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[[File:VEMP.jpg|Figure 1: Vestibula Evoked Myogenic Potentials (see chapter '[[Complex Systems]]'|left|400x400px]]This detailed summary explores the debated connection between posture, the trigeminal system, and prosthetic rehabilitation in the diagnosis of orofacial disorders, including Temporomandibular dysfunctions (TMDs). This complex relationship is examined through the lens of vestibular evoked myogenic potentials (VEMPs), which are diagnostic tools used to study the integration of sensory inputs from the vestibular system into motor responses affecting jaw muscles. The discussion also touches on broader implications in the fields of neurology and rehabilitation, offering insights into the intricate interactions within the human body's sensory and motor systems.  
[[File:VEMP.jpg|Figure 1: Vestibula Evoked Myogenic Potentials (see chapter '[[Complex Systems]]'|left|400x400px]]This summary examines the complex relationship between posture, the trigeminal system, and prosthetic rehabilitation in diagnosing orofacial disorders, particularly Temporomandibular Dysfunctions (TMDs), through the lens of vestibular evoked myogenic potentials (VEMPs). VEMPs serve as critical diagnostic tools that evaluate the integration of sensory inputs into motor responses affecting jaw muscles, with broader implications for neurology and rehabilitation.  


The chapter begins by addressing the ongoing debate regarding the correlation between dental occlusion, posture, and temporomandibular disorders. It points out the critical need for a careful evaluation of clinical symptoms without being swayed by prevailing medical doctrines that might lead to diagnostic errors.
The discussion begins by critically evaluating the debated links between dental occlusion, posture, and temporomandibular disorders, highlighting the need for careful symptom assessment that avoids conventional diagnostic biases. It details how VEMPs, especially those evoked by visual-induced vection, illustrate the neurological connections between sensory perceptions and motor responses, emphasizing the body's complex mechanisms.


VEMPs are discussed as a pivotal diagnostic approach to understanding the trigeminal/vestibular correlation. The narrative explains how VEMPs, specifically the click-evoked cervical vestibular myogenic potentials (cVEMPs), are influenced by visual motions that create an illusory sensation of movement, known as vection. The increase in cVEMP amplitude during vection illustrates the neurological connection between sensory perceptions and motor responses, highlighting the body's complex response mechanisms.
The text addresses controversies over dental occlusion’s impact on postural stability, presenting varied scientific opinions supported by studies. It also discusses the methodological challenges in studying these relationships, noting the limitations of current research such as small sample sizes and the need for more comprehensive studies.


The text delves into the controversies surrounding the relationship between dental occlusion and postural stability. It presents both supporting and opposing views within the scientific community, backed by numerous references and studies. Proponents argue that disturbances in the craniomandibular system can influence overall postural alignment through neuromotor pathways and myofascial connections. Critics, however, question the clinical relevance of these correlations, citing studies with inconclusive or conflicting results.
In conclusion, the narrative advocates for an evidence-based approach in diagnosing and treating conditions that integrate dental, postural, and neurological factors, calling for more rigorous research to clarify these complex relationships. This overview not only highlights the role of VEMPs in understanding craniofacial and postural interrelations but also considers the broader clinical implications in neurology, orthodontics, and physical therapy.{{ArtBy|autore=Gianni Frisardi}}
 
==Introduction to Occlusion and Posture==
A significant portion of the discussion is devoted to the methodologies used in studying the occlusion-posture relationship. The challenges of accurately measuring and interpreting the complex interactions between dental malocclusions and body posture are examined. The summary critiques the limitations of current research, including small sample sizes and the lack of comprehensive, high-quality studies that integrate dynamic and static assessments of posture and dental occlusion.
 
The narrative prepares to introduce a specific clinical case that exemplifies the practical implications of these theories in medical practice. It sets the stage for a detailed examination of a patient with marked temporomandibular and postural anomalies, intending to apply and possibly validate or refute the discussed theories through real-world application.
 
In concluding, the summary underscores the necessity of maintaining an open, evidence-based approach when diagnosing and treating conditions that may involve the integration of dental, postural, and neurological factors. It calls for more rigorous and expansive research to better define the connections between the stomatognathic system and overall body health, suggesting that future studies should aim to clarify these complex relationships using advanced diagnostic tools and more representative sample sizes.
 
This comprehensive overview not only sheds light on the specific topic of VEMPs and their role in understanding craniofacial and postural interrelations but also reflects on the broader implications for clinical practices in neurology, orthodontics, and physical therapy.<blockquote>
== Keywords ==
'''Vestibular Evoked Myogenic Potentials (VEMPs)''' - Refers to the diagnostic tools used to study the interaction between the vestibular system and muscle responses, crucial for understanding sensory and motor integration in the context of occlusion and posture.
 
'''Temporomandibular Dysfunctions (TMDs)''' - Describes disorders related to the temporomandibular joint, which are central to discussions of occlusion and postural stability in the medical and dental fields.
 
'''Trigeminal System''' - Points to the nerve system involved in facial sensation and motor functions, which is discussed in relation to its connection with vestibular inputs and its implications for occlusion and posture.
 
'''Orofacial Disorders''' - Broad term covering disorders of the face and mouth, relevant here for the discussion of how these conditions intersect with posture and neurological functions.
 
'''Postural Stability''' - Concerns the body's ability to maintain a stable posture, a key topic in the debate over the impact of dental occlusion on overall body posture.
 
'''Dental Occlusion''' - Refers to the alignment of teeth and the way the upper and lower teeth come into contact, which is analyzed for its potential impact on bodily posture and neuromuscular function.
 
'''Neuromuscular Responses''' - Relates to the responses of the muscular system to neural stimuli, particularly in the context of how occlusion may affect these responses.
 
'''Cervical Vestibular Myogenic Potentials (cVEMPs)''' - A specific type of VEMP that helps illustrate the interaction between visual stimuli and vestibular responses, showing how sensory illusions like vection can influence muscular responses in the neck.
 
'''Prosthetic Rehabilitation''' - Refers to the use of prosthetics in the rehabilitation process, especially relevant in discussions of restoring function and alignment in patients with orofacial disorders.
 
'''Myofascial Connections''' - Pertains to the connective tissue that surrounds and supports muscles, discussed in the context of how these structures may link the masticatory system to broader postural dynamics.</blockquote>{{ArtBy|autore=Gianni Frisardi}}
===Introduction===




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Posture is understood as the position of the human body and its orientation in space which requires the analysis and integration of stimuli from three systems: vision, vestibular and proprioception.<ref>Guez G. The Posture. In: Kandel E., Schwartz J., editors. Principles of Neural Science. Elsevier; Amsterdam, The Netherlands: 1991. pp. 612–623.</ref><ref>Czaprowski D., Stoliński L., Tyrakowski M., Kozinoga M., Kotwicki T. Non-structural misalignments of body posture in the sagittal plane. Scoliosis Spinal Disord. 2018;13:6. doi: 10.1186/s13013-018-0151-5.</ref> Over the years, numerous observations have been made on the factors influencing postural stability. <ref>Iwanenko J., Gurfinkel V. Human postural control. Front. Neurosci. 2018;12:17. </ref><ref>Guerraz M., Bronstein A.M. Ocular versus extraocular control of posture and equilibrium. Neurophysiol. Clin. 2008;38:391–398. doi: 10.1016/j.neucli.2008.09.007.</ref><ref>Hamaoui A., Frianta Y., Le Bozec S. Does increased muscular tension along the torso impair postural equilibrium in a standing posture? Gait Posture. 2011;34:457–461. doi: 10.1016/j.gaitpost.2011.06.017.</ref><ref>Kolar P., Sulc J., Kyncl M., Sanda J., Neuwirth J., Bokarius A.V., Kriz J., Kobesova A. Stabilizing function of the diaphragm: Dynamic MRI and synchronized spirometric assessment. J. Appl. Physiol. 2010;109:1064–1071. doi: 10.1152/japplphysiol.01216.2009.</ref><ref>Szczygieł E., Fudacz N., Golec J., Golec E. The impact of the position of the head on the functioning of the human body: A systematic review. Int. J. Occup. Med. Environ. Health. 2020;33:559–568. doi: 10.13075/ijomeh.1896.01585.</ref> The role of the craniomandibular system is now being increasingly analyzed in relation to it. <ref>Tardieu C., Dumitrescu M., Giraudeau A., Blanc J.L., Cheynet F., Borel L. Dental occlusion and postural control in adults. Neurosci. Lett. 2009;450:221–224. doi: 10.1016/j.neulet.2008.12.005.</ref><ref>Munhoz W.C., Hsing W.T. Interrelations between orthostatic postural deviations and subjects’ age, sex, malocclusion, and specific signs and symptoms of functional pathologies of the temporomandibular system: A preliminary correlation and regression study. Cranio. 2014;32:175–186. doi: 10.1179/0886963414Z.00000000031.</ref><ref>Pérez-Belloso A.J., Coheña-Jiménez M., Cabrera-Domínguez M.E., Galan-González A.F., Domínguez-Reyes A., Pabón-Carrasco M. Influence of dental malocclusion on body posture and foot posture in children: A cross-sectional study. Healthcare. 2020;8:485. doi: 10.3390/healthcare8040485.</ref><ref>Amaricai E., Onofrei R.R., Suciu O., Marcauteanu C., Stoica E.T., Negruțiu M.L., David V.L., Sinescu C. Do different dental conditions influence the static plantar pressure and stabilometry in young adults? PLoS ONE. 2020;15:e0228816. doi: 10.1371/journal.pone.0228816.</ref> Many theories attempt to explain the association between the masticatory organ and posture, including myofascial chains, trigeminal nerve activation or deactivation, and subsequent interaction in the brainstem.<ref name=":0">Cabrera-Domínguez M.E., Domínguez-Reyes A., Pabón-Carrasco M., Pérez-Belloso A.J., Coheña-Jiménez M., Galán-González A.F. Dental malocclusion and its relation to the podal system. Front. Pediatr. 2021;9:654229. doi: 10.3389/fped.2021.654229.</ref><ref>Myers T.  Anatomy Trains: Myofasziale Leitbahnen (für Manual- und Bewegungstherapeuten) Elsevier Health Sciences; Berlin, Germany: 2015.</ref><ref>Pinganaud G., Bourcier F., Buisseret-Delmas C., Buisseret P. Primary trigeminal afferents to the vestibular nuclei in the rat: Existence of a collateral projection to the vestibulo-cerebellum. Neurosci. Lett. 1999;264:133–136. doi: 10.1016/S0304-3940(99)00179-2. [PubMed] [CrossRef] [Google Scholar] [Ref list]</ref> However, this is a controversial topic in the scientific community. There is both evidence to support that relationship<ref name=":1">Bracco P., Deregibus A., Piscetta R. Effects of different jaw relations on postural stability in human subjects. Neurosci. Lett. 2004;356:228–230. doi: 10.1016/j.neulet.2003.11.055.</ref><ref name=":2">Manfredini D., Castroflorio T., Perinetti G., Guarda-Nardini L. Dental occlusion, body posture and temporomandibular disorders: Where we are now and where we are heading for. J. Oral Rehabil. 2012;39:463–471. doi: 10.1111/j.1365-2842.2012.02291.x. </ref><ref name=":3">Sakaguchi K., Mehta N.R., Abdallah E.F., Forgione A.G., Hirayama H., Kawasaki T., Yokoyama A. Examination of the relationship between mandibular position and body posture. Cranio. 2007;25:237–249. doi: 10.1179/crn.2007.037. </ref><ref name=":4">Cuccia A., Caradonna C. The relationship between the stomatognathic system and body posture. Clinics. 2009;64:61–63. doi: 10.1590/S1807-59322009000100011.</ref><ref name=":5">Marchena-Rodríguez A., Moreno-Morales N., Ramírez-Parga E., Labajo-Manzanares M.T., Luque-Suárez A., Gijon-Nogueron G. Relationship between foot posture and dental malocclusions in children aged 6 to 9 years. A cross-sectional study. Medicine. 2018;97:e0701. doi: 10.1097/MD.0000000000010701</ref><ref name=":6">Iacob S.M., Chisnoiu A.M., Buduru S.D., Berar A., Fluerasu M.I., Iacob I., Objelean A., Studnicska W., Viman L.M. Plantar pressure variations induced by experimental malocclusion—A pilot case series study. Healthcare. 2021;9:599. doi: 10.3390/healthcare9050599.</ref> and to refute it.<ref name=":7">Michelotti A., Buonocore G., Farella M., Pellegrino G., Piergentili C., Altobelli S., Martina R. Postural stability and unilateral posterior crossbite: Is there a relationship? Neurosci. Lett. 2006;392:140–144. doi: 10.1016/j.neulet.2005.09.008.</ref><ref name=":8">Perinetti G., Contardo L., Silvestrini-Biavati A., Perdoni L., Castaldo A. Dental malocclusion and body posture in young subjects: A multiple regression study. Clinics. 2010;65:689–695. doi: 10.1590/S1807-59322010000700007.</ref><ref name=":9">Scharnweber B., Adjami F., Schuster G., Kopp S., Natrup J., Erbe C., Ohlendorf D. Influence of dental occlusion on postural control and plantar pressure distribution. Cranio. 2017;35:358–366. doi: 10.1080/08869634.2016.1244971.</ref><ref name=":10">Isaia B., Ravarotto M., Finotti P., Nogara M., Piran G., Gamberini J., Biz C., Masiero S., Frizziero A. Analysis of dental malocclusion and neuromotor control in young healthy subjects through new evaluation tools. J. Funct. Morphol. Kinesiol. 2019;4:5. doi: 10.3390/jfmk4010005.</ref>  
Posture is understood as the position of the human body and its orientation in space which requires the analysis and integration of stimuli from three systems: vision, vestibular and proprioception.<ref>Guez G. The Posture. In: Kandel E., Schwartz J., editors. Principles of Neural Science. Elsevier; Amsterdam, The Netherlands: 1991. pp. 612–623.</ref><ref>Czaprowski D., Stoliński L., Tyrakowski M., Kozinoga M., Kotwicki T. Non-structural misalignments of body posture in the sagittal plane. Scoliosis Spinal Disord. 2018;13:6. doi: 10.1186/s13013-018-0151-5.</ref> Over the years, numerous observations have been made on the factors influencing postural stability. <ref>Iwanenko J., Gurfinkel V. Human postural control. Front. Neurosci. 2018;12:17. </ref><ref>Guerraz M., Bronstein A.M. Ocular versus extraocular control of posture and equilibrium. Neurophysiol. Clin. 2008;38:391–398. doi: 10.1016/j.neucli.2008.09.007.</ref><ref>Hamaoui A., Frianta Y., Le Bozec S. Does increased muscular tension along the torso impair postural equilibrium in a standing posture? Gait Posture. 2011;34:457–461. doi: 10.1016/j.gaitpost.2011.06.017.</ref><ref>Kolar P., Sulc J., Kyncl M., Sanda J., Neuwirth J., Bokarius A.V., Kriz J., Kobesova A. Stabilizing function of the diaphragm: Dynamic MRI and synchronized spirometric assessment. J. Appl. Physiol. 2010;109:1064–1071. doi: 10.1152/japplphysiol.01216.2009.</ref><ref>Szczygieł E., Fudacz N., Golec J., Golec E. The impact of the position of the head on the functioning of the human body: A systematic review. Int. J. Occup. Med. Environ. Health. 2020;33:559–568. doi: 10.13075/ijomeh.1896.01585.</ref> The role of the craniomandibular system is now being increasingly analyzed in relation to it. <ref>Tardieu C., Dumitrescu M., Giraudeau A., Blanc J.L., Cheynet F., Borel L. Dental occlusion and postural control in adults. Neurosci. Lett. 2009;450:221–224. doi: 10.1016/j.neulet.2008.12.005.</ref><ref>Munhoz W.C., Hsing W.T. Interrelations between orthostatic postural deviations and subjects’ age, sex, malocclusion, and specific signs and symptoms of functional pathologies of the temporomandibular system: A preliminary correlation and regression study. Cranio. 2014;32:175–186. doi: 10.1179/0886963414Z.00000000031.</ref><ref>Pérez-Belloso A.J., Coheña-Jiménez M., Cabrera-Domínguez M.E., Galan-González A.F., Domínguez-Reyes A., Pabón-Carrasco M. Influence of dental malocclusion on body posture and foot posture in children: A cross-sectional study. Healthcare. 2020;8:485. doi: 10.3390/healthcare8040485.</ref><ref>Amaricai E., Onofrei R.R., Suciu O., Marcauteanu C., Stoica E.T., Negruțiu M.L., David V.L., Sinescu C. Do different dental conditions influence the static plantar pressure and stabilometry in young adults? PLoS ONE. 2020;15:e0228816. doi: 10.1371/journal.pone.0228816.</ref> Many theories attempt to explain the association between the masticatory organ and posture, including myofascial chains, trigeminal nerve activation or deactivation, and subsequent interaction in the brainstem.<ref name=":0">Cabrera-Domínguez M.E., Domínguez-Reyes A., Pabón-Carrasco M., Pérez-Belloso A.J., Coheña-Jiménez M., Galán-González A.F. Dental malocclusion and its relation to the podal system. Front. Pediatr. 2021;9:654229. doi: 10.3389/fped.2021.654229.</ref><ref>Myers T.  Anatomy Trains: Myofasziale Leitbahnen (für Manual- und Bewegungstherapeuten) Elsevier Health Sciences; Berlin, Germany: 2015.</ref><ref>Pinganaud G., Bourcier F., Buisseret-Delmas C., Buisseret P. Primary trigeminal afferents to the vestibular nuclei in the rat: Existence of a collateral projection to the vestibulo-cerebellum. Neurosci. Lett. 1999;264:133–136. doi: 10.1016/S0304-3940(99)00179-2. [PubMed] [CrossRef] [Google Scholar] [Ref list]</ref> However, this is a controversial topic in the scientific community. There is both evidence to support that relationship<ref name=":1">Bracco P., Deregibus A., Piscetta R. Effects of different jaw relations on postural stability in human subjects. Neurosci. Lett. 2004;356:228–230. doi: 10.1016/j.neulet.2003.11.055.</ref><ref name=":2">Manfredini D., Castroflorio T., Perinetti G., Guarda-Nardini L. Dental occlusion, body posture and temporomandibular disorders: Where we are now and where we are heading for. J. Oral Rehabil. 2012;39:463–471. doi: 10.1111/j.1365-2842.2012.02291.x. </ref><ref name=":3">Sakaguchi K., Mehta N.R., Abdallah E.F., Forgione A.G., Hirayama H., Kawasaki T., Yokoyama A. Examination of the relationship between mandibular position and body posture. Cranio. 2007;25:237–249. doi: 10.1179/crn.2007.037. </ref><ref name=":4">Cuccia A., Caradonna C. The relationship between the stomatognathic system and body posture. Clinics. 2009;64:61–63. doi: 10.1590/S1807-59322009000100011.</ref><ref name=":5">Marchena-Rodríguez A., Moreno-Morales N., Ramírez-Parga E., Labajo-Manzanares M.T., Luque-Suárez A., Gijon-Nogueron G. Relationship between foot posture and dental malocclusions in children aged 6 to 9 years. A cross-sectional study. Medicine. 2018;97:e0701. doi: 10.1097/MD.0000000000010701</ref><ref name=":6">Iacob S.M., Chisnoiu A.M., Buduru S.D., Berar A., Fluerasu M.I., Iacob I., Objelean A., Studnicska W., Viman L.M. Plantar pressure variations induced by experimental malocclusion—A pilot case series study. Healthcare. 2021;9:599. doi: 10.3390/healthcare9050599.</ref> and to refute it.<ref name=":7">Michelotti A., Buonocore G., Farella M., Pellegrino G., Piergentili C., Altobelli S., Martina R. Postural stability and unilateral posterior crossbite: Is there a relationship? Neurosci. Lett. 2006;392:140–144. doi: 10.1016/j.neulet.2005.09.008.</ref><ref name=":8">Perinetti G., Contardo L., Silvestrini-Biavati A., Perdoni L., Castaldo A. Dental malocclusion and body posture in young subjects: A multiple regression study. Clinics. 2010;65:689–695. doi: 10.1590/S1807-59322010000700007.</ref><ref name=":9">Scharnweber B., Adjami F., Schuster G., Kopp S., Natrup J., Erbe C., Ohlendorf D. Influence of dental occlusion on postural control and plantar pressure distribution. Cranio. 2017;35:358–366. doi: 10.1080/08869634.2016.1244971.</ref><ref name=":10">Isaia B., Ravarotto M., Finotti P., Nogara M., Piran G., Gamberini J., Biz C., Masiero S., Frizziero A. Analysis of dental malocclusion and neuromotor control in young healthy subjects through new evaluation tools. J. Funct. Morphol. Kinesiol. 2019;4:5. doi: 10.3390/jfmk4010005.</ref>  
====Content supporting correlation====
===Content supporting correlation===
 


The authors of the scientific reports, who recognize the associations between the systems in question, give two indications for the possible interactions. The first, i.e. ascending disturbances, refers to the situation in which bad posture and disturbances of the peripheral structures (e.g. lower limbs), through myofascial neuromotor activities and the dura mater, functionally condition the cranio-mandibular structures. Conversely, a chain of descending disorders is present when anomalies of the craniomandibular region affect posture and body areas located more distally, including the pelvis and lower extremities.<ref name=":0" /><ref name=":11">Michalakis K.X., Kamalakidis S.N., Pissiotis A.L., Hirayama H. The Effect of clenching and occlusal instability on body weight distribution, assessed by a postural platform. BioMed Res. Int. 2019;2019:7342541. doi: 10.1155/2019/7342541.</ref><ref name=":12">Julià-Sánchez S., Álvarez-Herms J., Cirer-Sastre R., Corbi F., Burtscher M. The influence of dental occlusion on dynamic balance and muscular tone. Front. Physiol. 2020;10:1626. doi: 10.3389/fphys.2019.01626.</ref><ref>Pacella E., Dari M., Giovannoni D., Mezio M., Caterini L., Costantini A. The relationship between occlusion and posture: A systematic review. Orthodontics. 2017;8:WMC005374.</ref><blockquote>[[File:Question 2.jpg|left|50x50px]]And on this nothing to say because no one can deny an anatomical-functional correlation between vestibular systems, cerebellum, trigeminal and peripheral neuromotor system. This is not an opinion but a proven scientific observation already reported somewhere in Masticationpedia.
The authors of the scientific reports, who recognize the associations between the systems in question, give two indications for the possible interactions. The first, i.e. ascending disturbances, refers to the situation in which bad posture and disturbances of the peripheral structures (e.g. lower limbs), through myofascial neuromotor activities and the dura mater, functionally condition the cranio-mandibular structures. Conversely, a chain of descending disorders is present when anomalies of the craniomandibular region affect posture and body areas located more distally, including the pelvis and lower extremities.<ref name=":0" /><ref name=":11">Michalakis K.X., Kamalakidis S.N., Pissiotis A.L., Hirayama H. The Effect of clenching and occlusal instability on body weight distribution, assessed by a postural platform. BioMed Res. Int. 2019;2019:7342541. doi: 10.1155/2019/7342541.</ref><ref name=":12">Julià-Sánchez S., Álvarez-Herms J., Cirer-Sastre R., Corbi F., Burtscher M. The influence of dental occlusion on dynamic balance and muscular tone. Front. Physiol. 2020;10:1626. doi: 10.3389/fphys.2019.01626.</ref><ref>Pacella E., Dari M., Giovannoni D., Mezio M., Caterini L., Costantini A. The relationship between occlusion and posture: A systematic review. Orthodontics. 2017;8:WMC005374.</ref><blockquote>[[File:Question 2.jpg|left|50x50px]]And on this nothing to say because no one can deny an anatomical-functional correlation between vestibular systems, cerebellum, trigeminal and peripheral neuromotor system. This is not an opinion but a proven scientific observation already reported somewhere in Masticationpedia.
Gianni
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