Abstract
Objectives
To quantify the depth of the Curve of Spee (CoS) in untreated orthodontic patients, evaluate its variations across Angle classifications, and identify its skeletal and dental morphological correlates.
Materials and Methods
This retrospective study analyzed digital intraoral scans and lateral cephalograms of 240 untreated orthodontic patients (age range: 13–17 years). Subjects were categorized into four groups: Angle Class I, Class II/1, Class II/2, and Class III. CoS depth was measured using OrthoCAD, while skeletal and dental variables were assessed via AX.Ceph software. Statistical significance was determined using one-way ANOVA with Tukey’s post-hoc tests, Pearson’s correlation coefficients, and multiple linear regression analysis to identify primary predictors of CoS depth.
Results
The mean CoS depth was 2.18 mm. Significant intergroup differences were observed, with the greatest depth recorded in Class II/2 (2.49 mm) and the shallowest in Class III (1.82 mm). CoS depth demonstrated significant positive correlations with overbite, overjet, ANB angle and Wits appraisal. Conversely, an inverse relationship was found with vertical skeletal parameters. A multivariate regression analysis identified overbite and sagittal skeletal indicators as the most relevant predictors of CoS depth.
Conclusion
The depth of the CoS is critically influenced by sagittal skeletal discrepancies and incisal relationship (overbite), with vertical craniofacial morphology playing a secondary role. These findings highlight its relevance in orthodontic diagnosis and treatment planning. And the need for the individualized mechanics for CoS leveling based on the patient's specific skeletal and dental phenotype.
Keywords: MeSH Terms: Malocclusion, Overbite, Adolescent
Author Keywords: Malocclusion, Angle Classification, Overbite
Introduction
In the lateral view, the occlusal plane of the adult human dentition exhibits a characteristic superior concavity. In the mandibular dental arch, this curvature extends from the posterior teeth toward the incisors, forming a distinct anteroposterior curve. This specific spatial and geometric arrangement was first described in 1890 by Ferdinand Graf von Spee. Based on the analysis of 120 skulls with significant attrition, he defined the occlusal line as part of an imaginary cylindrical surface tangent to the anterior border of the mandibular condyle, the occlusal surfaces of the second molars, and the incisal edges of the mandibular incisors. This anatomical and functional curvature is widely recognized as the Curve of Spee (CoS) (1).
The precise functional role of this curvature has not yet been fully understood. Nevertheless, mastication, as a fundamental function of the maxillofacial system, largely depends on the balance between crushing and shearing forces among the teeth. It is hypothesized that the CoS performs a critical biomechanical role by optimizing force vectors in the posterior segment, thereby increasing the efficiency of food processing. Consequently, the transmission and distribution of occlusal forces during mastication are improved, suggesting that the CoS, in addition to its morphological significance, also has an important mechanical function (2, 3).
The understanding of the etiology and development of the CoS remains limited, and available evidence suggests that it is a multifactorial process. Recent evidence indicates that its formation results from a complex interaction between craniofacial growth, tooth eruption and the functional maturation of the neuromuscular system. Furthermore, the sagittal and vertical position of the mandible relative to the cranial base represents a key variable in its development (4, 5). The CoS is also present in various forms in other mammals, supporting its phylogenetic and functional basis (6).
Furthermore, Andrews defined six fundamental characteristics of normal occlusion and demonstrated that, in subjects with ideal occlusion, the CoS was either completely flat or only slightly defined. He reported that optimal tooth contact occurs when the occlusal plane is relatively flat. Accordingly, leveling the occlusal plane has become a primary therapeutic objective in contemporary orthodontic practice (6).
Despite the lack of a standardized consensus regarding leveling protocols, this procedure remains a routine component of orthodontic treatment. This has prompted numerous studies aimed at analyzing its correlations with various dentoalveolar and skeletal parameters (7-11).
Given that previous studies on the relationship between the CoS and craniofacial morphology have shown inconsistent and sometimes contradictory results, further analyses are needed to clarify these associations. Therefore, this study aimed to determine the average depth of the CoS in patients starting orthodontic treatment, examine its relationship with Angle classification, and analyze its association with various dental and skeletal parameters.
Materials and Methods
This cross-sectional retrospective study utilized digital intraoral scans (iTero Element 2, Align Technology, San Jose, CA, USA) and lateral cephalometric radiographs obtained from the orthodontic database of the Department of Orthodontics, University Hospital Center XXXXXX. A total of 240 subjects (age range: 13–17 years) were enrolled in the study based on the following inclusion criteria: presence of complete permanent dentition with all teeth in occlusal contact, absence of significant dental crowding and no history of prior orthodontic treatment. These criteria were established to ensure sample homogeneity and to eliminate confounding variables that could potentially affect dental arch morphology. The sample was divided according to Angle classification into four cohorts: Class I, Class II/1, Class II/2, and Class III, based on both clinical examination and cephalometric analysis. Digital models were analyzed using OrthoCad software (Align Technology, Inc.) for gnathometric assessment. Cephalometric analysis of the radiographs was performed using AX.Ceph software (Audax LLC, Slovenia) to evaluate sagittal and vertical skeletal parameters.
The depth of the CoS was defined as the perpendicular distance between the deepest point of the mandibular dental arch and a reference line connecting the tip of the incisal edge of the mandibular incisor with the tip of the distal cusp of the most posterior mandibular tooth. Measurements were performed separately on the left and right sides of the dental arch, and their arithmetic mean was used for statistical analysis (Figure 1).
Figure 1.
Measurement of the depth of the CoS using OrthoCad software (Align Technology, Inc.).
The study was approved by the Ethics Committee of the University Hospital Centre XXXXXX (approval number 02/013 AG).
Statistical analysis
Data were analyzed using descriptive statistics, with results expressed as mean values (M) and standard deviations (SD) for the total sample. Intergroup comparisons of the CoS depth across Comparisons across Angle classifications were conducted using a one-way analysis of variance (ANOVA), followed by Tukey’s post hoc test for multiple comparisons to identify specific intergroup differences. The association between the depth of the CoS and dental and skeletal variables was evaluated using the Pearson’s correlation coefficient (r). Variables demonstrating a statistically significant correlation were subsequently entered into a multiple linear regression model, with the CoS depth serving as the dependent variable. Statistical significance for all tests was set at p < 0.05. All analyses were performed using IBM SPSS Statistics (version 29.0; IBM, Armonk, NY).
Results
Mean values and standard deviations of the analyzed cephalometric, dentoalveolar, and occlusal parameters, according to Angle classification and for the total sample (n = 240), are presented in Table 1.
Table 1.
| Class I | Class II/1 | Class II/2 | Class III | Total | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Mean | SD | Mean | SD | Mean | SD | Mean | SD | Mean | SD | |
| SNA | 81.29 | 3.78 | 81.88 | 3.86 | 81.62 | 2.95 | 80.90 | 3.29 | 81.42 | 3.49 |
| SNB | 78.48 | 3.74 | 77.01 | 3.95 | 76.91 | 2.87 | 82.91 | 3.62 | 78.83 | 4.30 |
| ANB | 2.81 | 2.06 | 4.88 | 1.87 | 4.71 | 1.63 | -2.01 | 2.88 | 2.60 | 3.51 |
| Wits | -0.10 | 2.85 | 4.55 | 3.06 | 4.17 | 2.66 | -6.89 | 3.22 | 0.43 | 5.47 |
| N-S:Sp-Pm | 8.91 | 3.26 | 8.00 | 2.95 | 9.05 | 2.52 | 9.24 | 3.19 | 8.80 | 3.01 |
| N-S:M-Go | 32.84 | 5.31 | 31.26 | 6.10 | 29.08 | 5.30 | 31.45 | 5.54 | 31.16 | 5.70 |
| N-S-Gn | 66.84 | 3.89 | 66.81 | 3.84 | 65.81 | 3.00 | 63.49 | 3.94 | 65.74 | 3.91 |
| Sp-Pm:M-Go | 23.95 | 5.36 | 23.25 | 5.57 | 20.02 | 5.35 | 22.21 | 4.93 | 22.36 | 5.48 |
| N-S-Ar | 123.47 | 4.84 | 124.75 | 5.13 | 124.57 | 5.49 | 121.73 | 5.51 | 123.63 | 5.36 |
| S-Ar-Go | 143.36 | 5.43 | 143.35 | 6.42 | 143.56 | 6.08 | 141.82 | 7.71 | 143.02 | 6.46 |
| M-Go-Ar | 126.01 | 6.41 | 123.16 | 6.28 | 120.95 | 6.20 | 127.91 | 5.76 | 124.51 | 6.68 |
| NSArGoM | 392.83 | 5.31 | 391.26 | 6.11 | 389.08 | 5.30 | 391.46 | 5.54 | 391.16 | 5.70 |
| N-Go-M | 73.51 | 4.06 | 70.88 | 4.49 | 68.76 | 4.46 | 74.10 | 4.66 | 71.81 | 4.89 |
| N-Go-Ar | 52.50 | 4.15 | 52.28 | 4.24 | 52.19 | 3.65 | 53.82 | 4.05 | 52.70 | 4.06 |
| 1:Sp-Pm | 110.99 | 7.23 | 113.87 | 7.51 | 99.29 | 6.54 | 116.08 | 6.80 | 110.06 | 9.53 |
| 1:M-Go | 91.95 | 5.27 | 96.67 | 5.89 | 93.49 | 6.97 | 84.48 | 6.07 | 91.65 | 7.52 |
| 1:01 | 133.12 | 10.75 | 126.21 | 8.73 | 147.20 | 9.13 | 137.23 | 8.42 | 135.94 | 11.98 |
| 1:NA | 5.56 | 1.72 | 5.85 | 1.68 | 2.88 | 1.49 | 6.25 | 1.83 | 5.13 | 2.14 |
| 1:NB | 4.75 | 2.04 | 5.19 | 1.57 | 3.44 | 1.58 | 3.78 | 1.66 | 4.29 | 1.85 |
| Overbite (mm) | 2.79 | 1.49 | 3.33 | 1.82 | 5.20 | 1.77 | 1.91 | 1.97 | 3.31 | 2.13 |
| Overjet (mm) | 3.89 | 1.68 | 7.46 | 2.84 | 4.43 | 0.85 | -1.27 | 2.79 | 3.63 | 3.83 |
| Spee (mm) | 2.00 | 0.78 | 2.42 | 1.04 | 2.49 | 0.79 | 1.82 | 0.88 | 2.18 | 0.92 |
The mean depth of the CoS for the total sample was 2.18 ± 0.92 mm. When stratified by Angle classification, the most pronounced mean depth was observed in Class II/2 (2.49 ± 0.79 mm), followed by Class II/1 (2.42 ± 1.04 mm). In contrast, Class I subjects exhibited a mean value of 2.00 ± 0.78 mm, while the lowest mean depth was identified in the Class III subjects (1.82 ± 0.88 mm). The intergroup distribution of these values is illustrated in Figure 2.
Figure 2.
Mean depth of the CoS according to Angle classification
One-way analysis of variance (ANOVA) revealed statistically significant differences in the depth of the CoS among Angle classes (F (3,236) = 8.16; p < 0.001). Subsequent Post hoc LSD analysis revealed significant differences between Class I and II/1 (p = 0.009), Class I and II/2 (p = 0.002), Class II/1 and III (p = 0.00025), and Class II/2 and III (p = 0.00004). No statistically significant differences were observed between Class II/1 and II/2 (p = 0.65) or between Class I and III (p = 0.27).
Correlation analysis showed that the depth of the CoS was significantly and moderately positively correlated with overbite (r = 0.406), Wits appraisal (r = 0.367; p < 0.05), overjet (r = 0.303; p < 0.05), and the ANB angle (r = 0.228; p < 0.05). In contrast, significant negative correlations were established with SNB (r = –0.249; p < 0.05), the gonial angle (M–Go–Ar) (r = –0.209; p < 0.05), and the lower anterior facial height (N–Go–Me) (r = –0.203; p < 0.05) (Table 2). All other analyzed parameters failed to demonstrate statistically significant associations with the depth of the CoS (Table 2).
Table 2.
| Correlations | |
|---|---|
| Variable | Spee (mm) |
| SNA | -0.076685 |
| SNB | -0.248619 |
| ANB | 0.228150 |
| Wits | 0.366889 |
| N-S:Sp-Pm | -0.047511 |
| N-S:M-Go | -0.079686 |
| N-S-Gn | 0.075501 |
| Sp-Pm:M-Go | -0.055968 |
| N-S-Ar | 0.045495 |
| S-Ar-Go | 0.108026 |
| M-Go-Ar | -0.208560 |
| NSArGoM | -0.079433 |
| N-Go-M | -0.202872 |
| N-Go-Ar | -0.100129 |
| 1:Sp-Pm | -0.151588 |
| 1:M-Go | 0.130300 |
| 1:01 | 0.064410 |
| 1:NA | -0.107727 |
| 1:NB | -0.078753 |
| Overbite (mm) | 0.405832 |
| Overjet (mm) | 0.302750 |
| Marked correlations are significant at p < .050 | |
The multiple linear regression analysis demonstrated statistical significance (F (9, 230) = 10.63, p < 0.0001), accounting for 29.4% of the total variance in the CoS depth (R2 = 0.294, adjusted R2 = 0.266). Overbite emerged as the primary predictor (β = 0.415, p < 0.0001), indicating that each 1 mm increase in overbite corresponds to a 0.178 mm increase in CoS depth. Other significant cephalometric predictors included ANB (β = -0.708, p < 0.0001), Wits appraisal (β = 0.682, p < 0.0001), N–Go–Me (β = 0.329, p = 0.0073), and M–Go–Ar (β = -0.192, p = 0.0496). Conversely, SNB, 1: Sp–Pm, 1: M–Go and overjet did not contribute significantly to the model (p > 0.05).
Discussion
This study aimed to determine the mean depth of the CoS in patients undergoing fixed orthodontic treatment and to analyze its association with Angle’s classification of malocclusion, and specific dental and skeletal parameters.
According to the results of the current study, the deepest CoS was observed in Class II/2 (2. 49 ± 0.79 mm), followed by Class II/1 (2.42 ± 1.04 mm), with no significant differences between these two subgroups . The CoS was significantly deeper in Class II patients compare to those with Class I and Class III subjects. This finding is in accordance with the study by Aboulfotouh et al. (12), who also concluded that patients exhibiting Class II/2 and II/1 had the deepest CoS among other classes of malocclusion. Similar findings have also been described in several earlier studies (13-18). These results confirm that the radius of the CoS is shorter in patients with Class II malocclusion. Moreover, it is well known that the depth of the CoS in the lower arch is affected by the anteroposterior position of the incisors (2, 12).
Although no significant difference was observed between Angle Class I and Class III subjects in the present study, Class III individuals exhibited a flatter (less concave) occlusal curvature. Two recent studies also reported that no significant difference was observed in the depth of the curve between Class I and Class III subjects. Moreover, the curve was less concave in subjects exhibiting Class III, which is in line with the results of the current study (15, 16). In contrast, a recent meta-analysis suggests that Class I malocclusions may demonstrate a significantly deeper CoS than Class III malocclusions, highlighting a point of divergence in the current orthodontic literature (19). Regarding other evaluated parameters, the depth of the CoS exhibited a positive correlation with overbite, overjet, ANB angle, and Wits appraisal.
The association between increased overbite and CoS depth is well-documented in the literature, with studies emphasizing that an increased CoS plays a fundamental role in the etiology of deep bite malocclusions (3, 18, 20). It is known that subjects exhibiting Class II/2 usually have an increased overbite (15, 21). Hence, it was expected that in those patients, the CoS would be the deepest.
Our results further align with Halimi et al. and other investigators (20, 22, 23) who reported that CoS depth is positively correlated with both overjet and overbite. Regarding skeletal patterns, individuals with an increased ANB angle demonstrated a significantly deeper CoS compared to those with skeletal Class I relationships, which is in accordance with the results of the current study (19). Thus, the CoS is directly related to the anteroposterior position of the maxilla and mandible and the horizontal position of the condyle.
Regarding skeletal vertical parameters, the CoS in the present study exhibited a negative correlation with both the gonial angle and lower anterior facial height. It has been shown that high-angle subjects have a flatter CoS compared to low-angle patients. Skeletal deep bites are generally linked to an exaggerated CoS, whereas high-angle patients usually display open-bite characteristics or a diminished overbite, resulting in a less pronounced occlusal curvature (11, 15, 24).
The evaluation of the depth of the CoS is an important part of orthodontic diagnosis, which is related to treatment planning (13). A primary treatment objective, particularly in Class II malocclusions, is the leveling of the CoS to achieve optimal intercuspation between the maxillary and mandibular dentition (6). Moreover, flattening of the CoS will not only decrease the overbite, but will also gain extra space for the mandibular teeth, which is especially important in cases exhibiting crowding in the lower dental arch. Furthermore, as the efficiency of occlusal forces during mastication is linked to the degree of curvature, achieving a flatter CoS remains a fundamental goal for functional stability and occlusal harmony during orthodontic treatment (16).
Conclusion
The most pronounced CoS was observed in Class II/II, followed by Class II/1. Conversely, the flattest occlusal curvature was characteristic in Class III subjects; although no statistically significant difference in CoS depth was found between Class I and Class III groups.
In conclusion, CoS depth demonstrated a significant positive correlation with overjet, overbite, the Wits appraisal, and with the ANB angle. Furthermore, a significant negative correlation was identified between CoS depth and vertical skeletal parameters, indicating that hyperdivergent growth patterns are associated with a flatter occlusal plane.
Footnotes
Conflict of interest
None declared
References
- 1.Spee FG. The gliding path of the mandible along the skull. J Am Dent Assoc. 1980. May;100(5):670–5. 10.14219/jada.archive.1980.0239 [DOI] [PubMed] [Google Scholar]
- 2.Orthlieb JD. The curve of Spee: understanding the sagittal organization of mandibular teeth. Cranio. 1997. October;15(4):333–40. 10.1080/08869634.1997.11746028 [DOI] [PubMed] [Google Scholar]
- 3.Marshall SD, Caspersen M, Hardinger RR, Franciscus RG, Aquilino SA, Southard TE. Development of the curve of Spee. Am J Orthod Dentofacial Orthop. 2008. September;134(3):344–52. 10.1016/j.ajodo.2006.10.037 [DOI] [PubMed] [Google Scholar]
- 4.Osborn JW. Orientation of the masseter muscle and the curve of Spee in relation to crushing forces on the molar teeth of primates. Am J Phys Anthropol. 1993. September;92(1):99–106. 10.1002/ajpa.1330920108 [DOI] [PubMed] [Google Scholar]
- 5.Shillingburg HT, Hobo S, Whitsett LD, Jacobi R, Brackett SE. Fundamentals of fixed prosthodontics. 3rd ed. Chicago: Quintessence Publishing; 1997. p. 85-6. [Google Scholar]
- 6.Andrews LF. The six keys to normal occlusion. Am J Orthod. 1972. September;62(3):296–309. 10.1016/S0002-9416(72)90268-0 [DOI] [PubMed] [Google Scholar]
- 7.Bernstein RL, Preston CB, Lampasso J. Leveling the curve of Spee with a continuous archwire technique: a long-term cephalometric study. Am J Orthod Dentofacial Orthop. 2007. March;131(3):363–71. 10.1016/j.ajodo.2005.05.056 [DOI] [PubMed] [Google Scholar]
- 8.Preston CB, Maggard MB, Lampasso J, Chalabi O. Long-term effectiveness of the continuous and sectional archwire techniques in leveling the curve of Spee. Am J Orthod Dentofacial Orthop. 2008. April;133(4):550–5. 10.1016/j.ajodo.2006.02.039 [DOI] [PubMed] [Google Scholar]
- 9.Arcas VC, Tig IA, Moga DFC, Vlad AL, Saceleanu A, Fratila AM. Correlation between depth of the curve of Spee and some specific malocclusion characteristics in a population from Sibiu County, Romania: a cross-sectional study. J Clin Med. 2024. May;13(10):2750. 10.3390/jcm13102750 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Krüsi A, Dritsas K, Kalimeri E, Kloukos D, Gkantidis N. Association of craniofacial patterns with the curve of Spee and the time required for orthodontic levelling. Dent J (Basel). 2022. September;10(9):175. 10.3390/dj10090175 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Fawaz P, Amm E, Khoury E. The curve of Spee and its levelling in different vertical skeletal patterns: a 3D set-up study. Int Orthod. 2021. December;19(4):659–68. 10.1016/j.ortho.2021.08.003 [DOI] [PubMed] [Google Scholar]
- 12.Aboulfotouh MH, El-Dawlatly MM. The relationship between the depth of the curve of Spee and different types of malocclusion. Egypt Orthod J. 2020;58:19–25. 10.21608/eos.2020.44824.1003 [DOI] [Google Scholar]
- 13.Tejashre MM, Balakrishnan S, Mandava SS, Singaraju GS, Singaraju JK, Harini A, et al. An observational study on the association between the curve of Spee and sagittal condylar guidance in different skeletal malocclusions. Cureus. 2025. May;17(5):e84679. 10.7759/cureus.84679 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Harini A, Kadiveti A, Vivek Reddy G, Alahari SSK, Singaraju GS, Mandava P. Predictors of curve of Spee leveling in Class II Division 1 malocclusion treated with reverse curve of Spee archwires: an observational study. Cureus. 2024. August;16(8):e67163. 10.7759/cureus.67163 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Sayar G, Oktay H. Assessment of curve of Spee in different malocclusions. Eur Oral Res. 2018. September;52(3):127–30. 10.26650/eor.2018.475 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Fawaz V, Purushothaman B, Siyo RKN, Naseem KT, Ashok A, Bavitha TK. Investigation of the change in the degree of Frankfort mandibular plane angle after levelling the curve of Spee in different malocclusion groups. J Orthod Sci. 2023;12:65. 10.4103/jos.jos_41_23 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Poorsoleiman T, Kazemi B, Tofangchiha M, Ranjbaran M, Bolbolian M, Pagnoni F, et al. Evaluation of sella turcica variations in lateral cephalometric radiographs and its association with malocclusion. Acta Stomatol Croat. 2024. June;58(2):169–76. 10.15644/asc58/2/6 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Radalj Miličić Z, Kranjčević Bubica A, Nikolov Borić D, Špalj S, Meštrović S. Linear predictors of facial rotation pattern in Croatian subjects with skeletal Class III malocclusion. Acta Stomatol Croat. 2018. September;52(3):227–37. 10.15644/asc52/3/6 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Paes-Souza SA, Marañón-Vásquez GA, Galisteu-Luiz K, Ferreira DMTP, Maia LC, Nojima MDCG. Is there variation in the depth of the curve of Spee in individuals with different dentoskeletal patterns? A systematic review with meta-analysis. Eur J Orthod. 2022. October;44(5):491–502. 10.1093/ejo/cjab078 [DOI] [PubMed] [Google Scholar]
- 20.Xiao P, Yu Y, Chen C, Hu T, Yang H, He F. Relationship between the mandibular curve of Spee and the maxillary compensating curve with dentoskeletal morphology: a cross-sectional study in Chinese young adults with normal occlusion. J Orofac Orthop. 2025. November;86(6):392–401. 10.1007/s00056-024-00533-2 [DOI] [PubMed] [Google Scholar]
- 21.Ciavarella D, Fanelli C, Suriano C, Campobasso A, Lorusso M, Ferrara D, et al. Curve of Spee modification in different vertical skeletal patterns after clear aligner therapy: a 3D set-up retrospective study. Prog Orthod. 2024. January;25(1):5. 10.1186/s40510-023-00503-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Halimi A, Benyahia H, Azeroual MF, Bahije L, Zaoui F. Relationship between the curve of Spee and craniofacial variables: a regression analysis. Int Orthod. 2018. June;16(2):361–73. 10.1016/j.ortho.2018.03.025 [DOI] [PubMed] [Google Scholar]
- 23.Kumari N, Fida M, Shaikh A. Exploration of variations in positions of upper and lower incisors, overjet, overbite, and irregularity index in orthodontic patients with dissimilar depths of curve of Spee. J Ayub Med Coll Abbottabad. 2016. October-December;28(4):766–72. [PubMed] [Google Scholar]
- 24.Parčina Amižić I, Šimunović L, Lapter Varga M. Reliability of Zagreb 82 MOD cephalometric assessment in determining the facial growth pattern. Acta Stomatol Croat. 2025. March;59(1):36–43. 10.15644/asc59/1/4 [DOI] [PMC free article] [PubMed] [Google Scholar]