The Class II Carriere Motion appliance

Stress Distribution and Tooth Displacement Analysis of Maxillary Molar Distalization by Different Designs of Jig in a Finite Element Study

Statement of the Problem

Despite the prevalence of CLII malocclusion, still the best mechanotherapy for non-extraction treatment is not verified.

Purpose

The aim of the present study was to evaluate the stress distribution and tooth displacement during maxillary molar distalization with the aid of two different constructions of jigs in three different lever arm heights.

Materials and Method

In this finite element study, models were meticulously constructed to represent the maxillary arch teeth (excluding the third molar), periodontal ligament, alveolar bone, maxillary brackets, main archwire, molar bands, jigs, and mini screws. These models were imported into Ansys software for simulation and analysis. Two different jig configurations with three different lever arm height were created. A 150-gram force was applied to simulate tooth movement, facilitate observation, and analyze its effects on oral components.

Results

In various experimental configurations involving tow jigs with differing lever arm heights, the central incisor exhibited displacement characterized by lingual and distal crown tipping, along with evidence of intrusion. Concurrently, the first molar displayed lingual and distal tipping, as well as extrusion, across six distinct modalities.

Conclusion

In the main, posterior teeth showed distal and lingual tipping and extrusion and anterior teeth demonstrated intrusion mesial and lingual tipping in all models. It seems the differences were due to different lever arm heights. Two types of jig had no significant effect on stress distribution and tooth movement.

Evaluation of the effects of different distalization systems on dentoalveolar structures in Class II malocclusions using finite element analysis

This study aimed to evaluate the movement pattern of two different distalization systems during the distalization of the maxillary dentition from the maxillary canine to the second molar tooth and the stresses in the periodontal ligament by anchoring the mandibular dentition using the finite element analysis method. A standard three-dimensional finite element model was created that simulates the mechanics planned to be implemented with maxillary and mandibular teeth, periodontal ligaments, cortical and trabecular bones. Two different distalization mechanics were applied to this model with the Carriere Distalizer appliance (CDA) and the clear splint appliance (CSA), and two scenarios were created. The amount of displacement of the teeth from the maxillary canine to the second molar tooth was calculated, and the von Mises stress distribution in the periodontal ligament of the relevant teeth was visualized with a color scale. The current study found that the distalization movement of the CDA and the CSA after the force applied by anchoring from the mandibular dentition was similar. Although the amount of distalization obtained with the CDA is higher, it is seen that the mass movement is more significant in the CSA. The CDA and CSA showed a similar distalization pattern. The current study findings suggest that the CSA can be added to the Class II distalization treatment options such as the CDA.

A novel appliance for Class II dentoalveolar correction

In recent years, a segmental approach to Class II correction has gained popularity among orthodontists. This concept is best represented by the Carrière Motion 3D™ Class II Appliance (CMA), which is an efficient and effective appliance for the treatment of Class II malocclusions. Although it is original and innovative, it also has some inherent flaws that can potentially interfere with its daily use. A segmental approach is described, based on a section of 0.016 × 0.022-inch stainless steel archwire connected to a molar band distally and to a bracket on the mesial side. This simple alternative presents a 'do-it-yourself' and an easy-to-construct mechanism that employs the same principles and identical mechanics to achieve Class II correction yet overcomes most of the disadvantages of other modalities. In our clinic, we found that this optional, useful sectional appliance can correct Class II malocclusion effectively, predictively and on a regular basis.

Current Trends in Pediatric Orthodontics: A Comprehensive Review

Pediatric orthodontics is a critical field focusing on the diagnosis, prevention, and treatment of dental and facial irregularities in children. This comprehensive review explores current trends and methodologies in pediatric orthodontics and discusses the multifactorial etiology of malocclusions, including genetic, environmental, and disease-related factors. The importance of proper diagnosis is highlighted, and the extraoral, intraoral, and functional evaluations essential for effective treatment planning are detailed. Various orthodontic conditions such as Class III and Class II malocclusions, abnormal oral habits, arch length discrepancies, anterior and posterior crossbites, open bites, and deep bites are examined in depth. The review also addresses the role of temporomandibular joint disorders (TMDs) and obstructive sleep apnea (OSA) in pediatric patients, emphasizing the need for early and accurate diagnosis to facilitate appropriate intervention. The use of clear aligners in early orthodontic intervention is evaluated given their efficacy and improved patient satisfaction compared to traditional appliances. Additionally, the article discusses the non-advisability of early interception for certain self-correcting malocclusions and the limitations of pediatric orthodontic treatment, including compliance-related issues and the unique anatomical considerations of deciduous dentition. This review aims to provide a detailed understanding of contemporary practices and challenges in pediatric orthodontics, offering insights for clinicians to enhance treatment outcomes and patient care.

Evaluating the Effects of Carriere Motion Appliance and Twin Block Appliances in Class II Correction-A Retrospective Study

This retrospective study compared Class II orthodontic non-extraction treatment using Carriere Motion Appliance (CMA) and Twin Block (TB) appliances.

METHODS

The treatment of 38 patients was assessed. Pre- and post-treatment cephalometric radiographs were analyzed to evaluate skeletal, dental, and soft tissue treatment outcomes and efficacy.

RESULTS

Both appliances effectively corrected the Class II molar relationship. When measured at the distal aspect of the first molar, TB achieved 4.22 mm, while CMA had a 2.55 mm correction. When measured in the mesial aspect, the CMA achieved a 3.9 mm correction. The changes in SNB and ANB were statistically significant only in the TB group. The CMA appliance demonstrated statistically significantly less protrusion of the mandibular incisors and less upper incisor retrusion without vertical changes compared to the TB appliance. The TB demonstrated statistically significant lower lip protrusion compared to the CMA.

CONCLUSION

The CMA corrects Class II malocclusions only by exerting a dentoalveolar influence and does not demonstrate the added effects associated with TB, such as elongation of lower facial height (LFH) and less loss of lower anchorage. Nonetheless, the correction in the TB group comprised both dentoalveolar and skeletal components. The CMA promotes a multidirectional upper and lower molar movement, and despite our 2D cephalometric analysis, we were able to estimate the extent of upper molar derotation.

Comparative evaluation of the dentoalveolar effects of three Class II correctors: A finite element analysis study

OBJECTIVE

To compare the stress distribution and total strain applied to the dentition, periodontal ligament (PDL) and cortical and trabecular bones by three Class II correctors using finite element analysis.

DESIGN

Three-dimensional analysis of stresses and total strain of the dentition with three Class II correctors.

SETTING

Computational study.

METHODS

Three-dimensional finite element models of Class II elastics, the Forsus Fatigue Resistant Device (FRD) and the Carriere Motion Appliance (CMA) were constructed from a cone-beam computed tomography (CBTC) image of an orthodontic Class II patient. The distribution of stress (von Mises and principal stress) and the total strain (mm) in maxillo-mandibular dentition, PDL, cortical and trabecular bone were analysed.

RESULTS

The highest von Mises yield and the maximum principal stress in the three models were found at the teeth, followed by the cortical bone, trabecular bone and PDL. The maximum stress and total deformation were located at the upper canines and lower molars in the Class II elastics and CMA models, in the upper first molars in the Forsus FRD and CMA, and in the lower first premolars in the Forsus FRD. In addition, stress was distributed in the anterior and posterior regions of the teeth, and the total deformation was found in the distal direction in the upper arch and in the mesial direction in the lower arch.

CONCLUSION

The stress concentrations in the three models were located close to the active components of each appliance, producing specific patterns of stress distribution and displacement that should be taken into account when planning the type of appliance to be used for the correction of the Class II malocclusion.

Cephalometric and digital model analysis of dentoskeletal effects of infrazygomatic miniscrew vs. Essix- anchored Carriere Motion appliance for distalization of maxillary buccal segment: a randomized clinical trial

TRIAL DESIGN

Parallel.

OBJECTIVE

To compare skeletally anchored Carriere Motion appliance (CMA) for distalization of the maxillary buccal segment vs. Essix anchored CMA.

METHODS

Thirty-two class II malocclusion patients were randomly allocated into two equal groups. One group was treated with infrazygomatic (IZC) miniscrew- anchored CMA (IZCG) and the other group treated with Essix retainer- anchored CMA (EXG). Two lateral cephalograms and two digital models for upper and lower arches were taken for each patient: immediately before intervention and after distalization had been completed.

RESULTS

Distalization period was not significantly different between the two groups. In contrast to EXG, IZCG showed insignificant difference in ANB, lower incisor proclination, and mesial movement of the lower first molar. There was significant rotation with distal movement of maxillary canine and first molar in both groups.

CONCLUSION

IZC anchored CMA could eliminate the side effects of class II elastics regarding lower incisor proclination, mesial movement lower molars with a more significant amount of distalization of the maxillary buccal segment but with significant molar rotation.

TRIAL REGISTRATION

The ClinicalTrials.gov Protocol Registration and Results System (PRS) has this RCT registered as (NCT05499221) on 12/08/2022.

Three-dimensional Evaluation of the Carriere Motion 3D Appliance in the treatment of Class II malocclusion

INTRODUCTION

This study aimed to quantify the outcomes of adolescent patients with Class II malocclusion treated with the Carriere Motion 3D Appliance (CMA) combined with full fixed appliances.

METHODS

Cone-beam computed tomography scans of 22 patients were available before orthodontic treatment (T1), at removal of the CMA (T2), and posttreatment (T3). The average age of the patients was 13.5 ± 1.6 years at T1, 14.1 ± 0.2 years at T2, and 15.6 ± 0.5 years at T3. The 3-dimensional image analysis procedures were performed using ITK-SNAP (version 3.6.0; www.itksnap.org, Hatfield, Pa) and SlicerCMF (version 4.11.0; http://www.slicer.org, Cambridge, Mass); skeletal and dentoalveolar changes relative to cranial base, maxillary, and mandibular regional superimpositions were evaluated.

RESULTS

Changes were analyzed with 1 sample t tests using the mean differences during the CMA phase (T1 to T2) and total treatment time (T1 to T3). Significant skeletal changes included a slight reduction of ANB from T1 to T3, mandibular growth (Co-Gn increment of 1.2 mm and 3.3 mm from T1 to T2 and T1 to T3, respectively), inferior displacement of point A, and anterior and inferior displacement of point B. The mandibular plane did not change significantly during treatment. During the CMA treatment, posterior tipping and distal rotation of the maxillary molars, tip back and inferior displacement of the maxillary canines, significant mesial rotation, and superior displacement of the mandibular molars were observed. These movements rebounded during the full fixed appliance phase except for the molar and canine vertical displacements. Clinically significant dental changes during treatment included a reduction in overjet and overbite, Class II correction of the molar and canine relationship, and proclination of the mandibular incisors.

CONCLUSIONS

The CMA is an effective treatment modality for Class II correction in growing patients because of a combination of mesial movement of the mandibular molar, distal rotation of the maxillary molar, and anterior displacement of the mandible.

Effect of Molar Distalization on Condyle-Glenoid Fossa Relationship

Objective

It is essential to be aware of the potential effects of orthodontic treatment on tissues and anatomical structures associated with the masticatory system, especially the temporomandibular joint (TMJ). Little information is available about the consequences of molar distalization on the TMJ. Therefore, this study is aimed at investigating the changes of the condyle-fossa relationship after molar distalization using the distal jet appliance.

Materials and Methods

The sample consisted of twenty-five patients (mean age 20.4 ± 2.6) who underwent molar distalization by the distal jet appliance. CBCT scans were taken before (T0) and after (T1) the completion of the molar distalization. Joint spaces (anterior, superior, and posterior) and cephalometric vertical angles (SN.GOME and Björk sum) were measured and compared at T0 and T1.

Results

Superior and posterior joint spaces increased significantly after molar distalization (PS 0.29 mm, P < 0.001, SS 0.06 mm, P < 0.5). Vertical cephalometric angles also increased after molar distalization by the distal jet appliance (SN.GOME 0.92°, Björk 1.11°).

Conclusion

There was a statistically significant increase in the superior and posterior joint spaces after molar distalization. However, this increase may not be of clinical importance. The vertical dimension has also increased.

A New Digital Method to Quantify the Effects Produced by Carriere Motion Appliance

The aim of this study was to analyze a novel digital technique to quantify the distal tooth displacement and derotation angle produced by the Carriere Motion Appliance (CMA). Twenty-one patients with a class II molar and canine relationship underwent orthodontic treatment with CMA. All patients were exposed before (STL1) and after the CMA placement (STL2), submitted to a digital impression, and afterwards, data were uploaded to specific cephalometric software to allow automatic mesh network alignment of the STL digital files. Subsequently, the distal tooth displacement of the upper canines and first upper molars, as well as the derotation angle of the first upper molars were analyzed using the Pearson correlation coefficient (ρ). Repeatability and reproducibility were analyzed using Gage R&R statistical analysis. An increase in canine displacement was correlated with an increase in contralateral canine displacement (ρ = 0.759; p < 0.000). An increase in canine displacement was correlated with an increase in molar displacement (ρ = 0.715; p < 0.001). An increase in upper first molar displacement was correlated with an increase in the contralateral upper first molar displacement (ρ = 0.609; p < 0.003) and the canine displacement (ρ = 0.728; p < 0.001). The distal tooth displacement showed a repeatability of 0.62% and reproducibility of 7.49%, and the derotation angle showed a repeatability of 0.30% and reproducibility of 0.12%. The novel digital measurement technique is a reproducible, repeatable, and accurate method for quantifying the distal tooth displacement of the upper canine and first upper molar, as well as the derotation angle of the first upper molars after using CMA.

Retrospective investigation of the 3D effects of the Carriere Motion 3D appliance using model and cephalometric superimposition

OBJECTIVES

Carriere Motion 3D™ appliance (CMA) represents a method for molar distalization and correction of class II malocclusion. The aim was to investigate the 3D effects of the CMA by superimposing digital models and cephalometric X-rays.

MATERIALS AND METHODS

We retrospectively examined 16 patients treated with CMA in combination with class II elastics. We compared digitized models and cephalometric X-rays of records taken before therapy and after the removal of CMA. The records were superimposed to assess the skeletal and dentoalveolar changes. The results of the cephalometric X-ray analysis were compared to an untreated age- and gender-matched sample.

RESULTS

Class II occlusion was corrected after 11.85 ± 4.70 months by 3.45 ± 2.33 mm. The average distalization of the upper first molars was 0.96 ± 0.80 mm. The analysis of the cephalometric X-rays confirmed a distalization of the upper first molars with distal tipping and revealed a mesialization of the lower first molars of 1.91 ± 1.72 mm. Importantly, CMA resulted in a mild correction of the skeletal class II relationship (ANB: - 0.71 ± 0.77°; Wits: - 1.99 ± 1.74 mm) and a protrusion of the lower incisors (2.94 ± 2.52°). Compared to the untreated control group, there was significant distalization of the upper first molars and canines with mesialization and extrusion of the lower first molars.

CONCLUSION AND CLINICAL RELEVANCE

CMA is an efficient method for treating class II malocclusions. However, the class II correction is only partially caused by a distalization of the upper molars.

Utilization of a 3D Printed Orthodontic Distalizer for Tooth-Borne Hybrid Treatment in Class II Unilateral Malocclusions

This paper introduces a novel method of 3D designing and 3D printing of a hybrid orthodontic tooth-borne personalized distalizer for treatment of unilateral Class II malocclusion. Research objectives were to clinically utilize 3D printed distalizers, appraise feasibility of this technique and compare two different biocompatible photopolymers (white and transparent). Frequency of distalizers’ debonding and patients’ aesthetical perception was evaluated on the set of 12 complete orthodontic treatments. The mean duration of treatment period with a bonded distalizer was 6.4 months. All cases were adults with unilateral Class II malocclusion managed with a hybrid approach as a part of Invisalign® comprehensive treatment. Results showed that such perspective practice is feasible for 3D design and in-office 3D printing of a personalized distalizer. Results also showed no clinically significant differences between both studied biopolymers. The paper discusses an evaluation of such personalized distalizer functionality with regard to the current state of the art and compares to conventional prefabricated alternatives like a Carriere® Distalizer™ appliance. Research showed a preference of patients towards transparent biocompatible photopolymer instead of the white A2 shade. The paper concludes that additive manufacturing from dental resins is a viable method in personalization and in-office 3D printing of orthodontic auxiliaries, particularly distalizers. New materials for orthodontic 3D printing endow enhanced individualization, thus more efficient treatment.

Cephalometric analysis of dental and skeletal effects of Carriere Motion 3D appliance for Class II malocclusion

INTRODUCTION

The objective was to describe the dental and skeletal changes obtained using the Carriere Motion Appliance (CMA), lateral cephalogram, and the corresponding cephalometric tracings.

METHODS

A sample of 29 patients with Class II malocclusion (mean age, 12.6 ± 1.7 years) was retrospectively selected. All patients were treated at a single center using a CMA as the primary sagittal correction device. Cephalometric tracings at the beginning and end of treatment were compared. Each cephalometric tracing was performed 3 times by the same operator.

RESULTS

Using the CMA, the 29 patients studied reached dental Class I in 4.4 ± 0.98 months. All measurements were subjected to statistical analysis, paired t test, and all displayed differences between T0 and T1 (P <0.05) except for the SNA. At the end of treatment, the Wits and ANB values were reduced by 1.38 mm and 0.8°, respectively. Overbite and overjet were also reduced by 1.4 mm and 2 mm, respectively. The SNB, FMA, LAFH, and IMPA increased to a lesser extent (ie, 0.7°, 0.4°, 1.5 mm, and 1.5°, respectively).

CONCLUSIONS

The CMA is a rapid and efficient means of correcting Class II malocclusion. Its effects are predominantly dentoalveolar, with minimal skeletal alteration of little clinical significance.

Anchorage control using miniscrews in comparison to Essix appliance in treatment of postpubertal patients with Class II malocclusion using Carrière Motion Appliance

OBJECTIVES

To evaluate anchorage control using miniscrews vs an Essix appliance in treatment of Class II malocclusion by distalization using the Carrière Motion Appliance (CMA).

MATERIALS AND METHODS

Twenty-four postpubertal female patients with Class II, division 1 malocclusion were randomly distributed into two equal groups. CMA was bonded in both groups, and one group was treated with miniscrews as anchorage (12 patients, mean age = 18.0 years) while the other group was treated with an Essix appliance as anchorage (12 patients, mean age = 17.8 years). For each patient, two cone-beam computed tomographic scans were obtained: one preoperatively and another after completion of distalization.

RESULTS

In the Essix appliance group, there was a statistically significant anterior movement (2.2 ± 1.43 mm) as well as proclination of the lower incisor (5.3° ± 4.0°), compared to a nonsignificant anterior movement (0.06 ± 1.45 mm) and proclination (0.86° ± 2.22°) in the miniscrew group. The amount of maxillary molar distalization was higher in the miniscrew group (2.57 ± 1.52 mm) than in the Essix appliance group (1.53 ± 1.11 mm); however, the difference was not statistically significant.

CONCLUSIONS

Miniscrews led to a decrease in the amount of anchorage loss in the mandibular incisors, both in terms of anterior movement and proclination.

Treatment effects of Carriere Motion Appliance on patients with class II malocclusion: A systematic review and meta-analysis

OBJECTIVE

To investigate the treatment effects of Carriere Motion Appliance (CMA) on class II patients.

METHODS

A comprehensive electronic search was performed in PubMed, Scopus, Web of science, ScienceDirect, ProQuest (dissertation and thesis), Google Scholar and ClinicalTrials.gov. All types of clinical trials that contained at least pre- and post-treatment measures of patients treated by CMA were included in this systematic review and meta-analysis. The risk of bias was assessed for all included studies. The considered outcomes were the skeletal, dento-alveolar, soft tissues, temporomandibular joint and airway changes, electromyographic activity and stability.

RESULTS

Sixteen studies were included in this systematic review and meta-analysis. The absence of randomized controlled trials which could induce confounding and selection of participant bias is considered the main risk of bias affecting the available studies. Regarding the skeletal changes, no significant effects were appreciated (changes in SNB angle; SMD=-0.13; 95% CI (-0.57, 0.31); P=0.58. Changes in SN-MP; SMD=-0.11; 95% CI (-0.54, 0.33); P=0.64). With respect to the dento-alveolar changes, an increased lower incisor's proclination (L1-MP) was observed; SMD=-0.69; 95% CI (-1.14, -0.24); P=0.003. CMA caused an increase in the airway volume, an increase in the masseter and temporalis muscles activities and a minor relapse of malocclusion after 4-years of follow-up. The results should be taken with caution because only secondary level of evidence was found.

CONCLUSIONS

The CMA used for the treatment of class II malocclusion did not cause skeletal changes; however, largely dento-alveolar effects were noticed. Prospective randomized clinical trials are highly recommended.