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16 TRENDS & APPLICATIONS Dental Tribune Asia Pacific Edition | 6/2017 Sagittal First Using the Carriere Motion appliance to treat Class II and III patients By Dr Luis Carrière, Spain When Dr Edward Angle first classi- fied malocclusions for orthodontic treatment, he created the catego- ries of Class I, Class II and Class III, the principal categories by which cases are still identified today. In basing his classification system on this one dimension—the sagittal dimension—Angle confirmed the sagittal relationship as being of primary importance and the one most critical and, indeed, most dif- ficult to correct. The Carriere Motion appli- ance (Henry Schein Orthodon- tics) is a technology that first ad- dresses the patient’s sagittal di- mension to establish a Class I platform prior to comprehensive orthodontic treatment. This is ac- complished usually within the initial three months of treat- ment. We call this protocol Sagit- tal First. Sagittal First eliminates competing force vectors inherent in traditional methodologies when traction is employed con- current with fixed appliance treatment. After establishing a Class I platform in the buccal seg- ments (intercuspation of the mo- lars, premolars and canines), the clinician finishes therapy with Carriere SLX brackets (Henry Schein Orthodontics) or another finishing appliance of choice, in- cluding Invisalign (Align Tech- nology) if appropriate. Employ- ing the Sagittal First approach using the Carriere Motion appli- ance makes achieving high-qual- ity finishes easier and simpler. The purpose of this article is to demonstrate application of the Sagittal First concept using the Carriere Motion appliance to treat Class II and III patients. The follow- ing two cases offer typical exam- ples of the types of difficult sagit- tal corrections the appliance can address. Case 1 Diagnosis and treatment plan A 23-year-old female patient presented for treatment exhibit- ing a moderate Class III malocclu- sion with a negative overjet, pro- clined lower lip with a flat supra- mentale, open bite and crowding in the lower arch (Figs. 1a–h). The treatment plan was to distalise the mandibular dentition into a Class I occlusion (Sagittal First) using the Carriere Motion Class III appliance, then generate space to alleviate the lower arch crowding and close the bite, utilising light- force archwires in a passive, self-ligating (PSL) system. While tongue trainers would be bonded in conjunction with the fixed ap- pliances later in treatment, the patient would also engage in tongue training exercises to cor- rect her improper tongue posi- tioning, especially while swallow- ing. Incorrect tongue positioning can compromise a satisfactory result. Bite closing would be ac- complished by action of the arch- wires in the PSL brackets, not by use of any vertical elastics. Verti- cal elastics would be employed only during the finishing phase of treatment. In this way, gentle 4a 4b 4c 5a 5b 5c 1a 1b 1c 1d 1e 1f 1g 2a 2b 2c 1h 3a 3b 3c Figs. 1 a–h: Initial situation: facial views of the patient (a–c), intra-oral views (d–f), cephalometric radiograph (g), dental panoramic tomogram (h).—Figs. 2 a– c: Situation after one month of correction with the Sagittal First approach. —Figs. 3 a– c: Situation after three months of correction.—Figs. 4 a– c: Situation after 12 months of treatment.—Figs. 5 a– f: Final situation after 14 months of treatment: intra-oral views (a–c), patient’s face (d), cephalometric radiograph (e), dental panoramic tomogram (f).