Three-dimensional Evaluation of the

Carriere Motion 3D Appliance in the Marah Mohamed ElSaid

treatment of Class II malocclusion
Abdelrahman Emad Khedr

Rana Sameh Hafez

 Indications
• Class I, Crowding
• Class II, Division 1
• Class II, Division 2
• Class II, Open bite
• Class II, Deep bite
• Class II, Blocked out upper cuspids
• Class II, Subdivision, left or right
(unilateral)
Position
 The canine pad with a hook attachment used for placement of intermaxillary elastics is
bonded to the anterior third of the clinical crown. In cases in which the maxillary canine
has not erupted or has erupted ectopically, the first premolar can be used as the anterior
attachment
Methodology and
Results
 22 patients 6
• Bilateral Class II dental (Cervical Vertebrae Excluded
relationship (Division maturation stage 3
1 or 2) or 4 at baseline)
• SN-GoGn • missing
intraoral scan
measurements <35
• no orthodontic or 28 Patients data from 1or
orthopedic treatment more time point.
before the initial • duration of
timepoint. treatment with
• growing patients. 7
• comprehensive,
adolescent 15 the CMA
appliance
nonsurgical, non-
extraction treatment males adolescen exceeded 12
was completed with a t females months.
CMA appliance used • technical issues
in the initial phase of with CBCT scan
treatment data, making
• No obvious analysis of
craniofacial
treatment
asymmetries and no
crossbites present at
impossible.
the initial time point.
Illustration of SN-GoGn angle and
FMA angle
 CMA used :
• rigid stainless-steel or acrylic bars bonded to the maxillary canines and first molars
bilaterally.
• An invisible retainer or mandibular lingual holding arch anchors
the mandibular dentition.
• elastics protocol for the CMA appliance was: Force 1 elastics protocol that generated about 375 g
of force during the first month, then Force 2 elastics that generated about 540 g of force after that.
 The sample of 22 CBCT scans and 22
stereolithography intraoral scans (IOS) was
taken at
• an initial time point (T1),
• an intermediate time point coinciding with
the removal of the CMA (T2),
• and an immediate posttreatment time point
(T3).
Thus, 66 CBCT scans
and 66 stereolithography files were available
for study.
Head orientation of T1: 3D planes were
used as a
reference to standardize and reproduce the
head
orientation across all patients accurately as
follows:
(1) Frankfort horizontal plane (FHP) to
match
the axial plane and made to pass through
point A
(2) midsagittal plane to match
the sagittal plane
• Construction of 3D segmentations of cranial
base, maxilla and mandible was created for
each time point and landmarks were placed
on each segmentation.
• These reference points were used as a guide
for superimpositions made to evaluate
changes that occured.
• Also 3D surface models were generated by
3D Slicer software model maker tool using
IOS digital models and landmarks were
placed on 1st molar, 1st premolar and canine
on left and right sides for approximation and
comparison.
• All superimpositions and approximations
were made between time points T2 – T1
(CMA tt) and time points T3 – T1 (Full tt).
Results
Skeletal
Changes
B
 Dental
Reduction inOverjet during CMA use (T1 to T2, 0.9
Changes mm) and final phase (T1 to T3, 1.4 mm) of treatment.
Overbite was also significantly with the Carriere
appliance (T1 to T2, 1.7 mm). Further reduction in
overbite occurred during treatment with full fixed
appliances, with an overall of 2.5 mm. Class II
correction in the molar relationship improved by 2.7 mm
during the initial phase of treatment, but this change was
to 1.6 mm of Class II correction by the end of fixed
appliance treatment .
Similarly, the canine relationship had 3.0 mm of Class II
correction from T1 to T2 but only 2.3 mm from T1 to T3
Discussion
Flaring of the mandibular incisors found was
also similar to that produced by Class II
treatment with the Forsus appliance .
The literature shows that functional
appliances cause flaring of the mandibular
incisors to varying degrees. including the
Herbst ,Forsus ,Twin block and mandibular
anterior repositioning appliance.
Study Limitations :
• Clinical outcomes may vary depending on their degree
of compliance .
• No established normative values for 3D because of
ethical concerns with unnecessary radiation exposure of
untreated patients
• Measurements and no untreated control group are
available for comparison, and so firm conclusions
cannot be made on this subject without normative
values.
• Nothing was mentioned regarding long term retention
after the final phase .
 Conclusions :
It was found effective treatment option for Class II correction in adolescent
patients with Class II malocclusions.
During the CMA phase,
REBOUNDEDMax. Molars
by the distal
end ofmovement,
treatmentdistal rotation, and tip back;
Max Canines showed tip back and vertical displacement.

,
 EXCEPT for the molar and canine vertical
displacement that remained significant at T3.

Correction in the Class II occlusal relationship after

treatment resulted from mandibular dentoalveolar
movements (mesial movement of the mandibular molar),
Maxillary molar Derotation, and forward displacement of
the mandible during growth rather than Distalization of
the maxillary dentition.
Thank You 