18

Sway area RP ICC 1 0.94 (0.82-0.98) 0.88 (0.64-0.96) 0.86 (0.57-0.95)

CV 0.14 0.14 0.16 0.18
ICP ICC 1 0.42 (0.03-0.81) 0.73 (0.21-0.91) 0.88 (0.63-0.96)
CV 0.17 0.18 0.16 0.18

ICC, intraclass correlation coefficients; CV, coefficient of variations. The ICC is shown as mean (95% CI) according to the corresponding baseline
recording scores (reported as 1). ICP, intercuspidal position; RP, rest position.

Table 3 – The method error of the posturographic parameters, for the different recording conditions and according to the
corresponding baseline scores (n = 15).
Parameter Condition Baseline 30 min 1 day 7 days
X COP Displacement RP 1 1519.4% (767.3-2271.4) 1307.8% (660.4-1955.1) 1789.6% (903.8-2675.5)
ICP 1 1062.5% (536.5-1588.4) 900.1% (454.6-1345.7) 1136.3% (573.8-1698.8)

Y COP Displacement RP 1 981.3% (495.6-1467.1) 1082.2% (546.5-1617.9) 1792.8% (905.3-2680.2)

ICP 1 211.2% (106.7-315.7) 237.9% (120.1-355.6) 149.0% (75.3-222.8)

Lateral load difference RP 1 35.2% (17.8-52.6) 50.2% (25.3-75.0) 66.6% (3.9-99.6)

ICP 1 53.8% (27.2-80.4) 56.7% (28.7-84.8) 56.1% (28.3-83.9)

Antero-posterior load difference RP 1 150.5% (76.0-225.1) 201.5% (101.8-301.3) 230.2% (116.2-344.1)

ICP 1 130.9% (66.1-195.7) 145.7% (73.6-217.8) 170.3% (86.0-254.7)

Sway velocity RP 1 5.7% (2.9-8.5) 7.2% (3.6-10.8) 9.5% (4.8-14.3)

ICP 1 17.1% (8.7-25.6) 9.7% (4.9-14.5) 8.3% (4.2-12.4)

Sway area RP 1 4.5% (2.3-6.7) 6.7% (3.4-10.0) 8.5% (4.3-12.7)

ICP 1 14.8% (7.5-22.2) 10.3% (5.2-15.4) 8.5% (4.3-12.8)

Method error calculate as mean (95% CI) according to the corresponding baseline recording scores (reported as 1), and expressed as percentage
COP, projection of the body centre of pressure; ICP, intercuspidal position; RP, rest position.

correlations between the masticatory system and body pos-

4. Discussion
Through a repeatability analysis, the present study reported
a huge difference in terms of performance among different
posturographical parameters obtained by the static vertical
force postural platform. While sway velocity and area suf-
fer minor method errors up to 25%, all the other parameters
showed notably lower repeatability. Moreover, a re-appraisal
of reported variations in these parameters, when analysing
ture, uncovered how these variations were mostly within or
well below the errors derived herein, in spite of the statistical
significance seen in the corresponding comparisons.
A comprehensive analysis of the possible errors to which
the posturographic platform measurements might suffer is of
particular importance in consideration of the relatively small,
but statistically significant, differences through which a corre-
lation between the masticatory system and body posture has
been claimed to exist. 13,15,18,19
 progress in orthodontics 1 3 ( 2 0 1 2 ) 273–280 277

Table 4 – Reappraisal of nine studies using static postural platform through calculation of highest variations (sorted from
greater to smaller) according to the different posturographic parameters, and other related information.
Parameter/Study Variation ES coefficient Group(s) feature and/or comparison (conditions, no. of subjects)
X COP displacement
Perinetti6 1400.0%* 0.64† Asymptomatic vs. symptomatic subjects (RP with cotton rolls, eyes closed,
n = 35 per group)
Present data 300.0% 0.12 RP vs. ICP, baseline (eyes open, n = 15)
Hellmann et al.19 61.6%* 0.34 SVC vs. MVC with cotton rolls bilaterally (eyes open, n = 20, test 2)
Bracco et al.13 25.3%* 0.28† Myocentric mandibular position vs. ICP (eyes closed, n = 95)

Y COP displacement
Present data 364.4% 0.47 RP vs. ICP, 30 min (eyes open, n = 15)
Perinetti6 176.9% 0.43 Asymptomatic vs. symptomatic subjects (RP with cotton rolls, eyes closed,
n = 35 per group)
Hellmann et al.19 94.9% 0.48 SVC vs. MVC with cotton rolls unilaterally (eyes open, n = 20, test 1)
Bracco et al.13 12.0%* 0.12 RP vs. ICP (eyes closed, n = 95)

Lateral load difference

Ferrario et al.14 141.3% 1.29† Asymptomatic vs. symptomatic subjects (MVC, eyes open, n = 10 per group)
Present data 31.0% 0.38 RP vs. ICP, 30 min (eyes open, n = 15)
Bracco et al.13 a 25.6%* 0.27 Myocentric mandibular position vs. ICP (eyes closed, n = 95)
Michelotti et al.16 25.4% 0.27† Absence vs. presence of crossbite (ICP with cotton rolls, eyes open, n = 52 and 26,
respectively)
Cuccia18 4.0% 0.38 RP vs. ICP (eyes open, n = 84)
Perinetti et al.7 3.6% 0.05 Subjects with variable degree of malocclusion, RP vs. ICP (eyes open, n = 122)

Antero-posterior load difference

Present data 40.0% 0.08 RP vs. ICP, baseline (eyes open, n = 15)
Perinetti et al.7 0.1% 0.00 Subjects with variable degree of malocclusion, RP vs. ICP (eyes open, n = 122)

Sway velocity
Michelotti et al.16 38.1% 0.25 Absence vs. presence of crossbite (ICP with cotton rolls, eyes open, n = 52 and 26,
respectively)
Perinetti6 14.9% 0.45 Asymptomatic vs. symptomatic subjects (ICP with cotton rolls, eyes open,
n = 35 per group)
Present data 8.9%* 0.50 RP vs. ICP, 7 days (eyes open, n = 15)
Perinetti4 5.7% 0.18 RP vs. ICP (eyes open, n = 26)
Perinetti et al.7 5.6% 0.09† Subjects with variable degree of malocclusion, RP vs. ICP (eyes open, n = 122)

Sway area
Hellmann et al.19 122.2%* 1.04 MVC with cotton rolls bilaterally vs. SVC (eyes open, n = 20, test 1)
Ferrario et al.14 57.9% 0.87 Asymptomatic vs. symptomatic subjects (RP, eyes open, n = 10 per group)
Sforza et al.17 45.7% 0.56† RP vs. more stable occlusion by wearing a split (eyes open, n = 11)
Perinetti6 40.4% 0.29 Asymptomatic vs. symptomatic subjects (RP with cotton rolls, eyes open,
n = 35 per group)
Perinetti4 22.1% 0.31† RP vs. ICP (eyes open, n = 26)
Gangloff and Perrin15 b 13.3%* 0.30† Before and after unilateral trigeminal anaesthesia (eyes open/closed, n = 27)
Present data 9.4%* 0.56† RP vs. ICP, 1 day (eyes open, n = 15)
Perinetti et al.7 1.1% 0.02 Subjects with variable degree of malocclusion, RP vs. ICP (eyes open, n = 122)

Asymptomatic and symptomatic, refer to negative and positive to TMDs, respectively. Where not specified, asymptomatic subjects (with normo-
occlusion) were recruited. a, as asymmetry index of right and left sides; b, as Romberg’s quotients. *, difference in the comparison that was
statistically significant; †, highest ES coefficient seen in the whole comparisons (of the parameters analysed herein) within a study. COP,
projection of the body centre of pressure; ICP, intercuspidal position; MCV, maximum voluntary clenching; RP, rest position; SVC, sub-maximal
voluntary clenching.

In the present study, the differences in posturographic
parameters, mainly sway velocity and area, showed statisti-
cally significant differences between the RP and ICP conditions
(Table 1) being thus in line with previously reported evi-
dence. 6,13,15,18 However, in consideration of the method errors
uncovered herein (Tables 2–4), these differences may not
be sufficient to claim any relevant correlation between the
occlusal state and body posture.
The ICCs is a useful measure of repeatability although it
may be biased when the CVs are extremely large or small.
Therefore, when considering both the ICCs and CVs, the
present study showed that the sway velocity and area should
be preferred over other parameters, particularly when inves-
tigating on possible correlations between the masticatory
system and body posture. While the spatial X and Y COP dis-
placements and antero-posterior load difference showed poor
repeatability, the lateral load difference exhibited acceptable
ICCs (and CVs), but also a method error generally above 50%,
thus limiting the use of this parameter.
As a limitation, the ICC cannot be used to assess any clinical
meaning of previously reported variations, which may be done
only through the knowledge of the method errors expressed
as percentage. Moreover, only three7,16,18 of the ten studies
retrieved for the present re-appraisal included a method error
278 progress in orthodontics 1 3 ( 2 0 1 2 ) 273–280

Fig. 1 – Representative posturographical parameters at the two occlusal conditions for subject no. 5.
COP, centre of pressure; ICP, intercuspidal position; RP, rest position. In spite of the apparently large variations in Y COP
displacement, antero-posterior load difference and sway velocity and area, between the two recordings, these are all within
the errors. Significant effects of mandibular position on body posture cannot be claimed.

analysis for lateral and antero-posterior load differences, sway
velocity and area. However, these errors were derived from
immediate test-retests of single recordings, while more accu-
rate data may be provided by recordings in multiple time
points, in which at least three consecutive recordings per
session are executed.25 Further limitations resides in the pre-
vious use of the Dahlberg’s formula7,16,18 (instead of the MME
variance estimator) that does not take into account system-
atic errors,12 and in the lack of the 95% CIs that should be
considered in such cases.12 Whereas the method error for the
load differences seen herein are notably greater as compared
to those previously reported, the results for the sway veloc-
ity and area (including the whole 95% CIs) obtained herein
are comparable with previous findings. Indeed, sway veloc-
ity has been reported to have mean errors of 7.8%16 and
6.6%,7 while reported errors for the sway area were of 29.2%16
and 5.5%.7 Of note, in two7,16 out of these three studies, the
authors concluded that significant correlations between the
masticatory system and body posture would be meaningless.
Even though direct comparison of present method errors with
previously reported variations might suffer some approxima-
tion, the calculation of the largest variations seen in previous
studies, along with the ES coefficients, would render this anal-
ysis more reliable. In several cases, the variations reported
were extremely low as compared to the errors here reported,
as was for the X and Y COP displacement (Table 4). Moreover,
lower variations for each parameter were generally those asso-
ciated to statistically significant differences. For instance, the
X and Y COP displacement variations of 25.3% and 12.0% were
reported as significant in one study.13 The statistical power
(due to the number of subjects) explains why small differences
may be significant, while the lack of clinical meaning of those
differences may be derived from the ES coefficients that were
very generally low and below 1.0.
A critical example in shown in Figure 1 reporting the
behaviours of the posturographical parameters of subjects no.
5 between the two RP and ICP recording conditions. While
the Y COP displacement varied from 0.5 mm to -0.8 mm,
and the lateral load difference from 2.6% to 5.4%, these
were within the range of errors uncovered herein. The same
consideration applies to the sway velocity and area whose
variations from 0.37 mm/s to 0.44 mm/s and from 1531 mm2 to
1844 mm2 , respectively, are not sufficiently large to claim any
real effect of occlusion state on the body posture, at least when
 progress in orthodontics 1 3 ( 2 0 1 2 ) 273–280
using a static postural platform in combination with these
parameters.
The present study shows that the significant differences
seen in previous studies investigating on possible correlations
between the masticatory system and body posture, through
the use of a static vertical force postural platform, are likely
to be in the range of the method error used. Therefore,
these measurements would not be suited for such purposes,
unless notably greater variations above the method errors, are
encountered.
5. Conclusions
1. The sway velocity and area are the most repeatable param-
eters when using postural platform, although a variation
up to 25% should be considered within the range of the
error.
2. Previous conclusions about existence of correlations
between the masticatory system and body posture reported
by the use of static vertical force postural platforms are to
be interpreted with caution.
Conflict of interest
The authors have no conflicts of interest to declare.
Riassunto
Obiettivo: La valutazione della ripetibilità di parametri posturo-
grafici rispetto all’analisi delle correlazioni tra il sistema masticatorio
e la postura corporea.
Materiali e metodi: Le misure posturografiche sono state eseguite
tramite pedana stabilometrica in 15 soggetti (26.4 ± 3.7 anni, 9 fem-
mine and 6 maschi) senza malocclusione in posizione di riposo (PR)
mandibolare e durante intercuspidazione (ICP). Sette parametri pos-
turografici sono stati misurati al baseline, 30 min, 1 e 7 giorni dopo.
L’analisi della ripetibilità è stata basata sull’estimatore del metodo
del momento (come percentuale sui valori di baseline, es. metodo
di errore) e sul coefficiente di correlazione intraclasse (CCI). Inoltre,
una meta-analisi della variazioni nelle misurazioni posturografiche
tra diverse condizioni occlusali, es. PR vs. ICP, da studi precedenti è
stata eseguita.
Risultati: Solo l’area e la velocità di oscillazione hanno avuto un
margini di errore e CCI accettabili rispettivamente fino a 14.8% e
0.94. I parametri spaziali, es. spostamento del centro di pressione
dal punto teorico, hanno avuto errori molto alti con ICC bassi che
nel migliore dei casi erano rispettivamente di 149,0% e 0.64. Alla
meta-analisi, dieci studi sono stati inclusi e un totale di 281 valori di
variazione sono stati calcolati, con la maggior parte delle differenze
statisticamente significative che erano per i parametri spaziali.
Conclusioni: L’area e la velocità di oscillazione hanno errori accetta-
bili ma un valore soglia del 25% deve essere usato come variazione
reale tra due misurazioni in diverse condizioni, es. PR e ICP. In consid-
erazione che la maggior parte dei risultati circa rilevanti correlazioni
tra il sistema masticatorio e la postura corporea sono basati su
parametri spaziali, con la più bassa ripetibilità, le rispettive con-
clusioni dovrebbero essere interpretate con cautela.
279
Résumé
Objectif: Évaluer la répétabilité de paramètres posturographiques
par rapport à l’analyse des corrélations entre le système masticatoire
et la posture corporelle.
Matériels et méthodes: Les measures posturographiques ont été
réalisées au moyen d’une plate-forme stabilométrique chez 15 sujets
(26.4 ± 3.7 ans, 9 femmes et 6 hommes), sans malocclusions en posi-
tion de repos (PR) mandibulaire et pendant intercuspidation (ICP).
Sept paramètres posturograpahiques ont été mesurés (valeur par
défaut, après 30 minutes, 1 jour et 7 jours). L’analyse de la répéta-
bilité a été fondée sur l’estimation par la méthode des moments
(comme pourcentage sur les valeurs de baseline, par exemple méth-
ode d’erreur) et sur le coefficient de corrélation intraclasse (ICC).
Nous avons réalisé aussi une méta-analyse des variations dans les
mesures posturographiques entre différentes conditions occlusales,
par ex., PR vs ICP, à partir d’études précédentes.
Résultats: Seulement l’aire et la vitesse d’oscillation ont enregistré
une marge d’erreur et un ICC acceptables jusqu’à 14,8% et 0.94
respectivement. Les paramètres spatiaux, par exemple, le déplace-
ment du centre de pression par rapport au point théorique, ont fait
état d’erreurs très élevés avec ICC faibles, étant dans les meilleurs
des cas 149,0% et 0.64 respectivement. Dix études ont été incluses
dans la méta-analyse et un total de 281 valeurs de variation ont été
calculées, la majorité des différences statistiquement significatives
portant sur les paramètres spatiaux.
Conclusions: L’aire et la vitesse d’oscillation ont des erreurs accept-
ables, mais une valeur seuil de 25% doit être utilisée comme variation
réelle entre deux mesures dans des conditions différentes (par ex. PR
et ICP). Eu égard au fait que la plupart des résultats autour des cor-
rélations importantes entre le système masticatoire et la posture sont
fondés sur des paramètres spatiaux, avec la répétabilité la plus faible,
les conclusions respectives doivent être interprétées avec précaution.
Resumen
Objetivo: Valorar la repetibilidad de registros posturográficos con
respecto al análisis de las correlaciones entre el sistema masticatorio
y la postura corporal.
Materiales y métodos: Las mediciones posturográficas se han lle-
vado a cabo por medio de plataforma estabilométrica en 15 sujetos
(26.4 ± 3.7 años, 9 mujeres y 6 varones), sin mala oclusión en posi-
ción de reposo (PR) mandibular y durante intercuspidación (ICP).
Siete registros posturagráficos han sido medidos (valor inicial y al
cabo de 30 minutos, 1 día y 7 días). El análisis de la repetibilidad
se ha basado en la estimación del método de los momentos (como
porcentaje en los valores iniciales, por ejemplo método del error) y en
el coeficiente de correlación intraclase (ICC). Además, se ha llevado
a cabo un meta-análisis de la variación en las mediciones postura-
gráficas entre diferentes condiciones oclusales, por ej., PR vs ICP, de
estudios anteriores.
Resultados: Sólo el área y la velocidad tuvieron un margen de
error y un ICC aceptables, respectivamente hasta 14,8% y 0.94. Los
parámetros espaciales, por ej., desplazamiento del centro de presión
del punto teórico, tuvieron errores muy altos con ICC bajos, que en el
mejor de los casos eran respectivamente 149,0% y 0.64. En el meta-
análisis se incluyeron diez estudios y se calcularon un total de 281
valores, la gran parte de las diferencias estadísticamente significati-
vas siendo para los parámetros espaciales.
Conclusión: El área y la velocidad de oscilación tuvieron errores
aceptables, pero un valor umbral de 25% debe ser utilizado como
280 progress in orthodontics 1 3 ( 2 0 1 2 ) 273–280

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