Journal of Oral Rehabilitation 2006 33; 423–429
Deviation from the Broadrick occlusal curve following
posterior tooth loss
H. L. CRADDOCK*, C. C. YOUNGSON† & M. MANOGUE‡
Dental Institute, Leeds, UK, Professor in Restorative Dentistry, Liverpool Dental School, Liverpool, UK and ‡Senior Lecturer, Leeds Dental
†
Institute, Leeds, UK
SUMMARY Production of an appropriate occlusal
curve for dentitions which have become deranged
because of tooth loss, overeruption, tipping and
drifting can present challenges for the dental tech-
nician. An earlier paper (J Oral Rehabil, 2005 32:
895–900.) demonstrates that the use of the Broadrick
flag method for producing the occlusal curve is
relatively accurate for most intact arches. This study
demonstrates that when a posterior tooth has
remained unopposed for 5 years or more positional
changes, which cause deviation from the Broadrick
curve, occur. The extent of the deviation may be
Introduction
Patterns of dental disease have changed dramatically
over the last quarter of a century, with most patients
keeping at least a partial dentition for their entire lives.
The increasing incidence of tooth wear, together with
changes following tooth loss, may mean that the
patient’s natural occlusal curve is not evident. Indeed
following a deranged occlusal curve, while carrying out
occlusal reconstruction, may result in occlusal interfer-
ences that could lead to destruction of restorations and
tooth tissue. Derangement of the occlusal curve
because of tooth positional changes after loss of a
posterior tooth have not been quantified in the litera-
ture and this investigation aims to determine the extent
of deviation from an ‘ideal’ curve for a sample of
partially dentate patients.
Review of the Literature
Over the last one and a half centuries, authors have
attempted to explain the geometry of the occlusal curve
ª 2006 Blackwell Publishing Ltd
*Lecturer in Restorative Dentistry, Leeds
extreme, potentially leading to difficulties in restor-
ing a harmonious occlusal scheme. This study also
demonstrates that the Broadrick curve may provide
an accurate reproduction of the occlusal curve, even
when the tooth forming the posterior determinant
of the curve is tipped. A moderate degree of tipping
of this tooth has little effect on the radius of the
Broadrick curve.
KEYWORDS: Broadrick occlusal curve, posterior tooth
loss
Accepted for publication 24 September 2005
by reference to various anatomical landmarks. Ferdi-
nand Graf Spee (1), originally described the form of the
occlusal curve, and postulated its anatomical determi-
nants in 1890. He postulated that the occlusal curve
forms part of a circle or ‘cylinder’, the axis of which is
formed by the crista lachrymalis posterior and the
horizontal midorbital plane (Fig. 1). Since then, the
relevance and development of the curve of Spee has
been studied by a number of authors. Page (2) presen-
ted evidence that the occlusal curve originates from a
combination of hinge axes controls and the mandibular
angle, and that it is distinct from the curve of Spee with
its theoretical distal extension to the head of the
condyle. The occlusal curve demonstrated by Page ends
at the most posterior cusp of the most posterior tooth,
whereas the curve of Spee is postulated to extend to the
anterior surface of the condylar head. A further
complication in this discussion is the occlusal plane,
whose definition is ‘the plane established by the
occluding surfaces of premolars and molars (3)’. This
is a trapezoidal surface extending from the distal cusps
of the most distal lower teeth to the tips of the canines,
doi: 10.1111/j.1365-2842.2005.01587.x
424 H . L . C R A D D O C K et al.
Fig. 1. Determination of the curve of Spee.
and is obviously curved in many cases. This is in conflict
with the true definition of a plane, which must be flat,
and brings into question the use of terminology
currently in use.
Ferrario et al. (4) compared what they described as
the ‘curve of Spee’ (which was in fact the occlusal
curve) on male and female groups of human subjects.
They determined that there was a difference in the
curves between the sexes and that there was a differ-
ence in the curves on each side of the arch. The male
curves were larger than female and the left side was
larger than the right in both groups. These researchers
used computer graphics plotted onto images of patient
study models to determine and measure the curves.
Therefore as there was no distal extension of the curve
to the head of the condyle, they were in actual fact
plotting the occlusal curve.
Orthlieb (5) used cephalometric images to study the
relationship of the curve of Spee to the axial
angulations of the posterior teeth. He concluded that
the mandibular incisors followed the tangent law. He
noted, however, that the posterior mandibular teeth
exhibited a progressive differential angle with the
direction of the tangent. This investigation was able
to determine the true curve of Spee, extending to the
condylar head, using radiographic tracings. A large
sample group of (470) subjects was studied. As well
as mathematically defining the differential angulation
of the posterior teeth (Fig. 2), the study also found
significant differences in the curve, relative to the
degree of overbite, and the skeletal classification. This
study shows that the development of the curve of
Spee is likely to be multi-factorial, and that the curve
ª 2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 423–429
Fig. 2. Progressive differential angle, mean angle between ideal
tangential direction and long axis of different posterior mandib-
ular teeth.
is likely to vary significantly between individuals.
Closure of proximal contacts and mesial drift was
felt by Orthlieb to be attributable to the forces
generated by this progressive angulation of the curve
of Spee.
Both of the above studies demonstrate that the
original ‘Tangent Law’ for the determination of the
angulation of the mandibular posterior teeth to be
invalid, and that significant variation can occur both
between individuals, and between each side in any
given subject. It follows that if we are to measure
deviations of an individual tooth from the occlusal
curve, we must be able to accurately determine the
curve for that particular dental quadrant in our speci-
fied subject.
Looking at the occlusal curve and its role in occlusal
rehabilitation and reconstruction, Weinberg (6) advo-
cated maintaining the patients natural occlusal plane,
arguing that optimum transmission of occlusal forces
are most likely if this is followed. He argued that if an
inappropriate curve were created, the crown root ratio
would be altered, together with the torquing forces
transmitted.
Following extensive tooth loss, the patients’ occlu-
sal plane may become distorted because of tipping,
drifting and overeruption and prosthodontic restor-
ation may be complicated by these changes. Lynch
and McConnell (3) considered this problem, and
suggested the use of a ‘Broadrick flag’, in order to
reproduce the ideal curve of Spee for an individual,
utilising Graf Spee’s original principles. They utilized
dental landmarks to create the curve, and introduced
modifications for different skeletal patterns. Although
this method did not allow for the incremental nature
of the occlusal curve described by Orthleib, it may
 THE BROADRICK CURVE AFTER POSTERIOR TOOTH LOSS
provide useful guidance in clinical restorative proce-
dures.
Aim of the study
To compare the deviation of the clinical occlusal curve
with a theoretical ideal, for patients with and without
the presence of an unopposed posterior tooth.
Method
Samples tested
Following consultation with a statistician, a sample size
calculation showed an adequate sample size for this
study would be 90 subjects and 90 controls. This was
calculated to detect a difference of 0Æ5 mm, at 90%
power. Two hundred adult patients were examined and
had study models made of their upper and lower
dentitions. These models were later scanned and
recorded as digital images.
Selection criteria
Local Ethical Committee approval was gained. Patients
from Leeds Dental Institute, with one to three adjacent
unopposed posterior teeth were invited to take part in
the study. For the purposes of this study ‘posterior’ is
defined as an upper or lower first or second premolar,
or first, second or third molar. The control group had
intact dentitions, without unopposed teeth.
Adult patients of 18 years or above were recruited. As
documentary evidence of when the missing teeth were
lost was unavailable, subjects in the test group had
documented evidence that the missing teeth had been
absent for 5 years or more. There was no specified
upper age limit. Written informed consent was obtained
from all subjects following a written and verbal
explanation of the purpose of the study and methods
to be used in the investigations.
Exclusion criteria
Unless documentary evidence was available showing
that the missing tooth/teeth had been lost for a
minimum of 5 years, patients were excluded from the
study. Teeth that were prevented from independent
movement, by involvement in support or retention for
fixed or movable prostheses were also excluded.
ª 2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 423–429
425
Sources of subjects
One hundred consecutive patients with one or more
unopposed posterior teeth were invited to take part in the
study. One hundred age and sex matched subjects, with
matching interdental bone height at the sites examined
were recruited as controls. The age for each subject was
matched
2 years with a control of the same sex. Bone
height was determined by measuring from the ameloc-
emental junction on bitewing or periapical radiographs
taken using paralleling techniques. Matching was to
within 1 mm of that of the subjects under investigation.
The sample consisted of 50 female and 50 male patients.
Measurement of deviation from the Broadrick occlusal curve
Alginate impressions were taken of the upper and lower
dentition. After casting in dental stone, the study
models were trimmed in a seven-sided configuration,
so that the buccal plane would lie parallel to the
scanner * surface when the models were placed on it.
The models were then scanned on a Black Widow 3696
USB scanner at a resolution of 350 DPI. For the subject
group only the side with tooth loss was scanned. The
same side was scanned for the control.
Using the Broadrick flag method described by Lynch
and McConnell (3), the ideal occlusal plane was created
using the scanned models. The anterior determinant
was the mid point on the distal slope of the lower canine
tooth, and the posterior determinant was the mid point
on the distal slope of the disto-buccal cusp of the lower
second molar. These points were used as the centre of
circles from which arcs were drawn (Fig. 3). In class 1
incisal relationships, an arc of 4-inch radius was drawn
from the centre of the distal slope of the incisal edge of
the lower canine. The same size arc was also drawn
from the tip of the distal cusp of the lower second molar
tooth. The intercept of these arcs was used to determine
the centre of a circle, which was drawn to lie against the
points on the lower canine and second molar already
described. For class 2 incisal relationships the initial arc
diameter was 3Æ75 inches, and class 3 relationships a
5-inch arc was used. The degree of overjet measured on
the study models was used to determine the incisal
classification. The distance of the furthest cusp tip from
the Broadrick curve was measured along the long axis of
the tooth for each individual. Where the deviation was
*Devcom Ltd, Sterling, UK.
426 H . L . C R A D D O C K et al.
Fig. 3. Creation of Broadrick curve where tipping has occurred.
Fig. 4. Direction of deflection from the Broadrick curve.
outside the existing curve a positive notation was given,
if the deviation was inside the curve a negative notation
was given. Where no deviation was detected a value of
zero was awarded. This is demonstrated in Fig. 4. This
procedure was carried out for both unopposed subjects
and control patients.
Statistical analysis
Paired t-tests were used to compare the findings
between subjects and controls. Significance was
assessed at the 0Æ05 level. Bland Altman plots were
used to determine examiner reliability.
Examination of the effect of tipping of the posterior
determinant tooth on the radius of the Broadrick Curve
Following the determination of the extent of tipping of
molar teeth distal to the site of tooth loss, it was decided
ª 2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 423–429
Fig. 5. Effect of tipping on radius of Broadrick curve.
that it would be appropriate to investigate the effect
that the mesial movement of the tipped tooth had on
the radius of the Broadrick curve.
Using a model of an intact lower arch, with a class 1
occlusion, the outline of the lower buccal teeth were
traced digitally (Fig. 5). The first permanent molar was
erased from the drawing and a Broadrick curve was
created using the mid-point on the distal slope of the
canine as the anterior determinant and the mid point on
the distal slope of the disto-buccal cusp of the second
molar as the posterior determinant (Tooth shown in
red). Using these canine and molar reference points, a
compass with a circle radius (red line) determined by the
incisal relationship was placed on each point, and
intersecting arcs drawn (Red arcs). Using the intersec-
tion of these arcs as the circle centre, an arc was drawn
from the canine tip, along the occlusal plane to deter-
mine the Broadrick occlusal curve (again shown in red).
The second molar tooth (green tooth) was then
tipped, about a fulcrum 1/3 of the root length from the
apex, mesially on its long axis by 18
. The mean tip of
the tooth was determined by measuring the tip of 76
molar teeth distal to extraction sites). The fulcrum of tip
 THE BROADRICK CURVE AFTER POSTERIOR TOOTH LOSS 427

was placed 1/3 of the root length from the apex. The Table 2. Deviation from the Broadrick curve when upper teeth
Broadrick curve was then re-drawn (in red) as des- are unopposed

cribed above, and the maximum difference between the

Group Mean (mm) Standard deviation Range (mm)
two radii measured. This is illustrated in Fig. 5.
Subjects 2Æ20 1Æ69 0–8Æ26
Controls 0Æ12 0Æ87 )1Æ65–2Æ5
Results
Table 3. Deviation from the Broadrick curve when lower teeth
Sample
are unopposed
The age range of the matched groups was 20–79 years.
The mean age was 50Æ26 years, with a standard devi- Group Mean (mm) Standard deviation Range (mm)
ation of 13Æ05. Subjects 0Æ47 1Æ79 )1Æ99–4Æ55
Controls )0Æ06 0Æ70 )1Æ69–1Æ30

Deviation from the Broadrick curve

Figure 6 demonstrates that for the group with miss-
Deviation from the Broadrick curve was found to be
ing posterior teeth 77% had a tooth or teeth deviated
marked in subjects who had unopposed posterior teeth,
more than 1 mm from the Broadrick curve, while only
while fairly minimal in the control group (Table 1).
14% of the control group had a deflection of this
Mean of difference between subject and control magnitude. 26% of the subject group had deviated in
groups ¼ 175 (standard deviation ¼ 193Þ excess of 2 mm, with none of the controls with this
extent of deflection.
95% confidence interval of the difference is When comparing the deviation, in the upper and
 222 to  128 lower arches, it was found that arches with unopposed
The results show that there is a statistically significant upper teeth are associated with a significant deflection
difference in the deviation from the Broadrick curve from the Broadrick occlusal curve (Tables 2 and 3).
between patients who have lost posterior teeth and the Mean of difference between upper arch subject and
control group.
control groups 208 (standard deviation ¼ 196Þ
Table 1. Deviation from Broadrick occlusal curve
95% confidence interval of the difference is 155--260
Group Mean (mm) Standard deviation Range (mm) Mean of difference between lower arch subject and
Subjects 1Æ98 1Æ87 )1Æ99–8Æ26 control groups 053 (standard deviation ¼ 169Þ
Controls 0Æ23 0Æ76 )1Æ69–2Æ5
95% confidence interval of the difference is
 027 to 132
Deviation from the Broadrick curve
60
Unopposed lower teeth are not associated with a
50 50 51 significant deflection from the Broadrick occlusal curve.
Number of subjects

40
subjects

30 controls Change in the Broadrick curve following tipping

27

20 The difference in radii of the occlusal curves drawn

13 14 before and after the tooth distal to the extraction site
10 9 10
6 4 6 5 had hypothetically tipped was 0Æ57 mm.
0 0 0
20 10 10 10
0
'-0.2 to '-1.01

'-1.01to0

0.01to1

1.01to2

2.01to3

3.01to4

4.01to5

5.01to6

6.01to7

7.01to8

8.01to9

Examiner reliability

When a single examiner is used, it is important

Extent of deviation in mm
to determine intra-examiner reliability. 10% of the
Fig. 6. Extent of deviation from the Broadrick occlusal curve. subject and control models were re-examined in order

ª 2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 423–429

428 H . L . C R A D D O C K et al.
Bland altman plot of deviation
from ideal curve
0.18
0.16
Difference in measurements
0.14
0.12
0.10
0.08
0.06
0.04
0.02
0.00
–0.02
–0.04
–0.06
–0.08
–1.5 –1.0 –0.5 0.0 0.5 1.0
Mean of measurement
Fig. 7. Bland Altman plot of examiner agreement.
to draw up a Bland Altman plot. The difference between
the initial and repeated measurements were plotted
against the mean of the two. Reliability is demonstrated
by at least 95% of the plots lying within two standard
deviations of the mean of the measurement differences.
Figure 7 shows the Bland Altman plot obtained, dem-
onstrating good inter-examiner reliability.
Discussion
The subject and control groups were age and sex
matched and were found to be of a comparable age
range to patients having lost posterior teeth in previous
studies on adult tooth loss (7). Obviously, a population
of this age group are likely to have experienced some
restoration in the arches under investigation, and it is
recognized that this could have had an effect on the
results obtained. It would have been virtually imposs-
ible to find totally unrestored arches, with one or more
missing teeth, to use in this study.
This method of model measurement has previously
been described by Craddock and Youngson (8), and has
been found to be reliable. The use of widely available
equipment and ‘user friendly’ software for model
measurement mean this method could have a wide
range of applications in dental research.
The Broadrick Flag technique (3) was designed as an
instrument to provide a guide to the location of the
centre of the Curve of Spee, from which a curve could
be created to facilitate the restoration of a posterior
quadrant. The Broadrick curve is used in this investi-
gation as a hypothetical ideal curve for each individual
patient, from which the deviation of individual teeth
can be measured. Craddock et al. (9) found that the
occlusal curve produced by the Broadrick flag method
closely approximated the natural occlusal curve.
When assessing the deviation from the Broadrick
curve, it is important to appreciate exactly what is being
measured. The investigation centred around determin-
ing whether patients with missing posterior teeth were
more likely to have one or more teeth, which deviated
significantly from the ideal Broadrick curve, relative to
the control group with intact arches. The only meas-
urement recorded for each individual was the maximum
deviation from the Broadrick Curve for an individual
1.5 2.0 tooth, and that therefore it is likely that the majority of
teeth along the curve are likely to be a closer fit.
Deviation for an individual tooth may be caused by
several factors, including tooth fracture, tooth wear,
poorly contoured restorations, tooth tipping and drift-
ing and failure of complete eruption, and may not be
representative of the fit of the curve for the remainder
of the quadrant.
Deviation from the curve could be because of
overeruption (8, 10), or tipping of teeth adjacent to
the site of tooth loss (11, 12). Undesirable effects of
tooth movement or malposition may include non-axial
tooth loading, complicated paths of insertion for resto-
rations, the presence of functional occlusal interfer-
ences and non-ideal tooth preparation for restorations.
All of these factors may have adverse effects on the
occlusion, the periodontium and the vital pulp. It was
beyond the remit of this study to assess the relationship
between the deviation in the Broadrick curve and the
presence of occlusal interferences. The occlusal factors
affecting the presence of an interference are complex
and multi-factorial, and lend themselves to a further
ongoing investigation by the same authors using
statistical modelling to explain this complex area of
study.
The aims of restorative treatment for those patients
with unopposed posterior teeth include the restoration
of occlusal and dental form, the restoration of function
and the maintenance and restoration of aesthetics. The
existence of a scientifically evaluated tool, which
restores the occlusal form for an individual, allows the
restorative team to make evidence-based decisions
when designing and restoring occlusal schemes.
The extent by which individual teeth deviate from
the Broadrick curve following posterior tooth loss is
statistically significant. What is more important is
whether these findings are of clinical significance.
Although the mean difference between the subject
ª 2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 423–429
 THE BROADRICK CURVE AFTER POSTERIOR TOOTH LOSS
and control groups was only in the order of 1Æ8 mm,
when the range of deviations was examined, some
teeth in the tooth loss group had large deviations
(maximum 8Æ26 mm), which would be of even greater
clinical significance. The results demonstrated that 26%
of subjects with posterior tooth loss had a deviation
from the Broadrick plane of 2 mm or more, and in
terms of restoring normal occlusal form and contact,
this is not without difficulty. To truly restore normal
function, in terms of tooth loading, orthodontic up-
righting of many tilted posterior teeth may be indicated
(13).
The degree of deviation from the Broadrick plane is
most significant both clinically and statistically when
upper teeth remain unopposed, in other words follow-
ing lower tooth loss. This is likely to be because of
overeruption of the unopposed teeth, and tilting of the
teeth adjacent to the extraction site. Although there is
no significant difference in the mean deviations for
subjects with missing upper posterior teeth, the results
showing extreme deflections of up to 4Æ55 mm are
likely to be of clinical significance when restoring
posterior occlusal form and function for these patients.
Another part of a more extensive study by the same
authors into tipping of teeth adjacent to the extraction
site determined that teeth distal to the extraction site
are likely to tip mesially following loss of their mesial
interdental contact. The mean tip was 18
. The forward
component of tipping would inevitably move the
posterior determinant mesially, thereby decreasing the
radius of the Broadrick curve. The models were not
assessed for open contacts distal to the tipped teeth as
the majority of these teeth were second molars and
were therefore the last standing tooth in the arch.
Mesial drift may compensate for loss of contact because
of both tipping and drifting, and therefore the presence
of space may not be a reliable indicator of tooth
movement in relation to the tooth distal to the
extraction site.
In order to determine how much effect this move-
ment had on the curve produced, a simple geometric
exercise was carried out, the results of which can be
seen graphically in Fig. 5. Accurate measurement of the
difference in the curve, at a point approximately half
way between the teeth bounding the extraction site,
reveals a change of <0Æ6 mm. This finding somewhat
validates the usefulness of this method for clinical use
when restoring some discrepancies in the occlusal
curve.
ª 2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 423–429
429
Conclusions
1. Following posterior tooth loss, there are both
statistically and clinically significant deviation of indi-
vidual teeth from the Broadrick occlusal curve.
2. Loss of a lower posterior tooth is likely to result in a
greater degree of deviation from the curve than loss of
an upper tooth, however, the extremes found in both
upper and lower arches may be of clinical significance.
3. Tipping of the posterior determinant tooth of the
Broadrick curve has little effect on the size of the radius
of the curve.
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Correspondence: H. L. Craddock, Room 6129, Leeds Dental Institute,
Clarendon Way, Leeds LS2 9L, UK.
E-mail: h.l.craddock@leeds.ac.uk