Craniomandibular disorders (CMD) and poor posture are rather frequent in the general population and require a critical diagnostic and therapeutic phase. An important role is played by the dental surgeon, expert in gnathology.

The aim of the present work is to demonstrate the importance of a thorough occlusal, gnathologic and postural examination in a partially toothless patient, in order to perform a prosthetic rehabilitation respecting the articular and neuromuscular components.

The clinical case is a 30-year-old female patient with occlusal disharmony, muscular overtone, painful limitations of opening and closing movement, articular click and consequent disharmonic postures. A thorough clinical examination of the TMJ was performed, along with intraoral registration with the Gothic arch tracing method and kinesiology. Finally, cotton rolls were placed between the teeth and then another postural examination was performed with a plumb line.

The patient, examined with cotton rolls placed between the teeth, both walking and plumb-line, showed a good posture re-establishment. This directed our analysis towards a clinical picture of descending postural dysfunction syndrome and, therefore, towards the need of a repositioning appliance.

A thorough evaluation of muscular system, TMJ and posture is fundamental to identify a descending postural dysfunction syndrome and to make a differential diagnosis with the ascending and mixed forms on a psychic base.

Before proceeding with complex prosthetic or implant-prosthetic rehabilitations in patients with postural and craniomandibular disorders, it is imperative to restore the stomatognathic balance, which allows for prosthetic manufactures in keeping with the postural system of the individual.
A failed resolution of the dysfunctional picture will contribute to worsen the set of symptoms with subsequent failures.

Fig.1 OPT showing inadequate occlusal contacts

Fig.2 A plane placed in the mandible with Gothic arch tracing

Fig.3 The patient anterior to the plumb line

Fig.4 The patient tilted to the right of the plumb line

Fig.5 Asymmetric malleoli

Fig.6 The patient with cotton rolls between the teeth: descending forms have good posture re-establishment; otherwise there is an exacerbation of the clinical picture


Fig.7 Well-balanced patient with a repositioning appliance

Fig. 7

Congresso Nazionale dei Docenti di Discipline Odontostomatologiche e Chirurgia Maxillo Facciale
Firenze – Siena, 14-16 Aprile 2011

Università degli Studi di Bari Dipartimento di Odontostomatologia e Chirurgia
Direttore: Prof.ssa D. DE VITO
Calabrodental S.r.l. Unità Operativa di Chirurgia Maxillo-Facciale Regione Calabria – Crotone Dir. San: Dott. M. W. Marrelli

F. Inchingolo, F. Carbotti,G. Dipalma, M. Serafini, M. Marrelli, A.M. Inchingolo, S. Di Teodoro, A. Palladino, M. De Carolis, A.D. Inchingolo


Mongini F. “ATM E MUSCOLATURA CRANIO-CERVICO-FACIALE: fisiopatologia e terapia.UTET
Mongini F. A combined method to determine the therapeutic position for occlusal rehabilitation.J. Prosthet. Dent., 47:434, 1982
McNamara J.A. Jr., Carlson D.S, Quantitative analysis of temporomandibular joint adaptations to protrusive function. Am. J. Orthod.,76:593-611,1979

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