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Emotion theory holds that unpleasant events prime withdrawal actions, whereas pleasant events prime approach actions. Recent studies have suggested that passive viewing of emotion-eliciting images results in postural adjustments. The main objective of this research was to investigate the effects of emotional inputs on the postural control. Ten healthy young adults looked at a series of emotion-eliciting images while standing on a force plate. The images were taken from the International Affective Picture System (IAPS). The posture-stabilometric parameters were statistically analyzed (RM ANOVA on Ranks). The results showed that the emotional inputs might influence body balance.

Among treatments in the literature for myofascial pain syndrome (MPS), the most reliable therapies in dentistry are spray and stretch, and, although less frequently used, anesthetic injection. Adult MPS subjects are often treated using fixed orthodontic therapy for resolution of malocclusion. There is no clarity in the literature on the prognosis of MPS during orthodontic therapy. The purpose of this study was to analyze the prognosis of MPS during orthodontic treatment of subjects with malocclusion, initially diagnosed as having MPS. The analysis covered the medical records of 91 young adult Caucasians scheduled for orthodontic treatment for various malocclusions. Thirty-seven of the patients were initially diagnosed as also having MPS (T0). Thirty patients began the orthodontic treatment and were recalled for a re-evaluation of MPS after dental alignment and dental class correction was achieved (T1). A wait-and-see strategy was applied in seven subjects who were included as the control subjects. They received no treatment for MPS. At T1, a statistically significant decrease was observed in the study group in the presence of any clicking or creaking noises from the jaw joint, a significant jaw joint and jaw muscle pain reduction, and a quality of life improvement. Among patients who were depressed at the beginning of treatment, the majority felt better at the follow-up evaluation. On muscular palpation, a statistically significant decrease was found on the visual analogic scale value of the middle fibers of the temporalis muscle, temporalis tendon, clavicular and sternal division of the sternocleidomastoid muscle, masseter muscles, and posterior cervical muscles. The temporalis and the masseter muscles showed a significant decrease in the number of subjects with trigger points (TrPs) in all areas in the study group, after treatment. The digastric and sternocleidomastoid muscles also showed a significant reduction in the number of subjects with TrPs. Subjects with MPS and malocclusion were treated using a fixed orthodontic treatment. They showed improvement, although no resolution, in the signs and symptoms of MPS, compared with the untreated control group.

This study investigated the prevalence of the signs and symptoms of temporomandibular disorders (TMD) in a population of children and adolescents. TMD signs and symptoms were recorded in 1134 subjects (593 males and 541 females; age range 5-15 years), divided into various groups according to the: (i) Angle dental class; (ii) presence and type of crossbite; (iii) gender; and (iv) age (ages 5-11 and 12-15 years). The percentages of signs and symptoms were compared using the chi2-test to determine the differences among the groups for the rates of TMD symptoms, bruxism, joint sounds, deviation during opening, reduced opening/lateral/protrusive movements, and myofascial pain. Subjects who were 12-15 years old showed a significantly higher prevalence of myofascial pain than those who were 5-11 years old (chi2 = 4.263; p < 0.05). Females showed a significantly higher prevalence of myofascial pain than males (chi2 = 3.882; p < 0.05). Subjects with posterior, unilateral crossbite showed a significantly higher prevalence of TMD symptoms (chi2 = 33.877; p < 0.001) and reduction of functional movements (chi2 = 10.800; p < 0.05) than those with no crossbite, or with anterior or posterior bilateral crossbite. TMD's signs and symptoms seem to be associated to some definite characteristics of the patient, such as female gender, young age, and presence of posterior unilateral crossbite.

This study evaluated the use of a fixed orthodontic appliance in treatment of temporomandibular disorder (TMD) compared to the use of an intra-oral splint. Fifty (50) adult patients, with confirmed anterior disk displacement with reduction in at least one temporomandibular joint (TMJ), were divided into three groups: 20 patients treated with AR splint (Group I); 20 patients treated with a fixed orthodontic appliance (Group II) and 10 patients who underwent no treatment (Control Group). Joint pain, joint noise, muscle pain, and subjective relief were evaluated monthly before the treatment began (T0) and for six months thereafter. Subjects in Group I and Group II displayed a significant decrease in joint pain (p < 0.01) from T2 and in muscle pain from T1 (p < 0.01) to T6. Subjects in Group I showed a higher decrease in the frequency of joint noise (p < 0.05) from T1 to T6, compared with Group II. At T2 and T3, the patients in Group II reported a significantly lower discomfort level associated with the devices than subjects treated with the AR splint (p < 0.05). However, at T5 and T6, this observation was inverted. The use of a fixed orthodontic appliance seems to be as efficacious as the use of an AR maxillary splint in the treatment of joint pain and muscle pain, but not in the treatment of joint noise. These results are valid, at least for the short-term clinical results (first six months of treatment). Clinical implications for long-term use are not clarified by these results.

This study evaluated the that effects a pathology of the knee, due to an anterior cruciate ligament (ACL) injury, has on muscular activity of neck, head, and trunk muscles. Twenty-five (25) subjects (mean age 28+/-9 years) with ACL injury of the left knee were compared with a control no-pathology group. Surface electromyography (sEMG) at mandibular rest position and maximal voluntary clenching (MVC) wasused to evaluate muscular activity of the areas: masseter, anterior temporalis, posterior cervicals, sternocleidomastoid (SCM), and upper and lower trapezius. The sEMG activity of each muscle, as well as the asymmetry index between the right and the left sides, were compared between the two groups. Subjects in the study group showed a significant increase in the asymmetry index of the sEMG activity of the anterior temporalis at mandibular rest position (p<0.05). At rest, the areas of anterior temporalis and masseter in the control group showed a significantly lower sEMG activity compared with subjects in the study group, both in the right and the left sides (p<0.05). The same was found for the sEMG activity of the areas of SCM and lower trapezius. At MVC, the right areas of anterior temporalis and masseter in the study subjects showed a significantly lower sEMG activity compared with the control group. The same was observed for the lower trapezius area, both in the right and the left sides. In general, ACL injury appears to provide a change in the sEMG activity of head, neck and trunk muscles.

It has been proposed that intraoral devices can influence cervical posture. Cervical posture might also be influenced by stimuli from the lower limbs, such as injury of the knee. The hypothesis to be tested is that intraoral devices are useful during the rehabilitation of orthopedic patients to accelerate the restoration of postural control. This study evaluates cervical posture on lateral skull radiographs in subjects who suffered anterior cruciate ligament (ACL) injury of the left knee. Twenty adult Caucasian males (mean age 30.6+/-9.2 yrs.) with ACL injury of the left knee were compared with 40 control subjects (mean age 27.9+/-7.2) who did not show any ACL injury. Lateral skull radiographs, made in natural head position (mirror position), were obtained for all subiects. Various postural and morphological variables were individualized on each radiograph. To assess errors due to landmark identification, duplicate measurements were made of 15 radiographs and compared using the Dahlberg formula. The method error from both sources was less than 0.5 degrees for all angular measurements and less than 0.5 mm for all linear measurements. No difference was observed between the two groups in any of the morphological variables of face or in the cervical lordosis angle (CVT/EVT). However, subjects in the study group showed significantly higher craniocervical angulations (SN/OPT, SN/CVT, SN/EVT, pns-ans/OPT, pns-ans/CVT, pns-ans/EVT, GoGn/OPT, GoGn/CVT, GoGn/EVT) compared with the control subjects (p<0.001). The subjects with ACL injury had significant head extension compared with the control subjects.

Discomfort associated with wearing an intraoral splint represents a problem in the management of temporomandibular joint (TMJ) internal derangement. This study evaluated whether the use of a mandibular splint during the day and a maxillary splint at night could be more comfortable and therefore as efficacious in internal derangement treatment as a maxillary splint (AR splint). Fifty (50) patients (average age 28.8; range 14-63) with confirmed internal derangement in at least one TMJ were divided into three groups: 20 patients treated with AR splint (Group I); 20 patients treated with a SVED (Sagittal Vertical Extrusion Device) and a MORA (Mandibular Anterior Repositioning Splint) (Group II); and 10 patients who underwent no treatment (Control Group). Joint noise, pain intensity and its character (as constant or chewing/biting pain), muscular pain, and subjective relief were evaluated monthly before treatment began (T0) and for six months thereafter. The following results were found: 1. Subjects in Group I and Group II displayed a significant decrease in joint pain (p<0.001), constant pain (p<0.001), chewing/biting pain (p<0.001), joint noise and muscle pain from the beginning through the sixth month follow-ups; 2. At T1 and T2, subjects in Group II reported significantly lower discomfort associated with the devices than subjects in Group I. The use of two splints seems to be as efficacious as the use of an AR maxillary splint; however an AR splint is considered more comfortable by patients, especially during the first months of therapy.

This purpose of this study was to investigate the immediate effects of plantar inputs on both the upper half muscle activity (anterior temporal, masseter, digastric, sternocleidomastoid, upper and lower trapezius, cervical) and the body posture, by means of electromyography (EMG) and vertical force platform, respectively. Twenty four (24) healthy adults, between the ages of 24 and 31 years (25.3 +/- 1.9), with no history of craniomandibular disorder or systemic musculoskeletal dysfunction, were randomly divided into two groups: test group (fourteen subjects) and control group (ten subjects). A first recording session (TO) measured the baseline EMG and postural patterns of both groups. After this session, the test group wore test shoes with insoles that stimulated the plantar surfaces, while the control group wore placebo shoes. After one hour, a second set of measurements (T1) were performed. Significant differences between the groups at baseline were observed in the left anterior temporal, left cervical, and left upper trapezius, as well as at T1 in the left anterior temporal and right upper trapezius (p < 0.05). Within-test group analysis showed a significant increase of the right upper trapezius activity (p < 0.05), whereas no changes were found by within-control group analysis. Lower risk of asymmetric muscle patterns and postural blindness in the test group compared to the control group was observed. Further studies are warranted to investigate the short and long-term effects of this type of insole, in patients with both craniomandibular-cervical and lower extremity disorders.

Previous studies on the relationship between morphological structure of the face and cervical posture have predominantly focused on vertical dimensions of the face. The aim of this study was to investigate whether there are significant differences in cervical posture in subjects with a different sagittal morphology of the face, i.e., a different skeletal class. One hundred twenty (120) children (60 males and 60 females, average age 9.5 yrs., SD+/-0.5) were admitted for orthodontic treatment. Selection criteria was: European ethnic origin, date of birth, considerable skeletal growth potential remaining and an absence of temporomandibular joint dysfunction (TMD). Lateral skull radiographs were taken in mirror position. Subjects were divided into three groups based on their skeletal class. The cephalometric tracings included postural variables. The most interesting findings were: 1. children in skeletal class III showed a significantly lower cervical lordosis angle (p<0.001) than the children in skeletal class I and skeletal class II; 2. children in skeletal class II showed a significantly higher extension of the head upon the spinal column compared to children in skeletal class I and skeletal class III (p<0.001 and p<0.01, respectively). This is probably because the lower part of their spinal column was straighter than those of subjects in skeletal class I and II (p<0.01 and p<0.001, respectively). Significant differences among the three groups were also observed in the inclination of maxillary and mandibular bases to the spinal column. The posture of the neck seems to be strongly associated with the sagittal as well as the vertical structure of the face.

There is a growing interest in the relationship between occlusion and posture because of a greater incidence of neck and trunk pain in patients with occlusal dysfunction. The study was designed to verify whether an alteration of the spinal column alignment may be experimentally induced in rats as a consequence of altering dental occlusion and also to investigate whether the spinal column underwent any further changes when normal occlusion was then restored. Thirty rats were divided into two groups. Fifteen (15) rats (test group) wore an occlusal bite pad made of composite resin on the maxillary right first molar for a week (T1). The same rats wore a second composite bite pad for another week on the left first molar in order to rebalance dental occlusion (T2). Fifteen rats were included in an untreated control group. All the rats underwent total body radiographs at T0 (before the occlusal pad was placed), at T1 (one week after application of a resin occlusal bite pad on the maxillary left first molar) and at T2 (one week after application of a second resin occlusal bite pad on the maxillary right first molar). A scoliotic curve developed in all the test rats at T1. There were no alterations of spinal position observed in any of the control rats. Additionally, the spinal column returned to normal condition in 83% of the test rats when the balance in occlusal function was restored. The alignment of the spinal column seemed to be influenced by the dental occlusion.

The authors compared postural changes produced in 20 Caucasian female children treated with the Frankel Functional Regulator appliance (FR-2) (Frankel Industries, Morangis Cedex, France) using cephalometric tracings and comparing the tracings to 20 untreated Class II controls from the University of Chieti. Each patient in the study group was treated for exactly two years by the same operator using the FR-2 appliance and a standardized design and clinical technique, including prefunctional orthodontics where indicated. The average starting age was 8.4 yrs. (SD+/-2.1). At the end of the therapy, the average age was 10.3 yrs. (SD+/-2.4). Two teleradiographs were made of each patient: the first one at the beginning of treatment and the second one after six months. The radiographs were taken with the subjects standing in the ortho-position with no ear rods in the cephalostat; mirror position was carried out. In order to detect errors due to landmark identification, duplicate measurements were made using ten radiographs, and the error variance was calculated using Dahlberg's formula. Thirty-seven variables were studied. The cervical lordosis angle (CVT/EVT) was significantly higher in the study group as compared to the control group (p<0.05) at the end of treatment, probably due to a significant backward inclination of the upper segment of the cervical column (OPTNer and CVTNer) in the treated group (p<0.001 and p<0.01) from pre- to posttreatment. There was no significant change in the lower segment of the cervical column inclination (EVT/Ver). The changes resulted in a weak association in the multiple regression model to an increasing of maxillary base length and mandibular protrusion (R2=0.272; p<0.05). Other variables in the multiple regression were not significant.

Pain and joint noises associated with temporomandibular joint (TMJ) internal derangement are often treated by using an intra-oral splint. This study evaluated whether an anterior repositioning splint (AR splint) could be more effective in the treatment of these symptoms than a full-arch maxillary stabilization splint (FAMS splint), because of its capability to re-establish immediately the normal condyle/disk relationship. The authors treated 40 patients (average age 16.8; range 8.0-24.0) with confirmed internal derangement, joint pain, and joint noises in at least one TMJ for at least two months, with AR splint (20 subjects) or FAMS splint (20 subjects); 10 untreated patients comprised the control group. Joint noise, joint pain, and the intensity of pain were assessed using a visual analogic scale (VAS), and the pain was characterized (i.e., constant or chewing/biting pain) and evaluated monthly for eight months. Significantly fewer AR splint patients experienced pain after four months of treatment. A significantly lower intensity of pain was experienced by the AR splint patients after two months of treatment. Significantly fewer AR splint patients experienced chewing/biting pain after eight months of treatment. The frequency of joint noises decreased over time, with no significant differences between the groups. In conclusion, the AR splint seems to be more effective in decreasing pain, but it seems to make no difference in the treatment of joint noises.

The literature reports evidence of various types of correlations between cervical alterations and cervical pain, and the existence of cervical pain in subjects with temporomandibular joint internal derangement (TMD). The hypothesis of this study is that cervical lordosis angle (CVT/EVT angle) alteration on cephalometrics could be correlated to the presence of TMD. The cephalometric records of 50 females with documented TMD were compared with those of a control group of 50 females. The subjects in the sample were 25-35 years of age, average 28.9 years (SD, 3.2). Radiographs were taken in mirror position, and seventeen variables, including the CVT/EVT angle, were traced. Double measurements were made to evaluate method error using Dahlberg's formula. Pearson's correlation coefficient and Mann-Whitney's t-test were used to evaluate the data. Intra-group analysis showed significant correlations between the CVT/EVT angle and mandibular length (p<0.01), mandibular position (p<0.05), mandibular divergence (p<0.01), and overjet (p<0.01) in both groups. Between groups, the analysis showed significant differences in CVT/EVT angle (p<0.05), maxillary protrusion (p<0.01), mandibular protrusion (p<0.01), mandibular length (p<0.01), mandibular divergence (p<0.05), and overbite (p<0.05).

Several published studies show a relationship between craniofacial morphology and head posture. The aim of this study was to evaluate the association between cervical lordosis angle and mandibular length from lateral skull radiographs, and to investigate the relationship between mandibular retrusion and cervical lordosis angle decreasing. The sample comprised 70 Caucasian adult women, average 27.4, in skeletal class II and Angle class II. Lateral skull radiographs were obtained in natural head position (mirror position). Ten morphological variables were individuated on tracings. In order to assess errors due to landmark identification, double measurements were made in ten randomly selected radiographs and were compared with Dahlberg's formula. A Sperman's rank correlation test showed a negative correlation (P < 0.01) between cervical lordosis and mandibular length (compensatory curvature of the cervical spine) and positive correlation between anterior cranial base and maxillary length (P < 0.05). Based upon the cross-sectional method, no conclusion was possible about the mechanism concerning these results. Future longitudinal studies in growing patients should be directed to understanding the extent of environmental and genotype influences on cervical lordosis angle.

This study was aimed at evaluating the effects of a novel physiotherapy machine called MAGMA (AntiGravitary Modification of the Myotensions of Asset) on postural and masticatory muscles of subjects with myogenic cranio-cervical-mandibular dysfunction (CMD), by using surface electromyography (sEMG). Fifteen subjects, nine males and six females (mean age 27.6 years), with CMD were included in the study. The bilaterally monitored muscles were: masseter, anterior and posterior temporalis, digastric, posterior cervical, sternocleidomastoid, and upper and lower trapezius. All muscles were monitored at rest, with a second record of maximal voluntary clenching (MVC) for both the masseter and anterior temporalis. Patients were subjected to MAGMA therapy for one session/week of 30 min over ten weeks. The surface EMG activity was recorded twice, at the baseline and at the end of the therapy. After MAGMA therapy, the sEMG activity at rest of the monitored muscles was significantly better when compared to the baseline; the only exception was the anterior and posterior temporalis muscles which did not improve. On the contrary, with the MVC, all the monitored muscles (masseter and anterior temporalis) significantly improved their sEMG activity. Although more investigations are needed, these results indicate that the use of such antigravitary therapy can provide a tool for resolving myogenic CMD.

A physiotherapeutic approach, with manual maneuvers and/or distraction appliances, is indicated in the treatment of temporomandibular joint disorders (TMDs) to prevent the progressive fibrosis of the muscle fibers. In this article, the authors report preliminary results of experimental and clinical studies conducted to assess the real effect of distraction in temporomandibular joint disorders. The experimental invivo studies confirmed the structural alteration due to compression and distraction on the capsular and condylar tissues. Clinical cases are reported to show the increase of the intraarticular vertical dimension, with a forward and downward movement of the condyles in a more physiologic condition.