{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,29]],"date-time":"2026-03-29T10:04:20Z","timestamp":1774778660914,"version":"3.50.1"},"reference-count":90,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:00:00Z","timestamp":1763424000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Applied Sciences"],"abstract":"<jats:p>Background: The development of the curve of Spee (CoS) is influenced by skeletal morphology, orofacial growth, tooth eruption timing, mandibular relationships, overbite, and neuromuscular development. This systematic review aims to determine the most effective orthodontic methods in correcting the curve of Spee. Methods: The systematic review protocol was registered on the PROSPERO platform and conducted according to the Cochrane and PRISMA guidelines. For its development, a standardized search was performed across different databases (MEDLINE, Cochrane Library, Embase and Web of Science) and grey literature. The risk of bias was assessed using Faggion, Jr.\u2019s guidelines for in vitro and in silico studies of dental materials, and the Rob-2 and ROBINS-1 tools for clinical studies. Results: The initial search found 748 studies, with 44 selected after full-text review. Of these, 22 were included in the quantitative analysis, assessing the effectiveness of braces (with or without extractions) and invisible aligners. Key methods for correcting the curve of Spee include various orthodontic archwires (nickel\u2013titanium (NiTi), stainless steel, beta-titanium), continuous and segmented techniques, reverse curve archwires, aligners, and treatment modalities including extraction protocols. Most in vitro studies and randomized studies had a high risk of bias, and non-randomized studies showed moderate to high bias risk. Conclusions: The results suggest that conventional techniques, particularly non-extraction approaches, may be more effective than aligners in correcting the curve of Spee, although the available evidence remains limited.<\/jats:p>","DOI":"10.3390\/app152212217","type":"journal-article","created":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T09:58:42Z","timestamp":1763459922000},"page":"12217","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effectiveness of Orthodontic Methods for Leveling the Curve of Spee: A Systematic Review with Meta-Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3283-5104","authenticated-orcid":false,"given":"In\u00eas","family":"Francisco","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal"},{"name":"Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal"},{"name":"Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal"},{"name":"Laboratory for Evidence-Based Sciences and Precision Dentistry, University of Coimbra, 3000-075 Coimbra, Portugal"},{"name":"Clinical Academic Center of Coimbra (CACC), Hospitais da Universidade de Coimbra, 3004-561 Coimbra, Portugal"},{"name":"Centre for Mechanical Engineering, Materials and Processes (CEMMPRE), Advanced Production and Intelligent Systems (ARISE), Department of Mechanical Engineering, University of Coimbra, 3004-504 Coimbra, Portugal"},{"name":"Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3004-504 Coimbra, Portugal"}]},{"given":"Ana L\u00facia","family":"Pinto","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal"}]},{"given":"Catarina","family":"Nunes","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal"},{"name":"Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal"},{"name":"Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal"},{"name":"Laboratory for Evidence-Based Sciences and Precision Dentistry, University of Coimbra, 3000-075 Coimbra, Portugal"},{"name":"Clinical Academic Center of Coimbra (CACC), Hospitais da Universidade de Coimbra, 3004-561 Coimbra, Portugal"},{"name":"Centre for Mechanical Engineering, Materials and Processes (CEMMPRE), Advanced Production and Intelligent Systems (ARISE), Department of Mechanical Engineering, University of Coimbra, 3004-504 Coimbra, Portugal"},{"name":"Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3004-504 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5682-3191","authenticated-orcid":false,"given":"Madalena","family":"Prata Ribeiro","sequence":"additional","affiliation":[{"name":"Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0015-8604","authenticated-orcid":false,"given":"Francisco","family":"Caramelo","sequence":"additional","affiliation":[{"name":"Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal"},{"name":"Laboratory for Evidence-Based Sciences and Precision Dentistry, University of Coimbra, 3000-075 Coimbra, Portugal"},{"name":"Clinical Academic Center of Coimbra (CACC), Hospitais da Universidade de Coimbra, 3004-561 Coimbra, Portugal"},{"name":"Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3004-504 Coimbra, Portugal"},{"name":"Laboratory of Biostatistics and Medical Informatics (LBIM), Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9269-5417","authenticated-orcid":false,"given":"Carlos Miguel","family":"Marto","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal"},{"name":"Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal"},{"name":"Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal"},{"name":"Laboratory for Evidence-Based Sciences and Precision Dentistry, University of Coimbra, 3000-075 Coimbra, Portugal"},{"name":"Clinical Academic Center of Coimbra (CACC), Hospitais da Universidade de Coimbra, 3004-561 Coimbra, Portugal"},{"name":"Centre for Mechanical Engineering, Materials and Processes (CEMMPRE), Advanced Production and Intelligent Systems (ARISE), Department of Mechanical Engineering, University of Coimbra, 3004-504 Coimbra, Portugal"},{"name":"Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3004-504 Coimbra, Portugal"},{"name":"Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal"},{"name":"Institute of Experimental Pathology, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6154-4173","authenticated-orcid":false,"given":"Anabela Baptista","family":"Paula","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal"},{"name":"Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal"},{"name":"Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal"},{"name":"Laboratory for Evidence-Based Sciences and Precision Dentistry, University of Coimbra, 3000-075 Coimbra, Portugal"},{"name":"Clinical Academic Center of Coimbra (CACC), Hospitais da Universidade de Coimbra, 3004-561 Coimbra, Portugal"},{"name":"Centre for Mechanical Engineering, Materials and Processes (CEMMPRE), Advanced Production and Intelligent Systems (ARISE), Department of Mechanical Engineering, University of Coimbra, 3004-504 Coimbra, Portugal"},{"name":"Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3004-504 Coimbra, Portugal"},{"name":"Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8937-361X","authenticated-orcid":false,"given":"Raquel","family":"Travassos","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal"},{"name":"Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal"},{"name":"Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal"},{"name":"Laboratory for Evidence-Based Sciences and Precision Dentistry, University of Coimbra, 3000-075 Coimbra, Portugal"},{"name":"Clinical Academic Center of Coimbra (CACC), Hospitais da Universidade de Coimbra, 3004-561 Coimbra, Portugal"},{"name":"Centre for Mechanical Engineering, Materials and Processes (CEMMPRE), Advanced Production and Intelligent Systems (ARISE), Department of Mechanical Engineering, University of Coimbra, 3004-504 Coimbra, Portugal"},{"name":"Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3004-504 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2615-2929","authenticated-orcid":false,"given":"Francisco","family":"Vale","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal"},{"name":"Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal"},{"name":"Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal"},{"name":"Laboratory for Evidence-Based Sciences and Precision Dentistry, University of Coimbra, 3000-075 Coimbra, Portugal"},{"name":"Clinical Academic Center of Coimbra (CACC), Hospitais da Universidade de Coimbra, 3004-561 Coimbra, Portugal"},{"name":"Centre for Mechanical Engineering, Materials and Processes (CEMMPRE), Advanced Production and Intelligent Systems (ARISE), Department of Mechanical Engineering, University of Coimbra, 3004-504 Coimbra, Portugal"},{"name":"Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3004-504 Coimbra, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,18]]},"reference":[{"key":"ref_1","unstructured":"Proffit, W., Fields, H., and Sarver, D. 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