Pacific Coast Society of Orthodontists Bulletin Winter 2021 - 37

Let's Talk About That

5. How long does active treatment typically
take?
For an adolescent Class II with end-on molars,
the total treatment time would be approximately 18-22 months in my hands, with 14-18
months of that with brackets on. If the original
Class II were closer to full cusp Class II, it would
add four to eight months, as this level of malocclusion is more difficult to predict with this
device.
6. What is done at each appointment during this
treatment?
See answer to No. 3 above:
a. Placement of lingual arch and bond distalizer
bars, teach elastic protocol
b. Elastic check, photos
c. Bond U2-2, elastics change to nights, photos
d. Remove distalizer bars, remove LHA, bond
U7-7, L7-7
e. Appointments every six weeks thereafter
to level, align, coordinate, finish, and detail
(finishing elastics as needed)
f. Retention
7. What would your occlusal treatment goal be?
The end of the full-time elastic phase ends with
achieving super Class I molars (1-2 mm past Class
I), then six more weeks of nighttime elastics, then
discontinuing elastics. In a properly chosen case,
this will hold up and not need additional anchorage or Class II mechanics through the course of
treatment. The final occlusal goal is Class I molar
and canine.
8. If using two-phase treatment, how do you
retain between phases?
As mentioned in the answer to No. 2, I don't use
this in Phase 1. However, if I have a lingual arch in
place from Phase 1 and have already used headgear, I'm more likely to use the Carriere® Motion™
in Phase 2.

Winter 2021 PCSO Bulletin

9. If using two phases, how do you approach
Phase 2? What appliances and auxiliaries do you
use?
Sometimes if the patient is considering clear
aligner treatment for Phase 2, I find using the Carriere® Motion™ is a good way to test a combination of fixed and clear aligner compliance before
diving in to a large lab fee. Using an overlay
retainer for anchorage in the lower with buttons
on the lower 6/6 for elastic attachment, plus the
bars in the upper as I've described above, can be a
good test. If the patient has trouble with compliance with the elastics or the aligner, it informs
me how to manage the case going forward.
Ultimately, the Carriere® Motion™ appliance is a
completely compliance-driven Class II corrector.
10. What type of retention do you use at the end
of treatment?
Generally, I would treat only deep-bite cases with
a Carriere® Motion™ appliance, not open-bite cases. The device is extrusive in nature and therefore
leads to bite opening. In deep-bite cases, I tend to
retain in an upper Hawley or Wraparound retainer with an anterior bite plane to help maintain
vertical. Because of the potential lower incisor
proclination with this device, I expect a higher
chance for incisor relapse, and therefore, I think
a bonded lower retainer is more predictable for
retention.
11. What are the shortcomings or possible complications of the appliance you are using, and how
do you handle them?
The appliance is extrusive; therefore, caution is
needed in patients who have gummy smiles, as
there may be more gingival display with extrusion. On the contrary, it may be helpful in patients
with limited incisor display.
The appliance is extrusive; therefore, caution
is needed in patients who have shallow overjet and overbite or a tendency to open bite, as

Pacific Coast Society of Orthodontists Bulletin Winter 2021

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Winter 2021