Craniocervical Posture and Skeletal Malocclusion in Adolescents: A Cross-Sectional Study

Objective: This study aimed to evaluate the relationship between craniocervical posture and skeletal malocclusion patterns in adolescents. Methods: This cross-sectional study included 80 adolescents aged 10–15 years diagnosed with skeletal Class I, Class II Division 1, Class II Division 2, or Class III malocclusion. Postural parameters—Sagittal Head Angle (SHA), Craniocervical Angle (CA), and Shoulder Angle (SA)—were assessed using standardized sagittal-plane digital photographs obtained in Natural Head Position. Skeletal classification and cephalometric measurements (SNA°, SNB°, ANB°, GoGn/SN°, and Occlusal Plane/SN°) were determined from lateral cephalometric radiographs. Intergroup comparisons were performed using the Kruskal–Wallis test, and posture–skeletal relationships were evaluated using Pearson and Spearman correlation analyses (p < 0.05). Results: No significant differences were observed in postural parameters among skeletal malocclusion classes (p > 0.05). In the overall sample, SHA showed weak negative correlations with SNA° (r = −0.284, p < 0.01) and SNB° (r = −0.381, p < 0.01), and a weak positive correlation with Occlusal Plane/SN° (r = 0.235, p < 0.05). No significant associations were identified for CA or SA. Subgroup analysis demonstrated that these associations were present exclusively in the Class II Division 2 group, where SHA showed strong negative correlations with both SNA° (r = −0.653, p < 0.01) and SNB° (r = −0.605, p < 0.01). Conclusions: Sagittal head posture may show phenotype-specific associations during adolescence, particularly in Class II Division 2 malocclusion. Incorporating postural assessment into orthodontic evaluation may enhance diagnostic understanding during growth.