ORIGINAL ARTICLE A comparison of the effects of rectangular and round arch wires in leveling the curve of Spee

Abdulaziz Kh. AlQabandi, BDS, MS,a Cyril Sadowsky, BDS, MS,b and Ellen A. BeGole, PhDc Chicago, Ill A prospective randomized clinical study was designed to evaluate the effects of full continuous arch wires, rectangular in cross section, on the axial inclination of lower incisors. The intention of rectangular arch wires is to counteract the labial crown moment usually produced during leveling the curve of Spee with full arch mechanics. Patients were randomly assigned to 2 groups. Group 1 (N = 12) received round arch wires throughout the leveling stage. Group 2 (N = 16) started with flat 0.016 0.022 nickel titanium arch wires progressing to 0.016 0.022 stainless steel. The preadjusted 0.018 0.025 edgewise appliance was used in all cases. Lateral cephalometric radiographs and mandibular study models were taken before treatment and when the curve of Spee was leveled (or in some cases when the overbite was considered clinically acceptable). In group 1, the lower incisor proclined a mean of 6.75 4.85 (P < .01) and in group 2 it proclined a mean of 6.10 3.95 (P < .01). However, no significant difference in proclination was detected between the 2 groups. Statistically significant, but low, correlations were demonstrated between change in lower incisor axial inclination and relief of crowding r = 0.45) and change in mandibular arch depth r = 0.54), which was in turn inversely correlated with change in intercanine width r = 0.45). In both groups, the lower incisors proclined with uncontrolled tipping that can probably be attributed to the intrusive force introduced by the arch wire being labial to the center of resistance of the lower incisors. The ability of the rectangular arch wires to control labial proclination following leveling of the curve of Spee, as used in this study, was not supported. (Am J Orthod Dentofacial Orthop 1999;116:522-9)

deep curve of Spee is usually associated with an increased overbite. Orthodontic correction of the overbite often involves leveling the curve of Spee by anterior intrusion, posterior extrusion, or a combination. Proclining the lower incisors has also been used in some cases to decrease the relative vertical overlap of the lower incisors by the upper incisors. Baldridge1 reported that decreasing the depth of the curve of Spee leads to an increase in arch circumference and that often the lower incisors will be proclined in direct response to this increase. Braun and Hnat2 found an association between lower incisor proclination and reduction in lower intercanine width. Others have attributed this incisor proclination to the treatment mechanics
From the University of Illinois at Chicago, College of Dentistry, Department of Orthodontics. This article is based on research submitted by Dr Abdulaziz AlQabandi in partial fulfillment of the requirements for the degree of Master of Science in Oral Sciences, University of Illinois at Chicago. aAhmadi Hospital, Ahmadi, State of Kuwait. bProfessor, University of Illinois at Chicago. cAssociate Professor, Biostatistics, University of Illinois at Chicago. Reprint requests to: Dr Cyril Sadowsky, University of Illinois at Chicago, College of Dentistry, Department of Orthodontics, 801 S. Paulina Street, Chicago, IL 60612 Copyright 1999 by the American Association of Orthodontists. 0889-5406/99/$8.00 + 0 8/1/100077

used and the introduction of intrusive forces labial to the center of resistance of the lower incisors producing a labial crown tipping moment, often with full arch mechanics. Lower incisor proclination may be undesirable as stability and esthetics could be compromised, in addition to placing the labial supporting tissues at risk. The use of rectangular arch wires with the edgewise appliance has been advocated with the expectation of counteracting the anticipated labial crown tipping. The purpose of this study is to determine whether rectangular arch wires are effective in controlling the labiolingual crown inclination of lower incisors as the curve of Spee is leveled during the initial stage of treatment compared to using solely round arch wires. The null hypothesis is that there is no difference in the effects on the axial inclination of the lower incisors when the curve of Spee is leveled with round arch wires exclusively as compared with rectangular arch wires. The findings should aid clinicians in choosing the appropriate mechanotherapy based on the treatment objectives for leveling the curve of Spee with full arch mechanics.
METHODOLOGY

The study design was randomized and prospective. The sample was derived from adolescent and adult

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patients treated in the graduate orthodontic clinic, College of Dentistry, University of Illinois at Chicago. The patients in the permanent dentition group had no or only mild crowding (3 mm) and a moderate to deep curve of Spee usually associated with a deep overbite. The treatment was nonextraction in the mandibular arch with the use of full arch mechanics with the 0.018 0.025 preadjusted edgewise appliance. The patient/parent signed a consent form before inclusion in the study. Suitable cases for inclusion were randomly assigned to either group 1 or 2. Cases in group 1 had the curve of Spee leveled by using progressively larger cross-section round wires that were changed approximately every 4 weeks, ending with a 0.016 stainless steel arch wire with a mild reverse curve of Spee to ensure complete leveling of the arch. Cases in group 2 received an initial 0.016 0.022 nickel-titanium rectangular arch wire; the manufacturers archform, which is ovoid, could not be altered. Fifteen of the patients received copper nickeltitanium at 35 (ORMCO, Orange, Calif) and one patient received Neosentalloy (GAC International, Central Islip, NY) as the initial arch wire. Group 2 cases progressed to 0.016 0.022 stainless steel rectangular arch wires with a mild reverse curve of Spee. For all stainless steel arch wires, the arch forms from the initial study models were maintained. In all cases, the premolars were completely erupted, were in occlusion, and were amenable to bracketing. A description of the sample is provided in Table I. The records consisted of mandibular plaster study models and lateral cephalometric radiographs taken before treatment (T1) and when the curve of Spee was completely leveled (T2). In some cases, the T2 records were taken when the overbite was considered clinically acceptable (1 to 2 mm) and the case was ready for the next stage of treatment. From the study models, the following variables were measured (Fig 1):
1. Arch depth from the canines in millimeters (Depth 3): the perpendicular distance between the midpoint of a line that extends between the distal contact point of the lower canines and the lower incisal edges. 2. Intercanine width in millimeters (Canine): the distance between the distal contact points of well-aligned canines. If canines were rotated, the measurement was taken from the mesial contact points of the lower first premolar. 3. Arch depth from the molars in millimeters (Depth 6): the perpendicular distance between the midpoint of a line that extends between the mesiobuccal cusp tips of the mandibular molars and the lower incisal edges. 4. Depth of curve of Spee in millimeters (Spee): the perpendicular distance between the deepest cusp tip and a flat

Table I. Sample

description
Group 1 (Round) Group 2 (Rectangular) 16 8 8 14.16 3.57 10.5424.42 3 8 5

Number of subjects: Gender Male Female Age Mean SD Range Malocclusion Class I Class II Division 1 Class II Division 2

12 6 6 15.12 4.83 11.4229.62 2 9 1

plane that was laid on top of the study cast, touching the incisal edges and the distal cusp tips of the most distal molar included in the continuous arch wire. The measurement was the summation of the curve of Spee on the right and left sides of the dental arch. 5. Amount of crowding/spacing in the anterior segment in millimeters (Space): for crowding the amount of overlap between the teeth was measured. Spacing was the measure of the gaps between the teeth.

The following variables were measured from the lateral cephalometric radiographs:
1. Lower incisor angulation to the functional occlusal plane in degrees (L1-OP). 2. Change in axial inclination of the long axis of the lower incisor in degrees (Incisor): measured as the angle between the two lines representing the long axis of the lower incisor at T1 and T2, respectively, after superimposing according to Bjrks3 structural method for mandibular superimposition (Fig 2). 3. Distance of the center of rotation to the lower incisal edge at T1 (DCRot): the center of rotation is determined as the point of intersection between the two lines representing the long axes of the lower incisor at T1 and T2, respectively, after superimposing according to Bjrks3 structural method for mandibular superimposition (Fig 2). MEASUREMENT ERROR

Ten models and 10 lateral cephalometric radiographs were remeasured after 2 weeks and the first and second measurements were compared using a paired t test. The null hypothesis tested was that of no difference between the 2 measurements.
DATA ANALYSIS

Paired t tests were used to determine whether the treatment changes within each group were statistically

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Fig 2. Mandibular superimposition: 1, change in axial inclination of the lower incisor in degrees (Incisor); 2, the distance in millimeters of the center of rotation to the incisal edge at T1 (DCRot).

B
Fig 1. A, Lower study model: 1, arch depth relative to the canines (Depth 3); 2, intercanine width (Canine); 3, arch depth relative to the molars (Depth 6). (See text for a detailed description of the variables.) B, Lower study model. 4, depth of the curve of Spee (Spee). (See text for a detailed description of the variables.) RESULTS

significant. The null hypothesis was that the treatment changes were equal to zero ( = .05). Independent t tests were used to determine any significant differences in treatment changes between the 2 groups. The null hypothesis tested was for no difference between group 1 and group 2 for all treatment change measurements with = .05. Correlation coefficients were used to determine any significant relationships among the variables. It was particularly important to determine whether lower incisor proclination was associated with other changes in the dental arch, for example, if arch width decreased, arch depth would be expected to increase, which could manifest as proclination of the lower incisor. Similarly, resolution of crowding could result in incisor proclination. Because change in lower incisor inclination could be affected by changes in groups of variables, multiple regression analysis was also performed. Lower incisor axial inclination was the dependent variable; the other variables were used as independent variables to explain the change in lower incisor axial inclination.

No significant differences at P > .05 were found between the 2 sets of measurements taken 2 weeks apart (Table II). The null hypothesis was not rejected, which indicates good intraexaminer reliability. In group 1 (round arch wires only), the curve of Spee was leveled in 6.3 months on average with a range of 4.5 to 10.5 months. In group 2 (rectangular wires), the curve of Spee was leveled in 6.1 months on average with a range of 2 to 11.5 months. The average depth of the curve of Spee for group 1 was 3.77 mm 1.19 (range, 2 to 6 mm) and for group 2 it was 4.2 mm 1.73 (range, 2.5 to 8.5 mm) with no difference between the 2 groups. In both groups, there was significant reduction in the depth of curve of Spee (Spee), increase in arch depth relative to molars (Depth 6), reduction in crowding (Space), and proclination of lower incisors considering both angulation (Incisor) and the change in center of rotation (DCRot), as shown in Tables III and IV. In group 1, the lower incisor proclined a mean of 6.75 4.85; in group 2, it proclined a mean of 6.10 3.95 around a center of rotation at a distance of 15.06 mm 8.05 mm and 14.50 mm 5.98 mm, respectively, from the incisal edge at T1. When groups 1 and 2 were compared, no statistically significant differences were found for any of the variables (Table V). No significant correlations were found between the change in the depth of curve of Spee and changes in any of the other variables (Table VI). Change in lower

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Table II. Measurement Variable Spee (mm) Space (mm) Canine (mm) Depth 3 (mm) Depth 6 (mm) Incisor () DCRot (mm) L1-OP ()

error of the difference between 2 successive recordings (n = 10)

Mean 0.00 0.60 0.10 0.25 0.25 0.10 0.00 0.05 SD 0.78 1.48 1.04 0.54 0.54 1.26 1.08 1.30 Mininum 1.00 1.50 2.50 1.00 1.00 2.00 2.00 2.00 Maximum 1.00 3.00 1.50 1.00 1.00 2.00 1.50 2.50 t 0.00 1.27 0.30 1.46 1.46 0.25 0.00 0.12 P 1.00 .23 .76 .17 .17 .80 1.00 .90

Table III. t Variable

Test to determine significance of treatment changes (group 1; n = 12)

Mean 1.77 0.93 0.25 0.54 1.09 6.75 15.06 SD 1.03 1.43 1.11 0.85 1.02 4.85 8.05 Minimum 3.50 1.50 2.00 0.50 0.50 0.00 0.00 Maximum 0.50 3.00 2.00 2.00 2.50 15.00 32.00 t 5.95 2.26 0.77 2.18 3.54 4.81 6.47 P .01 .04 .45 .05 .01 .01 .01

Spee (mm) Space (mm) Canine (mm) Depth 3 (mm) Depth 6 (mm) Incisor () DCRot (mm)

Table IV. t Variable

Test to determine significance of treatment changes (group 2; n = 16)

Mean 2.62 1.10 0.56 0.21 1.09 6.10 14.50 SD 1.36 1.36 1.39 0.85 1.28 3.95 5.98 Minimum 5.50 0.50 1.75 1.00 1.50 1.50 7.00 Maximum 0.50 4.00 4.00 1.50 3.00 18.00 25.00 t 7.71 3.26 1.60 1.02 3.41 6.18 9.68 P .01 .01 .12 .32 .01 .01 .01

Spee (mm) Space (mm) Canine (mm) Depth 3 (mm) Depth 6 (mm) Incisor () DCRot (mm)

incisor axial inclination was significantly associated with change in tooth-arch discrepancy r = 0.45), and change in arch depth r = 0.54). Significant negative correlation was found between the change in intercanine width and the change in arch depth r = -0.45). With the use of multiple regression analysis, change in intercanine width accounted for 35% of the variability in change in lower incisor axial inclination and when combined with change in crowding, only 41% of the total variability was accounted for by these two variables. No equation is reported since the r squared value was too small for adequate prediction.
DISCUSSION

In this study, no attempt was made to separate the sample according to gender, type of malocclusion, or age of the patient. Braun and Schmidt4 compared nongrowing white males and females with Class I and Class II malocclusions who had never received treat-

ment. They reported that the shape of the curve of Spee was the same for men and women based on the contact points between the mandibular teeth taken from lateral cephalometric radiographs. Carter and McNamara5 reported no difference in the depth of curve of Spee between males and females when measured from the dental casts taken before treatment. Bishara6 reported similar trends in posttreatment changes in male and female patients after orthodontic treatment with the edgewise appliance with or without extractions. Braun and Schmidt4 also reported that the curve of Spee was found to be identical for Class I and Class II malocclusions. McDowell and Baker7 compared growing and nongrowing patients who received nonextraction treatment, with their deep overbites corrected by leveling with continuous arch wires. They reported that the axial inclination and the position of the incisors after treatment were similar in both groups. Therefore, no

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Table V. Independent

t test to compare treatment changes between groups 1 and 2

Group 1 (N = 11) Group 2 (N = 15) Maximum 0.50 3.00 2.00 2.00 2.50 15.00 32.00 Mean change 2.62 1.10 0.56 0.21 1.09 6.10 14.50 SD 1.36 1.36 1.39 0.85 1.28 3.95 5.98 Minimum Maximum 5.50 0.50 1.75 1.00 1.50 1.50 7.00 0.50 4.00 4.00 1.50 3.00 18.00 25.00 t 1.89 0.32 0.65 0.98 0.01 0.37 0.20 P .06 .75 .51 .33 .99 .71 .84 SD 1.03 1.43 1.11 0.85 1.02 4.85 8.05 Minimum 3.50 1.50 2.00 0.50 0.50 0.00 0.00

Variable Spee (mm) Space (mm) Canine (mm) Depth 3 (mm) Depth 6 (mm) Incisor () DCRot (mm)

Mean change 1.77 0.93 0.25 0.54 1.09 6.75 15.06

Table VI. Correlation

coefficient analysis (total sample, n = 28)

Space (mm) Canine (mm) Depth 3 (mm) Depth 6 (mm) Incisor () DCRot (mm) L1OP ()

Spee (mm) Spee (mm) Space (mm) Canine (mm) Depth 3 (mm) Depth 6 (mm) Incisor () DCRot (mm) L1-0P () *P < .05. 1.00 0.26 0.20 0.01 0.27 0.17 0.18 0.17

1.00 0.23 0.43* 0.43* 0.45* 0.23 0.06

1.00 0.43* 0.45* 0.07 0.27 0.06

1.00 0.77* 0.50* 0.02 0.08

1.00 0.54* 0.08 0.21

1.00 0.20 0.26

1.00 0.12

1.00

attempt was made in this study to separate the sample according to the age of the patient. The arch wires used during the leveling stage were not cinched. The concept behind cinching is to maintain arch perimeter by holding the crowns of teeth together. Koenig and Burstone8 calculated a large increase in mesiodistal forces if the wire is not free to slide within the brackets. They used a 0.016 stainless steel arch wire attached to a canine and a premolar. These forces are directed to move the brackets toward each other. Another side-effect of a cinched or tied back arch wire is a dramatic increase in moments around the respective center of resistances. However, Elms et al9 reported no significant change in axial inclination of the lower incisor on 42 patients after tying back the arch wire throughout most of the treatment. The initial arch wire was not cinched, and the arch length was maintained.10 The effects of not cinching the arch wires would be similar in both groups in the present study but might affect the pattern of lower incisor proclination by masking any third order effect produced by the rectangular arch wire. It was decided that no cinching be done in the present study. No significant differences in any of the variables between the two groups were found in this study, including the amount of lower incisor proclination, as a consequence of leveling the curve of Spee. In spite of the fact that a power analysis demonstrated that larger

sample sizes would be needed for significance, we found 6 of 7 treatment changes in group 1 (round arch wires) to be significant and 5 in group 2 (rectangular arch wires). Given the small differences between groups and the large variability, particularly for incisor angulation (Incisor) and distance of the center of rotation from the incisal edge (DCRot), very large samples would be needed and the clinical relevance of the differences would be in question. The inability of the 0.016 0.022 rectangular arch wire to produce a third order moment and prevent the labial proclination of the lower incisors might be attributed to the amount of play between the 0.016 0.022 arch wire and the 0.018 0.025 bracket, the edge bevel associated with the arch wire and the low torsional stiffness of superelastic nickel-titanium arch wires used in the initial stages of leveling. Technically speaking, an arch wire with a dimension of 0.016 0.022 can cause a third order moment as a result of the diagonal dimension in cross section being larger than the vertical dimension of the bracket slot. However, before the arch wire can engage the slot and produce torque (moment of a couple), it has to rotate in the slot to a certain degree that is a reflection of the amount of play between the arch wire and the bracket slot. Dellinger11 calculated this angle to be 6.7 using the dimensions of the arch wire and the bracket slot provided by the manufacturer. In contrast, Sebanc et al12 found that this angle always exceeded

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the theoretically calculated values and varied between 10.3 and 14.1. He attributed this to the edge bevel in the arch wire. Odegaard et al13 demonstrated that the amount of play is different among arch wires of different materials with the same dimension due to variation in the bevel edge. Sebanc et al12 attributed this to the mechanical and wear properties of each alloy. Meling and Odegaard14 measured the radius of the edge bevel and found it to be 0.09 mm for Copper Nickel-Titanium (35) and 0.04 mm for Neosentalloy. Odegaard et al13 demonstrated that the restraining effect of ligatures could produce torque control even though the play had not been completely eliminated. However, they suggested that the torque is of doubtful clinical effect. This play between the arch wire and the bracket slot results in the arch wire losing some of its torsional activation when engaged into the bracket slot. A 0.016 0.022 Copper Nickel-Titanium (35) and Neosentalloy arch wire were used in this study because of their superelasticity. Kusy15 described Copper Nickel-Titanium (35) and Neosentalloy as thermoelastic nitinols. It is a martensitic active alloy that exhibits a thermally induced shape memory effect. On distortion and insertion into the patients mouth, the appliance is activated by the warmth of the oral cavity and returns to its predetermined austenitic shape. Kusy and Wilson16 reported that the elastic modulus of the high temperature or austenitic phase was 3 times greater than that of the low temperature or martensitic phase. However, Meling and Odegaard17 indicated that Copper Nickel-Titanium (35) and Neosentalloy are extremely heat sensitive. They reported an 85% and 72% reduction in torque when the Copper Nickel-Titanium (35) and Neosentalloy arch wires respectively, were subjected to cold water transiently. They also reported that after applying 10 cycles of cold water, 10 seconds each time, the Copper Nickel-Titanium (35) regained only 60% of the original torque after 2 hours. Even the Neosentalloy did not recover fully after 2 hours. The authors concluded that the arch wire might not provide adequate constant torque when subjected to a transient cold stimulant. Meling and Odegaard18 calculated the mean torsional stiffness of nickel-titanium at 37 to be 0.70 Nmm/degree. The authors found that for twist angles below 20 the 0.016 0.022 nickel-titanium arch wires develop very little torque. Even at 25, the torque levels were less than 5 Nmm as a result of torsional clearance. No attempt was made in this study to measure the amount of torsional activation for the rectangular arch wire and the amount of the labial root torque needed, but it could be that the rectangular arch wire might have not been activated enough to deliver the required

labial root torque. Any attempt to measure the angle of twist should take into consideration the initial mesiodistal angulation of the lower canines, which will partly determine the vertical level and the plane of the cross section of the anterior segment of the arch wire relative to the plane of the bracket slots of the lower incisors. As for the cause of lower incisor proclination, 3 possible explanations have been provided in the literature: (1) an increase in arch length is required as the curve of Spee is leveled; (2) a decrease in intercanine width; (3) the intrusive forces of the arch wire being applied labial to the center of resistance of the lower incisors. No correlation was found in this study between the leveling of the curve of Spee and the increase in the lower incisor angular change. Similar results have been reported by Chung et al19 where they used records taken before and after treatment. However, Baldridge1 leveled the curve of Spee in the laboratory and reported a significant increase in arch length requirement. Similarly, when Braun et al20 leveled the curve of Spee using a computer model, they noticed a small increase in arch length requirement that was not substantiated by statistical tests. The latter 2 studies differed in that the first leveled the curve of Spee by uprighting and elevating the lower posterior teeth and the second leveled a line that passed through the distobuccal cusp tip of the lower second molar and the mesiobuccal cusp tip of the lower first molar. Hemley21 described a curve of Spee with mesial tipping of the mandibular molar and distal tipping of the mandibular canine with the 2 premolars locked below the line of occlusion. He indicated that these conditions create an exaggerated curve of Spee and by distally uprighting the molar and mesial uprighting the canine, the 2 premolars will be free to erupt into the line of occlusion. Strang and Thompson22 described a deep curve of Spee as a result of elevated anterior teeth, depressed premolars, and mesially inclined molars. They indicated that an exaggerated curve of Spee requires distal tipping of mandibular molar teeth, elevation of mandibular premolars, and depression of incisors. Thus one wonders if uprighting of the molars and canines during leveling the curve of Spee is needed, and to do so, where should the center of rotation be and how much do we need to move the crowns of those teeth to remove the wedging effect on the premolars to allow their passive eruption. Therefore, one should differentiate between a deep curve of Spee with mesially inclined molars and distally inclined canines that may need to be uprighted and a deep curve of Spee with just differential vertical eruption between the anterior and posterior teeth. In addition, to study

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change in arch perimeter, one should specify the treatment objectives and the mechanotherapy needed for leveling the curve of Spee. Correlation coefficient analysis for the total sample indicated that resolution of crowding was associated with proclination of the lower incisors r = 0.45). However, there was no significant difference between the 2 groups in the amount of change in crowding. Lower incisor proclination was associated with an increase in arch depth r = 0.54), which was in turn negatively associated with a reduction in intercanine width r = 0.45). Braun and Hnat2 arrived at the same relationship between change in intercanine width and change in arch depth. This might indicate that as the intercanine width is decreased, the arch depth increases and is manifested by lower incisor proclination. However, with the use of multiple regression analysis, only 41% of the variability in change of lower incisor proclination could be accounted for by resolution of crowding and change in intercanine width. The type of tipping that the lower incisor undergoes during proclination is defined by the position of the center of rotation, which is determined by the force system applied on the tooth relative to its center of resistance. The center of resistance (CR) is defined as that point on the tooth where, if a single force passed through, pure translation would result. Burstone and Pryputniewicz23 determined that for a single rooted tooth it is one third of the root length apical to the alveolar crest along the long axis of the root. When the force passes at a distance from the CR, the tooth will undergo a combination of translation and rotation. The rotation is caused by the moment of that force that equals the force multiplied by the perpendicular distance of the force to the CR. Rotation occurs around a center of rotation (CRot), which is an instantaneous point during tooth movement. Uncontrolled tipping occurs when CRot is close to the center of resistance and can be caused with a single force applied to the tooth at a certain distance from CR. Kusy24 indicated that the M/F ratio, when CRot at CR, is equal to the distance of the force to the CR as explained by the following equation,
M/F (at bracket) = Net moment = Mforce = FxD = Dmm Net force Force F

is introduced that will reduce the effect of the moment of the force. The same effect can be introduced by moving the applied force closer to the CR. In this study, an intrusive force would be closer to the center of resistance when lower incisors are upright with the expectation that the initial inclination of lower incisor, as quantified in this study by the lower incisorocclusal plane angle at T1, would have been correlated with the location of the center of rotation. However, correlation coefficient analysis did not reveal such an association. The center of rotation was on average slightly apical to the center of resistance with no difference in its position between the 2 groups. If one assumes an average lower central incisor with a crown length of 9 mm and root length of 12.5 mm25 and considers the location of the center of resistance as indicated by Burstone and Pryputniewicz,23 the center of rotation in this study would be slightly apical (2 mm in group 1 and 1 mm in group 2) to the center of resistance. Therefore, the lower incisors proclined with uncontrolled tipping consistent with that previously described by Burstone and Pryputniewicz23 when a single lingually directed force was applied to the crown of a tooth.
CONCLUSIONS 1. No difference in change in lower incisor axial inclination between groups 1 and 2 was demonstrated in this study. Therefore, the technique of using a 0.016 0.022 superelastic nickel-titanium followed by a 0.016 0.022 stainless steel with a mild reverse curve of Spee as used in this study did not prevent labial proclination of lower incisors after leveling the curve of Spee with a continuous arch wire. 2. Lower incisor proclination occurred by uncontrolled tipping around a center of rotation slightly apical to the center of resistance. 3. No association between reduction in depth of curve of Spee and proclination of the lower incisor was demonstrated. 4. Lower incisor proclination was significantly correlated with reduction in intercanine width and reduction of crowding. However, only 41% of the variability of lower incisor proclination could be accounted for by the variables used in this study.

Because M/F ratio will determine the position of the CRot relative to CR, any change in distance between the force to the CR will cause a change in CRot through a change in its moment around the CR.23 With a single lingually directed force, the CRot will be slightly apical to CR, and CRot will start moving apically once a counteracting couple (lingual root torque)

We would like to thank Dr Stanley Braun for his advice and suggestions in the design of this study. Thanks also to the Ormco Company for donating the arch wires used in this study. Also to the residents in the Department of Orthodontics, University of Illinois at Chicago, for their patience and cooperation in participating in this study.

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