CRANIO®

The Journal of Craniomandibular & Sleep Practice

ISSN: 0886-9634 (Print) 2151-0903 (Online) Journal homepage: http://www.tandfonline.com/loi/ycra20

Head and Cervical Spine Postures in Complete

Denture Wearers

Maarit A.M. Salonen D.D.S., Aune M. Raustia D.D.S., Ph.D., Jan Huggare D.D.S.,
Ph.D. & Stephen D. Smith D.M.D.

To cite this article: Maarit A.M. Salonen D.D.S., Aune M. Raustia D.D.S., Ph.D., Jan Huggare
D.D.S., Ph.D. & Stephen D. Smith D.M.D. (1993) Head and Cervical Spine Postures in Complete
Denture Wearers, CRANIO®, 11:1, 30-35, DOI: 10.1080/08869634.1993.11677938

To link to this article: http://dx.doi.org/10.1080/08869634.1993.11677938

Published online: 18 Feb 2016.

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0886-9634111 01-
0030$03.00/0, THE
JOURNAL OF
CRANIOMANDIBULAR
PRACTICE,
Copyright© 1993
by CHROMA, Inc.
Manuscript received
April 20, 1992; revised
manuscript received
July 6, 1992;
accepted July 11, 1992
Address for reprint requests:
Maarit A.M. Salonen, D.D.S.
Department of
Prosthodontic and
Stomatognathic Treatment
lnst~ute of Dentistry
Univers~ of Dulu, Anland
Aapistie3
SF-90220 Oulu
Finland
• PHYSIOLOGY
HEAD AND CERVICAL SPINE POSTURES IN
COMPLETE DENTURE WEARERS
Maarit A.M. Salonen, D.D.S., Aune M. Raustia, D.D.S., Ph.D.,
Jan Huggare, D.D.S., Ph.D.
ABSTRACT: Signs and symptoms in the stomatognathic system and head and cervical spine postures
were evaluated in 10 edentulous patients prior to renewal of their dentures, as well as immediately and
six months after insertion of new dentures. Natural head posture was recorded using the fluid-level
method and measured from the roentgen cephalograms. It was shown that the variables duration of
edentulousness and free-way space displayed positive correlations with the dysfunction symptoms. In
addition, the patients who needed oral rehabilitation the most, who received the greatest reduction in
their free-way space, were seen to have raised their heads more than average. There was also an
inverse correlation between the reduction of clinical dysfunction index score and cervical spine postures.
he prevalence of edentulousness in the population
T is decreasing due to the change in attitudes con-
cerning dental care, preventive activity and infor-
mation on caries and periodontitis. The prevalence of
Dr. Maarit A.M. Salonen received her edentulousness has been shown in one Finnish survey to
D.D.S. degree from the Institute of be 6% in subjects over 35 years old, 39% in subjects over
Dentistry, University ofTurku, Finland,
in 1979. She has been a teacher and 50 years old, and 69% in subjects over 65 years old. 1
senior lecturer at the Institute of Prosthetic treatment for edentulous patients calls for great
Dentistry, University of Oulu, Finland, skill and may be more difficult today because of increased
since 1979, in the Department of
Prosthodontics and Stomatognathic aesthetic and functional requirements. This places more
Physiology. emphasis on the importance of diagnosis.
Changes in interjaw relations after the insertion of
immediate dentures and forward and upward displace-
ment of the mandible due to the resorption of its alveolar
process have been reported earlier, 2 in addition to the way
in which the insertion of complete dentures affects head
posture and induces changes in EMG activity in the main
Dr. Aune M. Raustia received her masticatory muscles. 3· 5 Partial or total extraction of the
D.D.S. degree from the Institute of
Dentistry, University of Helsinki, permanent teeth alters the sagittal and vertical dimension
Finland, in 1974. She has been a teacher of the occlusion, which also has an effect on masticatory
in the Institute of Dentistry, University of function. 6 The aim was to study the short-term effects of
Oulu, Finland, since 1978. She received
her Odont. Dr. degree from the same renewed complete dentures on head and cervical spine
university in 1986. Dr. Raustia currently postures.
works as a senior lecturer in the Analysis of variance, Pearsons correlation analysis,
Department of Prosthodontics and
Stomatognathic Physiology, Institute of and paired t-test were the statistical methods used in eval-
Dentistry, University of Oulu, Finland. uation of dysfunction index, clinical, and cephalometric
variables.
Materials and Methods
The anamnestic dysfunction index of Helkimo, dura-
30
SALONEN ET AL CERVICAL SPINE POSTURES

the condition of the mucosal areas adjacent to the den-

tures and the denture-bearing area was recorded.
The patients came to the Institute ofDentistry, University
of Oulu, for a renewal of their complete dentures, and the
prosthetic treatment was performed in the usual manner11
by the students in the Department of Prosthodontics and
Stomatognathic Physiology.
Eight of the subjects were re-examined as soon as they felt
familiar with, and were pleased with, the use of their new
dentures. All of the subjects were re-examined after wearing
their new dentures for approximately six months (Table 1).

Figure! Results
Angles used for determining head posture and cervical spine inclination.
(Reprinted with permission from Aune M. Raustia: Head Posture and The mean edentulous period was 23.1 years (range of 10
Cervicovertebral and Craniofacial Morphology in Patients with
Craniomandibular Dysfunction. J Craniomandib Pract 1992; 3: 174.) to 40 years) and the mean age of the dentures was 14.4
years (range of 2 to 30 years) (Table 1). The mean free-
tion of the edentulous period, and the age of the dentures way space before prosthetic treatment, recorded while
of 10 subjects were ascertained prior to clinical stom- wearing the old dentures, was 5.3 mm (range of 1 mm to
atognathic, prosthetic, and roentgen-cephalometric 12 mm) (Table 2).
examinations. Eight of the subjects were women and Most of the subjects had moderate alveolar resorption
two were men, with a mean age of 57.6 years, a stan- in the upper jaw and advanced alveolar resorption in
dard deviation (SD) of 8.7, and an age range of 42 to 67 the lower jaw. The retention of the dentures was gener-
years old. Natural head posture was recorded using a ally poor (Table 1).
fluid-level method described by Showfety et aJ.1 and Preprosthetic surgery was needed for four patients
Huggare8 and measured from the cephalograms mainly in (excision of hyperplastic tissue), and stomatitis was
accordance with the variables described by Solow and treated with fungal antibiotics in three cases.
Tallgren9 (Figure 1). Most of the subjects had anamnestic dysfunction index
The retention and condition of the dentures were eval- IT, and only two were anamnestically symptom-free. Two
uated and the degree of alveolar crest resorption was of the subjects had clinically severe dysfunction (Di:ill)
examined by palpation and visual inspection from casts (Table 2). Five of the eight patients examined immedi-
employing the scale of Lekholm et al. 10 The vertical ately after insertion of the new dentures had an unchanged
dimension of the occlusion was determined phonetically or increased clinical dysfunction index while five of the
and the free-way space was measured extraorally by the 10 patients examined after six months had a lower dys-
two-dot technique with a ruler. 11 A stomatognathic exam- function score than at the beginning of prosthetic treat-
ination was performed according to Krogh-Poulsen 12 and ment (Table 2). There was a positive correlation between
Table 1
Age, Sex, Duration of Edentulousness, Age and Retention of Old Dentures and Degree of Alveolar Resorption*
Time of Age of Retenti!lll Qf the !&nllln:~ O!:~QfB.!:~QD
Subject Age Edentulousness Dentures Upper Jaw Lower Jaw Upper Jaw Lower Jaw
IF 42 20 16 good moderate B B
2M 60 21 21 poor poor B c
3F 63 10 10 moderate poor B c
4F 67 30 10 poor poor A B
SF 60 30 30 poor poor D E
6M 53 20 2 moderate poor c c
7F 67 40 20 poor poor c c
SF 59 30 20 poor poor B c
9F 61 20 5 poor poor B c
10F 44 10 10 poor poor B c
* Modified from Lekholm et al. 1985 in 10 subjects examined for renewal of their dentures. A, most of the alveolar ridge is present; B, moderate
residual ridge resorption has occurred; D, some resorption of the basal bone has begun; E, extreme resorption of the basal bone has taken place.

JANUARY 1993, VOL. 11, NO. 1 THE JOURNAL OF CRANIOMANDIBULAR PRACTICE 31

CERVICAL SPINE POSTURES SALONEN ET AL.

Table2
Distribution of Anamnestic and Clinical Dysfunction Indices of Helkimo
IMQ~lrl:~DI Imme!li~l:t i!&r ins!:JliQn Qf n~w den~~ f2 mQnth~ Sl&:r insertiQn Qf n~w d~nnu:~s
Subjects Aj Oj Oj score FWSI Oj Ojscore Oj Ojscore FWS2
IF I I 2 3 I 2 I 2 2
2M II ill 12 10 I 1 4
3F II 4 3 II 8 3
4F I 4 3 I 4 2
SF I 2 10 II 7 II 7 1
6M II II 7 2 II 7 3
7F II ill 12 12 ill 12 2
SF 0 0 0 5 I 2
9F II II 7 0 0 0 0
10F 0 2 4 0 0 0 0 2
Free-way space before (FWS 1) and six months after (FWS2) prosthetic lrealment in 10 edentulous patients.

the dysfunction index before treatment and the need for increased) were seen to have raised their heads more than
increasing the vertical dimension of occlusion (FWS 1- average, and there was an inverse correlation between the
FWS2, r = 0.616). reduction in the clinical dysfunction index score and cervi-
Six months after oral rehabilitation the dysfunction cal spine posture, in that the patients with an improve-
index displayed a positive correlation between the vari- ment in their dysfunction problem showed extension of the
ables duration of edentulousness (r 0. 777) and the = spine (Table 4).
change in vertical dimension of occlusion (r =0.674).
A progressive elevation of the head from the pretreat- Discussion
ment to the post-treatment recordings was seen, in the
form of a significant increase between the initial and final Considerable attention has been paid to head posture and
values of the craniovertical (NSLNER; FORNER) and cervicovertebral and dentofacial morphology, particularly
craniocervical (NSUOPT) angulations, p < 0.05 (Table 3). in the fields of orthodontics and prosthodontics, and later
No significant change in the cervical spine inclination also in stomatognathic physiology.4.8. 13• 14 Signs and symp-
was observed. toms in the stomatognathic system and head and cervical
The patients who experienced the greatest reduction in spine postures were evaluated here in 10 edentulous
their free-way space (vertical dimension of occlusion patients prior to prosthodontic treatment involving the
renewal of their complete dentures and twice during the
Table 3 next six months.
Means and Standard Deviations for Head and Craniomandibular disorders are common in complete
Cervical Spine Postures in 10 Subjects* denture wearers, elderly subjects having more signs and
n m symptoms than younger ones, with sex and the number of
N=IO N=S N=IO sets of dentures mentioned as etiological factors. 15• 16 Loss
-
X so X so X so of the vertical dimension of the occlusion also correlates
CraniQv~rtica]
NSUVER 110.8 3.62 102.0 1.24 103.7 3.43 I-illt
Table4
FOR/VER 97.4 4.35 98.6 3.93 99.7 3.68 I-illt Coefficients of Correlation Between Head and
Craniocervical Cervical Posture Changes and Changes in the
NSUOPT 93.1 7.80 95.1 6.38 95.7 5.74 I-illt Free-Way Space* and Dysfunction Scoret
FOR/OPT 89.7 7.75 91.6 6.30 91.8 5.14 FWS Oj

Cervical inclination NSUVER -0.24 0.14

OPTIHOR 97.8 7.97 97.9 6.20 99.0 6.88 NSUOPT -0.11 0.24
OPT/CVT 10.8 8.07 11.0 8.07 11.2 8.15 OPT/HOR -0.01 0.009
CVTIHOR 85.0 4.67 84.6 6.00 86.0 4.62 OPT/CVT 0.22 -0.48
* With complete dentures recorded before renewal of their dentures CVT/HOR 0.08 -0.774-
(I); after becoming accustomed to their renewed dentures (II); and *FWS
about six months after insertion of the renewed dentures (ill). tDi
t p < 0.05, paired t-test. 4- p<O.Ol

32 JANUARY 1993, VOL.11, N0.1 THE JOURNAL OF CRANIOMANDIBULAR PRACTICE

SALONEN ET AL
positively with craniomandibular disorders .17 This was
also observed in the present data, where the mean ages of
the subjects and their dentures, the duration of edentu-
lousness and the free-way space were higher in the cases
of moderate or severe dysfunction than in those involving
mild symptoms or no symptoms at all (Tables 1 and 2).
If the vertical change in the occlusion is beyond the
level of the subject's adaptation ability it may exacerbate
the dysfunction symptoms for some time. This can be
seen in Table 2, where patient number 7, in whom the
vertical dimension of the occlusion increased by 10 mm,
still had severe dysfunction after six months.
On the other hand, if the change in vertical dimension
was small (1 mm to 3 mm), its influence on the clinical
signs and symptoms of dysfunction seemed to be favoable
(Table 2). Perhaps the use of occlusal splints on the old
dentures before final prosthetic treatment would be prefer-
able in such cases, so that the change in the vertical dimen-
sion of the occlusion could be accomplished gradually.
The pretreatment craniovertical angulations of the pre-
sent subjects correspond to those reported previously
both for patients with craniomandibular disorders (CMD) 13
and for elderly women who had been wearing complete
dentures for at least 15 years. 14 But in this material the
cervical spine was inclined slightly further forward also
leading to an increase in craniocervical inclination. This
could be due to the different approaches used for the
assessment of natural head posture. 14
The head posture changes observed here are in contrast
to the observations ofTallgren et al., 4 who did not find any
significant change in head and cervical column postures
during a one-year period after providing partially edentu-
lous patients with immediate complete dentures. This dis-
crepancy could well be explained by dissimilarities in the
mode of treatment. Immediate denture treatment does not
usually include bite raising, while the renewal of old den-
tures always carries with it at least some change in
mandibular position. It is a well-known fact that any
change in the mandibular rest position will also affect the
head posture. 18• 19
Analogically to the increase in the vertical facial
dimension observed on renewing the dentures of the pre-
sent subjects, Daly et al. 20 found that temporary bite
opening in young adults caused extension of the head.
Theron et al. 21 also observed an immediate elevation of
the head after the insertion of complete dentures in
patients who had been edentulous for at least six months.
As the present results point out that raising of the
occlusal height by renewing the dentures has an influence
on head and cervical spine postures, it is important to
evaluate the vertical and sagittal occlusal dimensions
JANUARY 1993, VOL 11, NO. 1
CERVICAL SPINE POSTURES
before starting prosthetic treatment and afterward, at
follow-up examinations when relining the dentures at
regular intervals.
References
I. Tervonen T, Bergenholtz A, Nordling H, et al.: Edentulousness and the use
of removable dentures among people 25, 35, 50, and 65 years old in
Ostrobothnia, Finland. Proc Finn Dent Soc 1985; 81:264-270
2. Tallgren A, Lang BR, Walker GF, Ash MM Jr: Roentgen cephalometric
analysis of ridge resorption and changes in jaw and occlusal relation-
ships in immediate complete denture wearers. J Oral Rehabi/1980; 7:77-
94
3. Tallgren A, Holden S, Lang BR, Ash MM Jr: Jaw muscle activity in com-
plete denture wearers - A longitudinal electromyographic study. J
Prosthet Dent 1980; 44: 123-132
4. Tallgren A, Lang BR, Walker GF, Ash MM Jr: Changes in jaw relations,
hyoid position, and head posture in complete denture wearers. J Prosthet
Dent 1983; 50:148-156
5. Tallgren A, Holden S, Lang BR, Ash MM Jr: Correlations between EMG
jaw muscle activity and facial morphology in complete denture wearers.
J Oral Rehabi/1983; 10:105-120
6. Passamonti G, Kotrajarus P, Gheewalla RK, et al.: The effect of immediate
dentures on maxillomandibular relations. J Prosthet Dent 1981; 45:122-
126
7. Showfety KJ, Vig PS, Matteson SR: A simple method for taking natural
head position cephalograms. Am J Onhod 1983; 83:495-500
8. Huggare J: The "fluid-level method" for recording natural head posture.
Proc Finn Dent Soc 1985; 81:199-203
9. Solow B, Tallgren A: Natural head position in standing subjects. Acta
Odontol Scand 1971; 29:591-607
10. Lekholm U, Zarb GA: Patient selection and preparation. Branemark P-1,
Zarb GA. Albrektson T (eds) Tissue-Integrated Prostheses. Chicago:
Quintessence Publishing Co., Inc. 1985; 199-209
II. Basker RM, Davenport JC, Tomlin HR: Prosthetic Treatment of the
Edentulous Patient. 2nd Ed., London: MacMillan Press Ltd., 1985
12. Krogh-Poulsen W: Patofunktion. 2nd Ed., Copenhagen: Munksgaard, 1979
13. Huggare JA, Raustia AM: Head posture and cervicovenebral and craniofa-
cial morphology in patients with craniomandibular dysfunction. J
Craniomandib Pract 1992; 10(3): 173-179
14. Tallgren A, Solow B: Long-term changes in hyoid bone position and cran-
iocervical posture in complete denture wearers. Acta Odontol Scand
1984; 42:257-267
15. Faulkner KDB, Mercado MDF: Aetiological factors of craniomandibular
disorders in completely edentulous denture-wearing subjects. J Oral
Rehabi/1990; 18:243-251
16. Mercado MDF, Faulkner KDB: The prevalence of craniomandibular disor-
ders in completely edentulous denture-wearing subjects. J Oral Rehabil
1991; 18:231-242
17. Monteith B: The role of the free-way-space in the generation of pain among
denture wearers. J Oral Rehabil 1984; II :483-98
18. Murphy WM: Rest position of the mandible. J Prosthet Dent 1961; 17:329-
332
19. Darling DW, KrausS, Glasheen-Wray MB: Relationship of head posture
and the rest position of the mandible. J Prosthet Dent 1984; 52: 111-115
20. Daly P, Preston CB, Evans WG: Postural response of the head to bite open-
ing in adult males. Am J Onhod 1982; 82:157-160
21. Thereon W, Slabben JCG, Cleaton-Jones t"E, Fatti PL: The
effect of complete dentures on head posture. J Prosthet Dent 1989;
62:181-184
Dr. Jan A. Huggare received his D.D.S. degree from the Institute of
Dentistry, University ofTurku, in 1977. He has been a teacher in the
Department of Oral Development and Orthodontics, University of
Oulu, where he also received his Odont. Dr. degree in 1987, and is
presently a senior lecturer. He is also an instructor for postgraduate
orthodontic teaching at the Universities of Oulu and Kuopio. From
1992, Dr. Huggare has been a visiting postgraduate research fellow at
the Dental School, University of Otago, New Zealand.
THE JOURNAL OF CRANIOMANDIBULAR PRACTICE 33
CERVICAL SPINE POSTURES
Discussion
HEAD AND CERVICAL SPINE POSTURES IN
COMPLETE DENTURE WEARERS
Stephen D. Smith, D.M.D.
Philadelphia, Pennsylvania
The clinical implications from this paper are signifi-
cant for all health care practitioners working in the head,
neck, and jaw areas on patients who have craniofacial
pain, temporomandibular joint (TMJ) disorders and
stomatognathic system symptomatology. Head, cervical
spine, and posture were evaluated before, versus after,
denture prosthesis work with replacement of old den-
tures. The current clinical group consisted of 10 subjects,
eight women and two men, with a mean average age of
57.6 years (range of 42 to 67 years).
Patients' symptomatology was reviewed along with
the amount of vertical dimension collapse. The need for
Figure!
Variables measured as indicative of head posture. Craniovertical:
NSUVER, angle between the nasion-sella line and the true vertical.
FOR!VER, angle between the foramen magnum line (line through the
basion and opisthion) and the true vertical. Craniocervical: NSUOPT,
angle between the nasion-sella line and the dorsal tangent to the odontoid
process of the second cervical vertebra. FOR/OPT, angle between the fora-
men magnum line and the tangent to the odontoid process of the second
cervical vertebra. Cervical incUnation: OPT/HOR, angle between the
tangent line to the odontoid process of the second cervical vertebra and the
true horizontal. OPT/CVT, angle between the tangent line to the odontoid
process of the second vertebra and the tangent line to the dorsal margins of
the corpus of the third and fourth cervical vertebra. CVT/HOR, angle
between the tangent line to the dorsal margins of the corpus of the third and
fourth cervical vertebra and the true horizontal.(Reprinted with permission
from Aune M. Raustia: Head Posture and Cervicovertebral and Craniofacial
Morphology in Patients with Craniomandibular Dysfunction. J Cranio-
mandib Pract 1992; 3:174.)
34 JANUARY 1993, VOL. 11, NO.1
SALONEN ET AL.
increased vertical dimension was assessed via measure-
ment of freeway space. Lateral cephalometric radi-
ographic tracings of head posture and cephalometric
radiographic landmarks were compared before, versus
after, prosthodontic treatment. Alveolar crest resorption
and stability of dentures in the mouth were also assessed.
The mean freeway space before prosthetic treatment was
5.3mm.
In this paper, analysis of the statistical and angular
tracing data related to head and cervical posture is diffi-
cult to interpret without referring to Huggare and Raustia. 1
In this article, Figure 1 descriptors are essential in inter-
preting the present paper's tables, particularly Table 3. In
the previous paper, a younger group of 16 adults who had
craniomandibular masticatory system dysfunction was
evaluated, comparing before, versus after, treatment.
The treatment consisted primarily of counseling,
occlusal adjustment, muscle exercises for the lower jaw,
splint therapy, and/or a combination of these. That group
had less forward head posture than the current edentu-
lous/full denture replacement group. In their comparison
of Huggare and Raustia's control group,' forward head
posture using the craniovertical measurement NSUVER
(sellatursica-nasion intersect to vertical line), showed 97
degrees in the control group and 101.9 degrees in the dys-
function group. This can be compared to the current
edentulous group's measurement mean of 110.8 degrees.
Based on this angulation, a significant increased forward
head posture is evident in the current group. In the previous
paper, 1 the post-treatment young adult group manifests a
straightening of the cervical spine. This was determined by
taking the OPT/CVT measurement, which is the measure-
ment between the tangent line of the odontoid process
intersecting the tangent line of cervical 3 and 4.
With cervical straightening, the OPT/CVT angle is
reduced. In the younger adult group, 1 this angle reduced
from 13.5 degrees to 12.3 degrees post-treatment in the
pretreatment dysfunction group. The control group had an
average angulation of 10.4 degrees. In the current edentu-
lous group, the OPT/CPT measurement was 10.8 degrees.
It actually increased to 11.0 degrees at initial insertion and
then increased to 11.2 degrees six months later.
THE JOURNAL OF CRANIOMANDIBULAR PRACTICE
SALONEN ET AL.
It is significant to note in Tables 1 and 2 of the current
paper, that denture patients with higher freeway spaces
had increased craniomandibular dysfunction, compared
to less freeway space in those with mild to no symptoms.
Concerning adaptations to altered vertical dimension,
the vertical change in occlusion may exacerbate the dys-
function and symptoms at times, particularly where the
vertical dimension change in "correcting the occlusion"
is beyond the patients' tolerance level. The authors noted
in Table 2 that patient #7, who had a 10 mm vertical
increase in denture correction, still had severe dysfunction
after six months.
Thus, in their discussion, Sa1onen et al. recommend
small vertical dimension changes in 1 mm to 3 mm incre-
ments so that clinical adaptation and restructuring can be
better tolerated. Their recommendation to use occlusal
splints or acrylic bonding/relines with dentures for a
gradual change is well taken.
Often, the patient with cervical dysfunction and degen-
erative cervical spine arthritic problems cannot adapt to
increases in vertical dimension. We often find that the
cervical musculoskeletal system must be addressed by
clinicians skilled in diagnosis and manual medicine man-
agement of these problems. 2
In cases of cervical harmony and no pre-existing cervi-
cal dysfunction, occlusal/splint changes may often show
symptom improvement without complications. However,
in chronic patients with complex musculoskeletal pat-
terns, the continued evaluation and re-assessment via a
team approach produces a more durable long-term physi-
ologic result in patient pain management. By the same
token, orthopedic manipulative medicine and other thera-
pies to the cervical region are often repetitive and inef-
fective without the dentists' involvement in the TMJ/jaw
posturing and occlusal corrections.
The integration of cervical assessment and neck
regional palpation into the phase 1 diagnosis and treat-
ment of patients with craniofacial pain and TMJ disorders
was discussed by Talley et al,3
The arthrokinematics of atlanto-occipital joint and its
relationship in head posturing to mandibular position was
discussed by Makofsky. 4 His emphasis was on the need
for positioning the jaw in a neutral head position (ortho-
static posture), where the cervical vertebra and cranial
base are in an ideal neutral position for the registration of
maximum intercuspation.
Rocabado 5 has recommended the measurement of the
odontoid plane, intersecting McGregors' plane (occiput
to posterior nasal spine) forming the craniovertebral
JANUARY 1993, VOL. 11, NO. 1
CERVICAL SPINE POSTURES
angulation. He defines the norm as being 101 degrees
(plus or minus 6). He also advocates assessing the posi-
tioning of the hyoid bone relative to cervical 3 and the
mandible. The hyoid bone should be below the line
drawn from the retrognathion of the anterior mandible to
the anterior, inferior border of cervical 3 in the normal-
ization of the cervical lordotic curve.
In another pertinent study, Rocabado and Tapia6
assessed children under orthodontic treatment. They cor-
related headache/pain symptomatology more with the
lower cervical spine than the upper cervical spine, with
symptomatology increasing as the normal lordotic curve
was lost, with flattening and kyphosis-reverse cervical
curve appearance. Similar clinical findings were found
by Huggare and Raustia1 as they related straightening of
the cervical spine to relief of symptomatology. The
straightening could not be observed from craniovertebral
angle change, but was due to cervical 3 and cervical 4
angulation changes related to the horizontal plane.
The clinical observations in this paper indicate the
need to consider occlusal height, vertical dimension, and
jaw posturing in relation to cervical posture.
Further ongoing research and a larger statistical sam-
pling would be helpful in determining clinical applica-
tion. The importance of the reciprocal relationship of the
stomatognathic system to the cervical region is of value
to every clinician involved in headache, TMJ disorders,
and facial pain. The need for an orthopedic team approach
in assessing and stabilizing the cervical-spinal/muscu-
loskeletal components is evident in any comprehensive
treatment plan. The clinical need for careful phase I stag-
ing of occlusal/TMJ rehabilitative therapy prior to phase
II finalization of fixed or removable prosthodontics
becomes even more apparent when reading papers deal-
ing with this subject.
References
I. Huggare JA, Raustia AM: Head posture and cervicovertebral and craniofa-
cial morphology in patients with craniomandibular dysfunction. J
Craniomnndib Pract 1992; 10(3):173-179
2. Urbanowicz M: Alteration of vertical dimension and its effect on head and
neck posture. J Craniomnndib Pract 1991; 9(2}:174-179
3. Talley R, Murphy G, SmithS, Baylin B, Haden J: Standards for the history,
examination, diagnosis and treatment of temporomandibular disorders
(TMD): A position paper. J Craniomnndib Pract 1990; 8(1):60-77
4. Makofsky HW: The effect of head posture on muscle contact position: The
sliding cranium theory. J Craniomnndib Pract 1989; 7(4):286-292
5. Rocabado M: Biomechanical relationship of the cranial, cervical and hyoid
regions. J Craniomnndib Pract 1983; 1(3):61-66
6. Rocabado M, Tapia V: Radiographic study of the craniocervical relation in
patients under orthodontic treatment and the incidence with related symp-
toms. J Craniomnndib Pract 1987; 5(1):36-42
THE JOURNAL OF CRANIOMANDIBULAR PRACTICE 35