Orthotown December 2022 - 16

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Leveling Curve of Spee on Continuous
AW Without Proclining Incisors
Townies debate whether a particular treatment approach could be possible
YJA12
Member Since: 07/09/16
Post: 1 of 16
In leveling a deep mandibular curve of Spee, if the incisors have ideal inclination or maybe
are already proclined, what is the best way to level the curve of Spee using a continuous arch wire
while also controlling lower incisor angulation? ■
10/8/2022
charlestonbraces
Member Since: 06/05/09
Post: 2 of 16
I don't think it will be possible for you to do so. By defi nition, presence of a CoS is crowding
manifested in a subtle way. When you level, they must come forward.
Do you have a case you can show so we can give you better advice? ■
10/10/2022
dhmjdds
Member Since: 11/16/04
Post: 3 of 16
Charleston is correct. To prove it to yourself, make a reverse-curve archwire in round stainless
steel, mark the midline, rest it on a fl at surface, and mark where the ends of the wire and the
midline are. Now, fl atten the wire, place the ends on the marks and see where the midline is now.
It will always be forward of the original mark. And the bigger the curve the wire originally had (in
other words, the deeper the original curve of Spee), the farther forward the midline must move.
So then what are your options? Extractions, distalization of the posterior teeth (diffi cult!), or
IPR if there's not too much curve of Spee and not too much original proclination. You also may
be able to intrude the incisors; this requires placing the intrusion vector directly through the long
axis of the anterior teeth and will leave some posterior curve of Spee. ■
10/11/2022
emac
Member Since: 11/21/11
Post: 4 of 16
FWIW, I have found it useful in some cases to level the curve, fl are the incisors, then extract.
Sometimes it's easier than fi ghting a deep bite with an exo space, because the patient chews out
my bite-opening bends. ■
10/11/2022
NyceBiteR
Member Since: 10/21/08
Post: 5 of 16
I have heard it recommended that you not level the CoS before a BSSO advancement and
instead tripod the occlusion so that you can advance the mandible more; then you are supposed
to level the CoS afterwards. This has never quite made sense to me because you can't just get
pure extrusion of the premolars without fl aring the incisors postsurgically, so then what have you
gained? Only other option is tipping back molars. Can anyone explain the rationale behind this? ■
10/11/2022
dhmjdds
Member Since: 11/16/04
Post: 6 of 16
I believe it's not really so you can advance the mandible more; you do it so you can increase
lower anterior face height in a low-angle case. If you have already leveled the CoS, you have
probably mostly intruded incisors, because those deep-bite patients have strong, vertically pulling
masseters that prevent bicuspid extrusion when there is occlusion.
If you leave the CoS, then advance the mandible, the bite will be open at the bicuspids and
canines, and then erupting them *should* be relatively easy.
That's the idea, anyway. ■
10/11/2022
16 DECEMBER 2022 // orthotown.com

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