ORIGINAL ARTICLE

Leveling the curve of Spee with

continuous archwire appliances in
different vertical skeletal patterns:
A retrospective study
Matteo Rozzi,a Manuela Mucedero,a Chiara Pezzuto,b and Paola Cozzaa
Rome, Italy

Introduction: The aim of this study was to determine the effects of the leveling of the curve of Spee in subjects
treated with preadjusted appliances in different skeletal vertical patterns. Methods: The study sample consisted
of 90 white patients (39 male, 51 female; age, 19 years 4 months 6 1 year 9 months), with a curve of Spee of
2 mm or greater before treatment. They were categorized into 3 groups: low-angle group (30 subjects; 12 male,
18 female; age, 19 years 1 month 6 1 year 4 months), normal-angle group (30 subjects; 14 male, 16 female; age,
19 years 6 months 6 2 years 1 month), and high-angle group (30 subjects; 13 male, 17 female; age, 19 years
7 months 6 1 year 5 months) by their vertical facial types. Cephalometric parameters were used to evaluate the
different dental movements after treatment. The curve of Spee was measured on digital dental casts. Analysis of
variance was used to determine any differences between the changes in the groups with time. Results: For the
skeletal variables, no significant modifications were found in the 3 groups. For the dentoalveolar variables, the
low-angle group showed significant buccal movements and intrusion of the mandibular incisors. The high-angle
group had greater extrusion of the posterior teeth associated with uprighting of the first and second molars.
Conclusions: In low-angle subjects, leveling of the curve of Spee occurs through buccal movement and
intrusion of the mandibular incisors; in high-angle subjects, it occurs through extrusion and uprighting of the
posterior teeth. (Am J Orthod Dentofacial Orthop 2017;151:758-66)

T
he curve of Spee is a naturally occurring phenom-
enon in the human dentition, and it is determined
clinically by the distal marginal ridges of the pos-
terior teeth in the arch and the incisal edges of the cen-
tral incisors.1
The development of curve of Spee probably results
from a combination of different factors including differ-
ences in the times of eruption of the mandibular perma-
nent teeth, variations in skeletal morphology and growth
of orofacial structures, sagittal jaw relationship and
a
Department of Clinical Sciences and Translation Medicine, University of Rome
“Tor Vergata”, Rome, Italy.
b
Department of Clinical Sciences and Translation Medicine, University of Rome
“Tor Vergata”, Rome, Italy; Private Practice, Rome, Italy.
All authors have completed and submitted the ICMJE Form for Disclosure of Po-
tential Conflicts of Interest, and none were reported.
Address correspondence to: Chiara Pezzuto, Fondazione Policlinico Tor Vergata
PTV, Department of Orthodontics, Viale Oxford 81, Rome 00133, Italy; e-mail,
pezzutochiara@gmail.com.
Submitted, July 2016; revised and accepted, September 2016.
0889-5406/$36.00
Ó 2016 by the American Association of Orthodontists. All rights reserved.
http://dx.doi.org/10.1016/j.ajodo.2016.09.023
758
incisor occlusion, and development of the neuromus-
cular system.2-6
Andrews7 described the 6 characteristics of normal
occlusion and found that the curve of Spee in subjects
with good occlusion ranged from flat to mildly curved,
noting that the best intercuspation occurred when the
occlusal plane was relatively flat. He proposed that flat-
tening the occlusal plane should be the treatment goal in
orthodontics.
Various sophisticated approaches to level the curve of
Spee were suggested by Burstone8 from true incisor
intrusion to eruption of the posterior teeth without
altering the positions of the incisors. At the same time,
leveling with round cross-section archwires or rectan-
gular cross-section archwires combined with torqued
incisor brackets is clinically popular because of its
simplicity. In either method, only 1 outcome occurs at
the end of leveling: posterior elevation and proclination
of the incisors (or masking by a cross-arch canine width
increase).9
Although leveling the curve of Spee is a common
occurrence in orthodontic practices, few studies have
Rozzi et al
been dedicated to examination of the relationship be-
tween orthodontic leveling of the curve of Spee and ver-
tical skeletal pattern.3,10-13
A simple correlation analysis between the radius or
the depth of the curve of Spee and skeletal facial types
was conducted. Farella et al3 reported, before orthodon-
tic treatment, a weak association between the variation
of the curve of Spee and the horizontal and vertical po-
sition of the mandible. Only 1 study has analyzed the
variation of some morphologic characteristics with or-
thodontic treatment according to facial type and re-
ported significant differences in overbite correction
between low-angle and high-angle subjects after treat-
ment.14
However, no studies have analyzed whether vertical
skeletal patterns influence orthodontic movements dur-
ing leveling of the curve of Spee.
The aim of this study was to evaluate the treatment
effects after leveling of the curve of Spee with full fixed
edgewise preadjusted appliance in subjects with
different skeletal vertical patterns.
MATERIAL AND METHODS
The sample for this retrospective study consisted of
90 white patients' orthodontic records (39 male, 51 fe-
male; mean age, 19 years 4 months 6 1 year 9 months)
treated without extractions at the Department of Ortho-
dontics at the University of Rome Tor Vergata in Italy.
These patients were selected using the following inclu-
sion criteria: full permanent dentition (excluding third
molars, extracted or not erupted), curve of Spee 2 mm
or greater before treatment, skeletal Class I (ANB angle,
0
-4
) or skeletal Class II (ANB angle, .4
) patterns14
(skeletal Class III were excluded because in these subjects
the deph of curve of Spee results to be reduced before
treatment3), postpubertal stage of skeletal maturity ac-
cording to the cervical vertebral maturation method,15
no previous orthodontic treatment, no periodontal dis-
ease or morphologic tooth anomaly, no dental restora-
tion or crown, and no mandibular asymmetry. All
subjects were categorized based on Little's irregularity
index for anterior crowding as moderate irregularity.16
Only patients with complete orthodontic records
were selected for this study. The records consisted of
dental casts and lateral cephalograms before treatment
(T1) and after orthodontic therapy (T2). All subjects
were treated with full fixed conventional preadjusted
edgewise brackets with McLaughlin-Bennet-Trevisi
values for tip and torque and a 0.022-in slot. A standard
continuous archwire sequence (016-in round,
0.017 3 0.025-in rectangular, 0.019 3 0.025-in rectan-
gular martensitic active nickel-titanium alloys [3M
American Journal of Orthodontics and Dentofacial Orthopedics
759
Unitek, Monrovia, Calif], and 0.019 3 0.025-in stainless
steel) was used in all subjects. Alignment and leveling
were considered obtained when passive engagement of
a 0.019 3 0.025-in stainless steel archwire was achieved.
The average duration of treatment was 24 6 4 months.
No auxiliary or curve of Spee wires were used during the
treatment phases.9 All archwires used were of uniform
arch form, and attachments were placed on all teeth
from second molar to second molar.
The cephalometric radiographs were scanned into
imaging software (version 11.0; Dolphin Imaging,
Chatsworth, Calif). Standard cephalometric landmarks
were then identified on each radiograph; the functional
occlusal plane (OP) was defined by a line intersecting the
intercuspation of the posterior occlusion17; the palatal
plane (PP) was defined by the ANS-PNS plane; the
mandibular plane (MP) was defined by the Go-Gn
plane.12 These cephalometric landmarks and reference
planes are shown in Figure 1. The following measure-
ments were determined on each lateral cephalogram:
SNA, SNB, ANB, SN^GoGn, FMA, y-axis, SN^OP, OP^MP,
SN^PP, IMPA, Up.Inc.^FP, overjet, overbite, and interin-
cisal angle (Int.Inc.). The cephalometric measurements
used in this study are shown in Table I and Figure 2.
After data collection, the subjects were grouped ac-
cording to their facial types (normal angle, high angle,
low angle) based on their pretreatment cephalometric
values for y-axis, mandibular plane angle, and SN^GoGn
angle. The normal-angle group (30 subjects; 14 male, 16
female; mean age, 19 years 6 months 6 2 years 1 month)
included subjects with a mandibular plane angle be-
tween 23
and 28
, y-axis between 63
and 69
, and
SN^GoGn angle between 27
and 37
. The high-angle
group (30 subjects; 13 male, 17 female; mean age,
19 years 7 months 6 1 year 5 months) included subjects
with a mandibular plane angle greater than 28
, y-axis
greater than 6
, and SN^GoGn angle greater than 37
.
The low-angle group (30 subjects; 12 male, 18 female;
mean age, 19 years 1 month 6 1 year 4 months) con-
sisted of subjects with a mandibular plane angle less
than 23
, y-axis less than 63
, and SN^GoGn angle less
than 27
. It was arbitrarily decided that at least 2 of 3
of these variables were required to determine facial type.
The vertical position of the maxillary and mandibular
central incisors (L1), mandibular first premolar (L4), and
mandibular first (L6) and second (L7) molars were
measured perpendicular to the palatal and mandibular
planes, respectively.14 The arch leveling was measured
by the changes in the measurements of the distances
of those teeth to the mandibular plane.
Dental casts were scanned by a tridimensional scan-
ner (D800; 3Shape A/S, Copenhagen, Denmark) with a
scan time of 25 seconds, resolution with 2 cameras at
April 2017  Vol 151  Issue 4
760
Fig 1. Landmarks and reference planes: S, Sella; N, na-
sion; Po, porion; Or, orbitale; ANS, anterior nasal spine;
PNS, posterior nasal spine; A, Point A; B, Point B; U1,
incisal edge of the maxillary central incisor; U1A, root
apex of the maxillary central incisor; L1, incisal edge of
the mandibular incisor; L1A, root apex of the mandibular
incisor; L4, cusp tip of the mandibular first premolar; L6,
mesial cusp tip of the mandibular permanent first molar;
L6A, mesial root apex of the mandibular permanent first
molar; L7, mesial cusp tip of the mandibular permanent
second molar; L7A, mesial root apex of the mandibular
permanent second molar; Pg, pogonion; Gn, gnathion;
Me, menton; Go, gonion; SN, sella-nasion plane, a line
from S to N; Frankfort horizontal plane, a line from Po to
Or; palatal plane, a line from PNS to ANS; occlusal plane,
a line drawn along the maximum intercuspation of the
posterior teeth; mandibular plane, a line from Go to Gn;
Go-Me plane, a line from Go to Me.
5.0 megapixels, and ultrahighpoint accuracy less than
15 mm. Each cast was scanned from 10 or more views
that were then combined and rendered into 3-
dimensional views with the software. The virtual 3-
dimensional models were measured and analyzed with
the software.
Curve of Spee value was measured as follows: the
distobuccal cusps of the left and right second molars
and the midpoint between the central incisors served
as the 3 landmarks; the occlusal plane, defined by
the midpoint of the center in the right and left incisor
edges and the tips of the right and left second molar
distobuccal cusps, was established in the mandibular
dental arch. The perpendicular distances from the
occlusal plane to the buccal cusp tip of each lateral
tooth were measured. Measurements were obtained
on the right and left sides in the deepest points of
April 2017  Vol 151  Issue 4 American Journal of Orthodontics and Dentofacial Orthopedics
Rozzi et al
Table I. Definitions of cephalometric measurements
Measurement Definition
Angular measurements (
)
SNA Angle between SN plane and NA plane
SNB Angle between SN plane and NB plane
ANB Difference between SNA and SNB
SN^GoGn Angle between SN plane and mandibular
plane
FMA Angle between FP plane and Go-Me plane
y-axis Angle between FP plane and line of S-Gn
SN^OP Angle between SN plane and occlusal plane
OP^MP Angle between occlusal plane and mandibular
plane
SN^PP Angle between SN plane and palatal plane
IMPA Angle between mandibular plane and line of
L1-L1A
Up.Inc.^FP Angle between FP plane and line of U1-U1A
Int.Inc. Angle between line of U1-U1A and line of L1-
L1A
L6^MP Angle between mandibular plane and line of
L6-L6A
L7^MP Angle between mandibular plane and line of
L7-L7A
Linear measurements (mm)
Overjet Sagittal linear distance from L1 to U1
Overbite Vertical linear distance from L1 to U1
L1-MP Linear distance from L1 to mandibular plane
L4-MP Linear distance from L4 to mandibular plane
L6-MP Linear distance from L6 to mandibular plane
L7-MP Linear distance from L7 to mandibular plane
U1-PP Linear distance from U1 to palatal plane
Refer to Figures 1 and 2 for the location of each landmark.
the curve. Landmarks, reference planes, and measure-
ments used are shown in Figure 3. The premolar used
in measuring the deepest part of the curve of Spee
had to be in occlusal contact with an opposing tooth
in the maxillary dentition. The curve of Spee value
was the summation of the curve of Spee on the right
and left sides of the dental arch, and the deepest point
was used as a representative value for the curve of Spee
on each side.
Statistical analysis
Data were analyzed with conventional descriptive
statistics. The normal distribution of the data was tested
with the Kolmogorov-Smirnov test. The hypothesis that
the data were normally distributed could not be rejected
for any variable.
To test the reliability of the measurements, 50 sets of
3-dimensional virtual models and lateral cephalograms
were selected randomly, and the experimental procedure
was repeated by the same operator (C.P.) 2 weeks later.
The 2 sets of coordinates were compared using paired
t tests, evaluated with Bland-Altman plots,18 and
Rozzi et al 761

Fig 2. Cephalometric measurements: 1, SNA; 2, SNB; 3, ANB; 4, SN^GoGn; 5, FMA; 6, y-axis; 7,

SN^OP; 8, OP^MP; 9, SN^PP; 10, IMPA; 11, Up.Inc^FP; 12, overjet; 13, overbite; 14, interincisive
angle (Int.Inc.); 15, L1-MP; 16, L4-MP; 17, L6-MP; 18, L7-MP; 19, U1-PP; 20, L6^MP; 21, L7^MP.

Fig 3. Digital model landmarks, reference planes, and measurements: DCR7, Distobuccal cusp of the
right second molar; DCL7, distobuccal cusp of the left second molar; LII, midpoint between the mandib-
ular central incisors; DPR, deepest point of the right mandibular arch; DPL, deepest point of the left
mandibular arch; occlusal plane, plane defined by DCR7, DCL7, and LII. Curve of Spee is the mean
value between perpendicular distances from the occlusal plane to DCR7 and DCL7.

confirmed by Pearson and linear regression analyses. No measurements, and between 0.14 and 0.63 mm for the
significant systematic errors were found between the linear measurements. A post hoc power test indicated
measurement sessions (P .0.01). The method errors an achieved power of 0.80 for the study. Multicompari-
varied between 0.12
and 0.56
for the angular son analysis of variance was used to determine whether

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762 Rozzi et al

Table II. Statistical comparison of curve of Spee depths (mm) between the sexes at T1
Males Females

DX SX Mean DX-SX DX SX Mean DX-SX

Group Mean SD Mean SD Mean SD Mean SD Mean SD Mean SD P value

Low angle 4.25 0.73 4.41 0.83 4.33 0.77 4.02 0.86 4.23 0.96 4.12 0.89 NS
Normal angle 3.57 0.91 3.25 0.65 3.41 0.82 3.89 1.01 3.37 0.77 3.63 0.85 NS
High angle 3.51 0.84 3.92 0.78 3.71 0.80 3.44 0.59 3.21 0.67 3.32 0.60 NS

Multicomparison ANOVA test was used.

DX, Curve of Spee on right side; SX, curve of Spee on left side.
*P \0.01; NS, Not significant.

Table III. Statistical comparison of cephalometric measurements between the groups at T1

Low angle (12 M, 18 F) Normal angle (14 M, 16 F) High angle (13 M, 17 F)

Variable Mean SD Mean SD Mean SD P value

SNA (
) 81.63 2.58 81.00 3.24 80.00 2.98 NS
SNB (
) 77.47 2.97 76.79 3.29 75.58 3.22 NS
ANB (
) 4.16 1.92 4.21 1.51 4.74 2.07 NS
SN^GoGn (
) 28.26 2.65 33.63 3.01 41.95 2.78 *
FMA (
) 19.00 1.63 26.05 1.84 33.21 2.45 *
y-axis (
) 55.84 2.19 58.32 2.79 62.74 2.94 *
SN^OP (
) 21.37 2.65 23.16 2.76 25.95 2.74 NS
OP^MP (
) 10.74 3.64 12.11 3.19 13.95 3.64 NS
SN^PP (
) 7.53 2.52 9.53 3.54 9.78 2.97 NS
IMPA (
) 96.63 3.45 94.00 3.76 93.84 3.51 NS
Up.Inc.^FP (
) 112.16 2.34 113.42 2.12 112.53 12.48 NS
Overjet (mm) 5.58 1.67 4.68 1.37 5.68 1.77 NS
Overbite (mm) 4.79 1.93 3.82 0.98 3.00 1.29 NS
Int.Inc. (
) 128.89 3.45 126.74 3.78 126.32 3.54 NS
L1-MP (mm) 37.00 3.75 37.21 3.44 39.42 3.89 NS
L4-MP (mm) 29.63 3.74 28.47 3.11 29.84 4.07 NS
L6-MP (mm) 26.89 3.41 25.58 3.04 28.79 3.86 NS
L7-MP (mm) 25.84 3.74 24.68 3.00 26.11 3.87 NS
U1-PP (mm) 27.47 3.09 26.95 3.75 28.95 2.73 NS
L6^MP (
) 87.89 2.75 85.84 2.34 84.42 2.78 NS
L7^MP (
) 90.68 2.13 86.53 2.78 87.95 2.59 NS
SPEE (mm) 4.22 0.82 3.47 0.83 3.52 30.82 NS
Multicomparison ANOVA test confirmed by pair-wise bivariate t test was used.
Refer to Table I for the definition of each measurement.
M, Male; F, female; SPEE, curve of Spee measured on digital model.
*P \0.01; NS, Not significant.

there were differences between the changes in the
groups with time. Variance analysis was then followed
by pair-wise bivariate contrasts in the form of t tests if
a significant difference was found. The level of signifi-
cance was set at P #0.01 for all statistical analyses.
RESULTS
No significant differences were found in the mean
measurements for pretreatment curve of Spee depth
for male and female patients or for the right and left
sides (Table II).
Analysis of the starting forms showed that the 3
groups had no statistically significant differences in
craniofacial and dental characteristics at T1 (Table III).
The only exception was a significant difference between
the groups for the variables of divergence (SN^GoGn,
FMA, y-axis) that were necessary for the skeletal distri-
bution of the subjects in the groups.
Pretreatment and posttreatment skeletal and dental
measurements for each group are described in Table IV.
The statistical comparisons of the T1 to T2 changes
(Table V) showed no significant intergroup differences
for skeletal measurements. An increase of 1.05
for the

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Rozzi et al 763

Table IV. Descriptive statistics for the pre and post-treatment cephalometric and dental casts parameters of the three
groups
Low angle Normal angle High angle

T1 T2 T1 T2 T1 T2

Variable Mean SD Mean SD Mean SD Mean SD Mean SD Mean SD

SNA (
) 81.63 2.58 81.37 2.77 81.00 3.24 81.11 2.99 80.00 2.98 79.26 2.30
SNB (
) 77.47 2.97 77.74 2.99 76.79 3.29 77.79 2.87 75.58 3.22 74.84 72.69
ANB (
) 4.16 1.92 3.63 1.30 4.21 1.51 3.53 1.71 4.74 2.07 4.53 2.22
SN^GoGn (
) 28.26 2.65 27.95 2.45 33.63 3.01 33.89 3.21 41.95 2.78 42.00 2.65
FMA (
) 19.00 1.63 19.26 1.79 26.05 1.84 27.00 2.74 33.21 2.45 33.79 3.12
Y AXIS (
) 55.84 2.19 56.26 1.93 58.32 2.79 59.06 3.41 62.74 2.94 63.79 2.39
SN^OP (
) 21.37 2.65 17.84 3.02 23.16 2.76 19.53 2.58 25.95 2.74 22.63 2.32
OP^MP (
) 10.74 3.64 11.84 3.46 12.11 3.19 14.26 3.12 13.95 3.64 19.26 3.49
SN^PP (
) 7.53 2.52 7.84 2.94 9.53 3.54 10.00 3.37 9.78 2.97 10.65 2.78
IMPA (
) 96.63 3.45 103.21 3.12 94.00 3.76 95.64 3.34 93.84 3.51 94.32 3.62
Up.Inc.^FP (
) 112.16 2.34 112.89 2.51 113.42 2.12 112.34 2.76 112.53 2.48 110.84 13.12
OVJ (mm) 5.58 1.67 3.61 1.13 4.68 1.37 2.53 0.72 5.68 1.77 3.16 1.25
OVB (mm) 4.79 1.93 2.68 0.86 3.82 0.98 2.18 0.83 3.00 1.29 2.11 0.80
Int.Inc. (
) 128.89 3.45 122.95 3.27 126.74 3.78 120.37 3.69 126.32 13.54 123.26 3.61
L1-MP (mm) 37.00 3.75 35.13 3.10 37.21 3.44 36.16 3.83 39.42 3.89 39.38 3.99
L4-MP (mm) 29.63 3.74 30.47 3.13 28.47 3.11 31.32 3.40 29.84 4.07 33.26 3.81
L6-MP (mm) 26.89 3.41 27.26 3.08 25.58 3.04 26.78 3.44 28.79 3.86 30.83 3.62
L7-MP (mm) 25.84 3.74 24.84 3.62 24.68 3.00 25.47 3.47 26.11 3.87 27.16 3.74
U1-PP (mm) 27.47 3.09 26.89 3.07 26.95 3.75 27.32 3.56 28.95 2.73 30.24 2.23
L6^MP (
) 87.89 2.75 85.47 2.46 85.84 2.34 82.79 2.27 84.42 2.78 80.42 2.82
L7^MP (
) 90.68 2.13 88.79 2.65 86.53 2.78 84.26 2.46 87.95 2.59 82.16 2.66
SPEE (mm) 4.22 0.82 1.53 0.65 3.47 0.83 1.13 0.86 3.52 0.82 1.42 1.02
Values are presented as mean 6 standard deviation.
Refer to Table I for the definition of each measurement.
SPEE, Curve of Spee measured on digital model.

y-axis value was evident in the high-angle group but not
statistically significant.
Significant effects of therapy were found for the den-
toalveolar variables.
The low-angle group had intrusion of the mandibu-
larr incisors (1.87 mm) significantly greater than that in
the high-angle group (0.04 mm) and increased procli-
nation movement of the mandibular incisors (IMPA,
6.58
) than both normal and high-angle groups
(IMPA, 1.64
and 0.48
, respectively). According to
Bernstein et al,12 angular changes less than 10
in
the long axes of the teeth do not have a significant ef-
fect on the perpendicular linear measurements made
from the incisal margin of the mandibular central
incisor to the mandibular plane. This parameter was
equivalent to a measurement carried on the center of
resistence of the tooth.
The high-angle group showed greater extrusion of
posterior teeth (L4, 3.42 mm; L6, 2.04 mm) associated
with uprighting of the first and second molars (L6^MP,
4.00
; L7^MP, 5.79
) compared with the low-angle group
(L4-MP, 0.84 mm; L6-MP, 0.37 mm; L6^MP, 2.42
;
L7^MP, 1.89
).
The evaluation of the differences between the
normal-angle (Int.Inc, 6.37
) and high-angle (Int.Inc,
3.06
) groups exhibited a significant reduction of the
interincisal angle in normal-angle group.
A significantly increased uprighting of the
second molar was found in the high-angle group
(L7^MP, 5.79
) when compared with the normal-
angle (L7^MP, 2.27
) and low-angle (L7^MP, 1.89
)
subjects.
Moreover, the high-angle group showed in-
creased clockwise rotation of the occlusal plane
(OP^MP, 5.31
) when compared with the low-angle
and normal-angle groups (OP^MP, 1.1
and 2.15
,
respectively).
The results indicate improvements in overbite values
in all groups. Greater modification in overbite values
was evident in the low-angle group (2.11 mm)
compared with the other groups, but it was not statis-
tically significant.
The modification of the curve of Spee with treatment
showed similar results in the 3 groups. The average
correction ranged from 2.69 mm in the low-angle group
to 2.10 mm in the high-angle group.

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764 Rozzi et al

Table V. Statistical comparison of the changes during treatment between the groups
Low angle (I) Normal angle (II) High angle (III)

T2-T1 T2-T1 T2-T1 Intergroup comparison

Variable Mean SD Mean SD Mean SD I-II I-III II-III
SNA (
) 0.26 0.18 0.11 0.07 0.74 0.52 NS NS NS
SNB (
) 0.27 0.19 1.00 0.70 0.74 0.75 NS NS NS
ANB (
) 0.53 0.30 0.68 0.48 0.21 0.14 NS NS NS
SN^GoGn (
) 0.31 0.21 0.26 0.18 0.05 0.03 NS NS NS
FMA (
) 0.26 0.18 0.95 0.67 0.58 0.41 NS NS NS
y-axis (
) 0.42 0.29 0.74 1.30 1.05 10.74 NS NS NS
SN^OP (
) 3.53 2.49 3.63 2.56 3.32 2.34 NS NS NS
OP^MP (
) 1.1 10.77 2.15 1.52 5.31 3.75 NS * *
SN^PP (
) 0.31 0.21 0.47 0.33 0.87 0.48 NS NS NS
IMPA (
) 6.58 4.65 1.64 1.15 0.48 0.33 * * NS
Up.Inc.^FP (
) 0.73 0.5 1.08 0.76 1.69 1.19 NS NS NS
Overjet (mm) 1.97 1.30 2.15 1.52 2.52 1.78 NS NS NS
Overbite (mm) 2.11 1.49 1.64 1.15 0.89 0.62 NS NS NS
Int.Inc. (
) 5.94 4.20 6.37 4.50 3.06 2.16 NS NS *
L1-MP (mm) 1.87 2.10 1.05 0.74 0.04 0.28 NS * NS
L4-MP (mm) 0.84 0.59 2.85 2.01 3.42 3.64 NS * NS
L6-MP (mm) 0.37 0.26 1.20 1.74 2.04 3.52 NS * NS
L7-MP (mm) 1.00 0.70 0.79 0.55 1.05 0.74 NS NS NS
U1-PP (mm) 0.58 0.41 0.37 0.26 1.29 1.71 NS NS NS
L6^MP (
) 2.42 1.70 3.05 2.86 4.00 4.24 NS * NS
L7^MP (
) 1.89 2.04 2.27 2.31 5.79 5.50 NS * *
SPEE (mm) 2.69 1.90 2.34 1.65 2.10 1.48 NS NS NS
Multicomparison ANOVA test confirmed by pair-wise bivariate t test was used.
Refer to Table I for the definition of each measurement.
SPEE, Curve of Spee measured on digital model.
*P \0.01; NS, Not significant.

DISCUSSION Also, Braun and Schmidt22 studied the differences in

The specific feature of this study was to evaluate the
changes of dentoskeletal parameters in orthodontic sub-
jects treated with full fixed edgewise preadjusted appli-
ances and having different skeletal vertical patterns and
an increased curve of Spee before treatment.
In this radiographic study, no patients had angular
changes greater than 10
for any teeth in question. Ac-
cording to the literature, angular changes less than 10

in the long axes of the teeth do not have a significant ef-
fect on the perpendicular linear measurements made
from L1, L4, L6, or L7 to the MP.12,19
These results indicated no significant differences in
the mean measurements for the pretreatment and
posttreatment curve of Spee depth for male and fe-
male patients. These results agree with those of Carter
and McNamara,20who reported no difference in the
depth of the curve of Spee between the sexes when
measured from the dental casts taken before the treat-
ment. Lie et al21 showed similar trends in posttreat-
ment changes in male and female patients after
orthodontic treatment with edgewise appliances with
and without extractions.
the curve of Spee between men and women and between
the different Angle classifications. The shape of the curve
for males and females seemed to be identical, and no
significant differences were found among Class I, Class
II Division 1, or Class II Division 2 subjects.23 In
our study, Class III subjects were excluded because the
depth of the curve results to be reduced before treat-
ment.3 In contrast with this finding, Farella et al3
demonstrated that the curve of Spee was also influenced
by the position of the mandible with respect to the ante-
rior cranial base, regardless of the reciprocal positions of
the mandible and maxilla in the sagittal plane. The more
anteriorly the mandible is positioned, the less marked the
curve.
The results in the literature about skeletal changes af-
ter curve of Spee leveling are few and in disagreement,
probably with a minimum of clinical relevance. Previous
studies have demonstrated that a straight-wire approach
to orthodontic treatment requiring leveling of the curve
of Spee is associated with increases in the vertical dimen-
sions of the face.12,24-27 Bernstein et al12 reported mean
y-axis change associated with treatment.

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Rozzi et al
This study showed a significant extrusion of the pos-
terior teeth especially in high-angle subjects (L4-MP,
3.42 mm; L6-MP, 2.04 mm). This movement caused
an increase of the y-axis value (1.05
) with an effect
on the total facial height as reported in previous studies,
but it was not statistically significant.12,24-27 Therefore,
the increase of the occlusal-mandibular plane angle re-
sulted from the clockwise rotation of the mandible
(although not significant) without a counterclockwise
rotation of the occlusal plane. A possible
explanation for the increased extrusion of posterior
teeth in the high-angle group with an increase of the
y-axis value could be the reduced resistance of mastica-
tory muscles to the extrusion leveling force of the ortho-
dontic archwire. In support of this thesis, Proffit et al28
reported a reduced occlusal force in long-face subjects
during chewing and swallowing compared with other
subjects. Other authors also found differences in
mandibular muscle morphology in subjects with
different skeletal facial patterns and larger masseter vol-
umes associated with brachyfacial subjects when
compared with dolichofacial subjects.29,30
In our study, most of the leveling of the curve of Spee
was accomplished by relative extrusion of the premolars,
buccal movement and intrusion of the mandibular inci-
sors, and uprighting and extrusion of the mandibular
molars. These findings agree with earlier studies, sug-
gesting that straight-wire techniques level the curve of
Spee by a combination of premolar extrusion and incisor
intrusion.12,25,31,32 Those studies did not, however,
provide data to quantify the suggested tooth
movements.
Analysis of the intergroup differences showed
increased posterior extrusion in the high-angle group
(L4-MP, 3.42 mm; L6-MP, 2.04 mm) and greater incisor
intrusion and proclination in the low-angle group (L1-
MP, 1.87 mm; IMPA, 6.58
).
As previously described, different magnitudes in
biting forces between high-angle and low-angle sub-
jects play an important role in the balance between
molar extrusion and incisor intrusion. The greater masti-
catory forces in the low-angle group could preclude the
overeruption of the posterior teeth and allow archwire
forces to intrude and procline the mandibular incisors.30
In the same manner, the biomechanics play an
important role during orthodontic leveling of the dental
arch. The archwire placed in the brackets of the mandib-
ular incisors creates an intrusion force. At the same time,
a moment to tip the crowns facially is created by distance
of the brackets forward from the center of resistance of
the teeth. In buccally tipped incisors, the magnitude of
this moment increase encourages incisor proclina-
tion.31,32 To standardize this biomechanical aspect, the
American Journal of Orthodontics and Dentofacial Orthopedics
765
3 groups were compared at T1 for IMPA values,
resulting in matched values for this parameter.
Although not significant, a difference in IMPA values
between the low-angle and high-angle groups was pre-
sent (96.63
and 93.84
, respectively). This could influ-
ence the magnitude of the moment, increasing the
incisor proclination in the low-angle subjects.
Pollard et al14 reported in the short term great differ-
ences between the groups for the interincisal angle. The
low-angle and the normal-angle groups showed signif-
icant reductions in interincisal angle during treatment
from maxillary and mandibular incisors proclination. In
agreement with the literature, we found that the high-
angle group had the lowest reduction of the interincisal
angle with treatment when compared with the normal-
angle and low-angle groups. Probably, a difference in
the results was due to a smaller number of analyzed sub-
jects and the different values between the studies of
axial inclination of mandibular and maxillary incisors
between the groups at T1.
A great clockwise rotation of the occlusal plane was
shown by the high-angle (OP^MP 5.31
) group when
compared with the low-angle and normal-angle groups
in this study (OP^MP, 1.1
and 2.15
, respectively). This
result is explained because the curve of Spee leveling
in the high-angle group occurred with greater move-
ment of the posterior than the anterior teeth; this agrees
with other authors who noted as the effect of contin-
uous archwire mechanics a clockwise opening rotation
of the occlusal plane.24-27,33-35
These results indicate improvements in overbite
values in all groups, but no differences were found in
overbite correction with treatment in the 3 vertical facial
patterns. Also, the amounts of leveling of the curve of
Spee with treatment were similar in the 3 groups.
Engel et al36 found that patients with a high
mandibular arc, an indication of a true brachycephalic
pattern, showed the least opening during treatment
and the greatest closing after treatment. On the con-
trary, Pollard et al14 reported in the short term a
greater correction of overbite in the low-angle group.
Probably, these opposing results were due to differ-
ences in pretreatment intergroup values of overbite
in the previous study. In this study, we matched the
3 groups at pretreatment for dental and skeletal
values.
After treatment, the different skeletal vertical facial
patterns showed similar average modifications of the
curve of Spee and overbite, but the dental movements
to achieve these corrections were different in the 3
groups. This did not influence the results of orthodontic
treatment in the short term, but it is important to eval-
uate the cause of relapse in the long term.
April 2017  Vol 151  Issue 4
766
CONCLUSIONS
The leveling of the curve of Spee depends on
different dental parameters based on skeletal vertical
pattern. In the low-angle subjects, orthodontic leveling
of the curve of Spee occurred through buccal movement
and intrusion of the mandibular incisors; in the high-
angle subjects, orthodontic leveling of the curve of
Spee occurred through extrusion and uprighting of the
mandibular posterior teeth.
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