ORIGINAL ARTICLE

Development of the curve of Spee

Steven D. Marshall,a Matthew Caspersen,b Rachel R. Hardinger,c Robert G. Franciscus,d
Steven A. Aquilino,e and Thomas E. Southardf
Iowa City, Iowa, Fredericksburg, Va, and Oklahoma City, Okla

Introduction: Ferdinand Graf von Spee is credited with characterizing human occlusal curvature viewed in
the sagittal plane. This naturally occurring phenomenon has clinical importance in orthodontics and
restorative dentistry, yet we have little understanding of when, how, or why it develops. The purpose of this
study was to expand our understanding by examining the development of the curve of Spee longitudinally
in a sample of untreated subjects with normal occlusion from the deciduous dentition to adulthood.
Methods: Records of 16 male and 17 female subjects from the Iowa Facial Growth Study were selected and
examined. The depth of the curve of Spee was measured on their study models at 7 time points from ages
4 (deciduous dentition) to 26 (adult dentition) years. The Wilcoxon signed rank test was used to compare
changes in the curve of Spee depth between time points. For each subject, the relative eruption of the
mandibular teeth was measured from corresponding cephalometric radiographs, and its contribution to the
developing curve of Spee was ascertained. Results: In the deciduous dentition, the curve of Spee is minimal.
At mean ages of 4.05 and 5.27 years, the average curve of Spee depths are 0.24 and 0.25 mm, respectively.
With change to the transitional dentition, corresponding to the eruption of the mandibular permanent first
molars and central incisors (mean age, 6.91 years), the curve of Spee depth increases significantly
(P ⬍ 0.0001) to a mean maximum depth of 1.32 mm. The curve of Spee then remains essentially unchanged
until eruption of the second molars (mean age, 12.38 years), when the depth increases (P ⬍ 0.0001) to a
mean maximum depth of 2.17 mm. In the adolescent dentition (mean age, 16.21 years), the depth decreases
slightly (P ⫽ 0.0009) to a mean maximum depth of 1.98 mm, and, in the adult dentition (mean age 26.98
years), the curve remains unchanged (P ⫽ 0.66), with a mean maximum depth of 2.02 mm. No significant
differences in curve of Spee development were found between either the right and left sides of the
mandibular arch or the sexes. Radiographic measurements of tooth eruption confirm that the greatest
increases in the curve of Spee occur as the mandibular permanent incisors, first molars, or second molars
erupt above the pre-existing occlusal plane. Conclusions: On average, the curve of Spee initially develops
as a result of mandibular permanent first molar and incisor eruption. The curve of Spee maintains this depth
until the mandibular permanent second molars erupt above the occlusal plane, when it again deepens.
During the adolescent dentition stage, the curve depth decreases slightly and then remains relatively stable
into early adulthood. (Am J Orthod Dentofacial Orthop 2008;134:344-52)

V
iewed in the sagittal plane, occlusal curvature termed the curve of Spee in the late 19th century, when
is a naturally occurring phenomenon in the Ferdinand Graf von Spee2,3 described it in humans.
human dentition. Found in the dentitions of In the sagittal view, Spee connected the anterior
other mammals and fossil humans,1 this curvature was surfaces of the mandibular condyles to the occlusal
a
surfaces of the mandibular teeth with an arc of a circle,
Visiting associate professor, Department of Orthodontics, College of Den-
tistry, University of Iowa, Iowa City. tangent to the surface of a cylinder lying perpendicular
b
Private practice, Fredericksburg, Va. to the sagittal plane. He suggested that this geometric
c
Orthodontic resident, College of Dentistry, University of Oklahoma, Okla- arrangement defined the most efficient pattern for
homa City.
d
Associate professor, Department of Anthropology, University of Iowa, Iowa maintaining maximum tooth contacts during chewing
City. and considered it an important tenet in denture con-
e
Professor, Department of Prosthodontics, College of Dentistry, University of struction. This description became the basis for Mon-
Iowa, Iowa City.
f
Professor and head, Department of Orthodontics, College of Dentistry, son’s spherical theory4 on the ideal arrangement of
University of Iowa, Iowa City. teeth in the dental arch, in which occlusal curvature is
Supported by the Dr George Andreasen Memorial Fund. described in the sagittal and frontal planes by the
Reprint requests to: Thomas E. Southard, Department of Orthodontics, College
of Dentistry, University of Iowa, Iowa City, IA 52242; e-mail, tom-southard@ tangent of a sphere with a radius of approximately 4 in.
uiowa.edu. Our current understanding is that, in sample popula-
Submitted, May 2006; revised and accepted, October 2006. tions tested, occlusal curvature can be fitted to the
0889-5406/$34.00
Copyright © 2008 by the American Association of Orthodontists. geometry of Spee’s cylinder and Monson’s sphere with
doi:10.1016/j.ajodo.2006.10.037 much individual variation.5-7
344
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 134, Number 3
Today in orthodontics, the curve of Spee commonly
refers to the arc of a curved plane that is tangent to the
incisal edges and the buccal cusp tips of the mandibular
dentition viewed in the sagittal plane. In contrast, the
prosthodontic specialty ignores the incisors and in-
cludes only the canine to the terminal molar as the
dental arch portion of the curve. The curve then
continues posteriorly to intersect the anterior surface of
the condyle as originally proposed by Spee.8-10
Modern orthodontics and reconstructive dentistry
differ with respect to the clinical significance of the
curve of Spee. Its proper management is critical for the
construction of stable complete dentures and might play
a role in the success of implant-supported restorations.7
In complete denture prosthodontics, establishing a
curve of Spee in harmony with the condylar guidance,
incisal guidance, plane of occlusion, and prosthetic
tooth cusp height is essential for developing a bilater-
ally balanced articulation, believed to maintain optimal
denture stability.11
In the prosthodontic restoration of the natural den-
tition, the treatment goal is a mutually protected occlu-
sion, whereby the posterior teeth disclude during ec-
centric functional movements. The curve of Spee, in
conjunction with posterior cusp height, condylar incli-
nation, and anterior guidance, plays an important role in
the development of the desired occlusal scheme.10 The
4-in Monson sphere is used by some to develop an
“idealized” reconstruction of the posterior dentition.12
In patients with a retrognathic mandible and steep
anterior guidance, it has been suggested that the occlu-
sal plane might be constructed with a shorter radius
than the 4-in standard reported by Monson to avoid
posterior interferences. The opposite is true in Class III
patients, when a larger (flatter) curve, typically a 5-in
radius, is more suitable.13
Andrews,14 in describing the 6 characteristics of
normal occlusion, found that the curve of Spee in
subjects with good occlusion ranged from flat to mild,
noting that the best static intercuspation occurred when
the occlusal plane was relatively flat. He proposed that
flattening the occlusal plane should be a treatment goal
in orthodontics. This concept, especially as applied to
deep overbite patients, has been supported by oth-
ers15-20 and produces variable results with regard to
maintaining a level curve after treatment.21-23
Our understanding of why the curve of Spee devel-
ops is limited. Some suggest that its development
probably results from a combination of factors includ-
ing growth of orofacial structures, eruption of teeth, and
development of the neuromuscular system. It has been
suggested that the mandibular sagittal and vertical
position relative to the cranium is related to the curve of
Marshall et al 345
Spee, which is present in various forms in mammals.1
In humans, an increased curve of Spee is often seen in
brachycephalic facial patterns24,25 and associated with
short mandibular bodies.26 However, the presence of
the curve of Spee based on a morphologic or cephalo-
metric predictor has not been definitive.
It has been suggested that the deciduous dentition
has a curve of Spee ranging from flat to mild, whereas
the adult curve of Spee is more pronounced.27 Expla-
nations for this observation cite the differences in cusp
height between the deciduous and permanent teeth and
the tendency for increased occlusal wear of the decid-
uous teeth. However, no quantitative research supports
this.
Furthermore, it was reported that, once established
in adolescence, the curve of Spee appears to be rela-
tively stable.28,29 Certain cephalometric and dental
factors are associated with individual variations in the
curve of Spee, but they do not predict its biologic
variance unequivocally. It appears that craniofacial
morphology is just 1 of many factors influencing its
development.6,23,26,30
Even though orthodontists must deal with the curve
of Spee in virtually every patient and prosthodontists
construct a curve of Spee for proper functional occlu-
sion, an in-depth understanding of its cause and devel-
opment is not found in the literature. The purpose of
this study was to increase our understanding by exam-
ining the development of the curve of Spee longitudi-
nally from the deciduous dentition to adulthood in a
sample of untreated subjects with normal occlusion.
MATERIAL AND METHODS
Sixteen male and 17 female subjects were selected
from the Iowa Facial Growth Study, which was started
by L. Bodine Higley and Howard Meredith in 1946; 89
boys and 86 girls were enrolled. They lived in or near
Iowa City, were predominately of Northern European
descent, and had clinically acceptable Class I occlu-
sions and normal facial skeletal features. At enrollment,
the children were not younger than 3 years of age.
Medical history, height, weight, and lateral and anterior
cephalograms were taken quarterly until age 5. Records
including lateral and anterior cephalograms, dental
casts, photographs, and anthropometric measurements
were taken biannually from ages 5 to 12. After age 12,
until about age 18, all records were taken annually.
Records were also taken once during early adulthood
(approximate age, 26 years).
The 33 subjects selected from that study for this
study were previously identified for research purposes
as having complete records into adulthood including
study casts without distortion or abrasion. All subjects
346 Marshall et al
Fig 1. Measurement of the maximum depth of the
curve of Spee.
had tooth eruption timing and eruption patterns within
normal ranges.
The maximum depth of the curve of Spee was
measured as the maximum of the perpendicular dis-
tances between the buccal cusp tips of the mandibular
teeth and a measurement plane described by the central
incisors and the distal cusp tip of the most posterior
tooth in the mandibular arch (Fig 1). A digital caliper
(model CD, 4-in CS, Mitutoyo, Aurora, Ill) was
mounted on a standard surveying table (Fig 2). Dental
casts were leveled to a plane defined by the distobuccal
cusps of the right and left most posterior tooth and the
most central point on the more erupted central incisor.
Permanent incisors used as a tripod landmark were
erupted with more than half of their clinical crown on
a cast and had greater or equal eruption height than the
adjacent deciduous lateral incisors.
Measurements of the curve of Spee were taken on
the left and right sides to within 0.01 mm. The right and
left maximum depths were recorded and averaged to
arrive at the average maximum depth for each subject at
each time point. In this article, we use “depth” to mean
the maximum depth of the curve of Spee. Study casts
selected for the time points for each subject were
chosen from each subject’s longitudinal study casts
based on tooth eruption.
T1: the study cast for each subject available be-
tween ages 3.5 and 5 years, earlier in age, by at least 6
months, than the study cast of full deciduous dentition
chosen for T2; 30 subjects had models.
T2: the study cast of the oldest age for which the
deciduous second molars and incisors still served as the
terminal reference points for the measurement plane; 33
subjects had models.
T3: the study cast of the youngest age for which the
permanent first molars and incisors were the measure-
ment plane references; 33 subjects had models.
T4: the study cast of the oldest age for which the
American Journal of Orthodontics and Dentofacial Orthopedics
September 2008
Fig 2. Apparatus used to measure the maximum depth
of the curve of Spee: a digital caliper vertically mounted
on a surveyor. The end of the digital caliper is enlarged
(inset) to show the modification of the caliper piston to
allow point contact with the study cast.
permanent first molars still served as the terminal
(posterior) reference points for the measurement plane;
33 subjects had models.
T5: the study cast of the youngest age for which the
permanent second molars were the terminal reference
points for the measurement plane; 33 subjects had
models.
T6: the study cast of the subject with fully erupted
adolescent dentition nearest in age to 16 years; 24
subjects had models.
T7: the study cast of the subject nearest in age to 26
years; 23 subjects had models.
Detailed statistics for the subjects from T1 to T7 are
given in Table I.
To ascertain reliability, duplicate measurements
were made of right maximum depth, left maximum
depth, and average maximum depth in 7 subjects (4
female, 3 male) for a total of 33 paired observations
(trials 1 and 2). There were no paired measurements for
T1; 7 paired measurements for T2, T3, and T6; and 6
American Journal of Orthodontics and Dentofacial Orthopedics Marshall et al 347
Volume 134, Number 3

Table I. Descriptive statistics for the subjects’ ages at each time point
Statistic T1 T2 T3 T4 T5 T6 T7

All subjects
Number 30 33 33 33 33 24 23
Mean 4.05 5.27 6.91 11.11 12.38 16.21 26.98
SD 0.39 0.5 0.65 1.24 1.34 0.41 1.36
Median 4 5 7 11 12 16 26.6
Minimum 3.6 4.6 6 7 10.6 16 25.1
Maximum 5.1 6 8.1 13 16 17 30.1
Female subjects only
Number 16 17 17 17 17 14 11
Mean 4.17 5.27 7.08 11.02 12.18 16.14 27.8
SD 0.4 0.49 0.69 1.36 1.07 0.36 1.42
Median 4 5 7 11 12 16 27.9
Minimum 3.6 4.6 6 7 11 16 25.4
Maximum 5.1 6 8.1 13 14 17 30.1
Male subjects only
Number 14 16 16 16 16 10 12
Mean 3.91 5.26 6.73 11.2 12.59 16.3 26.23
SD 0.34 0.53 0.57 1.15 1.59 0.48 0.75
Median 3.95 5 7 11 12.3 16 26.55
Minimum 3.6 4.6 6 8 10.6 16 25.1
Maximum 4.9 6 8 13 16 17 27.5

paired measurements for T6 and T7. Two subjects had
4 paired observations; and the remaining 5 subjects had
5 paired observations.
Intraclass correlations were used to measure the
relationship between the 2 trials. The intraclass corre-
lation is typically used in situations such as this, where it
is of interest to obtain a measure of intrarater agreement
for quantitative outcomes.31,32 Perfect agreement corre-
sponds to an intraclass correlation coefficient of 1. An
intraclass correlation of 0 indicates complete lack of
agreement between the duplicate measures. Statistical
tests were used to test the null hypothesis that the
intraclass correlation coefficient, P, was equal to 0
against the 2-sided alternative hypothesis that P was not
equal to 0. The intraclass correlation coefficient for
measurement of average maximum depth, right maxi-
mum depth, and left maximum depth was 0.999 with a
P value ⬍0.0001.
At each time point, descriptive statistics were ob-
tained for age and for left, right, and average maximum
depth of the curve of Spee; this was done for all
subjects and separately for the sexes. The Wilcoxon
signed rank test was used to compare changes in
maximum depth between 2 adjacent time points. In
these instances, the Wilcoxon signed rank test for
paired data was used to test the null hypothesis that
median change between adjacent time points was equal
to 0. Adjustment for multiple comparisons was made
by using the standard Bonferroni method with an
overall 0.05 level of type I error.33
Radiographic measurements and analysis
Based on preliminary findings, our attention was
drawn to the increase in the curve of Spee specifically
at the time of eruption of the mandibular permanent
incisors, first molars, and second molars. Tracings of
the mandible were made for each of the 33 subjects by
using lateral cephalograms at T2 and T3, and T4 and
T5. At T2, the distobuccal cusps of the deciduous
second molars (right and left), mandibular permanent
first molars (right and left), and the incisal tips of the
deciduous central incisors were identified. At T3, the same
molar landmarks plus the incisal tip of the permanent
central incisors were identified. At T4 and T5, the
distobuccal cusps of the mandibular permanent first
molars, mandibular permanent second molars (right
and left), and the incisal tip of the permanent central
incisors were identified. For T2, a line was constructed
tangent to the deciduous central incisor tip and the
distobuccal cusp tip of the deciduous second molar
(average of right and left molars). For T4, a line was
constructed tangent to the permanent central incisor tip
and the distobuccal cusp tip of the permanent first
molar (average of right and left molars). For each
subject, the T2 tracing was superimposed on the T3
tracing, and the T4 tracing was superimposed on the T5
tracing according to the American Board of Orthodon-
tics standards by using the best fit on the mandibular
symphysis and canal. With the digital caliper, the
vertical change in the tooth landmarks compared with
348 Marshall et al
Fig 3. Sample mandibular superimposition for a sub-
ject. Solid line is the cephalometric tracing at T2. Dotted
line is the cephalometric tracing at T3. Line A represents
the T2 reference plane between the mandibular decid-
uous second molars and central incisors used for cast
measurements. Vertical bars B, C, and D represent
measurements made with the digital caliper and cor-
rected for radiographic magnification as described in
the text. To calculate the relative eruption of the man-
dibular permanent first molars and permanent incisors
relative to the mandibular deciduous second molars
between T2 and T3, the amount of eruption at C was
subtracted from that measured at B and D. The same
analysis was carried out between T4 and T5 to measure
the relative eruption of the mandibular second molars.
the constructed line was measured (Fig 3). The rela-
tively small amount of time between the points allowed
accurate superimposition. Corrections for radiographic
enlargement of linear measurements were made for
each subject at each time point as previously reported
for the Iowa Facial Growth Study.34
RESULTS
Table II gives the descriptive statistics for the
average maximum curve of Spee depth for T1 through
T7. Figure 4 is a plot of these data. In the deciduous
dentition, approximately a year before change to the
transitional dentition (mean age, 4.05 years) and imme-
diately before change to the transitional dentition (mean
age, 5.27 years), the curve of Spee is minimal and does
American Journal of Orthodontics and Dentofacial Orthopedics
September 2008
not change significantly (P ⫽ 0.84), with mean depths
of 0.24 ⫾ 0.29 mm and 0.25 ⫾ 0.34 mm, respectively.
With change to the transitional dentition, corresponding
to the eruption of the mandibular permanent first molars
and central incisors (mean age, 6.91 years), the curve of
Spee increases significantly (P ⬍ 0.0001) to a mean
depth of 1.32 ⫾ 0.77 mm. Just before the eruption of
the mandibular permanent second molars (mean age,
11.11 years), the curve remains unchanged (P ⫽ 1.0),
with a mean depth of 1.31 ⫾ 0.58 mm. Just after the
eruption of the mandibular permanent second molars
(mean age, 12.38 years), the curve increases (P ⬍ 0.0001)
to a mean depth of 2.17 ⫾ 0.75 mm. In the adolescent
dentition (mean age, 16.21 years), the curve decreases
slightly (P ⫽ 0.0009) to a mean depth of 1.98 ⫾ 0.67
mm. In the adult dentition (mean age, 26.98 years), the
curve does not change (P ⫽ 0.66), with a mean depth
of 2.02 ⫾ 0.78 mm. No significant differences in curve
of Spee change were found between the right and left
sides or between the sexes. Descriptive statistics for
differences between curve depths of adjacent time
points are shown in Table III.
Radiographic (lateral cephalometric) measurements
comparing tooth eruption during the greatest increases
in curve of Spee depth (mean ages 5.27-6.91 and
11.11-12.38 years) indicate that eruption of the teeth
defining the termini of the curve (permanent incisors,
first molars, or second molars) places them significantly
above the occlusal plane, thus increasing the depth of
the occlusal curve (Fig 3 and Table IV). On average
between T2 and T3, the mandibular permanent incisors
erupted 3.33 ⫾ 1.51 mm, and the mandibular perma-
nent first molars erupted 3.35 ⫾ .94 mm above the
deciduous second molar-deciduous incisor occlusal
plane established at T2, whereas, during the same
interval, the mandibular deciduous second molars
erupted only 1.03 ⫾ 0.79 mm relative to the occlusal
plane established at T2. On average between T4 and
T5, the mandibular second molars erupted 3.08 ⫾ 0.85
mm above the permanent first molar-permanent central
incisor occlusal plane established at T4, whereas the
permanent first molars, deciduous second molars/sec-
ond premolars, first premolars, and central incisors
erupted above the same occlusal plane 1.00 ⫾ 0.48,
1.01 ⫾ 0.53, 1.03 ⫾ 0.68, and 1.16 ⫾ 0.88 mm,
respectively.
DISCUSSION
The principal findings of this study are shown in
Figure 4. The curve of Spee depth is minimal in the
deciduous dentition; its greatest increase occurs in the
early mixed dentition as a result of permanent first
molar and central incisor eruption; it maintains this
American Journal of Orthodontics and Dentofacial Orthopedics Marshall et al 349
Volume 134, Number 3

Table II. Descriptive statistics for the average maximum curve of Spee depth
Statistic T1 T2 T3 T4 T5 T6 T7

All subjects
Number 30 33 33 33 33 24 23
Mean ⫺0.24 ⫺0.25 ⫺1.32 ⫺1.31 ⫺2.17 ⫺1.98 ⫺2.02
SD 0.29 0.34 0.77 0.58 0.75 0.67 0.78
Median ⫺0.18 ⫺0.14 ⫺1.33 ⫺1.25 ⫺2.32 ⫺2.15 ⫺2.15
Minimum ⫺1.31 ⫺1.44 ⫺3.45 ⫺2.4 ⫺3.73 ⫺3.27 ⫺3.33
Maximum 0 0 0 ⫺0.21 ⫺0.52 ⫺0.8 ⫺0.47
Female subjects only
Number 16 17 17 17 17 14 11
Mean ⫺0.3 ⫺0.28 ⫺1.47 ⫺1.37 ⫺2.3 ⫺2.12 ⫺1.96
SD 0.32 0.35 0.86 0.48 0.71 0.7 0.79
Median ⫺0.31 ⫺0.15 ⫺1.47 ⫺1.25 ⫺2.33 ⫺2.27 ⫺2.15
Minimum ⫺1.31 ⫺1.44 ⫺3.45 ⫺2.24 ⫺3.73 ⫺3.27 ⫺3.33
Maximum 0 0 0 ⫺0.63 ⫺0.54 ⫺0.95 ⫺0.86
Male subjects only
Number 14 16 16 16 16 10 12
Mean ⫺0.18 ⫺0.23 ⫺1.16 ⫺1.24 ⫺2.03 ⫺1.8 ⫺2.08
SD 0.24 0.33 0.65 0.67 0.79 0.61 0.81
Median ⫺0.12 ⫺0.09 ⫺1.08 ⫺1.24 ⫺2.24 ⫺1.82 ⫺2.05
Minimum ⫺0.7 ⫺1.24 ⫺2.1 ⫺2.4 ⫺3.02 ⫺2.68 ⫺3.24
Maximum 0 0 ⫺0.03 ⫺0.21 ⫺0.52 ⫺0.8 ⫺0.47

Fig 4. Sample mean curve of Spee average maximum depth from T1 to T7. Each subject’s mean
maximum depth of the curve of Spee was calculated as the average of the left and right maximum
depths at each time point.

depth until it increases to maximum depth with eruption
of the permanent second molars and then remains
relatively stable into late adolescence and early adult-
hood.
To our knowledge, this is the first report measuring
longitudinally the depth of the curve of Spee. These
findings support the suggestions of Ash27 that the
deciduous dentition has a curve of Spee ranging from
flat to mild and the adult curve is more pronounced.
These findings also support those of Carter and
McNamara28 and Bishara et al29 that, once established
in adolescence, the curve of Spee appears to be rela-
tively stable.
The curve of Spee can be modeled as a simple
curve, with its length defined by an arc of a circle and
its depth (sharpness or flatness) determined by the
radius of the same circle. In this sample, we measured
change in curve depth during a change in arc length as
350 Marshall et al American Journal of Orthodontics and Dentofacial Orthopedics
September 2008

Table III. Wilcoxon signed rank test results for differences in average maximum depth between 2 sequential time
points
Epoch difference Sample size Mean difference SD Median difference Minimum Maximum Wilcoxon P value

2-1 30 ⫺0.02 0.25 0.0 ⫺1.0 0.5 0.8388

3-2 33 ⫺1.07 0.73 ⫺1.1 ⫺3.1 0.5 ⬍0.0001
4-3 33 0.01 0.71 ⫺0.2 ⫺1.4 1.9 1
5-4 33 ⫺0.86 0.65 ⫺0.8 ⫺1.9 0.9 ⬍0.0001
6-5 24 0.35 0.45 0.3 ⫺0.7 1.3 0.0009
7-6 21 ⫺0.11 0.57 0.1 ⫺1.3 0.7 0.6636

The null hypothesis is that the median change between adjacent time points ⫽ 0.

Table IV. Measurement (mm) of vertical eruption for selected teeth at T3 and T5 compared with the curve of Spee
measurement plane constructed at T2 and T4
Time point Teeth measured Mean (SD) Median Minimum/maximum

T3 Mandibular permanent first molars 3.35 (1.26) 3.09 0.91/5.76

Mandibular deciduous second molars 1.03 (0.79) 1.21 0.05/2.85
Mandibular permanent central incisors 3.33 (0.91) 3.57 0.34/4.66
T5 Mandibular permanent second molars 3.08 (0.85) 3.00 1.70/5.20
Mandibular permanent first molars 1.00 (0.43) 0.93 0.00/2.10
Mandibular deciduous second molars or permanent 1.01 (0.58) 0.90 0.14/2.30
second premolars
Mandibular permanent first premolars 1.03 (0.68) 0.90 0.00/2.80
Mandibular permanent central incisors 1.16 (0.88) 1.00 0.00/4.00

a result of permanent first and second molar eruptions.
It is possible to have an increase in the depth of a simple
curve by increasing the arc length alone (circle radius
unchanged). Therefore, the documented change in maxi-
mum depth in our sample might be due to a change in
curve shape, a change in curve length, or both.
A plausible explanation for the development of the
curve of Spee is that mandibular permanent teeth erupt
before their maxillary antagonists. This means that, in
large measure, the curve of Spee develops as a dental
(not skeletal) event. In other words, on average, erup-
tion of the mandibular permanent first molars precedes
the maxillary permanent first molars by 1 to 2 months,
and the mandibular permanent central incisors precede
the maxillary permanent central incisors by 12 months.
Furthermore, the mean age of emergence of the man-
dibular second molars is 6 months before the maxillary
second molars.35,36 This differential timing could permit
unopposed mandibular permanent first molar and incisor
eruption beyond the established mandibular occlusal
plane, especially if deciduous second molars are in a flush
terminal plane relationship or the maxillary deciduous
second molars have small distolingual cusps. Later, man-
dibular second molar eruption could likewise be relatively
unopposed. The result of both events would be deepening
in the curve. Of course, this dental event (mandibular
permanent molars erupting before maxillary molars)
could simply be a way of providing an evolutionary “kick
start” to curve of Spee development.
In addition to the possible contribution of eruption
timing, craniofacial variation and its affects on biome-
chanics might also influence the curve of Spee.37 The
dentitions of most mammals have a curve of Spee, and
there is an association between the forward tilt of the
mandibular posterior teeth and the orientation of the
masseter muscle in many mammals.1,38 Farella et al6
reported that condylar height (relative to the occlusal
plane) and anteroposterior position of the mandible
(relative to the cranial base) are associated with curve
of Spee depth. Based on our results, the finding of
Farella et al could be simply explained by the fact that,
in patients with small mandibles, the mandibular per-
manent incisors could keep erupting (curve of Spee
increasing) until they contact the palate. Although our
results point to a strong eruption (dental) influence on
curve of Spee development, we agree that other cranio-
facial factors probably play a role; we are currently
investigating the impact of these factors.
We found no statistically significant differences
between the depth of the curve of Spee and the left and
right sides of the arches. This result contrasts with the
results of Farella et al,6 who found that left-side curves
were significantly deeper in both sexes.
What are the clinical implications of our findings?
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 134, Number 3
Several studies have compared treatment techniques to
deal with exaggerated curves of Spee and the stability
of those treatments.21,24,39-41 Our findings provide in-
sight into the magnitude of the curve of Spee during
development. These results give orthodontists a guide-
line about the normal curve of Spee depth at the end of
treatment or after the patient has settled in retention.
Furthermore, since our findings indicate that the great-
est increase in the curve of Spee occurs with the
eruption of the mandibular second molars, we believe
that this underscores the importance of including the
second molars in orthodontic treatment.
CONCLUSIONS
1. The occlusal plane in the deciduous dentition is
relatively flat.
2. The largest increase in the maximum depth of the
curve of Spee occurs during, and results specifically
from, the differential eruption of the mandibular
permanent first molars and incisors relative to the
deciduous second molars.
3. The curve of Spee maintains this depth until the
mandibular permanent second molars erupt above
the occlusal plane, when it again deepens.
4. During the adolescent dentition stage, the curve
decreases slightly and then remains relatively stable
into early adulthood.
5. There are no significant differences in maximum
depth of the curve of Spee between either the
right and left sides of the mandibular arch or the
sexes.
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