The curve of Spee revisited

Stanley Braun, DDS, MME, ~ William P. Hnat, PhD, b and Baxter E. Johnson, DDS, MS

Indianapolis, Ind., and Louisville, Ky.

Through the use of a sophisticated measuring device and support computer technology, accurate arch circumferences were determined for 27 casts that exhibited moderate to severe curves of Spee. Arch circumference differences were subsequently obtained by comparing the measured arch length to a planar projection formed by the center of the incisal tips anteriorly and the distobuccal cusp tips of the second molars distally. A general relationship has been derived for the arch circumference differential, resulting from the elimination of the curve of Spee, versus the severity of the curve. The arch circumference reduction is considerably less than that found by earlier investigators, implying that the incisor protrusion often associated with leveling the curve of Spee is not primarily due to the aforementioned differential, but rather more directly due to the mechanics used in leveling the curve of Spee. (Am J Orthod Dentofac Orthop 1996;110:206-10.)

A significant curve of Spee is often evident in malocclusions with deep overbites. This curve is frequently leveled as part of overbite reduction. Clinicians have b e e n concerned for some time with the degree of reduction in arch circumference that accompanies leveling, for this is believed to lead to incisor protrusion) In recognition of this, Tweed and others employed Class I I I elastics in conjunction with second order tip-back bends to prevent incisor flaring during overbite correction. 2 One popular rule of thumb for estimating the resulting loss of arch circumference is that 1 m m of arch circumference is needed for each millimeter of curve of Spee depth present. .3 Baldridge 4 and Garcia 5 found the ratio to be more accurately expressed by the formulas Y = 0.488 X - 0.51 and Y = 0.657 X + 1.34, respectively, where Y is the arch length differential in millimeters and X is the sum of right and left side maximum depths of the curve of Spee in millimeters. In a mathematical model, G e r m a n e et al. 6 determined the relationship to be nonlinear, and the arch circumference differential less than a one-to-one ratio for curves of Spee having a depth of 9 m m or less. Woods 7 showed that incisor flaring may be primarily related to the mechanics of leveling the curve of Spee, not necessarily due to the differential in arch circumference. H e stated that the reduction of the curve may be achieved through
aClinical Professor. bAssociate Professor, Mechanical Engineering, J. B. Speed Scientific School, University of Louisville. CChairman, Department of Orthodontic, Pediatric and Geriatric Dentistry, School of Dentistry, University of Louisville. Reprint requests to: Dr. Stanley Braun, 7940 Dean Rd., Indianapolis, IN 46240. Copyright 1996 by the American Association of Orthodontists. 0889-5406/96/$5.00 + 0 8/1/59986 *The depth is taken as the sum of the right and left side measured to the deepest portion of the curve of Spee from a flat plane.

anterior teeth intrusion and/or tip-back mechanics without flaring the incisors. This investigation was undertaken to determine more precisely the arch circumference difference by using highly accurate m o d e r n measuring technology. Previous methods of investigating the relationship to a flat plane involved a significant degree of m e a s u r e m e n t error, as well as inaccurate assumptions that the curve of Spee is part of an arc of a circle, and the arch form may be expressed by the Bonwill-Hawley arch form or by a catenary
curve.t

MATERIALS AND METHODS

Twenty-seven mandibular casts of untreated patients were selected from the Orthodontic Clinic at the University of Louisville School of Dentistry. Each of the casts had fully developed dentitions without absent teeth, except for the third molars. Casts exhibiting occlusal attrition or ectopically erupted teeth were not included. The severity of the curves of Spee was recorded by summing the right and left side maximum depths from a flat plane formed by the tips of the mandibular incisors anteriorly and the distal cusp tips of the second molars posteriorly. Each cast was oriented in a Brown and Sharp Micro VaI Coordinate measuring machine (Brown & Shays Manufacturing Co., North Kingston, R.I.) as seen in Fig. 1. This device is used extensively in the precision machine tool industry. The unit's frictionless air-bearing probe resolves the coordinates of a point in space in each of the three orthogonal axes to 0201 mm. Linear accuracy is 0.006 mm and repeatability is 0.004 ram. The casts were each secured to a fixed plane, and the touch trigger probe used to identify each measurement point, recordt A catenary curve is described as the curve assumed by a linked wire freely suspended at its end points. This curve does not resemble a curve of Spee nor a dental arch form as shown by Garcia. 5

206

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Braun, Hnat, and Johnson 207

Fig. 1. Brown and Sharp Precision Coordinate measuring machine (2 photographs).

ing the corresponding XYZ coordinates automatically in a computer readout. Measurements were taken at each cusp tip from the distobuccal cusp tip of the second molar proceeding around the arch, recording each successive cusp tip coordinates of the first molars, premolars, and canines. The center point of each incisal edge was recorded for each of the incisors. The complete arch form in threedimensional space for each of the 27 casts were recorded in this manner. A repeatability study using one cast was conducted to evaluate the variation of the measurements. The results revealed the mean deviation to be less than 0.5%. The mathematical relationship of the above recorded coordinates to a flat plane determined by the incisal edges anteriorly and the distobuccal cusp tips of the second molars posteriorly was derived by using the XYZ coordinates to calculate the total arch circumference. The distance between any two points A(xa, ya, zl) and

B(x2, Y2, z2) in space is the magnitude of the vector connecting them and given by IA BI = N/(xz - x02 + (Y2 - Yl)2 + (z2 - Zl)2 Each tooth coordinate measurement represents a point in space. The total arch circumference is the magnitude of the summation of all the vectors connecting these points.
n-1

CT =

~/(xi -- xj)2 + (Yi -- yj)2 + (z i _ zj)2

i=l j=i+l

C T represents the total arch circumference in threedimensional space and n is the number of teeth measured. The planar projection of the total arch circumference is calculated using a similar method except the depth coordinate z, i.e., depth of Spee, is excluded.

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Braun, Hnat, and Johnson

Amegcan Journal of Orthodontics and Dentofacial Orthopedics August 1996

Z'
....

Total a r c h c i r c u m f e r e n c e Planar projection of total a r c h c i r c u m f e r e n c e

Fig. 2. Two-dimensional schematic of total arch circumference related to planar projection.

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Fig. 3. Graph of arch circumference differential versus curve of Spee depth.

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(Yi - yj)2

Cprepresents the planar project of the total arch circumference. The difference between total arch circumference and the planar projection of the total arch circumference is illustrated in two-dimensional space in Fig. 2. The fiat plate arch circumference differential is the difference between C T and Cp.
RESULTS The arch circumference along the actual curve of Spee and arch form of each cast minus the flat plane projection for each cast is plotted against the curve of Spee depth in Fig. 3. The regression equation derived from these data is Y = 0.2462 X - 0.1723, where Y is the arch circumference differential in millimeters and X the sum of the right and left side maximum depths of the curve of Spee in millimeters. The correlation coefficient is 0.918. DISCUSSION AND CONCLUSIONS Fig. 4, a graph of the findings obtained in this study, as well as those of earlier investigators, illustrates that the arch circumference loss related

to leveling the curve of Spee is not as an important factor in causing incisor flaring as previously thought. For example, with a severe curve of Spee whose total depth is 9 mm, the total arch circumference loss is 2.04 m m [ Y = 0.2462 ( 9 ) 0.1723 = 2.04 mm]. This is 52.6% of the closest value suggested by any earlier investigator. If in this severe curve of Spee, the 2.04 m m arch circumference is added to the arch distance anterior to the canines, as in Fig. 5, the incisal edges of the central incisors are advanced 0.78 mm, which corresponds to tipping a typical mandibular incisor 3.2. ~ This is less incisor tipping than is frequently seen after arch leveling with continuous arch wires containing reverse curves of Spee. Excessive incisor tipping results from intrusive forces at the incisor brackets that create tipping moments on each incisor as seen in Fig. 6. Since the arch wire engages adjacent brackets 'around the arch, the incisor crowns are insufficiently constrained from tipping forward in response to the tipping moments, even though the arch wire may be tied or cinched back. In addition, the posterior teeth are elevated, which may be undesirable unless sufficient compensatory skeletal growth occurs.

American Journal of Orthodontics and Dentofacial Orthopedics Volume 110, No. 2

10

Braun, Hnat, and Johnson

209

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Fig. 4. Comparison graph of all investigative studies.

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Fig. 6. Leveling by use of c o n t i n u o u s arch mechanics.

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Braun, Hnat, and Johnson

American Journal of Orthodontics and Dentofacial Orthopedics August 1996

Eruptive Force M Intrusive Force

.....- . , . . . . ~ . . . ~ A ~ v a t i o n

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Fig. 7. Leveling mechanics and force system for incisor intrusion. M

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Alternatively, the curve of Spee may be leveled by incisor intrusion without tipping. This is achieved by controlling the magnitude of the intrusive force on the incisors to be approximately 15 gm per tooth to avoid root foreshortening. 9-1 The intrusive force should pass through the center of resistance of the incisors to avoid any tipping moments, as in Fig. 7.11 Anecdotal evidence suggests that the corresponding eruptive forces at the buccal teeth should not exceed 100 gm so as not to overcome occlusal forces and result in eruption? Although it does not occur frequently, a treatment objective may require intruding six anterior teeth to level the curve of Spee. Each canine requires an intrusive force of approximately 50 gm to obtain true intrusion. Since intrusion of all six anterior teeth would exceed 100 gm (4 [15 gm] + 2 [50 gm]), the canines should be intruded separately. 9 If a treatment objective requires leveling the curve of Spee by posterior eruption, one may use the segmented system illustrated in Fig. 8, where a passive wire is contoured to fit the brackets from canine to canine. An indentation in the gingival direction is contoured into this wire. This indentation corresponds to the location of the center of resistance of the six anterior teeth. The active posterior eruptive spring extends bilaterally from

the auxiliary tubes of the first molars and is activated to produce a force in excess of 100 gm to overcome the forces of occlusion. The anterior teeth will not flare while the posterior teeth erupt, leveling the curve of Spee. Thus the curve of Spee may in fact be leveled without excessive flaring of the incisors by using appropriate biomechanics to achieve predetermined treatment objectives.
REFERENCES

1. Proffit WR, Epker BN. Treatment planning for dentofacial deformities. In: Bell W, Proffit R, eds. Surgical corrections of dentofacial deformities. Philadelphia: WB Saunders, 1980:167. 2. Tweed CH. A philosophy of orthodontic treatment. Am J Orthod i945;31:74-113. 3. Proffit WR, Ackerman J. Diagnosis and treatment planning in orthodontics. In: Graber TM, ed. Orthodontics: current principals and techniques. St Louis: CV Mosby, 1986:64. 4. Baldridge DW. Leveling the curve of Spee: its effect on mandibular arch lengths. J Pract Orthod 1969;3:26-41. 5. Garcia R. Leveling the curve of Spee: a new prediction formula. J Tweed Foun d 1985;13:65-72. 6. Germane N, Staggers JA, Rubinstein L, Revere JT. Arch length considerations due to the curve of Spee: a mathematical model. Am J Orthod Dentofac Orthop 1992;102:251-5. 7. Woods M. A reassessment of space requirements for lower arch leveling. J Clin Orthod 1986;20:770-8. 8. Ash MM. Wheeler's dental anatomy, physiology and occlusion. Philadelphia: WB Saunders, 1993:151. 9. Burstone CJ. Deep overbite correction by intrusion. Am J Orthod 1977;72(1):122. 10. Dellinger EL. A histologic and cephalometric investigation of premolar intrusion in the Macaca speciosa monkey. Am J Orthod 1967;53:325-55. l i . Marcotte MR. Biomechanics in orthodontics. Philadelphia: BC Decker, 1990: 164-5.