Cervical Vertebral Maturation as a Moderator of the Relationship Between Sagittal Malocclusion Type (Skeletal vs Dentoalveolar) and Dynamic Postural Balance in Children and Adolescents: A sex-stratified analysis
DOI:
https://doi.org/10.33295/1992-576X-2026-3-ORTH-1Keywords:
sagittal malocclusion, CVM, cervical vertebral maturation, postural balance, stabilometry, skeletal Class II, skeletal Class III, biological age, sex differencesAbstract
Introduction. The relationship between sagittal malocclusions and postural balance remains controversial due to inconsistent findings in previous literature and insufficient consideration of biological age and skeletal maturation. Cervical Vertebral Maturation (CVM) may play a key role in postural adaptations; however, its moderating effect on the occlusion–posture axis remains underinvestigated.
Aim. To evaluate the role of CVM as a moderator of the relationship between sagittal malocclusion type (skeletal vs dentoalveolar) and dynamic postural balance parameters in children and adolescents, accounting for sex differences.
Materials and Methods. A cross-sectional controlled study included 250 participants aged 9–18 years: 200 patients with sagittal malocclusions (Class II/1, Class II/2, and Class III) and 50 controls with physiological occlusion. The malocclusion type was determined based on clinical examination and cephalometric analysis (ANB angle), categorizing cases into skeletal and dentoalveolar forms. Biological maturity was assessed using the Cervical Vertebral Maturation (CVM) method (CS1–CS6 according to Baccetti et al.), categorized into prepubertal, pubertal, and postpubertal stages. Dynamic postural balance was evaluated using a Zebris FDM stabilometric platform (center of pressure [CoP] displacement, sagittal instability, head inclination, and plantar load distribution). Statistical analysis involved ANOVA, non-parametric tests, Spearman correlation, and moderation analysis (PROCESS macro for SPSS, Model 1), stratified by sex and malocclusion class.
Results. Patients with skeletal malocclusions demonstrated the most pronounced impairments in dynamic postural balance during the pubertal growth peak (CS3–CS4), whereas dentoalveolar forms showed no significant deviations from age norms. Moderation analysis revealed a statistically significant moderating effect of CVM stage on the relationship between skeletal malocclusion and postural balance parameters in males (p < 0.05), whereas in females this effect did not reach statistical significance.
Conclusions. Cervical Vertebral Maturation (CVM) serves as a key biological moderator of the relationship between sagittal malocclusion type and dynamic postural balance. The most pronounced postural disturbances occur in males with skeletal malocclusions during the pubertal growth period, underscoring the necessity of incorporating biological age and sex into the comprehensive functional assessment of orthodontic patients.
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