Effects of Positional Plagiocephaly on Dental and Mandibular Alignment

Lisa Abernethy, MS, L/CPO, Alyssa Davis, MS;

Baylor College of Medicine – Orthotics and Prosthetics

Creation Date December 2025

Re-assessment Date July 2026

Clinical Question

Does the presence of positional plagiocephaly affect dental alignment and symmetry, and if so, does cranial remolding orthosis treatment resolve it?

Background

Cranial remolding orthoses (CROs) are used to treat and correct the head shape of infants with cranial asymmetries such as plagiocephaly.^1,2 Since the Back to Sleep campaign in 1994, head shape abnormalities such as plagiocephaly and brachycephaly have become much more prevalent.³ Some side effects of plagiocephaly and brachycephaly might include dental and facial asymmetries.^3,4

Examples of dental asymmetries are malocclusions (misaligned bite), mandibular deviation from midline, and asymmetries of the chin. Though there are a significant number of studies that have been published about CROs, very few have looked at their connection to dental malocclusions and asymmetry.

Search Strategy

All searches were performed on October 9, 2024. Web of Science was searched using search terms cross-referenced with the topic; PubMed was searched using the title and abstract; Embase was searched using the title, abstract, and keywords; OVID was searched using the MP function (title, abstract, keywords, synonyms, etc.); and EBSCO was searched using the abstract.

Databases Searched: Web of Science, PubMed, Embase, OVID, EBSCO, JPO, and CINAHL

Search Terms: {(Plagiocephaly OR brachycephaly) AND (Dental OR orthodontics OR mandible) AND (Cranial remolding orthosis OR helmet)}

Inclusion/Exclusion Criteria: The inclusion criteria were full text available, English publication available, cranial remolding orthosis as intervention, objective measurements taken and results provided relating to the mandible, and positional plagiocephaly or brachycephaly. The exclusion criteria included craniosynostosis and repositioning as the only intervention.

Synthesis of Results

A total of seven studies met the inclusion criteria, five of which included a comparative group. Three longitudinal studies with sample populations of 28, 63, and 100 (two with a nontreated control group) investigated dental effects and found DP might be associated with a higher prevalence of occlusal abnormalities in primary dentition, especially malocclusion and deviation of midline.^5–7 According to Nevaste, Sasaki, and Moon, who looked at 16, 123, and 48 DP patients, DP is associated with an asymmetric face and mandible, where mandibular deviation was associated with contralateral cranial flattening.^4,8,9

Furthermore, Moon found that mandibular asymmetry was correlated with severity of CVA. St. John did not find significant displacement of the temporomandibular joint; however, they did find auricular displacement correlated with the severity of cranial asymmetry.¹⁰

Clinical Message

In conclusion, the studies noted a pattern where the ipsilateral plagiocephaly side matched mandibular asymmetry. However, some limitations were noted. All the studies used different measurements, making it difficult to accurately compare the results. Some of the measurements used did not have any correlation with plagiocephaly, and none of the studies included before-and-after intervention comparisons. Further research is needed prior to drawing a definitive conclusion.