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ISSN 1983-5183

Rev. Odontol. Univ. Cid. São Paulo


2016; 28(2): 110-6,mai-ago

CURVE OF SPEE: A LITERATURE REVIEW.


CURVA DE SPEE: UMA REVISÃO DE LITERATURA.
Elias, KFL*
Denis Clay Lopes dos Santos**
Daniel Negrete***
Everton Flaiban****

ABSTRACT
The curve of Spee (COS) is an important characteristic of the dental arch that was described as an occlusal
curvature seen in the sagittal plane. This natural phenomenon has clinical importance in orthodontics and
restorative dentistry. This study aim to gather the current knowledge of COS in order to become a guide for a
construction of an optimal occlusion. The methodology utilized was a review and compilation of the most per-
tinent literature articles. The following were deliberated in this review: development, measurement, evolutive
similarities, gender, side, properties, the purpose of levelling, the sorts of levelling and the long-term stability
of the COS. In conclusion, although a large amount of research on COS already exists, there is no standard
methodology to define an ideal model of treatment and/or prevention. Nevertheless, its results give dentists a
complete overview to establish their approach towards a successful long-term stability treatment.
Descriptors: Dental occlusion • Curve of Spee • Intrusion • Extrusion • Levelling; Stability.

RESUMO
A Curva de Spee é uma característica importante da arcada dentária e foi descrita como uma curvatura oclusal
vista a partir do plano sagital. Esse fenômeno natural é de grande importância clínica especialmente em orto-
dontia e em dentística. Este estudo tem como objetivo compilar o atual conhecimento sobre a Curva de Spee
com intenção de se tornar um guia para o desenvolvimento de uma oclusão eficiente. A metodologia utilizada
foi revisão de literatura sobre a Curva de Spee e os tópicos discutidos são: desenvolvimento, mensuração, simi-
laridades evolutivas, gênero, comparação entre lados, propriedades, o propósito do nivelamento, as maneiras
de se nivelar e a estabilidade a longo prazo. Apesar do grande número de pesquisa sobre a Curva de Spee, não
existiu um padrão de metodologia ou mensuramento para definir um modelo ideal para tratamento e/ou pre-
venção. Como conclusão, este artigo fornece uma ampla visão para capacitar o cirurgião-dentista em direção
a um tratamento de sucesso e de estabilidade.
Descritores: Oclusão dentária • Curva de Spee • Intrusão • Extrusão • Nivelamento • Estabilidade.

**** Dentist - kfelias@hotmail.com


**** Ph.D. in Orthodontics - Orthodontics professor at School of Dentistry, Universidade Cruzeiro do Sul, São Paulo, Brazil - dr.denis@globomail.com
**** Master in Orthodontics - Orthodontics professor at School of Dentistry, Universidade Cruzeiro do Sul, São Paulo, Brazil - +55 11 99922-5415
**** Master in Orthodontics - Orthodontics professor at School of Dentistry, Universidade Cruzeiro do Sul, São Paulo, Brazil - +55 11 97036-8808

110
ISSN 1983-5183
INTRODUCTION development of the neuromuscular sys- Elias KFL
Santos DCL
Curve of Spee (COS) is an anatomic cur- tem, and eruption of teeth3.
Negrete D
vature of the mandibular dental arch seen Spee on his studies suggested that this Flaiban E
in the sagittal plane described by Graf Von geometric arrangement defined the most
Curve of spee:
Spee, a prosector at the Anatomy Institu- efficient pattern for maintaining maximum a literature
te of Kiev, in 1890 and Biedenbach, Hotz tooth contacts during chewing1. This state- review.
and Hitchcock have recently represented ment became the foundation for Monson’s
it in 19801. This natural phenomenon has spherical theory on the idealistic arrange-
clinical importance for an ideal functional ment of the teeth in the dental arch4.
occlusion, thus far it provides a small un- More recently, it was advocated that
derstanding of the reasons it occurs. the COS have a biomechanical function
The aim of this study is to issue a com- during food processing by increasing the
pendium of the pre-existent knowledge crush/shear ratio between the posterior
into a guide for orthodontics and resto- teeth and the efficiency and resistance of
rative dentistry appliances about develo- occlusal forces during mastication5.
pment, management and the long-term Development of the Curve of Spee
stability of COS. It is assumed that the deciduous denti-
tion has a COS ranging from flat to mild.
METHODOLOGY The COS depth is minimal in the deci-
duous dentition (flat), its greatest increase
To prepare this project PubMed/ME-
occurs in the early mixed dentition as a
DLINE, Cochrane and Scopus sciences
result of permanent first molar and central
were utilized as biomedical search engi-
incisor eruption; it maintains this depth
nes. The searching term used was COS
until it increases to maximum depth with
with helping the truncation symbol * on
the eruption of the permanent second mo-
the word curv*. The research was restric-
lars. During the adolescent dentition sta-
ted to English, Portuguese and Spanish
ge, the curve depth decreases slightly and
languages and no other limited metho-
then remains relatively stable into early •• 111 ••
dology had been employed. The articles
adulthood6, 7.
were selected according to the applicabi-
A likely theory for the development of
lity of this study.
the COS is that mandibular permanent
DISCUSSION teeth erupt before their maxillary antago-
nists. This means the COS is not skeletal,
Spee predicted the curvature from a
indeed, develops as a dental event. On
sagittal view analysing the skulls to defi-
average, eruption of the mandibular per-
ne the line of occlusion as the line on a
manent first molars antecede the maxillary
cylinder tangent to the anterior border of
permanent first molars by 1 to 2 months,
the condyle, the occlusal surface of the se-
mandibular permanent central incisors
cond molar, and the incisal edges of the
precede the maxillary permanent central
mandibular incisors1. The definition of the
incisors by 12 months, and mandibular se-
COS for prosthodontics is an anatomic
cond molars are 6 months before the ma-
anteroposterior curve established by the
xillary second molars8.
occlusal alignment of the teeth, as projec-
Gender and Side Influence
ted onto the median plane, beginning with
In general, there is no significant diffe-
the cusp tip of the mandibular canine and
rence on the COS between males and fe-
following the buccal cusp tips of the pre-
males and either the right and left sides of
molar and molar teeth, continuing throu-
the mandibular arch9, 10, 11.
gh the anterior border of the mandibular
Evolutive similarities
ramus, ending with the anterior-most por-
In reason of the different kinds of ali-
tion of the mandibular condyle2 . Despite
mentation, two types of occlusion exist.
the understanding of the reason why and
In the case of carnivorous skulls, lateral Rev. Odontol.
how the COS exist is limited, it is believed Univ. Cid. São
mandibular movements are absent, the
that the COS is a combination of factors, Paulo
mandibular ramus is short and the COS is 2016; 28(2):
including growth of orofacial structures,
non-existent. On the other hand, the her- 110-6,mai-ago
ISSN 1983-5183
Elias KFL bivorous type has very important lateral to a deeper COS16 . In addition, when the
Santos DCL
mandibular movements, the mandibular anterior teeth have no vertical stop, their
Negrete D
Flaiban E ramus is higher and COS is deep. There is continued eruption will contribute to the
also an association between the forward deepening of the COS20, 21.
Curve of spee:
a literature
tilt of the mandibular posterior teeth and The purpose of levelling the Curve
review. the orientation of the masseter muscle12. of Spee
Osborn, in his comparative study, con- On the six characteristics of normal oc-
cluded that the tilt of the COS increases clusion described by Andrews, it was pro-
the crush/shear ratio of the force produced posed that the COS in subjects with good
on food between the posterior molars. The occlusion ranged from flat to mild. For this
parallel tilt of superficial  masseter maxi- reason, it was suggested that levelling and
mizes the efficiency with which this mus- flattening the occlusal plane should be a
cle contributes to the crush component of treatment goal in orthodontics22. This con-
the bite force in the sagittal plane13. cept has been supported by others with
Measurement of Curve of Spee regard to maintaining stable results after
Clinically, the depth of COS is mea- treatment10, 18.
sured by a line that is positioned on the Therefore, levelling of the COS is a rou-
mandibular occlusal surfaces and the fur- tine orthodontic practice and several stu-
thermost depth from this plane is noted. dies have compared treatment techniques
However, some authors do not include to deal with exaggerated COS and the
the incisors in the depth measurements stability of those treatments. These tooth
because super-erupted incisors result in a movements are mostly extrusion of mo-
greater depth of the COS14. lars, the intrusion of incisors and incisor
Academically, the COS could be mea- proclination19, 21, 23, 24, 25, 26, 27 28, 29 30.
sured by a flat plane formed by the incisal Extrusion of posterior teeth
edge of the mandibular central incisors to Extrusion of posterior teeth is a possi-
the distal cusp tip of the second molars. ble treatment for patients with excessive
•• 112 •• Perpendiculars are projected on this line COS. The most typical technique is con-
from the cusp tips of all teeth in this half tinuous archwire23, 28,31. A variation of this
arch. A sum of these perpendiculars is cal- practice is to proceed with maxillary exa-
culated for the right and the left side7, 15, 16, ggerated COS wires or/and mandibular
17, 18
. reverse COS. Increasing step bends in an
It is assumed by some authors that the archwire similarly levels the COS. Other
deepest point of the COS is the mesiobuc- methods consist of the use of a bite plate,
cal cusp of the first molar independent of which permits the posterior teeth to erupt.
the sort of malocclusion.17, 18, 19 Nonethe- In addition, altering bracket placement
less, Harris and Corruccini found in their heights helps to level the COS as well30 .
research that the commonly deepest point A main concern is that every millimetre of
of the COS is on a premolar14. extrusion increases the incisor overlap by
Properties of Curve of Spee between 1.5-2.5 mm29, 30.
Not only is COS correlated with over- The indications for extrusion of poste-
-bite and overjet, but also COS is descri- rior teeth are short lower facial height and
bed as the deepest in class II, while it is moderate-to-minimal incisor display29, 30.
flatter and with insignificant variances in On the other hand, the disadvantages are
class I and III subjects19. instability in non-growing patients, incre-
It was established by Veli, Ozturk and ase in the interlabial gap, excessive inci-
Uysal that the depth of the COS is grea- sor exhibition and worsening of gingival
test in the Class II Division 1, followed by smile21, 30,32 . Furthermore, extruding pos-
Class II Division 2, Class I, and Class III. teriors could cause a rise in lower facial
However, there is no significant difference height and patients with strong facial mus-
Rev. Odontol. between Class II division 1 or 217, 18. cles have a tendency to relapse after the
Univ. Cid. São Furthermore, COS is directly proportio- orthodontic treatment33.
Paulo
2016; 28(2):
nal to the overjet and over-bite of an in- Intrusion of incisors
110-6,mai-ago dividual. By increasing them, it will lead The intrusion of incisors is a necessa-
ISSN 1983-5183
ry method to level COS particularly for Flattening the COS seems to be very Elias KFL
Santos DCL
patients with a large vertical dimension, stable on a long-term basis31,42, 43. The
Negrete D
excessive incision-stomion distance and a long-term stability of the correction of Flaiban E
large interlabial gap. 29, 30,34. The four most COS is established by several factors, such
Curve of spee:
common techniques are: Burstone19, Begg as the amount of growth, age, neuromus- a literature
and Kesling35 (1977), Ricketts36 (1976) and cular adaptation, muscle strength, original review.
Greig37 (1983). malocclusion and the specific nature of its
The four methods apply tipback twists correction, for example intrusion or/and
at the molars to provide an intrusive force extrusion30, 44.
at the incisors and recognise the extreme More stability is also expected after
significance of a light and continuous for- pronounced levelling deviations of deep
ce application29, 30. On the other hand, this curves, while there is a propensity in the
orthodontic treatment has a notable risk direction of less stability and more natural
factor associated with external apical root fluctuations when treatment contains sli-
reabsorption38, 39. ght changes10.
Incisors proclination
Incisors proclination is another option CONCLUSION
to levelling the COS. Some researchers Although exist a considerable amount
claim that COS is predominantly flat- of research about COS, there is no stan-
tened by proclining the lower incisors40. dard methodology as a control group, tre-
For each 1 mm of levelling, the mandibu- atment conduct, and measurement of sta-
lar incisors will be proclined 4°, without bility. As a conclusion, there is not enough
increasing the arch width. In addition, it evidence to define an ideal model of treat-
is suggested that 1 mm of arch circumfer- ment and prevention.
ence is required to level each 1millimeter However, these results give orthodon-
of the COS26,41 . However, it is assumed tists and all dentists not only a deeper
by Pandis et al that the amount needed guideline for establishing their behaviour
is variable depending on the type of me- towards a successful long-term stability •• 113 ••
chanics applied40. treatment, but also how to have a more
Long-term stability assertive approach to the levelling of COS
based on each patient’s needs.

Rev. Odontol.
Univ. Cid. São
Paulo
2016; 28(2):
110-6,mai-ago
ISSN 1983-5183
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•• 116 ••

Rev. Odontol.
Univ. Cid. São
Paulo
2016; 28(2):
110-6,mai-ago