Special Investigation Procedure of Postural Disorder Related to

Developmental Mandibular Asymmetry: A Review

Ervina Sofyanti

, Trelia Boel

, and Denny Satria

Department of Orthodontics, Faculty of Dentistry, Universitas Sumatera Utara, Medan-Indonesia

Departement of Dentomaxillofacial radiograph, Faculty of Dentistry, Universitas Sumatera Utara, Medan-Indonesia

Faculty of Pharmacy, Universitas Sumatera Utara, Medan-Indonesia

Keyword: Mandibular, trunk, asymmetry, body postural disorder

Abstract: Some previous studies have reported the comprehensive visions about the correlation between

developmental of dentofacial problems and postural disorder. This paper aims to describe some evidence

bases dentistry in malocclusion patients with mandibular asymmetry which should be considered as a

multidisciplinary approach, especially related to the postural disorder. We used different electronic

databases like Pubmed Health and Google Scholar with specific keywords such as mandibular asymmetry,

trunk asymmetry, body postural asymmetry. In this study, there was an indication that most studies reported

that temporomandibular disorder (TMD) involved and contribute to this phenomenon asymmetry. We

assumed the necessity for considering these as a special investigation procedure in developing asymmetries

examination. However, the limitation of epidemiological studies in these developmental asymmetries should

consider the translational approach in determining the etiology and the risk factors in the future.

1 INTRODUCTION

The timing of the pubertal growth spurt is

paramount in planning orthodontic treatment since

the general growth and development influence

orthodontic treatment prognosis. In human skeletal

growth, the skeletal basis of the postural is normally

developed at the same age as well as mandibular

growth and development (Mellion, 2013, Sharma,

2014). By understanding the relationship between

the stomatognathic system and body posture, we can

improve the muscular-skeletal disorders that are

associated with temporomandibular joint disorders,

occlusal changes, and tooth loss (Cuccia, 2009).

The symmetry assessment becomes a key

determinant for assessing attractiveness and

expressions in psychology and anthropology

nowadays, including facial and body posture.

The point at which normal asymmetry becomes

abnormal cannot be easily defined and is often

determined by the clinicians sense of balance and

the patient's sense of imbalance. There was

generalized asymmetry of the face and body with the

left-sided predominance in the evaluation of

laterality nose, face, and body as a new finding

(Hafezi, 2017). In dentistry, a signiﬁ cant facial

asymmetry may adversely affect the patient’s

orofacial, nutritional and psychosocial development

caused esthetic and functional problems (Bishara,

1994; Srivastava, 2018; Choi, 2015).

Comprehensive evaluations of asymmetries might be

one of great helps for the physicians,

physiotherapists, and dentist for every precise

diagnosis and thus selecting the best possible

functional rehabilitation techniques. Because of less

design and diagnostic techniques in solving the

mystery of development asymmetry that including

dental, craniofacial and body postural; the

gnathology world required to increase more

interdisciplinary approach. Further researches to

establish a direct link between poor posture and

TMD is required in order to obtain good function,

improve aesthetics, and stability (Pacella, 2017).

Previous studies have reported some

comprehensive visions between developmental of

dentofacial problems and postural disorder.

However, the amount of dentists that was able to

diagnose the occlusal disease and of those who

diagnose many people resort to aggressive treatment

modalities is still limited. Patients with facial

asymmetry usually exhibit compensatory head

posturing due to which the head is tilted slightly to

Sofyanti, E., Boel, T. and Satria, D.

Special Investigation Procedure of Postural Disorder Related to Developmental Mandibular Asymmetry: A Review.

DOI: 10.5220/0009859300750079

In Proceedings of the 2nd International Conference on Tropical Medicine and Infectious Disease (ICTROMI 2019), pages 75-79

ISBN: 978-989-758-469-5

the right or left to compensate for the effect of

asymmetry. Therefore, the clinician should

deliberately orient the patient’s head to correct any

compensatory head posture prior to making a proper

objective and quantitative examination. The patient

is also advised to eliminate other compensatory

mechanisms such as mannerisms and hairstyle that

might mask the asymmetric deformity, thus

misleading the treatment plan (Srivastava, 2018).

There are many compensation mechanisms

occurring within the neuromuscular system

regulating body balance (Manfredini, 2012). Also,

there was a well-preserved postural balance in the

presence of temporomandibular joint internal

derangement that related to mandibular asymmetry

should be considered in potential inﬂuence the

whole body posture that leads to TMD, and vice

versa. There was no feature of any peculiar changes

in body posture (Rocha, 2016).

In spite of there were no certain conclusion in

some associations between the cephalometric

variables and the EMG activity of the head, neck,

and trunk muscles were observed, there was possible

on the mechanism concerning these results and

require longitudinal studies in the future (Tecco,

2010). This review study about special investigation

procedure of postural disorder related to

developmental mandibular asymmetry due to the

multifactorial of asymmetry and homeostasis of

human being, especially in facial and posture.

1.1 Methodology

All published articles were obtained in electronic

databases like PubMed, Scopus, Web of Science,

and Google Scholar. The search keywords included

mandibular asymmetry, trunk asymmetry, body

postural asymmetry

1.2 Mandibular Symmetry

In orthodontics, we can anticipate difficulties

with treatment if we are well informed about the

principles of symmetry and thoroughly familiar with

craniofacial growth (Camille, 2013). The previous

study that was conducted in 1460 patients at the

University of North Carolina and reported that 34%

of individuals were found with a prevalence of facial

asymmetry, with a deviation of the chin being the

most remarkable feature of asymmetry. Deviation of

the chin was present in 74% of asymmetrical

patients, with a frequency of lateral guidance of the

upper and midface equal to 5% and 36%,

respectively (Severt and Proffit, 1998).

An understanding of the etiology of mandibular

asymmetry and a thorough methodical diagnostic

approach is essential for the appropriate

management of patients presenting with dentofacial

asymmetry (Brionne, 2013). The management of

patients presenting with a mandibular asymmetry

that focusing particularly on the treatment of

developmental asymmetries is a prime diagnostic in

orthodontic treatment nowadays (Chia, 2008).

Mandibular asymmetry has an embryological origin.

The morphogenesis of the facial bones is the

culmination of complicated mechanisms that take

place between the 4th and 10th week in the life of

the embryo. A malfunction of the mechanisms of

cellular migration, of apoptosis or of cellular

differentiation can compromise these processes and

lead to malformations (Lin, 2013). In the vertical

plane, facial asymmetry is apparently most prevalent

among patients with a vertical growth pattern

(Severt and Profitt, 1998). Unilateral vertical

maxillary excess and mandibular asymmetry are

usually associated with an occlusal cant. This

explains why most asymmetries cannot be treated

with single-jaw surgery (Cheong and Lo, 2011). The

development of asymmetry is a complex and

multifactorial phenomenon. Facial asymmetry is

scarcely addressed in dental literature although

being highly prevalent in the overall population. The

limitation of epidemiological studies, as well as

histological and genetic research aiming at

determining the etiology and the risk factors, should

be advised in the future (Thiessen, 2015).

1.3 Imbalance Body Postural

Body posture is deﬁned as the result of the

relationship between near segments of the body as

well as the interconnections between all segments

composing the human body. From a theoretical

viewpoint, the ideal posture is the condition in which

all structures combine their work to maintain static

and dynamic balance with maximum efﬁciency and

minimal overload and energy expense. On the

contrary, poor posture is seen as a faulty relationship

between the different body segments, requesting an

increased demand for adaptation to the support

structures and a decreased equilibrium efﬁciency

(Gonzalez, 1996). The postural disorders that were

identic with trunk imbalance or asymmetry, are

variations in transversal, vertical, and sagittal

(Sidlauskiene, 2015).

ICTROMI 2019 - The 2nd International Conference on Tropical Medicine and Infectious Disease

1.4 Mandibular Asymmetry and

Imbalance Posture

There was plausible evidence for an increased

prevalence of unilateral Angle Class II

malocclusions associated with scoliosis and an

increased risk of malocclusions, such as lateral

crossbite and midline deviation in children affected

by scoliosis. Then, the improvement of some

documentation about associations between a reduced

range of lateral movements and scoliosis seems

convincing because also mentioned about the

association between plagiocephaly and scoliosis

(Huggare, 1998; Saccuci, 2011). Previous studies

reported the trunk asymmetry and postural disorder

as the phenotype of scoliosis. There was a more

frequent and severe dentofacial deviation in the

spinal disorder with Scheuermann's disease than

scoliosis children. Caution of early detection was

required from an orthodontic point of view (Segatto,

2008). In the correlation analysis, the ramus length

difference and anterior nasal spine-mention angle

had a possible correlation with the coracoid height

difference, clavicular angle, radiographic shoulder

height, and clavicle-rib intersection difference (

P<.05) (Hong, 2011). The degree of mandibular

deviation has a high correlation with the degree of

scoliosis and trunk imbalance in a case-control study

of the adult population. There was a linear trend in

the degree of scoliosis and shoulder imbalance

correlated with the degree of mandibular deviation.

The direction of mandibular deviation was the same

as that of the lateral bending of thoracolumbar

vertebrae whilst was opposite to the direction of

lateral bending of cervical vertebrae (Zhou, 2013).

The symmetry of craniofacial structures remains

unaffected by moderate trunk asymmetry in young

adults (Zepa, 2003). While correlations between jaw

position and body posture for the cervical spine can

exist, there was a postural compensatory mechanism

that leads to minimalize the effects of jaw position

and body posture for cervical spine in general

population (Arienti, 2017). Visual perception control

is most important in orienting the head in the frontal

plane in the Swedish young adults, with moderate

trunk asymmetry and the head position maintained

by cervical spine adaption. However, there was a

significant difference between patients with a

skeletal horizontal-vertical facial axis and patients

with a basal distal–mesial position for the facial

depth in pelvic torsion (Lippold, 2007).

By including postural considerations in

orthodontic diagnosis at the final analysis, it will

lead to a total corporal analysis in mandibular

asymmetry in addressing the clinical approach

integrating treatment of corporal posture into

orthodontic care (Amat, 2008). There was a

relationship between mandibular position and body

postural. Conversely, changing body posture

affected the mandibular position in asymptomatic

subject between 21 to 53-year-old (Sakaguchi,

2007). In the evaluation of postural body stability

and malocclusions in different skeletal patterns of

orthodontic patients showed that decreased stability

and increased sway in based on malocclusion

severity. Then a signiﬁcant increasing of sway area

and sway velocity postural parameters in body

postural stability between subjects with myogenous

TMD compare to healthy controls (Arumugam,

2016; Nota, 2017).

1.5 Malocclusion and Imbalance

Posture

It was concluded that malocclusion is associated

with the posture of the changes, since the balance,

only two studies presented this outcome and was in a

considered positive for the worsening of static

equilibrium, but with no clinical application, and

another positive for improves dynamic balance

(Stancker, 2015). The more extended treatment of

the malocclusions closely correlated to postural

disorders in children with spinal disorders (Segatto.

2008). However, there were claims of an association

between body posture and dental occlusion in

growing subjects should be discarded on the basis of

epidemiological observations among 12-year-old

children in Italy (Perillo, 2008).

The existence of clinically relevant correlations

between malocclusion traits and body posture in

population age range 10.6-16.3-year-old among

local sports subjects based on posturography as a

diagnostic aid was not suggested (Perrineti, 2010).

However, it differs with another study that reported

about sway area seems to be the most sensitive

parameter for evaluating the effect of occlusion on

body posture in healthy subjects (Baldini, 2013).

There is not enough scientiﬁc evidence to support an

overview about preventing postural imbalances or

alteration of spine curvatures by performing occlusal

and/or orthodontic treatment although some

associations between occlusal factors and postural

alterations have been reported (Michelotti, 2019).

Special Investigation Procedure of Postural Disorder Related to Developmental Mandibular Asymmetry: A Review

2 DISCUSSION

The individual’s postural position can suffer

biomechanical alterations due to stomatognathic

alterations. This condition causes clinically visible

changes in dysfunctional individuals and affecting

the performance of the involved structures including

temporomandibular joint, cervical, spinal, and leg

that lead to body posture (Strini, 2008; Salkar, 2014).

This issue is important since all gnatological’s

athletes should be analyzed individually and

carefully with clinical and instrumental analyses in

order to consider the possible real effectiveness of an

occlusal splint to improve the postural structure and

sports performance (Baldini, 2012). The present

study reviewed the literature studies showing the

relationship between wrong posture and TMD. The

close relationship has also been confirmed between

TMD and changes in body posture. Patients with

TMD are expected to present postural shifts, such as

the anterior displacement of the head, increased

cervical lordosis, and lack of shoulder leveling

(Armantea, 2004). However, the variance of body

postural disorder that leads to the poor

methodological quality of analysis can explain for the

weak evidence observed (Chaves, 2014). There was

only 21 % among practitioners in India that were

aware of the interdisciplinary approach in treating

patients with severe malocclusion, TMD,

musculoskeletal, myofascial pain and body postural

(Joshi, 2015).

3 CONCLUSIONS

There was an indication that most studies reported

that temporomandibular disorder (TMD) involved

and contribute to this phenomenon asymmetry. We

assumed the necessity for considering these as a

special investigation procedure in developing

asymmetries examination. However, the limitation

of epidemiological studies in these developmental

asymmetries should consider the translational

approach in determining the etiology and the risk

factors in the future.

ACKNOWLEDGMENTS

We want to thank for the Ministry of Research and

education with the Grant no.

11/E1/KP.PTNBH/2019 and also for Derek’s

assistance.

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Special Investigation Procedure of Postural Disorder Related to Developmental Mandibular Asymmetry: A Review