Manfredini Occlusione Dentale e Postura

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2012 BlackwellPublishing doi:10.1111/j.13652!"2.2012.022#1.$

Jo ur na l o f Oral Rehabilitation%ou&nal o' (&al )ehabilitation 2012 3#* "63+",1

)e-iew &ticle

/ental occlusion bod ostu&e and teo&oandibula&

diso&de&s: whe&e we a&e now and whe&e we a&e heading 'o&

/. 4)7/889 . ;. P7)857::8

?@ L. >A)/) / 858

9

9/ea&tent o' 4a$illo'acial


2/12

2012 BlackwellPublishing

abno&alities o& atients with 4/. 8n a&ticula&

clais 'o& t&eating 4/ acco&ding toathohsiological

concets to co&&ect u&o&ted occlusoostu&al abno&

alities see to be based on doubt'ul theo&ies. he

in-asi-e natu&e o' such t&eatents &eFui&es that these

concets ha-e to be&o-en with e-idencebased data

which account &oe&l 'o& the hsiolog o' such

&elationshis.

cco&ding to the &oonents o' these concets

a&o&iate diagnostic &ocedu&es andinst&u3ent ha-e


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20! / . 4 ) 7 / 8 8 et al.

to be adoted to easu&e stoatognathic 'unction and

to assess its ossible &elation with the whole bod

ostu&e. o this u&ose se-e&al echanical o& elec

t&onic de-ices ha-e beenutilised as 3easu&e3ent tools

in the &esea&ch setting* aong othe&s the include

su&'aceelect&oog&ah Ds74>E kinesiog&ah DG>E

ostu&al lat'o&s and ostu&og&ahic de-ices. ow

e-e& thei& use in the clinical setting as standalone

diagnostic tools has &aised st&ong negati-e c&iticis

within the scienti'ic counit D1+3E. 8ndeed the

ost coonalication 'o& soe o' the abo-e de-ices

is in the diagnosis o' 4/ whe&e the a&e '&eFuentl

used to diagnose occlusal abno&alities and to lan

thei& i&&e-e&sible co&&ection to anage and e-en &e

-ent 4/ stos D"E.


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2012 BlackwellPublishing

e$aine&s and with the adotion o' 3easu&e3ent

tools the -alidit o' which was not assessed. lso a

causeande''ect &elationshi wasne-e& assessed as this

would &eFui&e longitudinal studies that a&e cu&&entl

lacking.

he lite&atu&e is not conclusi-e also as 'o& the

in'luence o' jaw ostu&e and occlusal 'eatu&es on the

'oot leaning a&ea. he a-ailable ostu&og&ahic tech

niFues and de-ices 'ailed to detect an association

between bod 2ostu&e and dental occlusion D1# 20E

o& when detected these we&e notabl sall and with

oo& clinical &ele-ance. ;linicall this eans that

t&igeinal&io&iocetion in'luencing ostu&e is likel

ediated b coensation echaniss th&ough a''e&

ent athwas to the neu&ouscula& sste &egulating

bod balance and ostu&e. s aconseFuence it can be

suggested that ostu&og&ahic techniFues a be

eloed 'o& the stud o' ostu&e hsiolog in the&esea&ch setting but thei& clinical use'ulness in den

tist& is oo&. 4o&eo-e& it sees that the e$ecution o'

cont&olled jaw oto& tasks has a ositi-e e''ect on

ostu&e cont&ol b &educing bod swa a&ea thus

suggesting that occlusal &io&ioceti-e'eedbacka''ects

ostu&e cont&ol indeendentl b the o&holog o'

dental occlusion D21E.

(cclusion0 bod1 2ostu&e and

4

s132to3s

he&e a&e se-e&al conce&ns that &e-ent '&o d&awing

conclusions on the hsioatholog o' the &elationshi

between occlusion and ostu&e and its clinical iact*

aong these the need to 'ind a&o&iate easu&e

ent de-ices and the lack o' ajo& associations

between an occlusal andJo& ostu&al 'eatu&es and

4/ stos.

s &ega&ds the 3easu&e3ent o' occlusal andostu&al

'eatu&es se-e&al techniFues De.g. s74> G> di''e&ent

clinical and inst&u3entalostu&og&ahic a&oachesE

we&e &oosed o-e& the ea&s to assess -a&ious neu&ouscula& -a&iableswhich we&e claied b &oonents

to be &elated with dental occlusion and bod ostu&e.

esitethee''o&ts ade in the &esea&ch setting to assess

and i&o-e the &eliabilit o' those inst&u3ental

de-ices 'o& the stud o' the stoatognathic sste

and the &elationshi with ostu&e D22+26E the ha-e

wellknown st&ong liits to thei& clinical alication

because o' the absence o' no&ati-e -alues cont&olled

'o& age se$ weight height and 'acial o&holog.

4o&eo-e& data inte&2&etation is o'ten isleadingowing

to the high int&a and inte&e$aine&s -a&iabilit 'o&

single as well as &eeated easu&esD2,E.

he ajo&it o' inst&u3ental data on the stoato

gnathic sste we&e achie-ed with s74> &eco&dings

which a hel to assess the kinesiologo' o-eent

diso&de&s to disc&iinate between di''e&ent t&eo&s

oclonus and dstonia to e-aluate gait and ace

diso&de&s to easu&e schohsical &eaction tie.

hei& use'ulness in the diagnostic and t&eat3ent 2ath

was o' ain diso&de&s is not suo&ted in the neu&o

logicallite&atu&e D2!E.

/esite thei& Fuick di''usion in the ea&siediatel

'ollowing thei& int&oduction on thedental a&ket D2#+

32E 'ew &esea&che&s 'ocused on the &eliabilit and

accu&ac o' the -a&ious technological de-ices and e-en

ea&l lite&atu&e &e-iews suggested that ost autho&s

'ailed to unde&stand thei& liits o' alication indentist& D33E. he adotion o'cont&olled e$e&iental

&otocols can a&kedl &educe the e''ects o' non

hsiological 'acto&s on s74> &eco&dings and ake

such techniFue a use'ul tool to un&a-el soe asects o'

jaw ele-ato&uscles 'unctioning D3"E. hus the ain

and&obabl uniFue 'ield o' alication 'o& s74> is

the &esea&ch setting while too an sho&tcoings

&e-ent '&o suggesting its clinical alication 'o&

diagnostic u&oses eseciall as conce&ns &esting

s74> -alues D35E.

s &ega&ds the &elationshi betweenocclusoostu&al

'eatu&es and clinical stos the lite&atu&e has

&eeatedl shown the oo&&edicti-e -alue o' occlusal

'eatu&es 'o& 4/ stos in ultile -a&iable odels

D36 3,E.


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in the 4/ &actice two ain lines o' &esea&ch ha-e

been ad-ancing 'o& ea&s -iI. the stud o' the

statistical association between ce&tainocclusal -a&iables

and the &esence o' signs and stos o' 4/ and

the attets to siulate e$e&ientall situations o'

occlusal st&ess to -e&i' thei& otential to daage the

4% andasticato& uscles.

(cclusal 'eatu&es we&e neithe& 'ound to beassociated

with 4% &obles D36E no& with uscle diso&de&s

D""E but the should be -iewed as the eans th&ough

which uscle 'o&ces a&e t&ansitted to the di''e&ent

st&uctu&es o' thestoatognathic sste D"5E. lso the

&esence o'occlusal abno&alities in atients with 4/

a be actuall due to joint degene&ation and J

o& &eodelling &esulting in an occlusal shi't D"6E.

7$e&ients on hu3an and anial odels in-esti

gating the otential o' occlusal inte&'e&ences to &o

-oke 4/ signs and stos showed that ossibleiat&ogenic abno&alities De.g. high occlusal &esto&a

tionsE can at wo&st cause local t&au3a. hose inte&

'e&ences deand ostu&al and 'unctional adatation o'

asticato& atte&ns which &a&el lead to dental

and J o& asticato& uscle ain. lso when those

stos occu& the see to beainl t&ansient and

can be easil &e-e&sed th&ough &eo-al o' the iat&o

genic inte&'e&ence. /ata '&o &andoised cont&olled

studies suggest that in health1 subjects the alication

o' an occlusal inte&'e&ence leads to a &eduction in the

usual 74> acti-it o' the assete& uscles D",E and

does not signi'icantl a''ect &essu&e ain th&esholds

D"!E.

8nte&estingl subjects with a 4/ histo& see to

&esond di''e&entl to iat&ogenic occlusal inte&'e&ences

coa&ed with subjects who &eo&ted no histo& o'

&e-ious 4/ D"#E. he 'o&e& we&e &eo&ted to ha-e

an inc&eased &isk o' &eo&ting ain with uscle ala

tion in &esonsetoocclusion abno&alities &o-okedb

dental&ocedu&es. hese obse&-ations should be bo&ne

inind when ca&&ing out occlusal t&eat3ents such as

&osthetic o& o&thodontic &ehabilitations which a

in-ol-e e&iods o' occlusal instabilit De.g. teo&a&&esto&ations inc&eases in -e&tical diension and teeth

shi'tingE. &o a 4/ &actitione&Ms e&secti-e it is

clea&l io&tant to a-oid o-e&estiating the io&

tance o' these &esults because &esonses to the int&o

duction o' an a&ti'icial inte&'e&ence cannot be eFuated

with the&esence o' 4/. Besides an acute e$e&i

3ental occlusal alte&ation cannot be coa&ed with a

clinical situation cha&acte&ised b the&esence o' a

NnonidealM dentition to which the atient hasg&aduall

adated o-e& a e&iod o' ea&s D50 51E.

8n -iew o' the abo-e conside&ations attets to

achie-e standa&dised easu&eents 'o& &esea&ch u&

oses as well as a o&e sensible a&oach tothe use o'

technolog 'o& clinical u&oses ust be encou&aged.

otwithstanding that it should bebo&ne in ind that

4/ ha-e a ulti'acto&ial aetiolog and that a single

causal 'acto& can be seldo identi'ied thus suggesting

caution be'o&ehothesising an causeande''ect links

based on soe occasional weak associations between

occlusoostu&al 'acto&s and 4/ desc&ibed in a 'ew

studies D52+5"E. (n the othe& hand0 it should also be

&eebe&ed that diinishing the &ole o' occlusion in

the aetiolog o' 4/ is not eFual than neglecting

wellestablished occlusal conce2ts in o&thodontics and

&osthetic dentist& because w&ong occlusion on

&esto&ed J t&eated dentition has the otential to causeiat&ogenic t&au3a i' acute changes o' the inte&a&ch

&elationshi a&e&o-ided D55 56E.

8n sua& a echanical a&oach to 4/ an

ageent b eans o' i&&e-e&sible occlusal t&eat3ents

De.g. o&thodontics &osthodontics and occlusal adjust

3entE0 which a&e o'ten &ecoended on the basis o'

inst&u3ental assessents o' atients with 4/ ust

best&ongl discou&aged '&o a scienti'ic -iewoint and

'i&l condened '&o an ethical -iewoint D3E.

(wing to the oo& knowledge on 4/ aetiolog at

the indi-idual le-el and also because o' the high

success &ates o' se-e&al conse&-ati-e a&oaches D5,+

60E the standa&d o' ca&e 'o& 4/ t&eat3ent is now

based on stos anageent b &e-e&sible and

nonin-asi-e t&eatents D61E. 8ndeed ost atients

with 4/ see to be good &esonde&s to unseci'ic

t&eatent &egiensbecause o' stosM 'luctuation

andsel'liitation &eg&ession to the 3ean 2heno3ena

and lacebo e''ect D62 63E. he athological &ele-ance

o' u&o&ted abno&alities such as joint click sounds

was st&ongl diinished D6"E and the&e is g&owing

e-idence that ch&onic 4/ ain is &elated to cent&al

sensitisation 2heno3ena that &eFui&e a cole$ultidiscilina& a&oach D65E. hus 4/ a&e nei

the& occlusal no& ostu&al athologies* the a&e

usculoskeletal diso&de&s needing 'o& a clinical an

ageent in line with that adoted 'o& siila& diso&

de&s in othe& 'ields o' edicine De.g. o&thoedics

&heuatolog and &ehabilitation edicineE and in

those ost se-e&e cases needing 'o& a ultidiscilin

a&e''o&t to anage ch&onic ain in coo2e&ation with


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othe& &o'essionals De.g. neu&ologists schiat&ists and

schologistsE.

iagnostic accu&ac1 o' technological

de-ices

8n theo& using inst&uents to easu&e objecti-el an

othe&wise subjecti-e clinical a&aete& is a 'ascinating

idea that &eFui&es an u23ost attention in li'eth&eat

ening 2athologies0 whe&e an1 otential sou&ce o'

diagnostic bias a lead to dis&uti-e conseFuences

and that also att&acts &esea&che&s '&o an edical

'ields dealing withusculoskeletal diso&de&s whe&e the

lea&ning cu&-e to achie-e standa&dised clinical diagno

ses isusuall long and '&ust&ating.

8n &actice to be use'ul in a clinical setting an

inst&uent should ha-e both inte&nal and e$te&nal

-alidit. he 'o&e& -alidit de&i-es '&o those 'acto&sthat dete&ine the &eeatabilit and technical e''icac

while the latte& -alidit deends on the inst&uentMs

accu&ac to easu&e the ainathological a&ke& Di.e.

the owe& to &ecognise disease -e&sus absence o'

diseaseE.

8n the 'ield o' 4/ the ain athological a&ke& is

ain. he need to 'ind an objecti-e &elationshi

between clinical stos De.g. ain e-oked with

alationE and inst&u3ental signs led to diinish the

&ole and to the identi' bette& the indications 'o&

othe&wise technicall e''icacious de-ices such as ag

netic &esonance iaging D,66!E on the basis o' thei&

in'luence on decisionaking and t&eat3ent2lanning

D6# ,0E.

he sae &easoning should be done to de'ine the

clinical use'ulness o' s74> G> and ostu&allat'o&s

which a&e e-en cha&acte&ised b a doubt'ul inte&nal

-alidit. Besides se-e&al wo&ks inthe lite&atu&e showed

that such techniFues ha-e a low accu&ac to disc&i

inate between atients with 4/ and astoatic

subjects D2, 33,1+,3E. hei& adotion as diagnostic o&

e-en t&eat3ent2lanning tools in atients with 4/

cannotbe justi'ied due to a too high e&centage o''alseositi-es which is u to !0K 'o& se-e&ala&aete&s

De.g. s74> -alues at &est allkinesiog&ahic a&aete&s

and all ostu&al lat'o&-a&iablesE D,3 ,"E.

/esite such sho&tcoings the lite&atu&e also

showed that s74> a 'ind &oising alication in

the clinical setting b conside&ing onl soe selected

a&aete&s and in a&ticula& the a$iu clenching

le-els. 8ndeed acco&ding to the ain adatation odel

and its integ&ation D,5 ,6E ain a''ects negati-el

oto& units &ec&uit3ent and causes a &eduction in

a$iu uscle 'o&ce with &esect to no&al hs

iological 'unctioning.


7/12

cha&acte&ising thei& adotion in the clinical setting.

8ndeed the latte& is too o'ten based on&esuti-e

athohsiological theo&ies aiing to justi' the need

'o& i&&e-e&sible and e$ensi-e occlusal t&eat3ents. he

scienti'ic counitMssceticis towa&ds the otential

use'ulness o' technological de-ices in the 4/ 'ield

conce&ns thei& adotion as standalone diagnostic tools

to inte&cet u&o&ted occlusal and ostu&al abno&al

ities that in the use&sM intentions need to beco&&ected.

ua&daa&dini L.

eo&oandibula& diso&de&s assessent: edicolegal con

side&ations in the e-idencebased e&a. % (&al )ehabil.

2011*3!:101+11#.

". ;ooe& B; Gleinbe&g 8. 7stablishent o'teo&oandibula&

hsiological state with neu&ouscula& o&thosis t&eatent

a''ects &eduction o' 4/ stos in 313 atients.

;&anio.

200!*26:10"+11,.

5. -anMt


8/12

10. 4ichelotti a&ella 4. 4alocclusion and bod ostu&e.

8n: 4an'&edini / ed. ;u&&ent conce2ts on

teo&oandib ula& diso&de&s. Be&lin: uintessence

Publishing* 2010:

2!3+2#3.

11. Go&bache& 7gge&s Goch L Gahlieke B.

;o&&elation between anoalies o' the dentition and

athol ogies o' the locooto& sste: a lite&atu&e &e-iew.

% (&o'ac (&tho.200"*65:1#0+203.

12. . eo&oandibula& diso&de&s do not co&&elatewith detectable alte&ations in bodostu&e. % ;onte /ent

P&act. 200,*5:60+6,.

21. ellann / >iannakooulos Blase& ) 7be&ha&d L

in the hu3an

3assete& and teo&alis uscle a&eas. ;&anio.

2005*23:130+

13,.

23. ;ast&o'lo&io a&ina / Bottin Piancino 4> B&acco

P 4e&letti ).


9/12

2,. Glasse& >/ (keson %P. he clinical use'ulness o'

su&'ace elect&oog&ah in the diagnosis and

t&eat3ent o' teo &oandibula& diso&de&s. %

/ent ssoc. 2006*13,:,63+,,1.

2!. Pullan oodin /


10/12

"". Landi 4an'&edini / ognini )oagnoli 4 Bosco4.

uanti'ication o' the &elati-e &isk o' ultile occlusal

-a&iables 'o& uscle diso&de&s o' the stoatognathic sste.

% P&osthet ent.200"*#2:1#0+1#5.

"5. Pe&etta ) 4an'&edini /. utu&e e&secti-es in4/ hsio

atholog. 8n: 4an'&edini / ed.;u&&ent concets on teo

&oandibula& diso&de&s. Be&lin: uintessence Publishing*

2010:153+16!.

"6. /e Boe-e& % ;a&lsson >7 Glinebe&g 8%. eed 'o&

occlusal the&a and &osthodontic t&eat3ent in the

anageent o' teo&oandibula& diso&de&s. Pa&t 88: tooth

loss and &osth odontic t&eat3ent. % (&al )ehabil.

2000*2,:6",+65#.

",. 4ichelotti a&ella 4 >allo L4 Qelt&i Palla


11/12

61. e&ican ssociation 'o& /ental )esea&ch. /) 4/ olic

stateent &e-ision. -ailable at: htt2://w ww.iad&.co/i"a/

ages/inde$.c'OageidS3"654 accessed on 3 4a&ch

2010.

62. >&eene ;odda&d > 4acaluso >4 4au&o >. oical &e-iew:

lacebo &esonses andthe&aeutic &esonses. ow a&e the &elatedO %

(&o'ac Pain. 200#*23:#3+10,.

63. 4an'&edini /. undaentals o' 4/ anageent. 8n: 4an '&edini

/ ed. ;u&&ent concets on teo&oandibula& diso& de&s. Be&lin:uintessence Publishing* 2010:305+31!.

6". Gononen 4 Haltio st&o . oes clicking in

adolescence lead to ain'ul teo&oandibula& joint lockingO Lancet.

1##6*3",:10!0+10!1.

65. ua&daa&dini L. g&eeent between

)esea&ch iagnostic ;&ite&ia 'o& eo&oandibula&

iso&de&s and agnetic &esonance diagnoses o' teo&oan dibula&disc dislaceent in a atient oulation. 8nt % (&al 4a$illo'ac

&eene ; studies &elated

to uscle and occlusal 'acto&s in health1 and 4/ subjects. %

(&al)ehabil. 200,*3":631+6"".

,3. Pe&inetti > ;onta&do L. Postu&og&ah as a diagnostic aid in

dentist&: a ssteatic &e-iew. % (&al )ehabil. 200#*36:#22+

#36.

,". 4an'&edini / ;ocilo-o a-e&o L e&&onato > onello ua&daa&dini L.


12/12

( ; ; L A < 8 ( P ( < A ) 7 / 7 4 P ( ) ( 4 / 8 B A L ) / 8 < ( ) / 7 ) < 215

,6. 4u&&a >4 Peck ;;. (&o'acial ain and jawuscle acti-it:

a new odel. % (&o'ac Pain. 200,*21:263+2,!.

,,. e&&a&io Q a&taglia >4 Lu&aghi 7 4 4o&ei&a )od&igues da Pelleg&ino > Pie&

gentili ; 4a&tina ). 8s unilate&al oste&io& c&ossbite associ

ated with leg length ineFualitO 7u& % (&thod. 200,*2#:

622+626.

;o&&esondence: /aniele 4an'&edini ea&tent o' 4a$illo'acial

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Manfredini Occlusione Dentale e Postura