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5005/jp-journals-10021-1144
RESEARCH ARTICLE
Prerna Raje Batham et al

Curve of Spee and Its Relationship with


Dentoskeletal Morphology
1
Prerna Raje Batham, 2Pradeep Tandon, 3Vijay Prakash Sharma, 4Alka Singh

ABSTRACT

Objective: The influence of craniofacial morphology on the variation of the depth of curve of Spee includes multiple factors. This plays an
important role in the leveling of the curve which is required for retention of achieved results. The study evaluates relationship between the varying
depths of curve of Spee and dentoskeletal features.
Materials and methods: 120 diagnostic casts and lateral head cephalograms of selected subjects on the basis of depths of curve of Spee as
measured on the mandibular casts were selected. The subjects were divided into three Groups (Group-I- 0-2 mm, Group -II >2-4 mm and
Group-III >4 mm of curve of Spee), and further into subgroups according to sex. Cephalometric and study cast variables were measured and
subjected to statistical analysis with curve of Spee as the dependent variable and others as independent variables.
Results: SNB, APDI, OM, Md5 - MP (mm), OJ and mandibular arch length were negatively correlated and ANB, Md6 to MP, ODI, overbite and
overjet were positively correlated with depth of curve of Spee in both males and females.
Conclusion: The curve of Spee is related to various dentoskeletal variables. Thus, the determination of this relationship is useful to assess the
feasibility of leveling the curve of Spee by orthodontic treatment.
Keywords: Curve of Spee, Dentoskeletal morphology.
How to cite this article: Batham PR, Tandon P, Sharma VP, Singh A. Curve of Spee and Its Relationship with Dentoskeletal Morphology. J Ind
Orthod Soc 2013;47(3):128-134.

INTRODUCTION stated that, there was a natural tendency for the curve to deepen
A profile view of human skull reveals an upward, concave curve with time because the lower jaw sometimes grows faster and
in the mandibular teeth extending from molars to incisors and continues for longer period than that of the upper jaw. This
corresponding downward, convex curve in the maxillary arch. causes the lower anterior teeth, which are confined by the
These peculiarities of the geometric arrangement of the teeth upper anterior teeth and lips, to be forced backward and upward,
were first described by Ferdinand Graf Von Spee1 in 1890, resulting in deeper overbite and deeper curve of Spee. So, the
treatment objective should be to achieve a flat curve as an
using 120 skulls with abraded teeth to define a line of
over treatment.
occlusion, to lie on a cylinder which is tangent to the anterior
Recently, the morphologic arrangement of the teeth in the
border of the condyle, the occlusal surfaces of second molar
sagittal plane has been related to the deep overbite, lower
and incisal edges of the mandibular incisors and has since been
incisor proclination and lower arch circumference.5-7
referred to as ‘The curve of Spee’.
Although, the influence of craniofacial morphology on the
It has been suggested that the curve of Spee has a
curve of Spee has been investigated, these studies ignore the
biomechanical function during food processing by increasing
simultaneous contribution of multiple factors to the individual
the crush shear ratio between the posterior teeth and the
variation of the curve. These individual variations play
efficiency of the occlusal forces during mastication.2,3
important role in the leveling of the curve which is an everyday
Andrews LF4 considered flat to slight curve of Spee to be occurrence in orthodontic practices and are required for stable
one of the six characteristics of normal occlusion. He also results.

1
MATERIALS AND METHODS
Lecturer, 2Professor and Head, 3Professor and Ex-Head, 4Assistant
Professor The present study was conducted on pretreatment study cast
1
Department of Orthodontics and Dentofacial Orthopedics, Sri Auribindo and lateral head cephalogram of 120 selected subjects on the
Institute of Medical Sciences, Indore, Madhya Pradesh, India
2-4
Department of Orthodontics and Dentofacial Orthopedics, Faculty of
basis of varying depths of curve of Spee as measured on the
Dental Sciences, CSM Medical University (Erstwhile KGMC), Lucknow mandibular study cast5 with the age range of 18 to 25 years
Uttar Pradesh, India (mean age-21.5 years). Distribution of sample is showen in
Corresponding Author: Prerna Raje Batham, I-43, RSS Nagar, LIG Table 1.
Colony, Indore, Madhya Pradesh, India, e-mail: prerna2k4@yahoo.co.in Subjects had a full complement of teeth with all teeth in
occlusion up to second molar. No previous orthodontic
Received on: 11/4/12 treatment was received by any of the subjects. Mild crowding
Accepted after Revision: 25/8/12 cases were accepted but gross crowding cases were excluded.

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Curve of Spee and Its Relationship with Dentoskeletal Morphology

No anterior or lateral cross bite was present. No cast value of these two measurements was used as the depth of
restoration or cuspal coverage was present. curve of Spee.5
High quality orthodontic impressions for diagnostic casts The cephalometric and study cast measurements used in
were taken by alginate impression material in the rim lock the study are described in Figures 2 to 7. The six skeletal
impression trays. The lateral cephalograms of the selected parameters, nine dentoalveolar parameters and three study cast
subjects were taken using the standard technique employed in parameters were measured.
the Department of Orthodontics and Dentofacial Orthopedics,
CSM Medical University (Erstwhile KGMC). The lateral Measurement of Reliability
cephalograms were traced on acetate tracing sheets 50 micron Reliability of measurements was tested by doing double
in thickness using a sharp 4H pencil on a view box using determinations of 20 cephalograms and 20 study casts
transilluminated light in a dark room. randomly selected at 15 days interval from the collected
sample by the same operator and comparison was drawn
MEASUREMENT OF CURVE OF between first and second determinations by paired ‘t’ test,
SPEE ON STUDY CAST whereas testing for method errors was done by using
The depth of curve of Spee was measured as the perpendicular Dahlberg’s formula. No significant differences in initial and
distance between the deepest buccal cusp tips and a scale that repeat readings of parameters were found. Hence, good
was laid on the top of the mandibular dental cast, touching the reliability can be laid on the observations made (Table 2).
incisal edges of the central incisors and the distal cusp tips of
RESULTS
the most posterior teeth in the lower arch (Fig. 1). The depth
of curve of Spee was measured with divider placed between The data so obtained was subjected to the statistical analysis
the deepest cusp tip and the scale. The measurements was made using statistical package program STATA version 9.2.
on the right and left side of the mandibular cast and the mean Descriptive statistics, including the mean and standard

Fig. 1: Measurement of curve of Spee Fig. 3: Skeletal vertical parameters

Fig. 2: Skeletal horizontal parameters Fig. 4: Dentoalveolar horizontal parameters

The Journal of Indian Orthodontic Society, July-September 2013;47(3):128-134 129


Prerna Raje Batham et al

Fig. 7: Measurement of mandibular arch length (mm)


Fig. 5: Dentoalveolar vertical parameters

Table 1: Distribution of sample

Group I Group II Group III


(flat = 0-2 mm) (normal = 2-4 mm) (deep > 4 mm)
(n = 40) (n = 40) (n = 40)

Ia—20 males IIa—20 males IIIa—20 males


Ib—20 females IIb—20 females IIIb—20 females

sex. Pearson’s correlation analysis was used to determine


correlation coefficients between the depths of the curve of
Spee and other variables used in the study. Furthermore a
multiple linear regression analysis was performed to
determine the relationship between the curve of Spee as the
dependent variable and other parameters as the independent
Fig. 6: Measurement of overbite (a) and overjet (b) variables.
Descriptive statistics, including the mean and SD values,
deviation values were calculated for all the parameters in each were determined for each Spee Group and are shown in
Group. Student t-test was used to determine the significant Tables 3 and 4 for both males and females.
differences between the mean and standard deviations of The correlation (Table 6) shows SNB, APDI, OM, Md5—
various parameters in the three Groups but among the same MP (mm), OJ and mandibular arch length were negatively

Table 2: Intraobserver comparison of mean ± SD of values of parameters

S. no. Parameters Mean ± SD values of Mean ± SD values t-value p-value


initial readings of repeat readings

Skeletal horizontal
1. SNB (degree) 80.40 ± 1.86 80.30 ± 1.89 2.39 0.95
2. ANB (degree) 2.84 ± 1.32 2.86 ± 1.73 4.61 0.35
3. APDI (degree) 85.40 ± 2.84 85.03 ± 4.28 5.75 0.18
Skeletal vertical
4. ODI (degree) 76.05 ± 5.99 76.24 ± 6.59 2.23 0.18
Dentoalveolar horizontal
5. Md6 to MP (degree) 83.20 ± 5.98 83.74 ± 3.17 0.82 0.41
6. Md7 to MP (degree) 94.45 ± 5.39 94.20 ± 4.91 0.15 0.87
7. OM (mm) 44.40 ± 3.32 44.20 ± 4.09 1.58 0.12
Dentoalveolar vertical
8. Md5 to MP (mm) 34.45 ± 2.24 34.35 ± 4.95 1.49 0.14
9. Md6 to MP (mm) 33.95 ± 2.37 33.87 ± 3.15 1.23 0.23
10. OJ (mm) 41.45 ± 4.03 41.35 ± 3.37 2.64 0.16
Study cast
11. Overbite (mm) 3.48 ± 1.44 3.57 ± 1.32 3.68 0.22
12. Overjet (mm) 2.50 ± 0.83 2.72 ± 1.47 3.70 0.34
13. Md. arch length (mm) 39.50 ± 2.03 39.32 ± 2.89 4.39 0.27

p-value: >0.05: nonsignificant; <0.05: just significant; <0.01: moderately significant; <0.001: highly significant

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Table 3: Comparison of mean and standard deviation values for Groups Ia, IIa and IIIa (males)

S. no. Parameters Group Ia flat Group IIa normal Group IIIa deep p-value
Mean ± SD Mean ± SD Mean ± SD Ia vs IIa Ia vs IIIa IIa vs IIIa
Skeletal horizontal
1. SNB 82.75 ± 3.58 79.85 ± 2.43 78.10 ± 3.57 <0.01** <0.001*** 0.07
2. ANB 2.60 ± 1.27 3.80 ± 1.24 5.55 ± 1.57 <0.01** <0.001*** <0.001***
3. APDI 85.85 ± 3.53 83.15 ± 2.39 77.95 ± 4.94 <0.01** <0.001*** <0.001***
Skeletal vertical
4. ODI 77.35 ± 5.87 81.30 ± 4.62 83.90 ± 8.93 <0.05* <0.01** 0.25
Dentoalveolar horizontal
5. Md6 to MP 82.70 ± 6.02 84.95 ± 5.27 85.85 ± 6.27 0.51 <0.05* 0.94
6. Md7 to MP 92.60 ± 7.42 95.05 ± 6.17 95.20 ± 3.96 0.18 <0.05* 0.92
7. OM (mm) 47.05 ± 3.92 46.80 ± 3.33 43.05 ± 3.78 0.82 <0.01** <0.01**
Dentoalveolar vertical
8. Md5 to MP 39.20 ± 2.35 38.00 ± 3.09 36.95 ± 2.99 0.17 <0.05* 0.28
9. Md6 to MP 37.75 ± 2.38 37.00 ± 3.36 36.15 ± 2.74 0.42 0.18 0.38
10. OJ (mm) 47.05 ± 4.96 42.60 ± 4.38 42.55 ± 5.14 <0.01** <0.05* 0.97
Study cast
11. Overbite 2.88 ± 1.37 3.73 ± 1.19 6.78 ± 2.67 <0.05* <0.001*** <0.001***
12. Overjet 2.20 ± 0.77 3.25 ± 0.82 6.65 ± 4.47 <0.001*** <0.001*** <0.01**
13. Md. arch length 40.50 ± 2.09 38.30 ± 2.20 37.40 ± 1.76 <0.01** <0.001*** 0.16

p-value : >0.05: nonsignificant; *<0.05: just significant; **<0.01: moderately significant; ***<0.001: highly significant

Table 4: Comparison of mean and standard deviation for Groups Ib, IIb and IIIb (females)

S. no. Parameters Group Ib flat Group IIb Group IIIb p-value


(0-2 mm) normal (2-4 mm) deep (<4 mm)
Mean ± SD Mean ± SD Mean ± SD Ib vs IIb Ib vs IIIb IIb vs IIIb

Skeletal horizontal
1. SNB 80.45 ± 1.76 80.40 ± 2.78 78.25 ± 3.61 0.57 <0.05* <0.05*
2. ANB 2.80 ± 1.32 3.20 ± 1.32 5.05 ± 1.73 0.34 <0.001*** <0.001***
3. APDI 85.40 ± 2.84 84.65 ± 3.97 77.53 ± 5.28 0.49 <0.001*** <0.001***
Skeletal vertical
4. ODI 76.05 ± 5.99 77.20 ± 5.75 80.50 ± 6.59 0.53 <0.05* 0.10
Dentoalveolar horizontal
5. Md6 to MP 83.20 ± 5.98 84.80 ± 6.27 86.55 ± 5.17 0.06 <0.05* 0.34
6. Md7 to MP 94.20 ± 4.91 94.45 ± 5.39 94.90 ± 5.32 0.79 0.87 0.67
7. OM (mm) 44.40 ± 3.32 42.70 ± 4.09 42.25 ± 5.09 0.11 0.12 0.76
Dentoalveolar vertical
8. Md5 to MP 34.45 ± 2.24 34.25 ± 2.55 33.10 ± 3.35 0.79 0.14 0.23
9. Md6 to MP 33.95 ± 2.37 33.80 ± 2.09 32.90 ± 2.51 0.83 0.23 0.18
10. OJ (mm) 41.45 ± 4.03 39.55 ± 4.27 38.70 ± 2.32 0.16 <0.05* 0.44
Study cast
11. Overbite 3.48 ± 1.44 3.90 ± 1.05 6.28 ± 2.48 0.26 <0.001*** <0.001***
12. Overjet 2.50 ± 0.83 2.80 ± 8.6 5.38 ± 3.57 0.26 <0.001*** <0.001***
13. Md. arch length 39.50 ± 2.03 38.30 ± 1.41 36.35 ± 2.89 <0.05* <0.001*** <0.001***

p-value : >0.05: nonsignificant; *<0.05: just significant; **<0.01: moderately significant; ***<0.001: highly significant

correlated and ANB, Md6 to MP, ODI, overbite and overjet Table 5: Multiple regression analysis
were positively correlated with depth of curve of Spee in both Parameters -coefficient (95% CI) p-value R2 change
males and females.
Multiple regression analysis was performed to see the ANB 0.250 (0.17, 0.33) <0.001***
Overbite 0.189 (0.12, 0.26) <0.001***
linear dependence of various studied parameters on curve of Mandibular archlength –0.119 (–0.18, –0.06) <0.001***
Spee. Corresponding -coefficient and their 95% confidence OJ (mm) –0.044 (–0.07, –0.01) <0.01** 0.66
interval (CI) are described in Table 5. Md5-MP (mm) –0.043 (–0.10, 0.00) <0.05*
Regression analysis shows that there was highly significant Md6-MP (degree) 0.041 ( 0.01, 0.11) <0.05*
correlation between curve of Spee and ANB, overbite, mandi- Constant 10.547 (6.16, 14.94) 0.000
bular archlength (<0.001***), where as for OJ (mm) it was
moderately significant (<0.01**) and for Md5 to MP (mm) DISCUSSION
and Md6 to MP (degree) was just significant (<0.05*). These
parameters explained 66% of the total variation of the curve of The assessment of relationship of curve of Spee with the
Spee. dentoskeletal morphology is essential to understand the

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Prerna Raje Batham et al

Table 6: Correlation of depth of curve of Spee with different parameters used in the study in male and female samples

S.no. Parameters Males Females


‘R’ ‘p’ ‘R’ ‘p’

Skeletal horizontal
1. SNB – 0.54 <0.001*** – 0.30 <0.05*
2. ANB 0.66 <0.001*** 0.55 <0.001***
3. APDI – 0.69 <0.001*** – 0.59 <0.001***
Skeletal vertical
4. ODI 0.35 <0.01** 0.31 <0.05*
Dentoalveolar horizontal
5. Md6 to MP 0.34 <0.05* 0.33 <0.05*
6. Md7 to MP 0.09 0.08 0.06 0.67
7. OM (mm) – 0.46 <0.001*** – 0.20 0.12
Dentoalveolar vertical
8. Md5 to MP – 0.32 <0.05* – 0.21 0.09
9. Md6 to MP – 0.23 0.08 – 0.17 0.19
10. OJ (mm) – 0.40 <0.05* – 0.34 <0.01**
Study cast
11. Overbite 0.76 <0.001*** 0.61 <0.001***
12. Overjet 0.71 <0.001*** 0.51 <0.001***
13. Mandibular arch length – 0.56 <0.001*** – 0.54 <0.001***

p-value : NS: nonsignificant; *<0.05: just significant; **<0.01: moderately significant; ***<0.001: highly significant

influence of multiple factors that leads to variation in the The parameters used were 10 cephalometric and 3 study
depth of the curve. It has been suggested that the mandibular cast, of which cephalometric parameters were further divided
sagittal and vertical position relative to the cranium is related into skeletal and dentoalveolar. Since the curve of Spee was
to the curve of Spee, which is present in various forms in significantly influenced by sagittal and vertical craniofacial
mammals (Farella et al).8 In humans, an increased curve of morphology as suggested by Farella et al,8 the cephalometric
Spee is often seen in brachycephalic facial patterns (Wylie9 parameters were further divided into four skeletal horizontal,
and Bjork)10 and associated with short mandibular bodies two skeletal vertical, five dentoalveolar horizontal and four
(Salem OH et al).11 dentoalveolar vertical parameters.
Although, leveling of the curve of Spee is an everyday The findings suggested that the depth curve of Spee was
occurrence in orthodontic practices, little research has been influenced by the position of the mandible with respect to the
done to examine the relationship of the curve of Spee and the anterior cranial base, i.e. SNB. The negative correlation value
multiple factors causing variation in its depth, which may be suggested that more the mandible was positioned anteriorly
useful to assess the feasibility of leveling the curve of Spee (large SNB angle) the depth of curve of Spee was less, and as
by orthodontic treatment. the SNB angle decreased from Groups I to III, depth also
The measurement of curve of Spee was done and the increased in both males and females. This was supported by
average of the distance on right and left side was taken as the studies done by Farella et al8 and Cheon et al.18
depth of curve of Spee (Nanda SK,12 Dale J,13 and Baydas It was found that the subjects with higher maxillo-
et al).5 This method of assessment of curve of Spee was easy mandibular discrepancies tend to have deeper curve of Spee.
to perform and lacked any magnificational and projectional
The value of ANB showed positive correlation with the depth
errors. Other authors like Baldridge6 used the perpendicular
of curve of Spee, i.e. was less in subjects with small value of
distances on both sides, Sondhi et al14 used the sum of the
ANB angle (suggesting Class I skeletal pattern) and as the value
perpendiculars, Bishara et al15 used the average of the sum of
of ANB angle increased the depth of curve of Spee also
the perpendicular distances to each cusp tip and Braun et al7
increased (the Class-II skeletal pattern) also supported by
and Braun and Schmidt16 used the sum of the maximum depth
Cheon et al18 and Orthlieb JD19 who suggested that the depth
on both sides.
The age group was in the range of 18 to 25 years to omit of curve of Spee was lesser in those with Class III malocclu-
any effect of growth on the curve of Spee since, the depth sions than in Class II malocclusions.
remained relatively constant during adulthood as compared to The curve of Spee was influenced by the skeletal pattern
the flat curve in decidous dentition and maximum deepening of the subjects as suggested by the values of APDI, that is
during adolescent dentition (Marshall et al).17 This was also smaller the APDI value in relation to the normal mean greater
supported by Farella et al8 who said that homogenous dental was the probability of distocclusion thus suggesting Class II
wear could be the reason for maintenance of curve of Spee in skeletal pattern and deep curve of Spee. This finding was similar
adulthood. to a study conducted by Cheon et al.18

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Overbite depth indicator was given by Kim,20 suggesting reported in their study that there is lack of correlation between
that lower the ODI value greater the chance of there being the depth of curve of Spee and perpendicular distance of
openbite or tendency toward an openbite. The overbite and mandibular plane to the molar cusp tip same was found in this
tendency toward deepbite were found to increase as the ODI study.
value increased. In the present study the findings suggested OJ signifies the vertical positioning of the lower dentition
that as the depth of curve of Spee increases from Groups I with respect to the condyle. It was measured as the perpendi-
to II the tendency for deep bite in the subjects also increases, cular distance between the superior most point on the condylar
this correlates with the increase value of overbite in Group III head (point ‘J’) and the point of intersection of this
as compared to Group I. Similar findings were also reported perpendicular to the occlusal plane (point ‘O’). In this study
by Trauten et al,21 who reported negative curve of Spee in the mean value for OJ (mm) was found to be decreasing from
openbite cases and deep curve of Spee in deep bite cases. The Groups I to III, this finding suggested that the dentition had
positive correlation value for both males and females suggested moved upward with respect to the condyle in deep curve of
that the value of ODI increases with increase in the depth of Spee Groups for both males and females. The finding signifies
curve of Spee. The higher value of ODI among Group-III that as the vertical distance between the lower dentition and
signifies deep bite and tendency toward deep bite in deep curve the condyle had decreased as the depth of curve of Spee was
of Spee Groups for both males and females Cheon et al.18 increased. The finding of the study was supported by the
Md6 to MP and Md7 to MP angles were considered to findings of Farella et al.8
asses the possible relation between the axial inclination of The mean value for overbite and overjet was found to be
the mandibular molars and the depth of curve of Spee. The increased from Groups I to III in both males and females. This
mean values were found to be increased with increase in curve suggested that when the anterior teeth have no vertical stop,
of Spee depth suggesting that the mesial inclination of the their continued eruption leads to deepening of anterior aspect
molars were increasing as the depth of the curve of Spee was of the curve. This was supported by findings of Shannon and
increased and the difference was found to be statistically Nanda.22 The positive correlation coefficient value also proved
significant. Similar findings were also reported by Shannon as the overbite increases depth of curve of Spee also increases.
and Nanda22 and Lie F,23 who suggested that deepening of curve These findings were supported by studies done by Alqubandi28
of Spee can occur as the axial inclination of the teeth and Lie F.23 These finding showed that the overbite measure-
increases. Osborn24 also showed similar findings and related ments in the deep Spee Group were significantly larger than
forward tilting of molars to the inclination of masseter muscle in the moderate and flat Spee Groups. The most pronounced
thus increasing crush- shear ratio, also supported by Hemley25 differences for overbite were found between the flat and deep
and Thompson and Strang.26 Spee Groups as supported by studies of Kuitert,29 Baydas et al5
OM (mm) was the distance measured from the most and Cheon et al.18 The statistically significant beta-correlation
posterior point of the dentition on the occlusal plane (point coefficients between the depth of curve of Spee and overbite
‘M’) to the point of intersection (point ‘O’) of a line (0.189) confirmed this result. These finding were supported
perpendicular from the superior most point on the condyle by Trauten et al21 and Orthlieb,19 they showed that there is
(Farella et al).8 It is the linear distance signifying the horizontal negative curve of Spee in open bite cases and as the curve of
positioning of the dentition with respect to the condyle. The Spee deepens the overbite also deepens.
value of OM (mm) was found to be decreasing from Groups I The value for mandibular arch length was found to be
to III suggesting that the samples in which the dentition was decreased from Groups I to III in both males and Females.
more posteriorly positioned with respect to the condyle, i.e. The possible explanation for these finding could be that as the
smaller the value of ‘OM’ greater the depth of curve of Spee. curve of Spee is deepening from Groups I to III the mandibular
The finding of present study supported the hypothesis by Farella incisors are becoming more uprighted and thus the
et al8 that the position of dentition in the mandibular arch in perpendicular distance from the midpoint between the incisal
relation to the condyle influences the shape of the curve of edges and a line passing through the distobuccal cusp tips was
Spee. becoming shorter, thus decreasing the mandibular arch length.
The difference of the mean value for Md5 to MP (mm) These findings were supported by De Praeter et al,30 who said
was just significant (<0.05) for Groups I vs III in male samples. that more pronounce curve could be considered as
Rest all the Groups showed nonsignificant correlations. This compensation for lack of arch circumference.
was due to greater infraposition of the mandibular second In similar findings Braun et al7 and Al Qubandi,28 said that
premolar with relation to mandibular plane in Group III as deep curve of Spee is associated with smaller mandibular arch
compared to other Groups leading to deep curve of Spee. In length and there is increase in the arch length as the curve of
the present study the deepest point of the curve of Spee was Spee is leveled.
found to be the cusp tip of second premolar region in maximum The purpose of this cross-sectional study was to find out
number of samples. Koyama27 and Lie F23 also supported this the correlation between the dentoskeletal morphology and the
finding and suggested that the deepest point of the curve is the depth of curve of Spee. This study has unmasked the
cusp tip of mandibular second premolar. Shannon and Nanda,22 dentoskeletal morphologic features associated with the flat,

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Prerna Raje Batham et al

moderate and deep curve of Spee. Subjects with deep curve of 8. Farella M, Michelotti A, van Eijden TMG, Martina R. The curve
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