Mandibular curve of spee

COS definition, development and treatment in orthodontics. Deep overbite and reverse curve. Different ways to level the COS. intrusion, extrusion or both.

1. Yasmine Al- Hajjeh June 28, 2012 Mandibular Curve of Spee: From Definition to Treatment

2. Outline 1. WHAT'S THE CURVE OF SPEE? 1.1.Graf Von Spee definition 1.2.Prosthodontic definition 1.3.Orthodontic definition 2. DEVELOPMENT 3. TREATMENT 3.1.Why should we flatten the occlusal curve? 3.2.How much space does a curve require to be flattened? 3.3.How can we level the curve? 4. STABILITY OF LEVELING THE CURVE 5. CONCLUSION 6. BIBLIOGRAPHY

3. 1.WHAT’S THE CURVE OF SPEE?

4. 1.1.Graf Von Spee definition Ferdinand Graf Von Spee (1855–1937),the first to describe the COS in humans in 1890. He proposed a radius of 6.5 - 7cm.   AL–SARRAF (H.A.),AGHA(N.F.),AL–DAWOTITTODY(A.D.).-A Comparative Study of Curve of Spee and Arch Circum- ference Between Class I Normal Occlusion and Class II Division 1 Malocclusion. Al– Rafidain Dent J. 2010; 10(2): 341–347.

5. 1.2.Prosthodontic definition Anatomical curve begins Cusp tip of the canine Buccal cusps of PM & M Mandibular condyle Radius: 4 inches (101.6mm ) The COS should be used as a reference for prosthetic reconstruction . XU (H.), SUZUKI (T.), MURONOI (M.) et al,- An evaluation of the curve of Spee in the maxilla and mandible of human permanent healthy dentitions. J Prosthet Dent 2004;92:536-9.

6. 1.3.Orthodontic definition An occlusal curve going from the most extruded anterior tooth extending to the most extruded posterior cusp. Xu H. et al. (2004): 83.4mm The COS is an important parameter to take into account when establishing a diagnosis. BRAUN (S.), HNAT (W.P.), JOHNSON (B.E.) - The curve of Spee revisited. Am J Orthod Dentofac Orthop 1996;110:206-10 . ORTHLIEB JD. - The curve of Spee : understanding the sagittal organization of mandibular teeth. Cranio 1997; 15: 333-40.

7. 1.3.1. Flat Curve of Spee In his 6 th key to optimal occlusion, Andrews believed that a flat plane of occlusion should be an orthodontic treatment goal. Andrews (L.F.). - The six keys to normal occlusion. Am J Orthod.1972, 62(3):296-309.

8. 1.3.2. Reverse curve of Spee Macroglossia can cause a reverse COS at the mandibular arch. Trauten et al.: in the presence of anterior open bite , the COS in the mandible was absent or negative. A reverse curve of Spee results in excessive room for the maxillary teeth. SIFAKAKIS (I.), PANDIS (N.), MAKOU (M.) et al. - Forces and moments on posterior teeth generated by incisor intrusion biomechanics. Orthod Craniofac Res 2009;12:305–311.

9. 1.3.3. Accentuated curve of Spee Deep curve of Spee and deep bite malocclusions are closely related. This is due to overeruption of anterior teeth or undereruption of posterior teeth. SREEDHAR (C.) and BARATAM (S.) - Deep overbite—A review (Deep bite, Deep overbite, Excessive overbite) – Annals and essences of dentistry. 2009 ; 1:8-25 .

10. Deep Bite Origin Functional classification Extent of deep bite Dental Skeletal True deep bite Pseudo deep bite Complete Incomplete

11. Crowding Crowding Deep bite Deep COS ANDREWS (L..F.) - The six keys to normal occlusion. AJO-DO.1972; 296-309 . Taken from the graduate Orthodontic Clinic at the Lebanese University.

12. 2. Development

13. 2.Development Iowa Facial Growth Study, 2008; started by Higley and Meredith in 1946. Sample mean curve of Spee average maximum depth. MARSHALL(S.D.), CASPERSEN(M.), HARDINGER(R.R.) et al. - Development of the curve of Spee. Am J Orthod Dentofacial Orthop 2008;134:344-52.

14. 3. Treatment

15. 3.1.Why should we flatten the occlusal curve? To ensure proper functional movements of the mandible in protrusion and lateral excursions Best static intercuspation (Andrews) Flat curve XU (H.), SUZUKI (T.), MURONOI (M.) et al,- An evaluation of the curve of Spee in the maxilla and mandible of human permanent healthy dentitions. J Prosthet Dent 2004;92:536-9.

16.   3.2.How much space does a curve of Spee require to be flattened? Different mathematical functions could be used to measure the space required. Y = 2/3 X + 1 Garcia Y = 1/2 X - 0.5 Baldrige COS depth : 1.5 mm 3 mm 1 mm

17. Mandibular anterior intrusion and/or 2. Mandibular posterior extrusion 3.3.How can we level the curve? 1 2

18. Intrusion P reventing eruption of the incisors while growth provides vertical space into which the posterior teeth erupt. PRESTON(C.B.), MAGGARD(M.B.), LAMPASSO(J.) et al. - Long-term effectiveness of the continuous and the sectional archwire techniques in leveling the curve of Spee . Am J Orthod Dentofacial Orthop 2008;133:550-5 . PROFFIT (W.R.), FIELDS, JR (H.W.) and SARVER (D.M.). The First Stage of Comprehensive Treatment: Alignment and Leveling. Contemporary Orthodontics. Mosby Elsevier. Canada: 2007. 551-576.

19. Absolute incisors intrusion: Utility arch Taken from the graduate Orthodontic Clinic at the Lebanese University

20. Absolute incisors intrusion: Three-piece intrusion arch C. Burstone 1950’s : segmentation allows for genuine intrusive movement. Taken from the graduate Orthodontic Clinic at the Lebanese University

21. Absolute intrusion: Miniscrews Used to provide anchorage for various types of tooth movements, including intrusion of the anterior and posterior teeth. Ara ú jo , T. M.; Nascimento , M. H. A.; Franco. F. C. M.; Bittencourt , M. A. V.- Tooth intrusion using mini-implants. Dental Press J. Orthod . 2008; 13(5):36-48

22. Extrusion Anterior bite plate It produces intrusion effect on mandibular anterior teeth and creates space between the posterior teeth so that they are free to erupt. STUANI (A.S.), STUANI (A.S.), STUANI (M.B.S.) et al. - Anterior Open Bite – Cephalometric Evaluation of the Dental Pattern. Braz Dent J 2006; 17: 68-70.

23. Extrusion Elastics Intermaxillary elastics have a vertical component that extrude posterior teeth and level the curve of Spee . BRATU (C.), FLESER (C.), GLAVAN (F.) - The effect of intermaxillary elastics in orthodontic therapy. TMJ 2004, Vol. 54, No.4.

24. Extrusion Miniscrews Cheng et al. placed the mini-implants in the mandibular posterior zones to upright the molars. Kuroda S and Tanaka E. Application of Temporary Anchorage Devices for the Treatment of Adult Class III Malocclusions. Semin Orthod 2011;17:91-97.

25. Surgery: Koële osteotomy Adult patient Very severe COS (more than 4 mm) with two occlusal planes (anterior & posterior) at different vertical levels Periodontal considerations that prevent traditional incisor intrusion

26. 4. Stability of leveling the curve

27. In well-treated patients, the observed relapse in the COS is minimal, and it occurs over an extended period of time. PRESTON(C.B.), MAGGARD(M.B.), LAMPASSO(J.) et al. - Long-term effectiveness of the continuous and the sectional archwire techniques in leveling the curve of Spee . Am J Orthod Dentofacial Orthop 2008;133:550-5.

28. 5. Conclusion

29. Thank you for your attention The mandibular curve of Spee (COS) is an important parameter to take into account when establishing a diagnosis and a treatment plan.

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