The relationship between vertical malocclusions and ossification changes in the cranial base and upper cervical spine

The growth and development of the maxillofacial complex share a common embryological origin with the cranial base and upper cervical spine; therefore, anomalies in these regions may be linked to variations in the skeletal pattern. This study aimed to evaluate the relationships between the morphological features of the sella turcica bridging, ponticulus posticus, posterior arch deficiency of the first cervical vertebra, known as the atlas, and the cervical vertebral maturation stages and vertical malocclusions. Randomly selected 300 pre-orthodontic treatment patients (aged 7 to 40 years) were divided into groups according to cervical stage (CS1-CS6) and type of vertical malocclusion. According to the study protocol, cephalometric analysis and evaluation of the sella turcica and atlas were performed twice by two researchers under the supervision of a radiologist. Statistical analysis was performed using SPSS 29.0. Sella turcica bridging was significantly more common in postpubertal patients (58.2%; p < 0.05). Ponticulus posticus and sella turcica bridging occurred more frequently in patients with low mandibular plane angle (43.3% and 51.1%, respectively), whereas atlas posterior arch deficiency occurred more frequently in patients with high mandibular plane angle (24.2%). However, only atlas posterior arch deficiency showed significant difference (p < 0.05). According to logistic regression, patients in the CS6 stage were less likely to have type 1 ponticulus posticus and more likely to have type 2 sella turcica bridging (p < 0.05). Patients with low angle were less likely to have atlas posterior arch deficiency (p < 0.05). Sella turcica bridging and atlas posterior arch deficiency are associated with the skeletal pattern and cervical stage. Sella turcica bridging was more prevalent during the postpubertal period, whereas atlas posterior arch deficiency was more prevalent in those with a high mandibular plane angle.