Correlation Between Craniovertebral Angle and Temporomandibular Disorders

The purpose of study was investigate the correlation between craniovertebral angle and Temporomandibular disorders.

Study Overview

• Status: Completed
• Conditions: Temporomandibular Joint Disorders
• Intervention / Treatment: Other

Detailed Description

Individuals with forward head posture (FHP) were three times more likely to develop temporomandibular disorder (TMD) compared to those with normal posture. It was discovered that improper head and cervical position was present in almost 70% of TMD participants. Participants with TMD were especially likely to have a forward-leaning head posture. Recommended postural testing as part of TMD evaluation, implying that postural disorders may cause or worsen TMD symptoms FHP is characterized as the cervical spine held in a protracted position for a prolonged duration; it can lead to alterations in head posture, ultimately leading to poor posture, which is thought to be a deviation from neutral or normal posture.

There is evidence from certain studies that people with TMDs have altered head and cervical spine posture, while no such link is found in other investigations. The skull, mandible, and cervical spine exhibit neurological and biomechanical connections, generating a functional complex that may be referred to as the "Cranio Cervical Mandibular system," which is related to the cervical area via muscles and ligaments.

TMD symptoms and cervical dysfunction are strongly correlated, supporting combined evaluation, and this will significantly aid in the treatment of participants with temporomandibular joint dysfunction and forward head posture.

• Study Type: Observational
• Enrollment (Actual): 68

Contacts and Locations

Study Locations

• Egypt
  • Cairo, Egypt
    • Mohamed Mahmoud Mousa

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Sixty-eight male and female participants aged between 18 and 40 years. All participants demonstrated measurable forward head posture, defined as a craniovertebral angle less than 50°, assessed using Kinovea software.

Description

Inclusion Criteria:

• Male and female with body mass index (18.5-29.9 kg/m2).
• Chronic temporomandibular joint dysfunction symptoms persisting for at least 3 months, with a cut-off point score of the Fonseca's Anamnestic Index of 20 points or more
• Craniovertebral angle (CVA) of less than 50°.
• Participants must exhibit measurable FHP, defined as a craniovertebral angle (CVA) <50°, assessed using Kinovea software.
• Participant has mouth opening less than 40mm.
• Participants haven't received any physiotherapy sessions on cervical or temporomandibular joint in last 6 weeks, nor have taken any non- steroidal anti-inflammatory drugs (NSAIDs) for the last two weeks preceding the study.

Exclusion Criteria:

• The subjects were excluded if they were unable to fulfil the inclusion criteria and if they had a history of any of the following:
• History of acute head, neck, or Temporomandibular joint trauma or any surgical intervention in these regions within the past 6 months.
• Congenital temporomandibular joint abnormalities.
• Participants with congenital deformities of the head and the neck.
• Participants with systemic diseases, such as rheumatoid arthritis.
• Participants received physical therapy or other conservative treatments for neck pain, temporomandibular disorders, or postural correction within the past 3 months.
• Major psychiatric disorders.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
Forward head posture group; Sixty-eight male and female participants aged between 18 and 40 years. All participants demonstrated measurable FHP, defined as a CVA of less than 50°, assessed using Kinovea software.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Craniovertebral Angle (CVA) assessment	The CVA was measured using digital image analysis of a lateral- view photograph of each participant seated in the same standard chair. Participants were instructed to adopt a relaxed posture, ensuring that the thoracic and lumbar regions contact the backrest, their gaze was directed toward the horizon, and both feet rest flat on the floor with knees flexed at 90°. A camera was positioned one meter from the participant on a level tripod at shoulder height. A marker was affixed with adhesive tape at the level of the C7 vertebra, ensuring that the participant's ear tragus remains visible within the photo frame. Identification of the C7 vertebra was conducted using active cervical rotation as described elsewhere. The image was analyzed using Kinovea 0.8.15 software, defining the craniovertebral angle as the angle formed between a horizontal line and the line connecting the spinous process of C7 to the ear's tragus. FHP is defined as CVA <50°.	8 weeks
Fonseca questionnaire for temporomandibular disorders (TMDs) assessment	The Arabic version of Fonseca's questionnaire was used for screening temporomandibular disorders (TMDs). The questionnaire consists of 10 questions, each question having a three-point scale. For each question, the participants were instructed that only one answer was marked: "yes" (10 points), "no" (0 points), and "maybe" (5 points). Based on the sum of their points, the individuals were classified as the TMD- free (0-15), mild TMD (20-40), moderate TMD (45-60), and severe TMD (70-100).	8 weeks
Temporomandibular joint opening	The TheraBite Jaw Motion Rehabilitation System was used to assess temporomandibular opening range. The participant was asked to open their mouth as wide as possible. The TheraBite scale was placed between the central incisors to measure the maximum vertical distance during active mouth opening. The scale is a disposable paper measurement tool used to assess maximum mouth opening (MMO) in millimeters (mm)	8 weeks
Temporomandibular joint lateral excursions	The TheraBite Jaw Motion Rehabilitation System was used to assess temporomandibular-lateral excursion range. The participant will be seated with a neutral head position. Initially, the examiner will align the scale's reference mark with the midline of the upper central incisors. Next, the participant will be instructed to move their mandible laterally; first to the right and then to the left, as far as comfortably possible without inducing pain. The lateral excursion will then be quantified by measuring the horizontal distance (in millimeters) between the upper midline and the new position of the lower incisor midline.	8 weeks

Collaborators and Investigators

• Sponsor: Cairo University
• Investigators: Study Director: Hussein Khalil, Sinai university; Study Chair: Nasr Abdelkader, Professor, Cairo university

Study record dates

Study Major Dates

• Study Start (Actual): November 1, 2025
• Primary Completion (Actual): January 20, 2026
• Study Completion (Actual): January 30, 2026

Study Registration Dates

• First Submitted: April 4, 2026
• First Submitted That Met QC Criteria: April 4, 2026
• First Posted (Actual): April 13, 2026

Study Record Updates

• Last Update Posted (Actual): April 13, 2026
• Last Update Submitted That Met QC Criteria: April 4, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Stomatognathic Diseases; Muscular Diseases; Joint Diseases; Jaw Diseases; Mandibular Diseases; Craniomandibular Disorders; Temporomandibular Joint Disorders
• Other Study ID Numbers: P.T.REC/012/006376

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No