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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

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. A repeatability study using one cast was conducted to evaluate the variation of the measurements. No. ya.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.xj)2 + (Yi -. and canines..x02 + (Y2 . The results revealed the mean deviation to be less than 0. zl) and B(x2. The distance between any two points A(xa. z2) in space is the magnitude of the vector connecting them and given by IA BI = N/(xz . The planar projection of the total arch circumference is calculated using a similar method except the depth coordinate z. depth of Spee. 2 Braun. is excluded.e. Hnat. The total arch circumference is the magnitude of the summation of all the vectors connecting these points.Yl)2 + (z2 . n-1 CT = • ~/(xi -. recording each successive cusp tip coordinates of the first molars. The center point of each incisal edge was recorded for each of the incisors. . ing the corresponding XYZ coordinates automatically in a computer readout. Y2.Zl)2 Each tooth coordinate measurement represents a point in space. Brown and Sharp Precision Coordinate measuring machine (2 photographs). 1. i. The complete arch form in threedimensional space for each of the 27 casts were recorded in this manner.American Journal of Orthodontics and Dentofacial Orthopedics Volume 110. and Johnson 207 Fig. Measurements were taken at each cusp tip from the distobuccal cusp tip of the second molar proceeding around the arch.5%. premolars.

as in Fig. which may be undesirable unless sufficient compensatory skeletal growth occurs. 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. 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.0 <~ ~: 1.78 mm. In addition..5 • • J • t~ _~g 1.2°. the total arch circumference loss is 2. I ~ 4 5 6 7 8 Curve of Spee Depth (mm) I 9 Fig. DISCUSSION AND CONCLUSIONS Fig.1723 I t . This is 52.. The correlation coefficient is 0.5 g 2.1723 = 2. The fiat plate arch circumference differential is the difference between C T and Cp.2462-0.yj)2 Cprepresents the planar project of the total arch circumference. Excessive incisor tipping results from intrusive forces at the incisor brackets that create tipping moments on each incisor as seen in Fig. with a severe curve of Spee whose total depth is 9 mm. 2. 4. 2. the incisor crowns are insufficiently constrained from tipping forward in response to the tipping moments..2462 ( 9 ) 0. If in this severe curve of Spee. the incisal edges of the central incisors are advanced 0. the posterior teeth are elevated.0. Since the arch wire engages adjacent brackets 'around the arch. the 2. Hnat. a graph of the findings obtained in this study. The difference between total arch circumference and the planar projection of the total arch circumference is illustrated in two-dimensional space in Fig.208 Braun. 2. even though the arch wire may be tied or cinched back...6% of the closest value suggested by any earlier investigator.04 m m arch circumference is added to the arch distance anterior to the canines.04 mm].2462 X . 5. n-1 Cp = E V ( x i .. 3. ~ This is less incisor tipping than is frequently seen after arch leveling with continuous arch wires containing reverse curves of Spee.04 m m [ Y = 0.xj) 2 + i=l j-i+l (Yi . Two-dimensional schematic of total arch circumference related to planar projection.. The regression equation derived from these data is Y = 0. which corresponds to tipping a typical mandibular incisor 3. 6.918. 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 1 X Fig. as well as those of earlier investigators..5 o 0 ! .. 3. 1 | 2 ~ ! 3 Spee Depth x 0. 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. and Johnson Amegcan Journal of Orthodontics and Dentofacial Orthopedics August 1996 Z' .o E _~ 0. .1723. Graph of arch circumference differential versus curve of Spee depth.

.. . ] /I t /. . '.. .J ) ) / i lo...::--" - CurrentStudy / 1 ~ 2 3 I 4 . ...p~e[m~e. . 1 : f ..20 o.~. ~ ~ " center of /47"Resistance Cent.... ..[.. o-" // . 4. Tipping Moment = FX F X .'/ .." .. s ./.' . ... 5 I 6 i 7 I 8 I 9 Total Curve of Spee Depth (ram) Fig.. and Johnson 209 ~ g = = 9 8 Ruleof Thumb. . ' 1 I I 'I .American Journal of Orthodontics and Dentofacial Orthopedics Volume 110.v.Star. I.. 5... 0.. 2 10 Braun.112~)mm/ I . H .... 6. ....ASED ARC DIMENSION l =. / / I I ( ~ 12... .. ~ ..erof..... .....oss7 %" " J I_ Fig.:J" o." . .~-" 1 . Hnat.-"" " ~ 1 . .7 /" V J / ... Germane (BonwilI-Hawley) .78 e =3. : .-.~...y 1" .. ..~1 . . t " .../ .. /...04ram ! -T'\l %--r" Jl I I I/F'~ ( I I I I~ -~. .~...- ~ ~ E E..'""'°*° . Comparison graph of all investigative studies. No... / ..=. Leveling by use of c o n t i n u o u s arch mechanics.. 1 " ". .. I ~ I ~ I ~ / .otauona! / < L . ° 0.. .78mm / __ INCRF. = 4 3 2 I "~'~" / -"" Baldridge 1 0 ~ _ ~ .-" . .-" ^ 11/. .-~ / . .. Dental g e o m e t r y related to arch circumference changes.... / ...% Center of Rotation at Center of Resistance Fig. °". . . / " . ~ 8 E E 7 6 5 Garcla .

53:325-55. . In: Graber TM. Wheeler's dental anatomy. a treatment objective may require intruding six anterior teeth to level the curve of Spee. Burstone CJ.. Leveling the curve of Spee: its effect on mandibular arch lengths. A reassessment of space requirements for lower arch leveling. 5.102:251-5.. In: Bell W.. 1986:64. M F F •. .3:26-41... . leveling the curve of Spee. Proffit WR. Leveling mechanics and force system for incisor intrusion.31:74-113.. An indentation in the gingival direction is contoured into this wire. Revere JT. Germane N. Tweed CH. J Pract Orthod 1969. 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.. ~ A ~ v a t i o n Incisor Combined Center of Resistance Fig. Staggers JA. ed. Philadelphia: WB Saunders.. Deep overbite correction by intrusion.~ . Each canine requires an intrusive force of approximately 50 gm to obtain true intrusion. Arch length considerations due to the curve of Spee: a mathematical model.210 Braun. Marcotte MR. one may use the segmented system illustrated in Fig. Am J Orthod i945. A philosophy of orthodontic treatment. The anterior teeth will not flare while the posterior teeth erupt. Ackerman J. Surgical corrections of dentofacial deformities. Since intrusion of all six anterior teeth would exceed 100 gm (4 [15 gm] + 2 [50 gm]). Philadelphia: BC Decker. 3. 6.. Baldridge DW. 4. J Tweed Foun d 1985. 9-1° The intrusive force should pass through the center of resistance of the incisors to avoid any tipping moments.... Philadelphia: WB Saunders.. Am J Orthod 1967. 8.20:770-8. 1993:151. as in Fig.. .. the canines should be intruded separately. 7. A histologic and cephalometric investigation of premolar intrusion in the Macaca speciosa monkey.. Orthodontics: current principals and techniques. 1980:167. l i .... and Johnson American Journal of Orthodontics and Dentofacial Orthopedics August 1996 Eruptive Force M Intrusive Force . Am J Orthod 1977. 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. Epker BN. Proffit R. Leveling the curve of Spee: a new prediction formula.13:65-72. Resistance Alternatively. Diagnosis and treatment planning in orthodontics.. Proffit WR. where a passive wire is contoured to fit the brackets from canine to canine. 7.i ~')" i . Ash MM. 8. REFERENCES 1.. . 10. . 8. Treatment planning for dentofacial deformities. This indentation corresponds to the location of the center of resistance of the six anterior teeth. Leveling mechanics by posterior eruption. Am J Orthod Dentofac Orthop 1992. 9 If a treatment objective requires leveling the curve of Spee by posterior eruption.. Garcia R. Rubinstein L. the curve of Spee may be leveled by incisor intrusion without tipping. St Louis: CV Mosby.. 7. 2.72(1):122. . Hnat. 9. 1990: 164-5..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... Center of . J Clin Orthod 1986. Biomechanics in orthodontics. . 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. Woods M. Dellinger EL. Fig.. eds. physiology and occlusion.. ~ ..

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