READERS’ FORUM

Letters to the editor*

The curve of Spee REFERENCES
1. Mew JRC. The aetiology of malocclusion: can the tropic premise
An article in the September issue was an excellent assist our understanding. Br Dent J 1981;151:296-302.
presentation of the characteristics and development of the 2. Mew JRC. The postural basis of malocclusion: a philosophi-
curve of Spee (Marshall SD, Caspersen M, Hardinger RR, cal overview. Am J Orthod Dentofacial Orthop 2004;126:
Franciscus RG, Aquilino SA, Southard TE. Development 729-38.
of the curve of Spee. Am J Orthod Dentofacial Orthop
2008;134:344-52). The authors accept that “Craniofacial
morphology is just one of the many factors influencing
its development.” Their broad inference is that it is largely
an inherited condition with little input from the environ-
ment; a viewpoint common within the orthodontic com- Author’s response
munity.
A mild curve of Spee, as found in many animal species We thank Dr Mew for his compliment and his thought-
and ancient humans, is of little concern to orthodontists, ful letter regarding our article (Marshall SD, Caspersen M,
but many are troubled by deeper curves that can be so Hardinger RR, Franciscus RG, Aquilino SA, Southard TE.
difficult to resolve. There was no mention of factors that Development of the curve of Spee. Am J Orthod Dentofa-
might be associated with an increase in this curve, other cial Orthop 2008;134:344-52). We agree that, in the
than possible variations in eruption times. orthodontic community, many view the curve of Spee, or
Interestingly, the word “tongue” did not appear once in other aspects of dentofacial form, as a product of inheri-
the article. Whenever the curve of Spee is increased, the tance “with little input from the environment.” However,
margins of the tongue will be seen to overlay the lingual we did not intend to assign a level of importance for any 1
cusps of the mandibular premolars, and the greater the factor, inherited or environmental, for the development of
curve, the more likely it is to overlay both the lingual and the curve of Spee. Adding this thought to our literature
buccal cusps, often with scalloping. As a student many review would have made this point more clear. Our
years ago, I was taught that the tongue adapts to dental and sentence, “. . . craniofacial morphology is just 1 of many
skeletal forms, but I know of no evidence to support this factors influencing its development,” was written to reflect
view or to suggest that tongue posture is not the determin- what we found in the anthropologic and dental literature.
ing factor of arch form, either then or now. That is, most studies that contribute to our knowledge of
For the specialty as a whole to ignore such an obvious the reason for the curve of Spee are products of “hard-
correlation is worrying. It is almost impossible to measure tissue” measurement. Contributions from the other “many
tongue posture, but that does not mean we can ignore it; at
factors,” including soft tissues, have not been well de-
the very least, we should accept that it is equally likely that
scribed.
any increase in the curve of Spee is due to lateral spread of
It was not possible for us to measure the influence of
the tongue. This could explain many idiosyncratic varia-
the tongue in our retrospective longitudinal study. Our
tions in arch form and offer additional options for treat-
omission of “tongue” in our article was not intended to
ment.
Orthodontics depends on logic as much as observation, discount the role of muscle activity in the development of
and we must not allow the present popularity of evidenced- dentofacial form. We agree that muscle activity and other
based orthodontics to blind us to obvious constant rela- essential data, much of which is not easily measured, are
tionships. My own research strongly suggests that correct needed to fully understand the confluence of heredity and
occlusion highly depends on correct tongue posture, and, environment that results in the curve of Spee. In this
as far as I am aware, this view has never been challenged regard, we find Dr Mew’s treatise on the postural basis of
scientifically.1,2 malocclusion1 thought-provoking and a valuable contribu-
John Mew tion toward greater understanding of the biology of our
Heathfield, Sussex, United Kingdom specialty.
Am J Orthod Dentofacial Orthop 2009;135:3 Steve Marshall
0889-5406/$36.00
Copyright © 2009 by the American Association of Orthodontists.
Iowa City, Iowa
doi:10.1016/j.ajodo.2008.10.009 Am J Orthod Dentofacial Orthop 2009;135:3-4
0889-5406/$36.00
*The viewpoints expressed are solely those of the author(s) and do not reflect Copyright © 2009 by the American Association of Orthodontists.
those of the editor(s), publisher(s), or Association. doi:10.1016/j.ajodo.2008.11.009

3
4 Readers’ forum American Journal of Orthodontics and Dentofacial Orthopedics
January 2009

REFERENCE I did note that a resolution was submitted to the AAO

1. Mew JRC. The postural basis of malocclusion: a philosophi- House of Delegates last May by the Mid-Atlantic Society
cal overview. Am J Orthod Dentofacial Orthop 2004;126: of Orthodontists that included “promoting environmentally
729-38. sound practices in . . . the recycling and safe disposal of
dental materials.” It was defeated in the 2008 House of
Delegates.
I wonder whether “recycling . . . of dental materials”
Divine proportions in the includes reusing brackets.
growing face In his response to the guest editorial, the editor-in-
chief wrote that, “As the need for greater awareness of our
I enjoyed the excellent article in the October issue environment grows, it is expected that this or a similar
(Ferring V, Pancherz H. Divine proportions in the growing resolution will surface again in the 2009 House of Dele-
face. Am J Orthod Dentofacial Orthop 2008;134:472-9). gates.”
Now that we have 3-dimensional (3D) capabilities, I think “Awareness,” while admirable, might need to be tem-
it is time that we as orthodontists start evaluating the entire pered with “education” about our environment. If we
face. I have been involved with 3D analysis of the face for subscribe to evidence-based practices and espouse to be
over 20 years. I worked with Dr Leslie Farkas for several scientists of our profession, then, although we might be in
years on 3D analysis of the face (before his death in an excellent position to make positive energy changes, we
October 2008). His life’s work is incredibly important; he should avoid hopping on any bandwagons, just because
worked with children and adults, measuring their faces, for they are popular. If you are confused by inflated concerns
over 50 years. A huge amount of work and information! about the environment, I recommend “Climate Confusion”
His work is important because he measured the actual by Dr Roy W. Spencer, formerly a senior scientist for
face—real 3D. All 2-dimensional (2D) images are dis- climate studies at NASA. Through those who dedicate
torted except at the central beam. This is true for both their lives to discovering the truth and realities of environ-
photographs and x-rays. The farther from the central beam, mental change, we can more correctly decipher ways to
the larger the distortion. Therefore, it is like apples to improve our offices and decide whether we need a resolu-
oranges to compare 2D photographs with 3D information tion from the AAO to do so.
from actual facial measurements (divine proportions). I Gerald W. Spencer (no relation)
have used 3D imaging routinely in my practice for 4 years. Sedalia, Mo
I have the I-Cat cone-beam imaging system (Imaging Am J Orthod Dentofacial Orthop 2009;135:4
Sciences International, Hatfield, Pa) and the 3dMD photo- 0889-5406/$36.00
Copyright © 2009 by the American Association of Orthodontists.
grammic imaging system (3dMD, Atlanta, Ga). These doi:10.1016/j.ajodo.2008.11.012
allow both hard- and soft-tissue analysis in true 3D. The
software for the surface analysis of the face was developed
by 3dMD based on Dr Farkas’s life’s work.
Much work went into this article, and my hat is off to Editor’s response
Drs Ferring and Pancherz. They have added immensely to
Letters to the editor are always welcome, but they have
the thought and understanding of facial esthetics. I sin-
special meaning to me when written in response to a guest
cerely applaud their efforts to combine 3D and 2D.
editorial.
However, I would like to see more studies using only 3D
I was in the AAO House of Delegates in May 2008 and
measurements and proportions.
heard the entire discussion that led to the defeat of the
Joe H. Mayes
resolution from the Mid-Atlantic Society of Orthodontists.
Lubbock, Tex
Am J Orthod Dentofacial Orthop 2009;135:4 As I understood it, the reason for the proposal was to
0889-5406/$36.00 provide greater access to accurate information about what
Copyright © 2009 by the American Association of Orthodontists. we can do in our offices to be more environmentally
doi:10.1016/j.ajodo.2008.11.011
responsible. It was about providing additional education,
not legislation. It might well be that recycling brackets
would be more harmful to the environment than purchasing
Is your practice turning green? them new. But where do we go to find out? It might be a
As always, I thoroughly enjoyed the October issue of waste of time for an orthodontist in the northwest to power
the AJO-DO, including the guest editorial by Charles L. his or her office with wind or solar power, as Dr Courtad
Courtad, “Is your practice turning green? It will perform has done in Colorado, but I don’t know where to get that
better, provide a healthier place to work, and might even information. I believe that the AAO could do more to help
save money.” The article was informative and made some busy private practitioners make these decisions. I see a
good points. resolution eventually passed in the House of Delegates that