Postural Assessment in Patients With Malocclusions

Postural Assessment Using 3D Spine Analysis in Patients With Malocclusions

This observational cross-sectional study aims to investigate the association between skeletal malocclusions and body posture using three-dimensional postural analysis. Patients will undergo cephalometric assessment, temporomandibular disorder evaluation using the Helkimo index, and non-invasive postural evaluation using the Spine 3D system, based on rasterstereography technology. Postural parameters, including thoracic kyphosis, lumbar lordosis, trunk inclination, pelvic asymmetry, and spinal deviations, will be analysed in relation to skeletal malocclusion classes and temporomandibular disorders. The study seeks to improve the understanding of the potential interactions between the stomatognathic system and global body posture and to support a multidisciplinary diagnostic approach in orthodontic patients.

Study Overview

• Status: Not yet recruiting
• Conditions: Malocclusion; Postural; Defect; Temporomandibular Disorder
• Intervention / Treatment: Radiation: Lateral teleradiography; Other: Temporomandibular assessment with Helkimo Index; Other: Three-dimensional postural assessment

Detailed Description

This observational cross-sectional study aims to evaluate the association between skeletal malocclusions and postural parameters assessed through three-dimensional postural analysis. Patients will be consecutively recruited according to predefined inclusion and exclusion criteria. Written informed consent will be obtained from all participants or from parents/legal guardians in the case of minors prior to enrolment.

For each participant, demographic and clinical data will be collected using a standardized Case Report Form (CRF). Orthodontic assessment will include lateral cephalometric radiography performed as part of routine clinical practice. Cephalometric analysis will be carried out to evaluate sagittal skeletal relationships through the measurement of Sella-Nasion-A Point, Sella-Nasion-B Point, and A Point-Nasion-B Point angles, allowing classification of skeletal malocclusion into Class I, Class II, or Class III. The presence and severity of temporomandibular disorders will also be evaluated using the Helkimo index as part of the routine orthodontic diagnostic assessment.

All participants will subsequently undergo a three-dimensional postural assessment using the Spine 3D system, a rasterstereography-based technology that enables non-invasive, radiation-free evaluation of spinal alignment and global body posture. The system provides quantitative analysis of several postural parameters, including thoracic kyphotic angle, lumbar lordosis angle, cervical curvature, trunk inclination, pelvic rotation, lateral spinal deviations, scapular symmetry, and pelvic symmetry.

The primary outcome of the study will be the thoracic kyphotic angle measured with the Spine 3D system. Secondary outcomes will include the remaining postural parameters, cephalometric measurements, and temporomandibular disorder assessment scores.

No experimental intervention or modification of standard clinical practice will be performed, as all procedures are observational and non-invasive. Statistical analysis will be conducted to evaluate the association between skeletal malocclusion classes, cephalometric variables, temporomandibular disorders, and postural parameters.

Sample size was calculated considering the thoracic kyphotic angle as the primary outcome. The calculation was based on data reported by Parrini et al. (2018), with a reference population mean of 49.24, an expected mean value of 47.41, a standard deviation of 5.24, α = 0.05, and power = 80%. Therefore, a minimum of 64 participants was required for the study.

Statistical analysis will be conducted with R software (R version 3.1.3, R Foundation for Statistical Computing, Vienna, Austria). Descriptive statistics will be calculated for all variables, including mean, standard deviation, median, minimum value, and maximum value. Linear regression analyses will be performed to evaluate the association between postural parameters, skeletal malocclusions, and temporomandibular disorders. Significance for all statistical tests will be predetermined at p < 0.05.

• Study Type: Observational
• Enrollment (Estimated): 64

Contacts and Locations

• Study Contact: Name: Maria Gloria Nardi, Dr.; Phone Number: 3386526714; Email: mariagloria.nardi01@universitadipavia.it

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Probability Sample

Study Population

Patients referred for orthodontic evaluation at the Unit of Orthodontics and Paediatric Dentistry, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, presenting skeletal malocclusion and undergoing routine orthodontic diagnostic assessment.

Description

Inclusion Criteria:

• Patients referred for orthodontic evaluation
• Presence of skeletal malocclusion
• Availability of lateral cephalometric radiograph
• Ability to undergo three-dimensional postural assessment using the Spine 3D system
• Patients of any age and sex
• Provision of written informed consent by the participant or by parents/legal guardians in case of minors

Exclusion Criteria:

• Previous orthodontic treatment
• Previous orthopaedic treatment affecting posture
• Presence of craniofacial syndromes or congenital anomalies
• History of spinal surgery
• Significant musculoskeletal disorders
• Neurological conditions affecting posture
• Use of medications affecting musculoskeletal function
• Inability to undergo postural assessment
• Lack of written informed consent

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Thoracic kyphotic angle	The thoracic kyphotic angle will be measured using the Spine 3D system, a non-invasive rasterstereography-based device for three-dimensional postural assessment. The parameter will be expressed in degrees and used to evaluate sagittal spinal alignment.	Baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Lumbar lordosis angle	The lumbar lordosis angle will be measured using the Spine 3D system and expressed in degrees.	Baseline
Cervical curvature	Cervical curvature will be assessed using the Spine 3D system as part of the three-dimensional postural evaluation.	Baseline
Trunk inclination	Trunk inclination will be measured using the Spine 3D system and expressed as a quantitative postural parameter.	Baseline
Pelvic rotation	Pelvic rotation will be assessed using the Spine 3D system and recorded as a quantitative postural parameter.	Baseline
Lateral spinal deviations	Lateral spinal deviations will be evaluated using the Spine 3D system to assess frontal plane postural asymmetries.	Baseline
Scapular symmetry	Scapular symmetry will be assessed using the Spine 3D system as part of the postural analysis.	Baseline
Pelvic symmetry	Pelvic symmetry will be assessed using the Spine 3D system as part of the postural analysis.	Baseline
Sella-Nasion-A Point angle	The Sella-Nasion-A Point angle will be calculated using the lateral cephalometric radiograph to assess the anteroposterior position of the maxilla.	Baseline
Sella-Nasion-B Point angle	The Sella-Nasion-B Point angle will be calculated using the lateral cephalometric radiograph to assess the anteroposterior position of the mandible.	Baseline
A Point-Nasion-B Point angle	The A Point-Nasion-B Point angle will be calculated using the lateral cephalometric radiograph to assess the sagittal skeletal relationship between the maxilla and mandible.	Baseline
Temporomandibular disorders	Presence and severity of temporomandibular disorders will be assessed using the Helkimo index.	Baseline

Collaborators and Investigators

• Sponsor: Andrea Scribante

Study record dates

Study Major Dates

• Study Start (Estimated): September 1, 2026
• Primary Completion (Estimated): September 30, 2028
• Study Completion (Estimated): September 30, 2028

Study Registration Dates

• First Submitted: May 19, 2026
• First Submitted That Met QC Criteria: June 17, 2026
• First Posted (Actual): June 23, 2026

Study Record Updates

• Last Update Posted (Actual): June 23, 2026
• Last Update Submitted That Met QC Criteria: June 17, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Stomatognathic Diseases; Muscular Diseases; Joint Diseases; Jaw Diseases; Tooth Diseases; Mandibular Diseases; Craniomandibular Disorders; Malocclusion; Temporomandibular Joint Disorders
• Other Study ID Numbers: 2026-POSTUREOCCLUSION

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES

Drug and device information, study documents

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