Article Data

  • Views 198
  • Dowloads 134

Original Research

Open Access

Craniocervical posture and skeletal relationship in Peruvian adolescents

  • Kelly Lisset Castro-Romero1
  • Julissa Amparo Dulanto-Vargas2,*,
  • Kilder Maynor Carranza-Samanez2

1School of Dentistry, Scientific University of the South, 15067 Lima, Perú

2Research Group in Dental Sciences, School of Dentistry, Scientific University of the South, 15067 Lima, Perú

DOI: 10.22514/jocpd.2026.047 Vol.50,Issue 2,March 2026 pp.181-190

Submitted: 26 August 2025 Accepted: 28 October 2025

Published: 03 March 2026

*Corresponding Author(s): Julissa Amparo Dulanto-Vargas E-mail: jdulanto@cientifica.edu.pe

Abstract

Background: Active skeletal growth occurs during adolescence. Elucidating cervical and craniofacial biomechanical connection can help to understand causal relationships and improve orthodontic diagnosis and treatment. This study aimed to evaluate the association between craniocervical posture (CP) versus the sagittal and vertical skeletal relationship (SR) in Peruvian adolescents. Methods: This retrospective study evaluated 153 digital lateral radiographs of adolescents (72 males and 81 females) aged 13 to 17 years (mean age 15.22 ± 1.52 years) distributed into nine groups according to the sagittal SR based on the point A‒nasion line to point B‒nasion line (ANB) angle (class I, II, and III) and vertical SR according to the nasion-sella line and the occlusal plane (NSL-OP’) angle (normodivergent, hypodivergent, and hyperdivergent). CP was analyzed using the Solow and Rocabado parameters. Multiple linear regression models were used to determine the association of CP and SR considering p < 0.05. Results: The sagittal and vertical SR groups showed associations with multiple parameters of CP (p ≤ 0.037). For nine CP parameters, a trend toward cervical flexion was observed in Class III adolescents and toward cervical extension in Class II adolescents across different vertical SR. In model 2, six CP parameters showed significant correlations with the ANB angle (R2 = 33.3%, p < 0.001) and the NSL-OP’ angle (R2 = 61.8%, p < 0.001). Conclusions: Craniocervical posture parameters were found to be associated with sagittal skeletal relationships. A tendency to the more extended CP was associated with a class II ANB angle, while CP was more flexed in class III regardless of vertical growth. Healthcare professionals should consider cervical posture in the multidisciplinary management of orthodontic treatment for adolescents.


Keywords

Adolescent; Cervical; Posteroanterior cephalometry; Posture


Cite and Share

Kelly Lisset Castro-Romero,Julissa Amparo Dulanto-Vargas,Kilder Maynor Carranza-Samanez. Craniocervical posture and skeletal relationship in Peruvian adolescents. Journal of Clinical Pediatric Dentistry. 2026. 50(2);181-190.

References

[1] Di Giacomo P, Ferrara V, Accivile E, Ferrato G, Polimeni A, Di Paolo C. Relationship between cervical spine and skeletal class II in subjects with and without temporomandibular disorders. Pain Research and Management. 2018; 2018: 4286796.

[2] Iwasaki T, Suga H, Yanagisawa-Minami A, Sato H, Sato-Hashiguchi M, Shirazawa Y, et al. Relationships among tongue volume, hyoid position, airway volume and maxillofacial form in paediatric patients with Class-I, Class-II and Class-III malocclusions. Orthodontics & Craniofacial Research. 2019; 22: 9–15.

[3] Yoakum CB, Romero AN, Latham C, Douglas EC, Gallagher KM, Terhune CE. Sex and height influence neck posture when using electronic handheld devices. Clinical Anatomy. 2019; 32: 1061–1071.

[4] Lombardo G, Vena F, Negri P, Pagano S, Barilotti C, Paglia L, et al. Worldwide prevalence of malocclusion in the different stages of dentition: a systematic review and meta-analysis. European Journal of Paediatric Dentistry. 2020; 21: 115–122.

[5] Adesina BA, Otuyemi OD, Ogunbanjo BO, Otuyemi DO. Cephalometric assessment of hyoid bone position in Nigerian patients with bimaxillary incisor proclination. Journal of West African College of Surgeons. 2016; 6: 117–135.

[6] Ahn MS, Shin SM, Yamaguchi T, Maki K, Wu TJ, Ko CC, et al. Relationship between the maxillofacial skeletal pattern and the morphology of the mandibular symphysis: structural equation modeling. Korean Journal of Orthodontics. 2019; 49: 170–180.

[7] Al-Khateeb SN, Al Maaitah EF, Abu Alhaija ES, Badran SA. Mandibular symphysis morphology and dimensions in different anteroposterior jaw relationships. The Angle Orthodontist. 2014; 84: 304–309.

[8] Jeyaraj P, Juneja P. A case of extreme skeletal class III malocclusion beyond the envelope of discrepancy, managed effectively by a modified ortho-surgical protocol. Journal of Maxillofacial and Oral Surgery. 2021; 20: 201–218.

[9] Sambataro S, Bocchieri S, Cervino G, La Bruna R, Cicciù A, Innorta M, et al. Correlations between malocclusion and postural anomalies in children with mixed dentition. Journal of Functional Morphology and Kinesiology. 2019; 4: 45.

[10] Kerbrat A, Schouman T, Decressain D, Rouch P, Attali V. Interaction between posture and maxillomandibular deformity: a systematic review. International Journal of Oral and Maxillofacial Surgery. 2022; 51: 104–112.

[11] Kim P, Sarauw MT, Sonnesen L. Cervical vertebral column morphology and head posture in preorthodontic patients with anterior open bite. American Journal of Orthodontics and Dentofacial Orthopedics. 2014; 145: 359–366.

[12] Paço M, Duarte JA, Pinho T. Orthodontic treatment and craniocervical posture in patients with temporomandibular disorders: an observational study. International Journal of Environmental Research and Public Health. 2021; 18: 3295.

[13] Dipalma G, Inchingolo AD, Pezzolla C, Sardano R, Trilli I, Di Venere D, et al. Head and cervical posture in sagittal skeletal malocclusions: insights from a systematic review. Journal of Clinical Medicine. 2025; 14: 2626.

[14] Peng H, Liu W, Yang L, Zhong W, Yin Y, Gao X, et al. Does head and cervical posture correlate to malocclusion? A systematic review and meta-analysis. PLOS ONE. 2022; 17: e0276156.

[15] Cabrera-Domínguez ME, Domínguez-Reyes A, Pabón-Carrasco M, Pérez-Belloso AJ, Coheña-Jiménez M, Galán-González AF. Dental malocclusion and its relation to the podal system. Frontiers in Pediatrics. 2021; 9: 654229.

[16] Liu Y, Sun X, Chen Y, Hu M, Hou X, Liu C. Relationships of sagittal skeletal discrepancy, natural head position, and craniocervical posture in young Chinese children. CRANIO®. 2016; 34: 155–162.

[17] Liu Y, Wang S, Wang C, Liu C. Relationships of vertical facial pattern, natural head position and craniocervical posture in young Chinese children. CRANIO®. 2018; 36: 311–317.

[18] Peng H, Liu W, Yang L, Yan P, Zhong W, Gao X, et al. Craniocervical posture in patients with skeletal malocclusion and its correlation with craniofacial morphology during different growth periods. Scientific Reports. 2024; 14: 5280.

[19] Hosseinzadeh Nik T, Janbaz Aciyabar P. The relationship between cervical column curvature and sagittal position of the jaws: using a new method for evaluating curvature. Iranian Journal of Radiology. 2011; 8: 161–166.

[20] Hedayati Z, Paknahad M, Zorriasatine F. Comparison of natural head position in different anteroposterior malocclusions. Journal of Dentistry. 2013; 10: 210–220.

[21] D’Attilio M, Caputi S, Epifania E, Festa F, Tecco S. Evaluation of cervical posture of children in skeletal class I, II, and III. CRANIO®. 2005; 23: 219–228.

[22] Salazar-Lara SE, Carranza-Samanez KM, Dulanto-Vargas JA. Sagittal skeletal relationship and craniocervical posture in Peruvian children. International Journal of Clinical Pediatric Dentistry. 2025; 18: 368–374.

[23] Vukicevic V, Petrovic D. Relationship between head posture and parameters of sagittal position and length of jaw. Medicinski Pregled. 2016; 69: 288–293.

[24] Bernal L, Marin H, Herrera C, Montoya C, Herrera Y. Craniocervical posture in children with class I, II and III skeletal relationships. Brazilian Research in Pediatric Dentistry and Integrated Clinic. 2017; 17: e3038.

[25] Kale B, Buyukcavus M. Effect of craniofacial growth pattern on head posture. Journal of Dentistry Indonesia. 2020; 27: 144–150.

[26] Ruderman A, Pérez LO, Adhikari K, Navarro P, Ramallo V, Gallo C, et al. Obesity, genomic ancestry, and socioeconomic variables in Latin American mestizos. American Journal of Human Biology. 2019; 31: e23278.

[27] Messina F, Di Corcia T, Ragazzo M, Sanchez Mellado C, Contini I, Malaspina P, et al. Signs of continental ancestry in urban populations of Peru through autosomal STR loci and mitochondrial DNA typing. PLOS ONE. 2018; 13: e0200796.

[28] Ramírez S, Díaz-Reissner C, Maldonado C, Jolay E, Ferreira-Gaona M, Fatecha A. Rocabado-penning skull-cervical posture in orthodontic patients. Scientific Dental Journal. 2024; 12: e208.

[29] Noll M, Candotti CT, da Rosa BN, do Valle MB, Antoniolli A, Vieira A, et al. High prevalence of inadequate sitting and sleeping postures: a three-year prospective study of adolescents. Scientific Reports. 2017; 7: 14929.

[30] Mihaiu J, Debucean D, Mihancea P, Maghiar AM, Marcu OA. Primary headache management in a multidisciplinary team—a pilot study. Journal of Medicine and Life. 2023; 16: 1127–1135.

[31] Kotuła J, Kuc AE, Lis J, Kawala B, Sarul M. New sagittal and vertical cephalometric analysis methods: a systematic review. Diagnostics. 2022; 12: 1723.

[32] Ardani IGAW, Wicaksono A, Hamid T. The occlusal plane inclination analysis for determining skeletal class III malocclusion diagnosis. Clinical, Cosmetic and Investigational Dentistry. 2020; 12: 163–171.

[33] Parcina Amizic I, Simunovic L, Lapter Varga M. Reliability of Zagreb 82 MOD cephalometric assessment in determining the facial growth pattern. Acta stomatologica Croatica. 2025; 59: 36–43.


Submission Turnaround Time

Top