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419Craniocervical posture: cephalometric and biophotogrammetric analysis

Table 1 – Intra-examiner reliability of cephalometric and biophotogrammetric

variables

Cephalometric variables ICC Confidence interval p

CVT/EVT 0.979 0.947 – 0.992 *0.000

CVA 0.995 0.987 – 0.998

CPL 0.901 0.754 – 0.960

Biophotogrammetric variables

FE 0.976 0.941 – 0.990 *0.000

A1 0.978 0.946 – 0.991

A2 0.997 0.993 – 0.999

DC 0.974 0.936 – 0.989

CVA: craniovertebral angle related to the flexion/extension head position; CVT/EVT cervical curvature ratio;
CPL: angle related to the position of forward head posture, FE: angle related to the flexion/extension head
position, A1: angle related to the forward head posture with vertex at the seventh cervical vertebra, A2: angle
related to the forward head posture with vertex in the external acoustic meatus, DC: cervical distance.

those below 0.75 indicate poor to moderate reliability17. Table 2 - Correlation between the different craniocervical
A descriptive analysis of the demographic variables of
postures evaluated in each method
age, weight, height and BMI was performed. Additionally,
we analyzed the correlation between variables related to Biophotogrammetric variables r p
craniocervical posture measured by cephalometry and by
biophotogrammetry as well as the correlation between A1 x A2 -0.21 0.05
postural variables measured by the two methods of evaluation.
For this purpose, the Pearson´s coefficient was used ranging A1 x FE - 0.62 0.00**
from -1 (negative correlation, variables vary in opposite
direction) to 1 (positive correlation, variables vary in the A2 x FE 0.23 0.01**
same direction). The correlation was considered strong for
values of correlation coefficient (r) greater or equal than 0.7, A1 x DC -0.68 0.00**
moderate when 0.3 <r <0.7, and weak when 0 < r < 0,318.
Analysis were performed using the STATISTICA 7.1 (StatSoft A2 x DC 0.11 0.21
Inc., Tulsa, OK, USA) and SPSS 17.0 (SPSS Inc., Chicago, IL,
USA) softwares and a significance level of 5% was considered. DC x FE 0.38 0.00**

Results Cephalometric variables

CVA x CPL 0.61 0.00*

EVT/CVT x CVA 0.33 0.06

EVT/CVT x CPL 0.15 0.11

A1: angle related to the forward head posture with vertex at the seventh cervical
vertebra; A2: angle related to the forward head posture with vertex in the external
acoustic meatus; FE: angle related to the flexion/extension head position; DC:
cervical distance, measures the curvature of the cervical spine; CVA: craniovertebral
angle regarding the flexion/extension head position; CPL angle related to the
position of forward head posture; CVT/EVT: cervical curvature ratio; level of
significance: *p<0.05, **p<0.01, Pearson’s Correlation Coefficient (r).

Results of the ICC showed excellent levels of reliability Table 3 – Correlation between craniocervical variables
for all measurements in the biophotogrammetric and evaluated by cephalometry and biophotogrammetry
cephalometric analyses by the same examiner at two different
times (Table 1). Correlated variables r p
CVA x FE - 0.41 0.00*
Correlations between biophotogrammetric and CPL x A1 0.68 0.00*
cephalometric variables tested separately for each method CPL x A2 -0.11 0.14
are presented in Table 2. CVT/EVT x DC 0.07 0.52

Table 3 shows the values related to the correlation Cephalometric variables: CVA craniovertebral angle related to the flexion/extension
between the two assessment methods of craniocervical head position; CVT/EVT cervical curvature ratio; CPL: angle related to the forward
posture. It was observed a moderate and significant agreement head posture. Biophotogrammetric variables: FE: angle related to the flexion/
(p=0.00) between the craniocervical postural variables that extension head position, A1: angle related to the forward head posture with vertex
measured the head flexion-extension position (CVA and FE) at the seventh cervical vertebra, A2: angle related to the forward head posture with
and the forward head posture (CPL and A1). vertex in the external acoustic meatus, DC: cervical distance, measures the
cervical spine curvature; level of significance: *p<0.05, **p<0.01, Pearson’s
Discussion Correlation Coefficient. (r).

The computerized biophotogrammetry is considered a angles, in both biophotogrammetric and cephalometric
reliable and reproducible method being an important tool in analyses obtained in the present study.
the evaluation of body posture3,19. High values of ICC for
the craniocervical postural variables measured by means of Recent studies have used cephalometry as a tool for
the manual cephalometric tracing have been demonstrated20, analyzing the alignment of the head and cervical spine in
corroborating the excellent levels of reliability for all drawing individuals with and without temporomandibular disorder,
considering the hypothesis of a possible association between

Braz J Oral Sci. 11(3):416-421