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application of the Sagittal First concept case report | Fig. 8b Fig. 8c Fig. 8a Fig. 8d Fig. 8e Case 2 Diagnosis and treatment plan A 27-year-old female patient presented for treat- ment exhibiting a Class II, division 1 malocclusion with a severely protrusive maxilla and a severely retrusive mandible. The patient had had previous orthodontic treatment with extraction of the lower premolars. In consultation with other orthodontists, orthognathic surgery was recommended, which she wanted to avoid. The treatment plan was to reposition the mandible forward, placing the case into a Class I occlusion (Sag- ittal First) using the Carriere Motion Clear Class II Ap- pliance, then complete treatment utilising light-force archwires in a passive, self-ligating system. The Mo- tion Clear Appliance is the latest addition to the family of Motion appliances, designed for the patient with high aesthetic demands. Treatment sequence Motion Clear Class II appliance bonded Treatment commenced with the Motion Clear Class II appliance bonded directly to the upper ca- nines and first molars with 6 oz, ¼ intraoral elastics for the first month and 8 oz, 3/16 elastics for the sec- ond and third months, engaged for Class II traction to molar tubes bonded to the lower second molars. An Essix .04 vacuum-formed retainer was employed in the lower arch for maximum anchorage. 3 months of sagittal correction, the occlusal lock of the Class I platform had been accomplished (Sagittal First) and the case was ready to progress to the next stage. The Motion appliance was re- moved. While in this case, it would have been easy to finish the case with Invisalign, the patient chose fixed appliances so Carriere SLX .022 PSL brackets were bonded. Treatment followed the Carriere System archwire sequence: .014 Cu Nitanium (27 °C) .014 x .025 Cu Nitanium(27 °C) .017 x .025 Cu Nitanium (35 °C) .019 x .025 Cu Nitanium (35 °C) The first wire, a .014 round Cu Nitanium wire, cor- rected the rotations of the incisors. With the .014 x .025 Cu Nitanium wire, power chain was used to close the spaces between the incisors. After these spaces closed, the .017 x .025 Cu Nitanium wire would begin torque control with the final arch- wire, the .019 x .025 Cu Nitanium wire, to finalise the axial angulations of the anteriors. When the up- per .019 x .025 archwire was engaged, three links of power chain were run bilaterally from the 2nd pre- molar to the 1st premolar and from the 1st premolar to a crimpable hook attached to the wire distal to the lateral incisor to retract the anterior segment, bring- ing it into the final desired position. Figs. 8a–e: Initial situation: patient’s facial lateral view (a); intraoral view (b–d); cephalometric X-ray (e). *Carriere Motion is a registered trademark of Henry Schein Orthodontics, Melville, NY. **Carriere SLX is a registered 11 months: Sagittal and fixed appliance treat- ment complete trademark of Henry Schein Orthodontics, Melville, NY. 3 months: Class I platform achieved By the end of the first month of sagittal correc- tion, there was already evidence of some derota- tion of the upper first molar and movement of the buccal segment (molars, premolars and canines) toward a Class I occlusion. Space was also begin- ning to open between the upper incisors. After With 3 months of sagittal treatment and 8 months of fixed appliance treatment, the case finished to a harmonic occlusal and facial result. The result exhibits an excellent repositioning of the mandible held in position by the occlusal lock of the Class I platform (intercuspation of the molars, pre- molars and canines). The mandibular repositioning ***Invisalign is a registered trademark of Align Technology, Inc., San José, CA. ****Cu Nitanium is a registered trademark of Henry Schein Orthodontics, Melville, NY. *****Essix is a registered trademark of Dentsply Raintree Essix, Sarasota, FL. ortho 1 2017 27