Smart devices, head posture, and malocclusion: is there a relationship? A prospective controlled study.

BACKGROUND: Considering the widespread and growing use of smart devices, this study aimed to investigate the association between smart device use and malocclusion, potentially mediated by changes in head posture. METHODS: Dental patients scheduled to undergo lateral cephalograms at a university dental hospital and who met the inclusion criteria were invited to participate. A questionnaire was completed to collect baseline demographics (age, gender, and parental education) and assess the severity of smart device use (MPPUS-10). Craniocervical and craniofacial measurements, hyoid bone position, and malocclusion characteristics were assessed using lateral cephalometric analysis. RESULTS: A total of 97 patients (aged 9 to 20 years) completed the questionnaire. Patients with moderate smart device use (n = 50) were excluded, and only mild users (G1 = 23) and severe users (G2 = 24) were included in the final analysis. The orientation of the maxilla relative to the vertical axis was significantly more clockwise in G2 (P = 0.013). Skeletal pattern assessment using ANB and Wits analyses showed that G1 had significantly more Class I skeletal patterns, while G2 had a higher prevalence of Class III patterns. Although severe users demonstrated more forward bending of the cervical column with smaller craniocervical angles, these differences were not statistically significant. CONCLUSION: This study suggests an association between severe smart device use and a higher prevalence of Class III malocclusion. Further research is needed to explore the relationship between smart device use, head posture, and craniofacial development.