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Eur Spine J. 2019 Jan 23. doi: 10.1007/s00586-019-05896-4. [Epub ahead of print]

Spinal deformity and malocclusion association is not supported by high-quality studies: results from a systematic review of the literature.

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IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, University of Turin, via Zuretti 29, 10121, Turin, Italy.
IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, Milan, Italy.
ISICO - Italian Scientific Spine Institute, Milan, Italy.



Several reports in the literature have suggested a causative association between oral occlusion and spinal deformity such as scoliosis and Scheuermann's disease or kyphosis. Based on these findings, a growing number of adolescents with spinal deformity receive orthodontic treatment, supposing a beneficial effect on the spine.


The aim of this study was to verify the association between spinal deformity and malocclusion in the orthopedic population and potential effect of orthodontic treatment on the spinal deformity.


The databases: MEDLINE, CINAHL, EMBASE, Cochrane Register, OTseeker and ScienceDirect were searched up to August 2017 for studies reporting on associations between spinal and occlusal conditions. Case series, cohort, case-control studies and randomized clinical trials were considered for analysis. Two reviewers independently selected studies, conducted quality assessment and extracted results. Methodological quality was assessed using MINORS score.


Nine publications reporting on 1424 patients were included. Studies were two case series, five case-control studies, one cohort study and one randomized clinical trial. The methodological quality was poor in 8/9 studies.


Evidence from three low-quality studies suggests an increased prevalence of occlusal dysfunction in patients with known spinal deformity, but the conclusions have a high risk of bias. No evidence of beneficial effects of orthodontic treatment on spinal deformity was found. These slides can be retrieved under Electronic Supplementary Material.


Dental occlusion; Kyphosis; Mandibular malocclusion; Scheuermann’s disease; Scoliosis; Spine deformity; Systematic review; Temporomandibular joint


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