ONLINE ONLY

Relationship between the curve of Spee and

dentofacial morphology evaluated with a 3-
dimensional reconstruction method in Korean adults
Se-Hwan Cheon,a Yang-Ho Park,b Ki-Suk Paik,c Sug-Joon Ahn,d Kazuo Hayashi,e Won-Jin Yi,f and
Seung-Pyo Leeg
Seoul, Korea, and Hokkaido, Japan

Introduction: The purposes of this study were to examine the curve of Spee of the maxillary and mandibular
arches by using a 3-dimensional reconstruction method and to determine the relationship between the curve
of Spee and dentofacial morphology with multiple regression analysis. Methods: Lateral cephalograms and
dental models were evaluated from 18 Korean men and 31 Korean women. The depth of the curve of Spee
was measured on the virtual dental models with computer software. Seventeen cephalometric variables
related to the lateral cephalograms were analyzed to determine differences in dentofacial morphology. The
Pearson correlation analysis and a multiple linear regression analysis were performed to determine the
relationship between the curve of Spee as the dependent variable and other cephalometric and dental
variables as the independent variables. Results: The depth of the curve of Spee in the mandibular arch was
significantly related to overbite, overjet, and the sagittal position of the mandible with respect to the anterior
cranial base. The curve of Spee was not affected by sex. Conclusions: These results will assist in the
determination of the sagittal organization of the teeth as a reference for prosthetic restoration and
orthodontic treatment. (Am J Orthod Dentofacial Orthop 2008;133:640.e7-640.e14)

T
he curve of Spee was described by F. Graf von describe it as a line from the tip of the canine touching
Spee1 in 1890. He used skulls with abraded the tips of the buccal cusps of the posterior teeth.3-6
teeth to define the line of occlusion as the line The morphologic arrangement of the teeth in the
on a cylinder tangent to the anterior border of the sagittal plane has been related to the slope of the
condyle, the occlusal surface of the second molar, and articular eminence, the incisal vertical overlap, the
the incisal edges of the mandibular incisors.1 Clinically, molar cusp height, and the amount of posterior con-
the curve of Spee is determined by the distal marginal tact.7 More recently, it was suggested that the curve of
ridges of the most posterior teeth in the arch and the Spee has a biomechanical function during food process-
incisal edges of the central incisors.2 Some authors ing by increasing the crush-shear ratio between the
a
Graduate student, Department of Oral Anatomy and Dental Research Institute, posterior teeth and the efficiency of occlusal forces
College of Dentistry, Seoul National University, Seoul, Korea. during mastication.8 Leveling the curve of Spee by
b
Associate professor, Department of Orthodontics, Kangdong Sacred Heart
Hospital, Hallym University Medical Center, Seoul, Korea.
anterior intrusion, posterior extrusion, or a combination
c
Professor, Department of Oral Anatomy and Dental Research Institute, of these is routine in orthodontic practice.9 Therefore,
College of Dentistry, Seoul National University, Seoul, Korea.
d
the assessment of the depth of the curve of Spee is
Assistant professor, Department of Orthodontics, Dental Research Institute,
College of Dentistry, Seoul National University, Seoul, Korea.
critical for orthodontic diagnosis and treatment.10
e
Assistant professor, Department of Orthodontics, School of Dentistry, Health However, there is little consensus in the literature
Sciences University of Hokkaido, Hokkaido, Japan. concerning the measurement of the curve of the Spee.
f
Assistant professor, Department of Oral and Maxillofacial Radiology and
Dental Research Institute, College of Dentistry, Seoul National University, Baldridge11 used the perpendicular distances on both
Seoul, Korea. sides. Bishara et al12 used the average of the sum of the
g
Assistant professor, Department of Oral Anatomy and Dental Research
perpendicular distances to each cusp tip. Sondhi et al13
Institute, College of Dentistry, Seoul National University, Seoul, Korea.
Supported by a grant from the Korea Health 21 R&D Project, Ministry of used the sum of the perpendiculars. Braun et al9 and
Health and Welfare, Republic of Korea (03-PJ1-PG1-CH09-0001). Braun and Schmidt14 used the sum of the maximum
Reprint requests to: Seoung-Pyo Lee, Department of Oral Anatomy, College of
Dentistry, Seoul National University, YeongunDong, ChongroGu, Seoul,
depth on both sides. Traditionally, these measurements
Korea; e-mail, [email protected]. are taken from study models or photographs with a
Submitted, October 2007; revised and accepted, November 2007. divider or caliper15 and a coordinate measuring ma-
0889-5406/$34.00
Copyright © 2008 by the American Association of Orthodontists. chine.9 As technology advanced, new measuring de-
doi:10.1016/j.ajodo.2007.11.020 vices became available— eg, 3-dimensional (3D) opti-
640.e7
640.e8 Cheon et al American Journal of Orthodontics and Dentofacial Orthopedics
May 2008

Fig 1. Three-dimensional dental model analysis: A, occlusal plane; B, curve of Spee, the deepest
point from the occlusal plane to buccal cusp tip of each lateral tooth; C, dental model measure-
ments, intercanine width (a), intermolar width (b), arch length (c); D, dental arch form, symmetry of
the dental arch evaluated by using the perpendicular distance at the canine (a, a=) and the second
molar (b, b=), the distances from the midpoint of the right and left incisor edge to the tips of the right
and left second molar distobuccal cusps (c, c=).

cal digitizers—that accurately measure small changes. and to determine the relationship between the curve of
At present, 3D virtual models are available for clini- Spee and dentofacial morphology by using multiple
cians, supplemented by dedicated software to perform regression analysis. The influence of sex on the curve
the necessary measurements. of Spee was also investigated.
Lateral cephalograms are widely used, both as
clinical tools and as a research technique, to study
craniofacial growth and orthodontic treatment. The MATERIAL AND METHODS
ability to predict the magnitude and direction of man- Eighteen men and 31 women (ages, 18-28 years;
dibular growth is also important in treatment planning mean, 24 years) were selected from the records of the
for growing patients. Although the mandible is 1 bone Department of Orthodontics at Kangdong Sacred Heart
in adults, it is developmentally and functionally divided Hospital, Seoul, Korea. The following criteria were
into several skeletal subunits.16 The basal bone of the used: no previous orthodontic treatment, no anterior or
mandibular body forms 1 unit, to which are attached the
lateral crossbite, no pathologic periodontal condition,
alveolar, coronoid, angular, and condylar processes,
no cast restorations or cuspal coverage, no temporo-
and the chin.17 The teeth and muscles that provide the
mandibular disorders, and clinically normal arch shapes
mandible’s functional matrix influence the growth of
with minimal dental crowding or spacing (ⱕ2 mm).
each skeletal subunit.18 The ultimate shape of a fully
grown mandible is the result of complex interaction A 3D analysis system was used for the dental model
between growth determinants and the functional envi- analysis. The system comprised a measuring unit
ronment that control the mandible.19 Among these (RapidForm 2004; INUS Technology, Seoul, Korea)
components of dentofacial growth, the influence of that obtained 3D information from the dental model
dentofacial morphology on the curve of Spee has been with laser scanning and an engineering workstation
systematically investigated in only a few studies, with (optoTOP-HE; Breukmann, GmbH, Meersburg, Ger-
conflicting findings.20,21 Therefore, the purpose of this many) that generated the 3D graphic for the dental
study was to examine the curve of Spee of the maxillary model.
and mandibular arch with a 3D reconstruction method The following measurements were made.
American Journal of Orthodontics and Dentofacial Orthopedics Cheon et al 640.e9
Volume 133, Number 5

Fig 2. Cephalometric horizontal measurements in this Fig 3. Cephalometric vertical measurements used in
study: SNA, angle determined by points S, N, and A; this study: FMA, angle formed between the Frankfort
SNB, angle determined by points S, N, and B; ANB, horizontal plane and the mandibular plane; gonial angle,
angle determined by points A, N, and B; body length, angle determined by points Ar, Go, and Me; ramus
distance between points Go and Me; APDI, the facial height, distance between points Ar and Go; ODI, the
angle ⫾ the A-B plane angle and again ⫾ the palatal angle of the A-B plane to the mandibular plane com-
plane angle. bined with the palatal plane to the Frankfort horizontal
plane angle.

1. The occlusal plane as defined by the midpoint of the 2. Intermolar width (Fig 1, C, b): the distance between
center in the right and left incisor edges and the tips the tips of the right and left first molar mesiobuccal
of the right and left second molar distobuccal cusps cusps.
was established in the maxillary and mandibular 3. Arch length (Fig 1, C, c): the shortest distance from
dental arches (Fig 1, A).12,22 a line connecting the tips of the right and left
2. The perpendicular distances from the occlusal plane second molar distobuccal cusps to the midpoint of
to the buccal cusp tip of each lateral tooth were the center of the right and left incisor edges.
measured, and the deepest point was used as a 4. Dental arch form (Fig 1, D): symmetry of the dental
representative value for the curve of Spee on each arch was evaluated by using the perpendicular
side (Fig 1, B).13,17,22-24 The average of the right distance from the tips of the canine and the second
and left sides was defined as the curve of Spee. molar distobuccal cusps to the dental arch center
line. The dental arch center line was drawn from the
One investigator (S.H.C.) traced all cephalograms. midpoint of the right and left incisor edges to
The tracings were digitized with a digitizer interfaced perpendicularly intersect the line connected by the
with a desktop computer. Twelve angular and 5 linear tips of the right and left second molar distobuccal
measurements were made and calculated on lateral cusps. We also measured the distances from the
cephalograms. The positions of all landmarks and their midpoint of the right and left incisor edges to the
measurements are shown in Figures 2 through 4. tips of the right and left second molar distobuccal
The following dental model measurements were cusps to evaluate the symmetry of the dental arch.
made.
Statistical analysis
1. Intercanine width (Fig 1, C, a): the distance be- Data were analyzed with conventional descriptive
tween the tips of the right and left canines. statistics. The normal distribution of the data was tested
640.e10 Cheon et al American Journal of Orthodontics and Dentofacial Orthopedics
May 2008

ination and enter methods was performed to determine

the relationship between the curve of Spee as the
dependent variable and the other variables as the
independent variables. P values less than 0.05 were
considered statistically significant.
To test the reliability of the measurements, 15 sets
of 3D virtual models were selected randomly, and the
experimental procedure was repeated. Testing for
method error for all measurements was done with
Dahlberg’s formula25 (method error ⫽ 兹⌺d2⁄ 2n
where d is the difference between 2 measurements of a
pair, and n is the number of subjects). The method
errors did not exceed 0.6 mm (range, 0.2-0.6 mm) for
the linear measurements.
To test the magnitude of the measurement error in
this study, the lateral cephalograms of 15 randomly
selected patients were measured again. With Dahl-
berg’s formula, the errors were 0.15 to 0.73 mm for the
linear measurements and 0.19° to 0.81o for the angular
measurements.
Fig 4. Cephalometric soft tissue measurements used in Intraexaminer reliability was quantified by using
this study: G-Sn-Pog=, angle determined by points G, the intraclass correlation coefficient (ICC). The ICC, a
Sn, Pog=; Cm-Sn-Ls, angle determined by points Cm, test of concordance or agreement for continuous data,
Sn, and Ls; U to E-line, perpendicular distance from the such as measurements of angles, ranges from 0 to 1. It
upper lip point to the E-line; L to E line, perpendicular is a measure of the homogeneity of elements in clusters
distance from the lower lip point to the E-line. and has a maximum value of 1 for complete homoge-
neity. According to Landis and Koch,26 the following
Table I. Perpendicular distances (mm) from the occlu- ICC interpretation scale was used: poor to fair (below
sal plane to the buccal cusp tips of each lateral tooth 0.4), moderate (0.41-0.60), excellent (0.61-0.80), and
n Mean SD
almost perfect (0.81-1). Almost perfect intraexaminer
reliability was determined for 27 measurements (ICC ⫽
U2 49 0.03 0.60 0.969-0.998).
U3 49 1.32 0.84
U4 49 2.01 0.71
U5 49 2.26 0.76 RESULTS
U6 49 1.51 0.80
L2 49 ⫺0.01 0.45 The means and standard deviations of the vertical
L3 49 ⫺0.15 0.69 distances from the occlusal plane to the buccal cusp tips
L4 49 0.54 0.96 of each lateral tooth are given in Table I. The deepest
L5 49 1.21 0.86 cusp tips were the buccal cusp of the maxillary second
L6 49 1.60 0.86
premolar and the mesiobuccal cusp of the mandibular
U, Maxillary; L, mandibular; 2, lateral incisor; 3, canine; 4, first first molar. The mean depths of the curve of Spee were
premolar; 5, second premolar; 6, first molar. approximately 2.26 mm in the maxillary arch (men,
2.28 mm; women, 2.24 mm) and 1.60 mm in the
with the Kolmogorov-Smirnov test. The hypothesis that mandibular arch (men, 1.61 mm; women, 1.60 mm)
the data were normally distributed could not be rejected (Table II).
for any variable, and therefore subsequent analyses There were no statistically significant differences
were made with parametric statistical tests. All the between the sexes in the curve of Spee in the maxilla (P
analyses were performed with commercial statistical ⫽ 0.876) and the mandible (P ⫽ 0.968) (Table II).
software (version 12.0; SPSS, Chicago, Ill). In addition, Therefore, all samples were statistically analyzed to-
the Pearson correlation analysis was used to determine gether. The depth of the curve of Spee in the maxillary
the correlation coefficients between the depth of the arch had a significantly positive correlation with that in
curve of Spee and other study variables. Furthermore, a the mandibular arch (r ⫽ .563, P ⫽ 0.000). The curve
multiple linear regression analysis with stepwise elim- of Spee in the right maxillary arch was significantly
American Journal of Orthodontics and Dentofacial Orthopedics Cheon et al 640.e11
Volume 133, Number 5

Table II. Depth of the curve of Spee (mm)

Total (n ⫽ 49) Men (n ⫽ 18) Women (n ⫽ 31)
Mean SD Mean SD Mean SD

Maxilla 2.26 0.76 2.28 0.98 2.24 0.62

Right 2.38 0.87 2.36 1.11 2.38 0.72
Left 2.13 0.86 2.20 1.04 2.10 0.76
P 0.042*
Mandible 1.60 0.86 1.61 1.07 1.60 0.73
Right 1.61 0.96 1.65 1.09 1.59 0.88
Left 1.58 0.89 1.56 1.11 1.60 0.75
P 0.767

*P ⬍0.05.

Table III. Dental model measurements (mm) Table IV. Dental arch form, symmetry of dental arch
(mm)
n Mean SD
n Mean SD
U intercanine width 49 35.78 2.28
U intermolar width 49 54.11 2.95 UR 49 55.29 2.45
U arch length 49 46.22 2.67 UL 49 55.05 2.62
L intercanine width 49 27.16 1.91 URC 49 18.03 1.18
L intermolar width 49 46.31 2.66 ULC 49 17.73 1.31
L arch length 49 41.06 2.13 URM2 49 30.27 1.74
ULM2 49 29.88 1.66
U, Maxillary; L, mandibular.
LR 49 49.50 2.34
LL 49 49.31 2.34
larger than that in the left side (P ⫽ 0.042) (Table II). LRC 49 13.57 1.03
However, there was no significant difference between LLC 49 13.59 1.06
LRM2 49 27.29 1.71
the right and left curve of Spee in the mandible (P ⫽ LLM2 49 27.04 1.65
0.767).
Dental model measurements are shown in Tables III UR, Distance from the midpoint in the right and left incisor edge to
the tip of the right second molar distobuccal cusp in the maxilla; UL,
and IV. No significant asymmetry in either arch was
distance from the midpoint of the right and left incisor edges to the
found at the canines or the second molars (Table IV). tip of the left second molar distobuccal cusp in the maxilla; URC,
The correlation coefficients between dentofacial dental arch form at the maxillary right canine; ULC, dental arch form
measurements and the curve of Spee in the mandible at the maxillary left canine; URM2, dental arch form at the maxillary
are given in Table V. The curve of Spee in the right second molar; ULM2, dental arch form at the maxillary left
second molar; LR, distance from the midpoint of right and the left
mandibular arch had significant correlations with the
incisor edges to the tip of the right second molar distobuccal cusp in
SNB and ANB angles; the anteroposterior dysplasia the mandible; LL, distance from the midpoint of the right and left
indicator: the facial angle ⫾ the A-B plane angle and ⫾ incisor edges to the tip of the right and left second molar distobuccal
the palatal plane angle (APDI); overbite depth indica- cusp in the mandible; LRC, dental arch form at the mandibular right
tor: the angle of the AB plane to the mandibular plane canine; LLC, dental arch form at the mandibular left canine; LRM2,
dental arch form at the mandibular right second molar; LLM2, dental
combined with the palatal plane to the Frankfort hori-
arch form at the mandibular left second molar.
zontal plane angle (ODI); overbite; overjet; G-Sn-Pog=,
maxilla to E-line, and maxillary arch length. The results
of the multiple linear regression analysis are presented virtual dental models and lateral cephalograms. The
in Table VI. After stepwise elimination, the overbite virtual model made with the 3D reconstruction method
alone explained 25.2% of the total variance of the depth has been shown to be accurate and reproducible in
of the curve of Spee. In the enter method, other clinical dentistry, and its clinical usefulness is excellent
variables in the study were included in the regression because these kinds of measurements would be difficult
model, and these variables explained only 25.9% of the to obtain from real patients. In this study, the virtual
total variance of the curve of Spee. occlusal plane was established to measure the curve of
Spee and the distance from the occlusal plane to tips of
DISCUSSION each tooth. Similar to previous findings, the deepest
The relationships between the curve of Spee and point in the curve of Spee in the mandibular arch was
dentofacial morphology were investigated with 3D at the mesiobuccal cusp tip of the first molar.27,28
640.e12 Cheon et al American Journal of Orthodontics and Dentofacial Orthopedics
May 2008

Table V. Dentofacial measurements and their correla- described before, but its clinical significance does not
tion to the depth of curve of Spee in the mandibular seem to be consequential because the difference is only
arch slight.33
Mean SD P r
Significant correlations were found between the
depth of curve of Spee in the mandibular arch and the
Horizontal measurements SNB and ANB angles, and APDI, but the curve of Spee
SNA (°) 80.97 3.28 0.556 ⫺0.086 in the maxillary arch had no correlation with horizontal
SNB (°) 78.55 3.54 0.007† ⫺0.380
craniofacial components. This correlation suggests that
ANB (°) 2.42 2.48 0.002† 0.427
Body length (mm) 77.33 5.49 0.225 ⫺0.177 the curve of Spee in the mandibular arch is influenced
APDI (°) 84.82 5.86 0.001† ⫺0.457 by the anteroposterior position of the mandible. The
Vertical measurements correlation between the ANB angle and the curve of
FMA (°) 26.40 5.47 0.151 0.208 Spee agrees with previous reports that the radius of the
Gonial angle (°) 123.01 6.56 0.456 0.109
curve of Spee is shorter in those with Class III
Ramus height (mm) 50.74 6.27 0.076 ⫺0.256
ODI (°) 66.69 6.25 0.005† 0.398 malocclusion than Class II malocclusion.21 When con-
Dental measurements sidering the vertical measurements assessed in our
Overbite (mm) 0.91 1.75 0.000† 0.517 study, the curve of Spee in the mandibular arch was
Overjet (mm) 3.70 2.02 0.001† 0.443 influenced only by ODI. However, some authors have
Interincisal angle (°) 119.06 10.10 0.852 0.027
shown that the curve of Spee is influenced by the ratio
IMPA (°) 94.08 6.47 0.553 0.087
FMIA (°) 59.52 7.45 0.114 ⫺0.228 between posterior and anterior facial heights31 and
U1 to FH (°) 120.46 8.22 0.096 ⫺0.240 vertical facial type.20,27 This disagreement is most
U1 to SN (°) 109.53 7.93 0.101 ⫺0.237 likely because Koreans have shorter anterior facial
Soft-tissue measurements height than white people.34
G-Sn-Pog= (°) 12.70 5.17 0.004† 0.408
There have been few studies on the relationship
Cm-Sn-Ls (°) 98.98 13.18 0.112 0.230
U to E-line (mm) 1.51 2.61 0.023* 0.324 between the curve of Spee and cephalometric soft-
L to E-line (mm) 3.78 3.06 0.151 0.299 tissue measurements. A significant correlation was
Dental model measurements discovered between the curve of Spee in the mandibular
U intercanine width (mm) 35.78 2.28 0.523 0.094 arch and G-Sn-Pog= and the maxilla to E-line in this
U intermolar width (mm) 54.11 2.95 0.270 ⫺0.161
study. This correlation seems to be because the G-Sn-
U arch length (mm) 46.22 2.67 0.000† 0.530
L intercanine width (mm) 27.16 1.91 0.134 ⫺0.217 Pog’ and the maxilla to E-line measurements have
L intermolar width (mm) 46.31 2.66 0.329 ⫺0.142 significant correlations with the anteroposterior posi-
L arch length (mm) 41.06 2.13 0.324 0.144 tion of the mandible with respect to the anterior cranial
U, Maxillary; L, mandibular; FH, Frankfort horizontal; 1, central base. The amounts of overbite and overjet significantly
incisor. influence the variation of the curve of Spee in the
*P ⬍0.05; mandibular arch. As the depths of overbite and overjet
†
P ⬍0.01. increase, the depth of the curve of Spee in the mandib-
ular arch also increases. The correlation coefficients
obtained from this study confirm this result. Multiple
However, a previous study reported that the deepest regression analysis suggests that the curve of Spee is
point of the curve of Spee in the mandibular arch was more influenced by than facial morphology.
in the second premolar.29 Overall, these findings suggest that the sagittal
In our subjects, the depth of the curve of Spee was organization of the teeth adjusts to dentofacial variation
not influenced by sex. The lack of sexual dimorphism by varying the depth of the curve of Spee to a minor
agrees with previous findings obtained from either extent. Only 25.9% of the variance of the curve could
2-dimensional28,30,31 or 3D32 evaluation of the occlusal be explained by the dentofacial variables in the regres-
curvature. In the maxillary arch, the curve of Spee on sion model. Most of the variation of the curve remains
the right side was significantly larger than that on the unexplained by dentofacial morphology and could
left side, regardless of sex. To evaluate the relationships probably be explained better by other factors. Osborn35
between the curve of Spee and dental asymmetry, a reported that the curve of Spee had a positive correla-
simple correlation analysis between the curve of Spee tion with the inclination of the masseter muscle. It
and maxillary transverse asymmetry was performed. As would be interesting to evaluate the simultaneous
the distance from the midline to the second molar contribution of several muscular lines of action to the
increased, the curve of Spee became deeper. The variations in the curve of Spee.
difference in the curve of Spee between sides has been Analysis of the curve of Spee might assist dentists
American Journal of Orthodontics and Dentofacial Orthopedics Cheon et al 640.e13
Volume 133, Number 5

Table VI. Results of multiple regression analysis

Statistically significant
Dependent variable: Sp independent variables B SE ␤ t value P value R2 change

Stepwise 1 Overbite (mm) 0.255 0.061 0.517 4.144 0.000 0.252

Stepwise 2 Overbite (mm) 0.202 0.062 0.411 3.285 0.002 0.331
APDI (°) ⫺0.047 0.018 ⫺0.321 ⫺2.565 0.014
Enter method SNB (°) ⫺0.002 0.043 ⫺0.010 ⫺0.056 0.956 0.259
ANB (°) ⫺0.017 0.107 ⫺0.048 ⫺0.154 0.878
APDI (°) ⫺0.027 0.045 ⫺0.185 ⫺0.605 0.549
ODI (°) 0.007 0.028 0.052 0.261 0.795
Overbite (mm) 0.166 0.093 0.336 1.772 0.084
Overjet (mm) 0.038 0.075 0.090 0.509 0.614
G-Sn-Pog= (°) 0.027 0.036 0.161 0.748 0.459
U to E-line (mm) 0.015 0.054 0.045 0.276 0.784

Sp, Curve of Spee in the mandible; B, unstandardized regression coefficient; SE, standard error of B; ␤, standardized regression coefficient; U,
maxilla.

in determining the sagittal organization of the teeth. 5. The more posteriorly the mandible is positioned,
The curve of Spee can be used as a reference for the more marked is the curve of Spee in the
prosthetic restoration and orthodontic treatment. Man- mandibular arch.
agement of the curve of Spee is critical for achieving 6. The curve of Spee in the mandibular arch is
stability of complete dentures and could play a role in influenced only to a minor extent by dentofacial
the success of implant-supported restorations.31 Our morphology. Multiple regression analysis showed
study was limited because the sample size was rela- that the curve of Spee in the mandibular arch is
tively small and limited to Koreans; there might be significantly influenced by overbite. Overbite alone
genetic factors that distinguish this population from can explain about 25.2% of the total variance of the
other groups. curve of Spee in the stepwise regression model.
We investigated the curve of Spee with a 3D virtual
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