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

<b>Objective:</b> This study aimed to evaluate the relationship between craniocervical posture and skeletal malocclusion patterns in adolescents. <b>Methods:</b> 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 (<i>p</i> < 0.05). <b>Results:</b> No significant differences were observed in postural parameters among skeletal malocclusion classes (<i>p</i> > 0.05). In the overall sample, SHA showed weak negative correlations with SNA° (r = -0.284, <i>p</i> < 0.01) and SNB° (r = -0.381, <i>p</i> < 0.01), and a weak positive correlation with Occlusal Plane/SN° (r = 0.235, <i>p</i> < 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, <i>p</i> < 0.01) and SNB° (r = -0.605, <i>p</i> < 0.01). <b>Conclusions:</b> 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.