Ortho Tribune U.K. Edition

OrthoTribune:DrCarrière,howlonghas the Motion appliance for Class III mal- occlusionsbeenonthemarket? We presented the appliance for the firsttimeattheAmericanAssociation of Orthodontists meeting this year. The approach is not entirely new and wehavebeenworkingonitforacouple of years. The Class II appliance was invented for Class II cases, but many participantsinseveralcoursesItaught on Class II, especially in Asia, asked whetheritcouldalsobeusedinClassIII cases.Inresponsetothis,wedecidedto explore this to see if it was a good op- tion. The results we achieved with the use of the Carriere Motion Class II Ap- plianceinClassIIIcaseswereamazing. Thismadeusrealisethatthisappli- ance was really changing the relation between the mandible and the max- illa, harmonising soft tissue and bal- ancingthepatient’sface.Wewerecom- pletelysurprisedbythefantasticfacial outcomes that we achieved with this minimalapproach.Wethusdecidedto createaspecialdesignaccordingtothe needs of the mandible, the Carriere MotionClassIIIAppliance. Could you please describe in short the design features of the Carriere Motion Class III Appliance? Why does it only have a simple molar bonding pad with asmallstepinthearmandwhydidyou abandonthejointdesignyouhavewith the Class II Motion Appliance (rotation ofthemolar)? If we look at the occlusion of the lowerarchinrelationtotheupper,nor- mallythereisaninclinationofthepos- terior segments owing to the fact that thebuccalsideofthemandibularmo- larsshouldfitbetweenthebuccaland the lingual aspects of the maxillary ones.Thismeansthatthedesignofthe traditionalClassIIpadballistoobulky. Often, it can interfere with the occlu- sion at the start of bonding, so we de- cided to create a flat surface on the posteriorsegmentinordertoavoidun- necessarycollisionsinClassIIImandi- bularpositioningwiththeappliance. What we have created is a design that is very clean and simple with only those features that are needed. Wehavealsoadaptedittotherequire- mentsofClassIIImalocclusions.While we used Motion Class II Appliances in Class III patients initially, we needed to create something that was really suited to Class III cases. We achieved this by flattening the profile, which is nowveryslimandstraightforward. It is very important to understand thatin95%ormoreofourfixedcases, we start treatment with the Carriere Motionappliance,whichisnotonlyre- stricted to Class II or III malocclusions but also extremely useful for those cases in which we have minor crowd- ing.Weneedtoopenlimitedspacebe- tweenthemaxillaryorthemandibular incisors in order to easily align the maxillaryteethorthemandibularan- terior teeth without protrusion while accomplishing what we term a“Super ClassIposteriorocclusion”.Forme,this is an elegant and efficient approach to cases that dramatically reduces the period for which brackets are worn by our patients. Reducing the time for whichthepatienthastowearbrackets is a very important factor for many patientsnowadays. Clear systems like Invisalign work amazingly well for simplifying treat- mentanddramaticallyshorteningthe aligner period. This way, many com- plexClassIIorIIIcasescaneasilybere- solved with Invisalign Lite treatment with less than fourteen aligners. This also makes treatment cheaper for patients and boosts the reputation of clinicians, as they are able to treat complex cases using very simple pro- cedures. The combination of the Motion appliance with our new passive self- ligatingbracketCarriereSLXandarch- wire sequence truly makes complex treatment simpler while creating adynamicandefficientscenarioinour treatments. We are very pleased with the new Carriere SLX. Technically speaking, it was a challenge, as we needed to create a masterpiece of precision.Ourengineersdidtheirbest workandweachievedthehighestlevel of technical bracket outcomes. It is a realgame-changer. How many cases have been treated withtheappliancesofar? Inouroffice,around100caseshave already been treated with the Motion Class III Appliance. It is astonishing to see the extraordinary change to the patient’sfaceeverytime,changesthat one could imagine have been accom- plished surgically, yet were achieved without a single extraction. I think the reason for this effect is the bal- anced combination of distalisation of the mandibular posterior segments, changeoftheposteriorocclusalplane, and anti-clockwise rotation of the mandiblethatcompletelychangesthe relationbetweenthemandibleandthe maxilla.Distalisationinthemandible is extremely fast and efficient mainly because there is an almost empty channel between the external and in- ternalcorticalbone.Thatisthereason weneedverylowforceelasticsinterms oftraction.Weonlyuse6oz,¼inch,and we normally never use 8 oz in Class III cases, which is what we normally use inClassIIcases. Looking at the occlusal plane, in ClassIIIcases,weintrudethemandibu- lar molars with the Motion appliance and extrude the canines. This intru- sion of molars and extrusion of ca- nines is necessary in Class III cases to changetheocclusalplane.Thisway,we bringthemandibleintoabetterfunc- tional and aesthetic position. The changebetweenthemandibleandthe maxilla that occurs in Class II and III cases is the main reason that we re- named the appliance from Distalizer to Motion. Not everything can be at- tributedonlytodistalisation. The Carriere Motion appliance changes the relation between the mandibleandthemaxillatosomeex- tent by altering the posterior occlusal plane, thereby moving the mandible and the maxilla into a better func- tional position while balancing the faceinClassIIandIIIcases. In retrognathic Class II patients, we combine maxillary distalisation, con- trolledmaxillarymolardistalrotation, and uprighting with mandibular re- positioningforabetterfunctionalrela- tion, giving stability to the case while balancing the position of the tempo- romandibular joint (TMJ) anatomical structures and harmonising the soft- tissue facial aesthetics. In Class III pa- tients,wepromoteposteriormandible repositioning, changing the posterior occlusal plane, combined with distal- isationoftheposteriorsegmentsfrom the canine to the molars. This ap- proach is often combined with a cer- tainupperarchdevelopmentwiththe Carriere SLX passive system to com- pensate for the typical premaxillary hypoplasiarelatedtothistypeofmal- occlusion. Our main objective is to es- tablish a stable and solid occlusion whilebalancingthepatient’sface. Have there also been cases in which the Class III malocclusion could not be corrected? Have you observed any TMJ problemsduringClassIIItreatment? We are normally confronted with two types of Class III patients, dental andskeletalClassIIIpatients.TheMo- tion Class III Appliance is a treatment “An elegant and efﬁcient approach” An interview with Dr Luis Carrière, Spain, developer of the Carriere Motion Class III Appliance Ortho Tribune United Kingdom Edition | 1/201510 TRENDS&APPLICATIONS “WhileweusedMotionClassIIAppliancesin ClassIIIpatientsinitially,weneededtocreate somethingthatwasreallysuitedtoClassIIIcases.” DTUK0415_34_36_OT10_12_Carriere 18.09.15 13:00 Seite 1 DTUK0415_34_36_OT10_12_Carriere 18.09.1513:00 Seite 1

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