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The first part of the present report deals mainly with the concept of posture – both in static and in dynamic sense – its relationships with equilibrium, weight balance and motion, its phylogenic origin, reasons why any orthodontic professional should be aware of it; moreover, different profile types and their connections with one’s own skeletal class are briefly discussed. Two more papers are following on the subject.
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Inter- relationships between orthodontics and posture: basic theories
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Inter- relationships between orthodontics and posture: basic theories
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                                                                                                                    Commentary



    Inter- relationships between orthodontics
    and posture: basic theories




                                                                                                                   li
                                                                                                                na
    Veleriano Luzi, MD, DDS*                                         Annibaldi (4) makes the following point: “posture, as a com-
    Stefano Di Carlo, MD, DDS*                                       plex expression of the state of nervous system, is sub-
    Cesare Luzi, DDS **                                              stantially the way in which each subject reacts and rules




                                                                                                             io
                                                                     its body, still or in motion”.
                                                                     Calandriello et al. (5) provide the following definition: “stan-
    “Sapienza” University of Rome, Rome, Italy                       ding posture of every person may be represented by the




                                                                                      az
    * Department of Oral and Maxillofacial Sciences,                 spatial inter-relationship that head, trunk, arms and legs
    ** Private practice, Rome, Italy                                 assume with regard to each other”.
                                                                     In the Internet site held by Rinaldi and Fontani (6) we can
                                                                     read this simple statement: “posture is best defined as the
                                                                     position maintained by our body both still and in motion”.




                                                                                    rn
    Corresponding author:                                            A professional with consistent knowledge in the field of
    Dott. Valeriano Luzi                                             body posture might find almost plain the sentence “Most
    Department of Oral and Maxillofacial Sciences                    credited protocols of postural evaluation are essentially ba-
    Via Caserta, 6 - 00161 Rome, Italy                               sed on models of structural and bio-mechanic analysis of




                                                                         te
    E-mail: valeriano.luzi@gmail.com                                 both skeletal and myo-fascial ties among different bone seg-
                                                                     ments and districts (7)”.
                                                                     In the very same paper by Urzì can we read a definition
                                                                 In  we find very useful for our goals, that is to say “posture is
    Summary                                                          every position our body is able to assume and maintain
                                                                     (therefore in equilibrium or weight balance) in any given
    The first part of the present report deals mainly with           circumstance”.
    the concept of posture – both in static and in dynamic           The author goes on by stating that “the preferential sy-
                                                    ni
    sense – its relationships with equilibrium, weight ba-           nergies of muscular chains are more important for stabi-
    lance and motion, its phylogenic origin, reasons why             lizing than for dynamic purposes”.
    any orthodontic professional should be aware of it; mo-          Even though we can easily identify many a functional ma-
                                            io

    reover, different profile types and their connections            nifestation able to get – and to keep – body equilibrium (e.g.
    with one’s own skeletal class are briefly discussed.             the rhythmic oscillations which do constitute a basic con-
    Two more papers are following on the subject.                    trol function), one should take note that a concept of sta-
                                   iz



                                                                     ble body posture is normally individuated in orthostatic po-
    Key words: posture, gravitational vertical line, skele-          sition, that is to say standing attitude and free two-footed
    tal class, balance.                                              weight charge.
                                                                     Normally this position is maintained through activity of mu-
                  Ed




                                                                     scles counterbalancing gravity, the so-called tonic exten-
    How may posture be defined?                                      sion muscles.
                                                                     A problem arises, when we realize that this position is com-
    There’s plenty of different definitions of the term ‘posture’,   pletely different from that in which we usually see our pa-
    some foggy and useless like the ideas of their creators,         tients…
    some merely tautological, many contradicting each other,         In case this sentence holds true, it wouldn’t be a bad idea
 IC




    and some really hard to understand.                              at all if we changed our mind and, from this moment on,
    Ricciardi (1) employs a definition for the wide audience:        we started examining our first visit patients both traditio-
    “the posture is nothing but the result of a complex inte-        nally seated and standing, in such a way as to be able to
    raction among brain, sense organs, and emotional states;         form a more comprehensive frame.
C




    the positions we adopt on our own are a kind of topogra-
    phic map of the human being; it’s our way of getting in touch
    with reality, the physical and mental expression of neuro-       Phylogeny and posture
    vegetative system, of the actual state of mind”.
©




    Messa (2), too, addresses the large public by stating that       It would seem of undeniable interest detecting how posture
    “the posture is also the expression of the physical state;       finds a place of its own along phylogenetic evolution, and
    it would be better speaking of a postural system”.               the way orthostatic position will be situated at the very top
    Here joins the club Henry Otis Kendall (3), who adds ano-        of such an evolutionary asset.
    ther capital brick to our wall as saying that “posture can       In order to demonstrate this assumption, may we consi-
    only be viewed like the situation characterized by the who-      der the series of passages from the fish to the amphibian,
    le of the positions of body articulations in any given mo-       to the quadruped, to ape and to the two-footed hominid.
    ment”:                                                           In spite of the fact that fish already owns a kind of laby-

    Annali di Stomatologia 2011; II (3-4): 45-48                                                                                  45
    V. Luzi et al.


    rinth, the latter only is active to give information on body        + erected station).
    spatial position, since body lay out in water is practically        Thus, a lowering of the canine cusp may be observed, with
    neutral because of the existence of swim bladder, situa-            occlusion change and primate diastema disappearing (at
    ted top of body barycentre, which makes more input for              least at statistical significance level), analogous reduction
    reflex antigravity activity meaningless.                            and lowering of molar cusps (even though at a milder de-
    Moreover, here no lateral mobility of head with respect to          gree when compared to front section) with – as a result




                                                                                                                       li
    trunk may be detected.                                              – a progressive functional prevalence exhibited by the back
    The amphibian is bound to counteract gravity force,                 sections.




                                                                                                                    na
    which acts more on them than on fish, owing to the new              This whole series of phenomena didn’t obviously appe-
    out-of-water situation, nevertheless should we consider the         ar at the same time: scientists tend to exclude any rigo-
    broad support basis (limbs in side position) and the ex-            rous synchronism of the steps and, even though a very tight
    tremely low height of body centre to ground (amphibians             functional relationship may be individuated, at this moment




                                                                                                                 io
    creep with belly on the ground, thus dissipating a consi-           our anthropologic acquaintances suggest the following re-
    derable energetic amount because of attrition); as a result,        construction: skull expansion (with all its connections) se-
    no balance problem can be observed.                                 ems relatively late, whilst postural uprighting is for sure ear-
    Head rests on collarbones in order to sustain its weight but,       lier, though not precisely identifiable on time scale: might




                                                                                         az
    as already seen in the fish, it practically has no lateral mo-      have taken place some fifteen million year ago, anyway not
    bility as to trunk.                                                 less than three million year ago, consequently then already
    The quadruped – to use a beautiful sentence by Sartori              present in individuals whose brain (and related intellectual
    (8) –issues its challenge to gravity, which is accomplished         powers) was still very little.




                                                                                       rn
    by barycentre elevation from floor in the same time that
    head finds its freedom from trunk (which stays parallel to
    floor) by placing itself in antero-superior position.               Why posture should be of interest
    And if the evolutionary step from creeping towards the              to any (good) orthodontist




                                                                            te
    upright-on-paws-condition finds its justification on the ba-
    sis of mechanical advantage (little or no attrition at all), more   Even taking for granted every single step as seen, one may
    bio-energetic motivation is supplied by the effort paws must        wonder why an orthodontic professional should be inte-
    endure in thrust phase: upright below body, as a matter of          rested in posture whatsoever.
    fact, the effort is largely reduced as to side position.
                                                                    In  There’s many a reason why: may we start by saying that
    This step also makes the presence of anti-gravity reflexes          in our field – nowadays especially – it only would seem cra-
    necessary (reflex of uprighting, of equilibrium, parachute)         zy not taking aesthetic factors into account.
    as stability progressively grows into a major issue.                As a matter of fact, an orthodontic treatment outcome is
    What about the biped? As trunk gets vertical backing up             often (right or wrong) judged only, or at least prevailingly,
                                                      ni

    only on lower limbs, we may see full expression of po-              according to the degree of facial aesthetic harmony the or-
    tentiality in elevation, thus completing adaptive evolution         thodontist was able to reach. Moreover, even choosing to
    in a context where weight force is king.                            only speak function, who among us would on purpose clo-
                                            io


    There’s plenty of advantages offered by this new situation,         se any orthodontic case he treated with a canted occlu-
    and all of them remarkable.                                         sal plane?
    First of all, hands get free and may be fully exploited; then,      Accordingly, we can’t avoid observing (and taking into ac-
                                  iz



    a better view of the nearby environment with horizon en-            count) the way our patients keep their head in relaxed spon-
    largement; moreover, much better breathing conditions are           taneousness, whether straight, inclined or whatever; in par-
    offered (breathing is more economical in the higher posi-           ticular, one should examine the situation as observed “three
                     Ed




    tion, since savannah is usually sultry); last but not least,        quarters” view, that is to say the most frequent angle (Fig.
    sense axes are offered a much improved locomotor sta-               1) we are usually watched from others on social occasions
    bility as to living on trees apes.                                  (and consequently judged or evaluated on a ‘interesting /
    Head control is therefore fundamental to keep stable sen-           not interesting’ scale).
    se axis useful to orientation (placed exactly in the head,          A fortiori we are therefore stimulated to investigate whe-
    hence the necessity to keep bi-pupilar axis parallel to             ther our patients’ cervical column shows a correct curva-
    ground, no matter how hard; head freedom only is allowed            ture or not (by the way, this is a capital though often ne-
 IC




    by neck tonic reflexes (both symmetrical and asymmetri-             glected point, as said before: usually sitting posture – the
    cal).                                                               one usually our patients are seen by us – is not the same
    At the end, top of homination process (that is to say ho-           as standing: we had better keeping this into account and
    minid / pongid splitting) is characterized – together with fun-     taking the necessary steps) both statically and in motion.
C




    damental postural uprighting matched with the two-footed            Let’s start this very short excursus from a survey on body
    locomotion – by a spectacular skull expansion (articula-            posture as observed in its relationship to vertical axis.
    ted language plus ideational processes that, coupled with
    hand freedom, offer way to unbelievable openings, from
©




    development of material culture to Internet) and by re-             Sagittal aspect (Barré’s vertical axis as observed
    markable reduction of jaws protrusion combined with net             in latero-lateral direction)
    arrangement of tooth arch, from tooth series reduction and
    gradual molar overpower (9).                                        Usually in most orthodontic offices there isn’t a postural
    In order to explain this series of changes, the hypothesis          analyser available (with revolving footboard and upper mir-
    has been advanced that dental arch may have not been                ror, not to speak of an adjustable twin-mirror).
    any longer necessary to perform tasks once fulfilled but            No problem: we only need a plumb line, that might be free
    now in charge of the “prehensile hand” (opposable thumb             (in which case we use it free-hand) or hanging from a tall

    46                                                                                       Annali di Stomatologia 2011; II (3-4): 45-48
    Commentary inter- relationships between orthodontics and posture: Basic Theories


                                                                         ling almost in the centre of the body projection polygon
                                                                         (even if a bit forward as to coxofemoral articulations).


                                                                         Forward and backward inclined profile




                                                                                                                        li
                                                                         Anyway the just outlined frame, such a ‘situation of ideal
                                                                         norm’, as someone (8) liked to define it, is by no means




                                                                                                                     na
                                                                         the one and only we could come across.
                                                                         As a matter of fact, it’s by and large more frequent the sta-
                                                                         tistical observation – among the many other possible body
                                                                         postures – of the three situations we are to watch in some




                                                                                                                  io
                                                                         detail.
                                                                         - 1st frame: the three benchmark points (gluteal / dorsal
                                                                         / occipital) lie on the same axis, but we face accentuated
                                                                         curves; usually we see this frame in patients with a valgus




                                                                                          az
                                                                         foot feature;
                                                                         - 2nd frame: gluteal distance is considerably decreased as
                                                                         compared with dorsal and occipital ones, with less deep
                                                                         vertebral curves; this frame, featuring forward placed body




                                                                                        rn
                                                                         barycentre (owing to column and head in forward position
                                                                         in comparison with gluteal prominence) is usually identi-
                                                                         fiable in association with hollow foot; this is usually refer-
                                                                         red to by posture professionals as ‘forward attitude’ tout




                                                                             te
                                                                         court;
                                                                         ‘Backward attitude’ will on the contrary be therefore the 3rd
                                                                         frame whose main features are occipital and dorsal arrows
                                                                         clearly decreased as compared with the gluteal one, ob-
                                                                     In  vious and consequent shifting towards the back of the body
    Figure 1 - “Three quarters” view, most frequent ‘social angle’ one
    is usually watched.                                                  barycentre; we may also note accentuated vertebral cur-
                                                                         ves and frequently a flat foot.

    enough support.
                                                       ni
                                                                         Mutual relation between profile and orthodontic
    If this little tool is not within reach, we can even do with a       skeletal class
    vertical wall free from other things, having our patient po-
    sition her/himself in a ‘spontaneous standing’ condition, that       Any professional dealing with body posture likes to refer
                                            io


    is to say feet on the same level but without obliging to a           to himself (10/11) as a physician ‘horizontally’ working, sin-
    predetermined distance or angle between them just in front           ce his specialty holds many a contact with other health wor-
    of the vertical line indicator (we don’t favour using pre-glued      kers (ophthalmologists, dentists, neurologists, ENT spe-
                                   iz



    to the floor templates that tend to limit the physiologic po-        cialists, orthodontists, orthopaedists, gastroenterologists,
    sitional gamma too much): let’s consequently observe                 rheumatologists, cardiologists, orthoepists, paediatri-
    which features of tonic muscular activity are shown by our           cians, kinesipaths, orthoptists, psychiatrists and so on).
                  Ed




    patient orthostatically upright with respect to the vertical         According to their opinion on our field, a strong biunique
    gravity line on the sagittal plane (that is to say watching          bond does exist between orthodontic skeletal class and
    her/his profile).                                                    postural profile (whether forward / normal / backward), bond
    Particularly, we are bound to examine distances from the             that can easily and usually be observed.
    vertical line of three benchmark points: most salient                Thus, subjects exhibiting an orthodontic skeletal class I tend
    point of gluteal prominence, most posterior point of phy-            towards a neutral and steady profile position, the ones pre-
    siologic kyphosis of the dorsal column and most posterior            senting an orthodontic skeletal class II usually show an-
 IC




    nape point (exterior occipital prominence).                          terior profile position – normally almost as stable as class
    Ideally, these three points should lie on the same line pa-          I); orthodontic skeletal class III subjects, on the contrary,
    rallel to vertical Barré’s line.                                     will tend to be both backward positioned and unsteady (of
    In the same manner we should go on evaluating distan-                course always from the standpoint of postural balance); for-
C




    ces (always from the gravity vertical line) of most anterior         ward inclined position usually tends to match with the so
    point of neck’s posterior part (cervical arrow) and of most          called ‘griffe’ of toes (Figs. 2 and 3), that is to say an atti-
    anterior point of lumbar column lordosis (lumbar arrow).             tude, as of claws, designed to guarantee exactly some sta-
    As already anticipated according to posturologic criteria,           bility even in the presence of such a positional frame.
©




    in well-balanced subjects these three distances (gluteal,            As an obvious implication of this observation, it follows that
    dorsal and occipital) should be almost equivalent.                   we clearly don’t need making a skeletal class diagnosis
    Beside this good alignment, should we observe some other             by watching more forward or more backward position of
    features: a very, very small (not more than minimal) acti-           both head and column as to gluteal plane (much more re-
    vity of anti-gravity muscles (tonic extensors muscles) who-          liable orthodontic investigation tools are available), but we
    se activity is requested in order to stabilize lower limbs, pel-     could easily (and usefully) take advantage of such a sta-
    vis and column (and exactly a pelvis in optimal balance,             tistically sensitive observation in order to suspect, for in-
    neither forward nor backward inclined) with barycentre fal-          stance, a potential in fieri class III in a boy (who maybe doe-

    Annali di Stomatologia 2011; II (3-4): 45-48                                                                                      47
    V. Luzi et al.




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                                                                                                                                 na
                                                                                                                              io
                                                                                                  az
    Figure 2 - Griffe’ of toes, lateral view.                                 Figure 3 - Griffe’ of toes, superior view.




                                                                                                rn
    sn’t offer any other alarm bell, let’s say who exhibits a full             3. Bricot B. La riprogrammazione posturale globale. Ed. Statipro – Mar-
    dental and skeletal class I, chewing and facial muscula-                      seille 1998.
    ture in the norm, harmonious face profile, nasal breathing,                4. Annibaldi L. Le colpe della psiche. Salute del 20/01/2001, 9.
                                                                               5. Calandriello B. et al. Postura e problemi ortodontici: diagnosi sem-
    non-progenic parents and relatives) and put him under re-
                                                                                  plificata delle alterazioni della colonna. Atti X° Congr. Naz. S.I.D.O.,




                                                                                   te
    gular control visits.                                                         Torino, S.I.D.O. 1989, 163/166.
    It may clearly be a false alarm, but it wouldn’t cost us no-               6. Rinaldi S, Fontani V. as qtd in 04.
    thing.                                                                     7. Urzì D. Principi di metodologia clinica interdisciplinare per la valu-
    But what if said boy would show out of the blue sky ano-
    ther slight, little brick of class III syndrome? That would
                                                                          In      tazione posturale dell'atleta di alta prestazione, Ed. C.R.E.P. - Pa-
                                                                                  dova 2000.
    obviously call for attention, and we could perhaps detect                  8. Sartori F. L’apparato stomatognatico organo sensoriale di control-
    in advance an incipient mandibular growth spurt that, in                      lo posturale. In: Postura, occlusione, rachide : problematiche in-
    the absence of the postural beep, we might as well have                       terdisciplinari /H. M. Da Cunha ... [et al.]. - Bassano del Grappa :
                                                                                  CPA, copyr. 1992. - 271 p. : ill.
                                                           ni
    neglected, at least in the initial onset.
                                                                               9. Ferrario V. Influenza della postura eretta sulla morfologia del cra-
    In our opinion, it’s surely worth losing a little time after it.              nio. In: Postura, occlusione, rachide: problematiche interdisciplinari
                                                                                  /H. M. Da Cunha ..[et al.]. - Bassano del Grappa : CPA, copyr. 1992.
                                                io

                                                                                  - 271 p. : ill.
    References                                                                10. Clauzade M. Marty J-P. Orthoposturodontie. Perpignan (France),
                                                                                  S.E.O.O. 2000.
     1. Ricciardi PM. as qtd in 02.                                           11. Ricciardi PM. Ora si insegna all’Università. Salute del 20/01/2001,
                                     iz



     2. Messa A. State dritti! I segreti della postura. La Repubblica - Sa-       8.
        lute del 01 Febbraio 2001.                                            12. Cabitza P, Daolio PA. Ortopedia. Ed. Raffaello Cortina, Milano 1989.
                     Ed
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©




    48                                                                                                 Annali di Stomatologia 2011; II (3-4): 45-48
