Evaluation of Head Posture in Wheelchair‐Bound Individuals and Its Relation to Malocclusion: A Proof‐of‐Concept Study

BACKGROUND: Malocclusions are significantly more prevalent among individuals with physical and mental disabilities. Head posture, particularly in wheelchair-bound individuals, may play a role in craniofacial growth and occlusal development, but its specific impact remains poorly understood. OBJECTIVE: To evaluate head posture in wheelchair-bound individuals and assess potential correlations with malocclusion characteristics. METHODS: Twenty wheelchair-bound participants (aged 6-30 years) were categorised into three groups based on their head control (full, partial, or no control). Head posture was dynamically measured on three axes (pitch, roll and yaw) using an Inertial Measurement Unit for precise 3D tracking. Malocclusions, including molar and canine sagittal relationships, overjet, overbite and crossbites, were assessed through standardised clinical examinations. RESULTS: All wheelchair-bound participants showed significantly greater deviations in head posture compared to controls. The roll axis differed significantly across groups (p = 0.004), with the no control group exhibiting the greatest deviation. A significant correlation was observed between pitch axis deviation and sagittal molar relationships (r = -0.59, p = 0.006), indicating that a backward head posture was associated with Class II malocclusion, while a forward head posture was linked to Class III malocclusion. No significant correlations were found for the roll or yaw axes. CONCLUSION: Significant head posture deviations were detected in wheelchair-bound individuals, with those having no head control showing more extreme deviations. This study found significant correlations between antero-posterior head posture deviations and sagittal molar relationships in wheelchair-bound individuals, suggesting that head posture could be a contributing factor to malocclusions in this population. Given the limited sample, these results should be interpreted cautiously.