Journal of Pharmacy &

Bioallied Sciences
J Pharm Bioallied Sci. 4(Suppl 2): S323-S328

Significance of curve of Spee: An orthodontic review

K. P. Senthil Kumar, S. Tamizharasi

Department of Orthodontics, KSR Institute of Dental Science and Research, Tiruchengode, Namakkal (Dt), Tamil Nadu,
India

Address for correspondence: Dr. S Tamizharasi, E-mail: senarasi@[Link]

Copyright: © Journal of Pharmacy and Bioallied Sciences

DOI: 10.4103/0975-7406.100287
Published in print: August 2012

Abstract
Exaggerated curve of Spee is frequently observed in dental malocclusions with deep
overbites. Such excessive curve of Spee alters the muscle imbalance, ultimately
leading to the improper functional occlusion. It has been proposed that an imbalance
between the anterior and the posterior components of occlusal force can cause the
lower incisors to overerupt, the premolars to infraerupt, and the lower molars to be
mesially inclined. This altered condition requires specialized skills for the practitioner.
It would be useful if we have a thorough knowledge of how and when this curve of
Spee develops, so that it will aid us in our treatment. The understanding of why the
curve of Spee develops is limited in literature. The purpose of this article is to
increase our knowledge regarding the development and its effect on dentition and its
treatment in exaggerated cases.

Curve of Spee is a naturally occurring phenomenon in the human dentition. This normal occlusal
curvature is required for an efficient masticatory system. Exaggerated curve of Spee is frequently
observed in dental malocclusions with deep overbites.[1] Such excessive curve of Spee alters the
muscle imbalance, ultimately leading to improper functional occlusion.

Orthodontists eventually deal with the curve of Spee in virtually every patient they treat. The
purpose of this article to increase our knowledge regarding the development and its effect on
dentition and its treatment in exaggerated cases.
Graf Von Spee
The curve of Spee was described by F. Graf von Spee[2] in 1890. Spee was a German anatomist
(1855–1937) who wrote an original article in 1890 and it has been recently represented in 1980.

He used skulls with abraded teeth to define the line of occlusion as the line on a cylinder tangent
to the anterior border of the condyle, the occlusal surface of the second molar, and the incisal
edges of the mandibular incisors.[2]

Most of Spee's predictions were made from a view of skulls perpendicular to the midsagittal
plane. He based his study using three propositions.[3]

Proposition one: Spee indicated that from a profile view, the molar surfaces lie on the arc of a
circle which, continued posteriorly, touches the anterior border of the condyle.

Proposition two: It is easy to demonstrate the curve in cases with marked attrition than in cases
with well-preserved cusps.

Proposition three: When other points besides molars were included in measurements from the line
of occlusion, they, along with the condyle, could be on a common arc.

Spee suggested that this geometric arrangement[4] defined the most efficient pattern for
maintaining maximum tooth contacts during chewing and considered it an important tenet in
denture construction. This description became the basis for Monson's spherical theory[5] on the
ideal arrangement of teeth in the dental arch.

Curve of Spee – Today

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.[5–8]

This anteroposterior curve, or curve of Spee, was defined as the anatomical curve established by
the occlusal alignment of the teeth, as projected onto the median plane, beginning with the cusp
tip of the mandibular canine and following the buccal cusp tips of the premolar and molar teeth,
continuing through the anterior border of the mandibular ramus and ending at the anterior aspect
of the mandibular condyle (Glossary of Prosthodontic terms 1994).[9] The curvature of the arc
would relate, on average, to part of a circle with a 4-inch radius.

More recently, it was suggested that the curve of Spee has a biomechanical function during food
processing by increasing the crush/shear ratio between the posterior teeth and the efficiency of
occlusal forces during mastication.[10]

Development
Viewed in the sagittal plane, occlusal curvature is a naturally occurring phenomenon in the human
dentition. Found in the dentitions of other mammals and fossil humans, this curvature was termed
the curve of Spee in 1890 when a German Anatomist, Ferdinand Graff Spee described it in
humans.

The understanding of how the curve of Spee develops is limited in literature. Some suggest that its
development probably results from a combination of factors including growth of orofacial
structures, eruption of teeth, and development of the neuromuscular system.[11] It has been
suggested that the mandibular sagittal and vertical position relative to the cranium is related to the
curve of Spee, which is present in various forms in mammals.[4] In humans, an increased curve of
Spee is often seen in brachycephalic facial patterns[1213] and associated with short mandibular
bodies.[14]

In a mechanical sense, the presence of a curve of Spee may make it possible for a dentition to
resist the forces of occlusion during mastication.[15–21] Although several theories have been
proposed to explain the presence of a curve of Spee in natural dentitions, its role during normal
mandibular function has been questioned.[162223] It has been proposed that an imbalance
between the anterior and the posterior components of occlusal force can cause the lower incisors
to overerupt, the premolars to infraerupt, and the lower molars to be mesially inclined.[2425]
According to Root and Fidler et al.[26] when a skeletal open bite is not present, the curve of Spee
in Class II malocclusions is deeper than in other malocclusions.

Andrews[27] noted that the occlusal planes in 120 non-orthodontically treated and ostensibly
normal occlusions varied from being generally flat to having a slight curve of Spee. This finding
led him to believe that the presence of a curve of Spee could be associated with post-orthodontic
treatment relapse. Andrews concluded, “even though not all of the orthodontic normals had flat
planes of occlusion, I believe that a flat plane should be a treatment goal as a form of
overtreatment.” A deep curve of Spee may make it almost impossible to achieve a Class I canine
relationship, though it may also result in occlusal interferences that will manifest during
mandibular function.

It is perhaps worthwhile noting that very little research has been undertaken to determine the most
effective method of leveling and to evaluate the long-term stability of leveling the curve of Spee.

Curve of Spee – From Flat to Mild

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. The findings were supported by Ash.[28] Its
greatest increase occurs in the early mixed dentition as a result of permanent first molar and
central incisor eruption; it maintains this depth until it increases to maximum depth with eruption
of the permanent second molars and then remains relatively stable into late adolescence and early
adulthood. These findings also support those of Carter[29] and McNamara[29] and Bishara et al.
[30] that once established in adolescence, the curve of Spee appears to be relatively stable.

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 of one of the many factors influencing its development.[31–33] The curve of
Spee is only influenced to a minor extent by craniofacial morphology. The curve is greatly
influenced by the horizontal position of the condyle and is weakly influenced by the vertical
craniofacial dimension and by the position of the mandible with respect to the anterior cranial
base.

Mew[34] quotes that whenever the curve of Spee is increased, the margins of the tongue will be
seen to overlay the lingual cusps of the mandibular premolar, and the greater the curve, the more
likely it is to overlay both the lingual and buccal cusps, often with scalloping.[3536] This is
because that the tongue adapts to dental and skeletal forms, but there is no evidence to suggest
that tongue posture is one of the determining factors of arch form.

Andrews in describing the six 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 others[37–42] and produces variable results with regard
to maintaining a level after treatment.[144344]
Construction of Curve of Spee
Various authors have used various techniques to measure the depth of curve of Spee. The curve of
Spee was universally likened to a part of a circle. In 1899, Bonwill proposed 4 inches (101.6 mm)
for the dimension of his “mandibular triangle.” Later, Monson (1932) proposed 4 inches as the
radius of this circle. However, Christensen (1959) reminds us that Wilson, in 1920, after
measuring 300 mandibles, found only 6% of them in agreement with the 4-inch radius proposed by
Bonwill. In fact, the mean radius of the curve, initially proposed by Spee himself, was much
lower, 65–70 mm in adults. Similar values was obtained by Hitchcock (1983): 69.1 mm± and
Orthlieb (1997): 83.5 mm.

However, there is little consensus in the literature concerning the measurement of the curve of the
Spee. Baldridge[45] used the perpendicular distances on both sides. Balridge and Garcia found the
ratio to be more accurately expressed by the formulae: Y = 0.488x - 0.51 and Y = 0.657x + 1.34,
respectively, where Y is the arch length differential in millimeters and x is the sum of right and
left side maximum depths of the curve of Spee in millimeters.[4647]

Bishara et al.[30] used the average of the sum of the perpendicular distances to each cusp tip.
Sondhi et al.[48] used the sum of the perpendiculars. Braun et al.[46] and Braun and Schmidt[49]
used the sum of the maximum depth on both sides. Traditionally, these measurements are taken
from study models or photographs with a divider or caliper[44] and a coordinate measuring
machine.[48]

The curve of Spee can also be determined by using a simplified occlusal plane analyzer (SOPA).
[50] An SOPA is preset at 4 inches from the condylar axis. The SOPA works with Denar
articulators. It is an excellent aid for establishing an ideal occlusal plane if all posterior teeth are
to be restored.

Dawson (1989) described reconstruction of the curve of Spee[51] with a flag technique (The
Broadrick Occlusal Plane Analyzer) which incorporated the same radius for almost all patients.
The flag technique was recently redescribed by Lynch and McConnell (2002).

As technology advanced, new measuring devices became available, e.g. 3-dimensional (3D)
optical digitizers that accurately measure small changes. At present, 3D virtual models are
available for clinicians, supplemented by dedicated software to perform the necessary
measurements.
Leveling the curve of spee
A review of literature reveals that there is disagreement among the proponents of the various
orthodontic techniques that are used to level deep curves of Spee.[1252–55] The discussion
involves around which leveling technique produces the most effective overbite correction as well
as the most stable long-term treatment outcomes. Clinicians who adhere to the Tweed philosophy
of orthodontic treatment use continuous archwires that incorporate reverse curve of Spee to
produce flat occlusal planes.

Accordingly, arch leveling occurs mostly by an extrusion of the lower premolar teeth in
conjunction with a minimal intrusion of the mandibular incisor teeth. In contrast to the earlier
approach, advocates of sectional arch orthodontic mechanics treat deep curve of Spee by intrusion
of mandibular incisors while usually allowing the lower premolars to erupt into occlusion. These
people believe that extruding posteriors will cause an increase in lower facial height. They further
believe that in individuals with strong muscles of mastication, the orthodontically extruded buccal
segments will tend to relapse after the orthodontic treatment, which will lead to recurrence of
anterior deep bites.[525657]

But a study conducted by Carcara et al.[1] with cases treated by Wick Alexander by his Alexander
Discipline showed that curve of Spee could be leveled successfully and results were stable when
continuous archwire mechanics were used. It must be kept in mind that not every straight wire
appliance has the unique prescription that is part of the Alexander Discipline, namely the -5°
torque in the mandibular incisor and the -6° distal tip built into the molar tubes. This unique
appliance prescription may play a large role in allowing for an effective, and controlled,
mandibular arch leveling. In addition, the mechanical principles of actively tying back a heat-
treated curved archwire may contribute to the success of arch leveling.

Correction of Exaggerated Curve of Spee

Correction of exaggerated curve of Spee can be achieved by the following tooth movements:

1. Extrusion of molars
2. Intrusion of incisors
3. Combination of both movements

Extrusion of posterior teeth

One millimeter of upper or lower molar extrusion effectively reduces the incisor overlap by 1.5–
2.5 mm. A very common method is the use of continuous archwires.[58] A close variation of this
technique is to use mandibular reverse curve of Spee and/or maxillary exaggerated curve of Spee
wires. Progressively increasing step bends in an archwire also levels the curve of Spee. Other
common methods include the use of a bite plate, which allows the posterior teeth to erupt.

Indications
in patients with short lower facial height, excessive curve of Spee, and moderate-to-minimal
incisor display.

Disadvantages
stability is questionable in non-growing patients. Major disadvantages include excessive incisor
display, increase in the interlabial gap, and worsening of gingival smile.[3959] Flaring of incisors
is a common disadvantage with reverse curve wires. The primary drawback of using step bends in
archwires to level curve of Spee is the change in cant of the occlusal plane toward a deeper bite.

Intrusion of incisors
Intrusion of upper and/or lower incisors is a desirable method to level curve of Spee in many
adolescent and adult patients.[60–62] The four common methods to facilitate intrusion of the
upper incisors are:

1. Burstone[63]
2. Begg and Kesling[64]
3. Ricketts[65]
4. Greig[66]

All four designs apply tipback bends at the molars to provide an intrusive force at the incisors. All
of them recognize the need for a light and continuous force application.

Indications
is particularly indicated in patients with a large vertical dimension, excessive incision-stomion
distance, and a large interlabial gap.

Disadvantages
A major risk factor associated with orthodontic treatment is external apical root resorption.
[67–71] Many clinicians seem to have a subjective opinion that incisor intrusion increases the risk
of apical root resorption. Many recent clinical studies[72–78] have proven that the use of intrusion
arches with average force provide a healthy biologic response with negligible root resorption.

Effects of Curve of Spee Leveling

A study conducted by Pandis et al.[79] showed that Curve of spee (COS) is mainly flattened by
proclining the mandibular incisors. For 1 mm of leveling, the mandibular incisors were proclined
4°, without increasing the arch width. But Afzal and Ahmed[80] measured the pretreatment and
postreatment plaster models and found that 1 mm of arch circumference necessary to level each 1
mm of COS was only an overestimation.

Continuous archwire
Bernstein et al.[81] performed a long-term cephalometric study and found that leveling of COS
with the continuous archwire technique takes place by a combination of premolar extrusion and, to
a lesser extent, by incisor extrusion. It is very effective in leveling the COS in patients with Class
II Division I deep bite malocclusions treated without extractions when the initial COS is 2–4 mm.

Comparison between rectangular and round archwires

AlQabandi et al.[82] evaluated the effects of full continuous archwire, rectangular and round, in
leveling and showed that in both groups, the lower incisors proclined with uncontrolled tipping,
which can be probably attributed to the intrusive force introduced by the archwire being labial to
the center of resistance of the lower incisors.

Age changes
The curve of Spee may get altered physiologically with age or pathologically in situations
resulting from rotation, tipping, and extrusion of teeth.

As the age advances, there is a significant change in the curve of Spee and decrease in posterior
disclusion during mandibular protrusion.[77] Hence, as patients grow older, clinicians should be
aware that the occlusal adjustments with age have gradually altered the curve of Spee of youth
toward a more favorable individual occlusal curvature. Thus, if the curve of Spee is not
maintained in these dentitions during full mouth rehabilitation, it may lead to interferences along
the mandibular movements which will jeopardize the health of the masticatory system.

Long-term stability
The stability of leveling curve of Spee may be dependent on the specific nature of its correction.
Additionally, various factors, such as growth and neuromuscular adaptation, may play a role in
relapse. Simons and Joondeph,[78] in a 10-year post-retention study, reported that proclination of
lower incisors and a clockwise rotation of the occlusal plane during treatment were significant
relapse factors. The stability of posterior extrusion is controversial. Variables such as the amount
of growth and the patient's age during treatment, muscle strength, adaptation, and the original
malocclusion have all been postulated as factors contributing to the long-term stability of
correction of curve of Spee.[83]

Burzin and Nanda[84] specifically investigated the stability of incisor intrusion and found that
maxillary incisor showed insignificant relapse.

According to Praeter et al.,[85] leveling the curve of Spee during orthodontic treatment seems to
be very stable on a long-term basis.

In maxillary arch
Very few studies have examined the characteristics of the curve of Spee in the maxillary arch. A
study conducted by Xu et al.[86] showed that the curve was significantly flatter in maxillary arch
than in mandibular arch.

Muscle force
A highly significant correlation is demonstrated between the forward inclination of the superficial
masseter muscle and the forward tilt of molar teeth in the sagittal plane, conforming to the
posterior end of the curve of Spee. The tilt of the curve of Spee increases the crush/shear ratio of
the force produced on food between the posterior molars.[87–89]

Sexual variation
Marshall et al.[490] have shown in their study there are no significant differences in maximum
depth of curve of Spee between either the right and left sides of the mandibular arch or the sexes.

Discussion
The study was performed to gain a thorough knowledge of the curve of Spee from orthodontic
aspect. The articles were searched in relation to orthodontic field from the year of 1970. But more
importance was given to the articles in the 2000 group. Of the 186 articles reviewed, 106 articles
were omitted as they did not match with the study purpose. The 90 articles used for this article are
given as references. In the 2000 group, most of the articles were based on construction of Spee and
leveling. We found that importance to its development or prevention was very less.

Conclusion
The understanding of curve of Spee in the field of orthodontics is very important as orthodontists
deal with it in virtually every patient they treat. But, however, articles offering an in-depth
understanding of its cause and development, and influencing factors are very few in the literature.
It starts its journey from the deciduous dentition and travels taking variable forms influenced by
various factors till the edentulous condition of an individual. Hence, clinicians should be aware
that the occlusal adjustments with age gradually alter the curve of Spee of youth toward a more
favorable individual occlusal curvature.

The correction of curve of Spee in a non-growing individual always poses a great problem to the
orthodontists. Hence, in future, more studies should be aimed at predicting the right age for the
correction of exaggerated curve of Spee. Studies should also be aimed at preventing the
exaggerated curve of Spee in younger age group.

Footnotes
Source of Support: Nil

Conflict of Interest: None declared.

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References
1. Sal Carcara C, Preston B, Jureyda O, authors. The relationship between the curve of spee, relapse, and the Alexander
discipline. Semin orthod. 2001;7:90–9
2. Spee FG, author. The gliding path of the mandible along the skull. J Am Dent Assoc. 1980;100:670–5. [PubMed]
3. Hitchcock HP, author. The curve of Spee in Stone Age man. Am J Orthod. 1983;84:248–53. [PubMed]
4. Marshall SD, Caspersen M, Hardinger RR, Franciscus RG, Aquilino SA, Southard TE, authors. Development of the curve
of Spee. Am J Orthod. 2008;134:344–52
5. Ramfjord SP, Ash MM, authors. Occlusion. 1971. 3rd ed. Philadelphia: W. B. Saunders;
6. Okesson J, author. Management of temporomandibular disorders and occlusion. 2003. 5th ed. St Louis: Mosby; p. 67–
197
7. Van Blarcom CW, author. The glossary of prosthodontic terms. 2005. 8th ed. St. Louis: Mosby;
8. Ramfjord SP, Ash MM, authors. Occlusion. 1971. 2nd ed. Philadelphia: W. B. Saunders. . 34.
9. Van Blarcom CW, author. Glossary of Prosthodontics. J Prosthet Dent. 1994;71:(6th ed). 43–104
10. Monson GS, author. Applied mechanics to the theory of mandibular movements. Dent Cosmos. 1932;74:1039–53
11. Osborn JW, author. Orientation of the masseter muscle and the curve of Spee in relation to crushing forces on the molar
teeth of primates. Am J Phys Anthropol. 1993;92:99–106. [PubMed]
12. Wylie WL, author. Overbite and vertical facial dimensions in terms of muscle balance. Angle Orthod. 1994;19:13–7
13. Bjork A, author. Variablity and age changes in overjet and overbite. Am J Orthod. 1953;39:779–801
14. Salem OH, Al-Sehaibany F, Preston CB, authors. Aspects of mandibular morphology, with specific reference to the
antegonial notch and the curve of spee. J Clin Pediatr Dent. 2003;27:261–5. [PubMed]
15. Root T, author. Level Anchorage. 1988. Monrovia, CA: Unitek Corp;
16. Sicher H, author. Oral Anatomy. 1949. St. Louis: CV Mosby;
17. Hemley S, author. Orthodontic theory and practice. 1953. 2nd ed. New York: Grune and Stratton;
18. Wheeler RC, author. A textbook of dental anatomy and physiology. 1950. 2nd ed. Philadelphia: W.B. Saunders;
19. Ash MM, author. Wheeler's dental anatomy, physiology and occlusion. 1984. 6th ed. Philadelphia: W.B. Saunders;
20. Osborn JW, author. Orientation of the masseter muscle and the curve of Spee in relation to crushing forces on the molar
teeth of primates. Am J Phys Anthropol. 1993;92:99–106. [PubMed]
21. Mohl ND, Zarb GA, Carlsson GE, Rugh JD, authors. A textbook of occlusion. 1988. Copenhagen: Munksgaard;
22. Dawson P, author. Evaluation, diagnosis and treatment of occlusal problems. 1974. St. Louis: CV Mosby;
23. Diamond M, author. Dental Anatomy. 1952. 3rd ed. New York: McMillan;
24. Strang RH, author. A textbook of orthodontia. 1950. 3rd ed. Philadelphia: Lea and Fiebiger;
25. Gresham H, author. A manual of orthodontics. 1957. Christ Church, New Zealand: N.M. Peryer;
26. Fidler BC, Artun J, Joondeph DR, Little RM, authors. Long-term stability of angle class II, Division I malocclusions with
successful occlusal results at the end of active treatment. Am J Orthod. 1995;107:276–85
27. Andrews FL, author. The six keys to normal occlusion. Am J Orthod. 1972;62:296–309. [PubMed]
28. Ash M, author. Wheeler's dental anatomy, physiology and occlusion. 1993. 7th ed. Philadelphia: W.B. Saunders;
29. Carter GA, McNamara JA, authors. Longitudinal dental arch changes in adults. Am J Orthod Dentofacial Orthop.
1998;114:88–99. [PubMed]
30. Bishara S, Jakobsen J, Treder J, Stasi M, authors. Changes in the maxillary and mandibular tooth size-arch length
relationship from early adolescence to early adulthood (A longitudinal study). Am J Orthod Dentofacial Orthop.
1989;95:46–59. [PubMed]
31. Farella M, Michelotti A, Martina R, authors. The curve of Spee and craniofacial morphology: A multiple regression
analysis. Eur J Oral Sci. 2002;110:277–81. [PubMed]
32. Shannon KR, Nanda R, authors. Changes in the curve of Spee with treatment and at 2 years posttreatment. Am J Orthod
Dentofacial Orthop. 2004;125:589–96. [PubMed]
33. Baydas B, Yavuz I, Atasarl N, Ceylan T, Dagsuyu I, authors. Investigation of the changes in the positions of upper and
lower incisors, overjet, overbite, and irregularity index in subjects with different depths of curve of Spee. Angle Orthod.
2004;74:349–55. [PubMed]
34. Mew J, author. The curve of Spee. Am J Orthod Dentofacial Orthop. 2009;135:3 [PubMed]
35. Mew JR, author. The aetiology of malocclusion: can the tropic premise assist our understanding. Br Dent J.
1981;151:296–302. [PubMed]
36. Mew JR, author. The postural basis of malocclusion: A philosophical overview. Am J Orthod Dentofacial Orthop.
2004;126:729–38. [PubMed]
37. Tweed CH, author. Clinical orthodontics. 1966. St Louis: Mosby; p. 84–180
38. Schudy FF, author. The control of vertical overbite in clinical orthodontics. Angle Orthod. 1968;38:19–38. [PubMed]
39. Burstone CR, author. Deep overbite correction by intrusion. Am J Orthod. 1977;72:1–22. [PubMed]
40. Koyama TA, author. Comparative analysis of the curve of Spee (lateral aspect) before and after orthodontic treatment-
with particular reference to overbite patients. J Nihon Univ Sch Dent. 1979;21:25–34. [PubMed]
41. Otto RL, Anholm JM, Engel GA, authors. A comparative analysis of intrusion of incisor teeth achieved in adults and
children according to facial types. Am J Orthod. 1980;77:437–46. [PubMed]
42. Garcia R, author. Leveling the curve of Spee: A new prediction formula. J Charles H. Tweed Int Found. 1985;13:65–72
43. Osborn JW, author. Relationship between the mandibular condyle and the occlusal plane during hominid evolution: Some
of its effects on jaw mechanics. Am J Phys Anthropol. 1987;73:193–207. [PubMed]
44. De Praeter J, Dermaut L, Martens G, Kuijpers-Jagtman AM, authors. Long-term stability of the leveling of the curve of
Spee. Am J Orthod Dentofacial Orthop. 2002;121:266–72. [PubMed]
45. Baldridge DW, author. Leveling the curve of Spee: Its effect on the mandibular arch length. J Pract Orthod. 1969;3:26–41
46. Braun S, Hnat WP, Johnson BE, authors. The curve of Spee revisited. Am J Orthod Dentofacial Orthop. 1996;110:206–
10. [PubMed]
47. Germane N, Staggers JA, Rubenstein L, Revere JT, authors. Arch length considerations due to the curve of Spee: a
mathematical model. Am J Orthod Dentofacial Orthop. 1992;102:251–5. [PubMed]
48. Sondhi A, Cleall JF, Begole EA, authors. Dimensional change in the dental arches of orthodontically treated cases. Am J
Orthod. 1980;77:60–74. [PubMed]
49. Braun ML, Schmidt WG, authors. A cephalometric appraisal of the curve of Spee in Class I and Class II, Division 1
occlusions for males and females. Am J Orthod. 1956;42:255–78
50. Dawson Peter E, author. Functional Occlusion from TMJ to Smile Design. 2007. Mosby Elsevier; p. 200–4
51. Re J-P, Perez C, Giraudeau A, Ager P, El Zoghby A, Orthlieb J-D, authors. Reconstruction of the curve of Spee. Z
Stomatologie. 1985;6:262–8
52. Bench RW, Gugino CF, Hilgers JJ, authors. Bioprogressive therapy. Part 2. J Clin Orthod. 1977;11:661–82. [PubMed]
53. Merritt J, author. A Cephalometric study of the treatment and retention of deep overbite cases [master's thesis]. 1964.
Houston TX: University of Texas;
54. Schudy FF, author. The association of anatomical applied to clinical orthodontics. Angle Orthod. 1966;36:190–203.
[PubMed]
55. Graber TM, author. Orthodontics: Principles and Practice. 1969. Philadelphia: W.B. Saunders;
56. Klineberg I, author. Occlusion: principles and assessment. 1992. Oxford, United Kingdom: Buterworth-Heinemann;
57. Otto RL, Anholm JM, Engel GA, authors. A comparative methods of intrusion of incisor teeth achieved in adults and
children according to facial types. Am J Orthod. 1980;77:437–46. [PubMed]
58. Weiland FJ, Droschl H, authors. Evaluation of continuous arch and segmented arch leveling techniques in adult patients –
a clinical study. Am J Orthod Dentofacial Orthop. 1996;110:647–52. [PubMed]
59. Nanda R, author. The differential diagnosis and treatment of excessive overbite. Dent Clin North Am. 1981;25:69–84.
[PubMed]
60. Nanda R, Marzban R, Kuhlberg A, authors. The Connecticut Intrusion Arch. J Clin Orthod. 1998;32:708–15. [PubMed]
61. Melsen B, Agerback N, Eriksen J, Terp S, authors. New attachment through periodontal treatment and orthodontic
intrusion. Am J Orthod Dentofacial Orthop. 1988;94:104–16. [PubMed]
62. Melsen B, author. Tissue reaction following application of extrusive and intrusive forces to teeth in adult monkeys. Am J
Orthod. 1986;89:469–75. [PubMed]
63. Burstone CJ, author. Deep overbite correction by intrusion. Am J Orthod. 1977;72:1–22. [PubMed]
64. Begg PR, Kesling PC, authors. The differential force method of orthodontic treatment. Am J Orthod. 1977;71:1–39.
[PubMed]
65. Ricketts RM, author. Bioprogressive therapy as an answer to orthodontic needs. Part I. Am J Orthod. 1976;70:241–68.
[PubMed]
66. Greig DG, author. Bioprogressive therapy: overbite reduction with the lower utility arch. Br J Orthod. 1983;10:214–6.
[PubMed]
67. Deshields RW, author. A study of root resorption in treated Class II Div I malocclusions. Angle Orthod. 1969;39:231–45.
[PubMed]
68. Harris E, author. Root resorption during orthodontic therapy. Semin Orthod. 2000;6:183–94
69. Linge BO, Linge L, authors. Apical root resorption in upper anterior teeth. Eur J Orthod. 1983;5:173–83. [PubMed]
70. Harry MR, Sims MR, authors. Root resorption in bicuspid intrusion. A scanning electron microscopic study. Angle
Orthod. 1982;52:235–58. [PubMed]
71. Ketcham A, author. A progress report of an investigation of apical root resorption of vital permanent teeth. Int J Orthod
Oral Surg Rad. 1929;25:310–28
72. Baumrind S, Korn EL, Boyd RL, authors. Apical root resorption in orthodontically treated adults. Am J Orthod
Dentofacial Orthop. 1996;110:311–20. [PubMed]
73. Kaley JP, Phillips C, authors. Factors related to root resorption in edgewise practice. Angle Orthod. 1991;61:125–32.
[PubMed]
74. Goerigk BD, Wehrbein H, authors. Intrusion of anterior teeth with the segmented arch technique of Burstone – a clinical
study. Fort der Kieferorthopadie. 1992;53:16–25
75. Dermaut LR, De Munck A, authors. Apical root resorption of upper inciors caused by intrusive tooth movement: a
radiographic study. Am J Orthod Dentofacial Orthop. 1986;90:321–6. [PubMed]
76. Costopoulos G, Nanda R, authors. An evaluation of root resorption incident to orthodontic intrusion. Am J Orthod
Dentofacial Orthop. 1996;109:543–8. [PubMed]
77. Ahmed I, Nazir R, Gul-e-Erum, Ahsan T, authors. Influence of malocclusion on the depth of curve of Spee. J Pak Med
Assoc. 2011;61:1056–9. [PubMed]
78. Simons ME, Joondeph DR, authors. Change in overbite: A ten-year postretention study. Am J Orthod. 1973;64:349–67.
[PubMed]
79. Pandis N, Polychronopoulou A, Sifakakis I, Makou M, Eliades T, authors. Effects of leveling of the curve of Spee on the
proclination of mandibular incisors and expansion of dental arches: A prospective clinical trial. Aust Orthod J.
2010;26:61–5. [PubMed]
80. Afzal A, Ahmed I, authors. Leveling curve of Spee and its effect on mandibular arch length. J Coll Physicians Surg Pak.
2006;16:709–11. [PubMed]
81. Bernstein RL, Preston CB, Lampasso J, authors. Leveling the curve of Spee with a continuous archwire technique: A long
term cephalometric study. Am J Orthod Dentofacial Orthop. 2007;131:363–71. [PubMed]
82. AlQabandi AK, Sadowsky C, Begole EA, authors. A comparison of the effects of rectangular and round arch wires in
leveling the curve of Spee. Am J Orthod Dentofacial Orthop. 1999;116:522–9. [PubMed]
83. Berg R, author. Stability of deep overbite correction. Eur J Orthod. 1983;5:75–83. [PubMed]
84. Burzin J, Nanda R, authors; Nanda R, editor. The stability of deep overbite correction. Retention and stability. 1993.
Philadelphia: WB Saunders;
85. De Praeter J, Dermaut L, Martens G, Kuijpers-Jagtman A-M, authors. Long-term stability of the leveling of the curve of
Spee. Am J Orthod Dentofacial Orthop. 2002;121:266–72. [PubMed]
86. Xu H, Suzuki T, Muronoi M, Ooya K, authors. An evaluation of the curve of Spee in the maxilla and mandible of human
permanent healthy dentitions. J Prosth Dent. 2004;92:536–9
87. Woods M, author. A reassessment of space requirements for lower arch leveling. J Clin Orthod. 1986;20:770–8.
[PubMed]
88. Lynch CD, McConnell RJ, authors. Prosthodontic management of the curve of Spee: Use of the Broadrick flag. J Prosthet
Dent. 2002;87:593–97. [PubMed]
89. Garcia R, author. Leveling the curve of Spee: A new prediction formula. J Tweed Found. 1985;13:65–72
90. Currim S, Wadkar PV, authors. Objective assessment of occlusal and coronal characteristics of untreated normals: A
measurement study. Am J Orthod Dentofacial Orthop. 2004;125:582–8. [PubMed]