2 carriere distalizer

The Carriere Distalizer™

Meet Dr. Luis CarrièreMeet Dr. Luis Carrière• 1991 DDS/Universidad Complutense de

Madrid• 1994 MSD/Master in Orthodontics and

Dentofacial Orthodpedics in Adults and Children, University of Barcelona

• Current Orthodontic Practice in Barcelona, Spain – Clinica Carriere,

iwww.carriere.es• Inventor of the Carriere Distalizer and

Carriere SLB Bracket• Worldwide Lecturer and internationally

i d t f t ti Cl IIrecognized expert for treating Class II occlusion

• Winner of Joseph E. Johnson Awards (AAO, 1995) and the Milia D’or (Festival Milia 1996)Milia, 1996)

• Member of Editorial Review Board of American Journal of Orthodontics

• Author of numerous articles published in the American JCO and Journal of thethe American JCO and Journal of the ADA

nterview with r. arriereI D C

CarriereLX System™ Products• Carriere Distalizer™

– Class II Correction in Average of 3-4 months– Controlled Molar Rotation and Uprighting– Corrects Class II at Beginning of Treatment Before Brackets – Non-Invasive Appliance Results in High Patient Cooperation

• Carriere LX® Self-Ligating Bracket– Passive Self-Ligation for Less Friction– Lower Forces Means Less Pain for Patient During Treatment– Low-Profile and Nickel Free– Ease of Use - Opens and Closes with Explorer or O2 Wire director and Opener– Ease of Use - Opens and Closes with Explorer or O2 Wire director and Opener

tool

• Premium NITI Archwires– Black Ti ® SE = 30% Reduced Friction– Super Elastic Nitanium® = Classic NITI SE Properties– Bio-Kinetix® Plus™ = Mid-Range Thermal– Bio-Kinetix® Niti – Low Force Thermal

CNA Wire– CNA Wire

The Carriere DistalizerThe Carriere Distalizer

The Carriere DistalizerThe Carriere DistalizerWhat is it? • It is a Class II direct bond appliance: it creates a Class I molar and

canine relationship – Class I platform of occlusioncanine relationship Class I platform of occlusion • Bonded from cuspid to first molar

How does it work?It i d t (1) b dil di t li ill t i t hil• It is used to (1) bodily distalize maxillary posterior segments while correcting (2) upper first molar rotation and (3) uprighting.

• Produces a distal rotational movement of the maxillary first molars around their palatal roots when necessaryaround their palatal roots, when necessary

• Simultaneously, produces a light and uniform force for distal molar movement.

• Independently, moves each posterior segment, from canine to molar,Independently, moves each posterior segment, from canine to molar, as a unit.

• No wire changes involved therefore it eliminates the distorting collateral forces that appears with every wire changes

• Minimal root resorption

CharacteristicsCharacteristics Molar pad: Ball that articulates in a socket

Hooks on pad: for the attachment of th Cl IIthe Class II elastics

Mold Injected

Canine pads = Allow the distal movement

Arm: runs posteriorly over

Mold Injected Metal (MIM), made of Nickel Free Stainless

the distal movement of the canine along the alveolar ridge without tipping.

the two upper premolars in a slight curve

Steel

The Carriere Distalizer – What is it?

• Direct bond appliance to cuspid andDirect bond appliance to cuspid and first molar used to bodily distalizemaxillary posterior segments while correcting upper first molar rotation and

i h iuprighting. • Requires a lower source of anchorage

such as a lingual arch or essix and ti t d ith ¼ i h h l tiactivated with ¼ inch heavy elastic.

• Goal is to treat and correct the Class II at the beginning of treatment BEFORE brackets are placed in mo th lea ingbrackets are placed in mouth leaving doctor with Class I platform.

The Carriere Distalizer – What is it?

• Average treatment time is only 3-4 months due to reduction in competing forces caused by braces and anterior teeth p g y(battle of the curve).

• Non-invasive, Nickel Free design for better bio-compatibility and patient comfort.

• Low inventory solution with no lab fees. Bonds with bracket adhesive.

• Fastest growing and most popular ClassOne product. g g p p p• 3 JCO articles released.

How it Works• The Carriere Distalizer mimics a human ball/socket joint allowing the first molar to rotate and upright.

• Built in stops engineered in the appliance keep the molar from over-rotating or distal tipping.g pp g

How it WorksHow it Works

The stiff arm maintains e act space bet een• The stiff arm maintains exact space between pre-molars during distalization.

• The cuspid pad is fixed and will not allow the• The cuspid pad is fixed and will not allow the cuspid to tip.

The ObjectiveThe Objective

Th di t li ti f th t i• The distalization of the posterior maxillary segments in a block, from

i t lcanines to molars.

ConceptConcept

To pro ide a rotation mo ement of the• To provide a rotation movement of the maxillary first molars around their palatal root and at the same time receive a distalizationand at the same time receive a distalization impulse to achieve a posterior occlusion in….

⇒Class I Platform

Class I PlatformIs the kind of occlusal relationship in which, the patient exhibits a perfect matchingthe patient, exhibits a perfect matching intercuspidation in Class I, between the molars and the canines. At the same timemolars and the canines. At the same time centric relation is coincident with centric occlusion.

Class I PlatformClass I Platform



Di t li M tDistalizer Movement

3 Type of Molar Movements3 Type of Molar Movements

• Uprighting of the crown, if it is mesiallyinclinedinclined

• Distal rotation around the palatal root.

M l S lf E i d M tMolar Self Engineered MovementsUprighting + Rotation

Self-Expressed Molar Self-Expressed Molar U i hti RotationUprighting

Biomechanics of the Distalizer• It gives “looseness” for movements but with

intentional limitations.• The freedom of movements has limitation stops that

have been incorporated in the morphology of the Distalizer = Cannot create over rotationDistalizer Cannot create over rotation

Biomechanics of the DistalizerMolar UprightingMolar Uprighting

Following uprighting: (2) Rotation.Collision points prevent the distalCollision points prevent the distal inclination of the molar crown

The device gives Freedom & Looseness for (1) upritghting the molar

Beyond this point: (3) Distalization.Collision points prevent the distal inclination of the molar crown

for (1) upritghting the molar

Biomechanics of the DistalizerMolar Rotation

The joint between distal base and mesial arm, permits the easy bonding on mesially rotated molars

Collision point between mesial arm and posterior base. Shoulder stop prevents the distal over-rotationonce corrected the mesial rotation of th lthe molar.



Self expressed molar rotation around palatal rootSelf expressed molar rotation around palatal root

Biomechanics of the DistalizerBiomechanics of the Distalizer


Biomechanics of the DistalizerSynchronic Movements

Rotation + Upriting

Biomechanics of the Distalizer

Rotation + Upriting



With only one activation it produces a multiple, y p psimultaneous and self expressed movement.

1 Translation in canine1. Translation in canine.

2. Translation in premolars.p

3. Uprighting, rotation and translation in the molar

Biomechanics of the DistalizerPassive Appliance Without Elastics


Patient CompliancePatient Compliance

Patient compliance er high beca se• Patient compliance very high because distalizer is used at beginning of treatment when patient cooperation is bestwhen patient cooperation is best.

• Non-invasive look/feel makes distalizer easy choice for patient and parents.choice for patient and parents.

• Use model and patient video during consultation to properly educate patient.p p y p

• Show patient choices of other non-compliant appliances such as Herbst.pp

Class II Elastic Recommendations

• Strength: 6 ½ ounces ¼ inch

Class II Elastic Recommendations

Strength: 6 ½ ounces, ¼ inch.– O2 Part Number: 407-042S (Rhino)

• Wearing time:Wearing time: 1. Low angle: 24h/except eating time.2. High angle: night time, if possible 14h/including part g g g , p g p

of daytime.

Sources of Anchorage for gMandible

• Traditional Lingual Arch• Preformed Fixed Lingual Control g

Arched (p/n 032-060 kit)• Full Bond LowerFull Bond Lower• Lower Essix With Attachments In Premolars

And Molars & Class II Hooks• Mini Screws In Lower Between 1st & 2nd

Molar “Absolute Orthodontic Anchorage g

Sample Case 1Sample Case 1

Sample Case 1

Sample Case 1Di t li B d dDistalizer Bonded

Sample Case 1Cl I Pl tf A hi d i 3 1/2 M thClass I Platform Achieved in 3 1/2 Months

Sample Case 1B f (T ) d Aft (B tt )Before (Top) and After (Bottom)

Sample Case 1Fi i h d CFinished Case


Sample Case 2

Sample Case 2


Sample Case 2Cl I Pl tf A hi d i 2 &1/2 M thClass I Platform Achieved in 2 &1/2 Months


Sample Case 2p





Sample Case 3ClassOne Platform Achieved in 3 MonthsClassOne Platform Achieved in 3 Months

Sample Case 3pClassOne Platform Achieved

Sample Case 3Carriere SLB Bonded

Sample Case 3Carrirere SLB BondedCarrirere SLB Bonded


Sample Case 3Carrière SLB BondedCarrière SLB Bonded


Sample Case 3Finished Case




Carriere Distalizer StudyCarriere Distalizer Study

N=60 Consec ti e PatientsN=60 Consecutive Patients33 Women (55%)

27 Men (45%) Average age at the beginning of g g g g

treatment: 14.35 years (std = 5.35)Range: 9 83 to 40 67 yearsRange: 9.83 to 40.67 years

Carriere Distalizer Study yTreatment Time

• All Class II PatientsAll Class II Patients.• Fully erupted permanent dentition 6 to 6.• Treatment need: distalization of maxillary posterior• Treatment need: distalization of maxillary posterior

segments, Canine to Molars into Class I.• Use of Distalizer as the first and only appliance for• Use of Distalizer as the first and only appliance for

distalization.• Treatment plan: Non extraction in maxillaTreatment plan: Non extraction in maxilla.

Carriere Distalizer Study yTreatment Time

L t l h l t k b f (T1) d• Lateral cephalograms taken before, (T1) and after Distalization “Class I Platform” accomplished (T2)accomplished, (T2)

• Mean time for Class I Platform is 4.27 months(std = 1.38)(std 1.38)

• Range: between 2 to 8 months

Carrière Distalizer Study

52 subjects (86.7%) had presence of third molars in x-rays.

None were extracted for Class IINone were extracted for Class II correction

“The presence of upper second maxillary molars did not correlate with the rate of maxillary first molar movement”. Muse D.S. et Al:

Molar and incisor changes with Wilson rapid molar distalization Am.Molar and incisor changes with Wilson rapid molar distalization Am. J. Orthod.1993;104:556-65

Carriere Distalizer Study yAnchorage

• 95% of the patients used a Lingual Archanchorage. g

• The remaining 5% use either a Full Bond, or Essix & Hooks anchorage.

Carriere Distalizer StudyCompliance

Level of Cooperation in the use of Elastics:

p

• 70% of subjects were completely complying (100% p.t.)26 7% f bj t hi hl l i ( 20% t )• 26.7% of subjects were highly complying (-20% p.t.)

• 3.3% of subjects were complying on average (-40% p.t.)

Carriere Distalizer StudyyCompliance

80

60

40

ntag

e 20

L l f i i h f l i

averagehightotal

Perc

en

0

Level of cooperation in the use of elastics

C i Di t li St dCarriere Distalizer StudyOral Hygiene

• 50% of subjects were acceptable50% of subjects were acceptable• 50% of subjects were excellent

Carriere Distalizer Study

Upper Molar Distalization (mm)

yMolar Distalization

Uppe o a sta at o ( )60

50

40

30

tage

20

10

6.005.004.003.00

Perc

ent 10

0

Upper Molar Distalization (mm)

Carrière Distalizer Study

• Distalizer has a significant effect on the distalization of

Conclusionsg

the molars and premolars 3.82 mm of mean (Range 3 to 6 mm) and shows consistent results in relation to the correction of maxillary first molar rotation andcorrection of maxillary first molar rotation and uprighting.

• The effect of the Carriere Distalizer is limited to Dental and Dento-Alveolar structures.

• The success of treatment requires the cooperation of the patient; which does not seem to be difficult tothe patient; which does not seem to be difficult to obtain because of the motivation, patient understanding the logics of the project, and because it i l d th fi t d f t t tis placed on the first day of treatment.

Appliance PlacementAppliance Placement

Instruction for use (cast)Instruction for use (cast)Measurements: Using a distometer measure from the

midpoint on the facial surface of the maxillary firstmidpoint on the facial surface of the maxillary first molar (buccal groove) to the midpoint of the facial surface of the maxillary canine. Measurements can be made intraorally or on a recent cast. (Distometersincluded in Distalizer case).

Selections: Find the correct length Distalizer — usingSelections: Find the correct length Distalizer using distometer. Using finger pressure, adjust the Distalizer bar to maximize conformity of the cuspid

d t th f f th id M O th d ti tpad to the surface of the cuspid. Many Orthodontists find it easier to fit the Distalizer to a recent cast.

Measurement Intra OralMeasurement Intra-Oral

Bond PreparationBond Preparation

• Mark Embrasure: Place marks at embrasures mesial to the molar and distal to theto the molar and distal to the cuspid. These marks assist in bonding of Distalizer.

•Wax Molar ‘Joint’: Place wax at the ‘ball and socket’ joint to jenhance stability of intraoral bonding (be careful not to get any wax on bonding pad)any wax on bonding pad).

Prep BondingPrep Bonding • Coat: Cover the entire

Distalizer pads with lightDistalizer pads with light cure composite.

• Cover: Protect the Distalizer• Cover: Protect the Distalizer pad from ambient light prior to intraoral placement. Cotton rolls shown in photo below prevent light screen from making contact with Distalizermaking contact with Distalizer pads coated with light cure composite.

Prep PatientPrep Patient

Isolate: Using lip retractor, dry triangle, single cotton roll, and/or lowvolume suction ensure adequate intraoralvolume suction, ensure adequate intraoralaccess while minimizing moistureEtch: Enamel acid etch the surface of the firstEtch: Enamel acid etch the surface of the first molar and cuspid as appropriate for the material selected.

PrepPrep

• Air Burst: Apply brief air burst to surface of etched cuspid and molar.B f B di A l S l A li i f• Before Bonding, Apply Sealant: Application of a filled resin primer is recommended for maximum tensile bond strengthmaximum tensile bond strength

Placement of the DistalizerPlacement of the Distalizer

• Bond Molar - Placement of Distalizer on the Molar:• Bond Molar - Placement of Distalizer on the Molar: Remove the Distalizer from beneath the light shield. Grasp the bar of the Distalizer on either embrasure

k i l ki h f P h lmark using locking hemostat, or forceps. Push molar pad into the correct position:

• OCCLUSAL/GINGIVAL - Place pad on gingival third ofOCCLUSAL/GINGIVAL Place pad on gingival third of molar. Remove excess ‘flash’ from tooth surface. Fully cure molar pad.

Placement of the Distalizer

• Bond Cuspid: Grasp the bar of the Distalizer on the mark for the embrasure distal to the cuspid using a locking hemostat or forceps Push the cuspid pad onto the middle thirdhemostat or forceps. Push the cuspid pad onto the middle third, labial surface of the cuspid. Fully cure the cuspid pad.

• Order of Bonding: Some Orthodontists prefer to first place the Distalizer pad on the first molar while others prefer to ensure theDistalizer pad on the first molar, while others prefer to ensure the exact placement on the cuspid by first placing the cuspid pad.

• Remove the Wax: Using an explorer, remove the wax that has been stabilizing the ball/socket joint of the Distalizerstabilizing the ball/socket joint of the Distalizer.

• Mandibular Arch: Can be anchored to the Orthodontist’s preference (lower lingual arch, fixed appliances, Essix lower appliance, or mini implant)implant).

Final Distalizer Procedures

• Re check for flash around Distalizer pad on upper• Re-check for flash around Distalizer pad on upper molar: Make sure no ‘flash’ is occluding with lower molar band and/or mandibular anchorage system. See red arrow above.arrow above.

• Attach elastics from molar to cuspid: First attach elastic at Mandibular Molar, and then stretch and attach to hook on Maxillary Cuspal Pad of Carrière DistalizerMaxillary Cuspal Pad of Carrière Distalizer.

• Instruction of Patient on: Elastic Wear - (22/7): Remove when eating. “Wear elastics at all other times.”



Sample Case 4


Sample Case 4Cl I Pl tf A hi d i 4 thClass I Platform Achieved in 4 months


Sample Case 4p

Sample Case 4Carrière SLB Bonded

Sample Case 4C iè SLB B d dCarrière SLB Bonded

Sample Case 4Carrière SLB Bonded



Sample Case 4B f (T ) d Aft (B ttBefore (Top) and After (Bottom)

Sample Case 4pFinished Case

Sample Case 4B f d AftBefore and After

Carriere Distalizer Product Information• 3 Main Sizes for 3 to 6 Bonding

– C DA23 – 23 mmC DA25 25– C DA25 – 25 mm

– C DA27 – 27 mm• 3 Smaller Sizes for 4 to 6 Bonding

C DA16 16– C DA16 – 16 mm– C DA18 – 18 mm– C DA20 – 20 mm

• Custom Sizes Available• Custom Sizes Available• Starter Kits Available

– C DAKIT – 23mm, 25mm, 27mmC DAMKIT 16 18 20 23 25 27– C DAMKIT – 16mm, 18mm, 20mm, 23mm, 25mm, 27mm

• Rulers, Storage Tray, Bonding Prep Guide, Syllabus, Patient Video, Patient Literature, and Elastics also available

Distalizer FAQDistalizer FAQ• What if the cuspid is not erupted or too high to bond?

– If the distalizer cannot be bonded to cuspid, doctor can either move the appliance to the 4 and 7 or use one of our new smaller sizes to span fromappliance to the 4 and 7 or use one of our new smaller sizes to span from the 4-6.

• What about patient compliance?– We have had very few docs report non-compliance. The main reason is the

Distalizer is used at beginning of treatment when compliance is best; notDistalizer is used at beginning of treatment when compliance is best; not mid-way through when the patient has already been put through pain. Also, Distalizer is very simple and comfortable in mouth. Patient also likes that they do not have to have brackets in mouth for initial phase of treatment. If doctor properly explains benefits, patient and parent will want to cooperate with treatmentwith treatment.

• How do you bond? (Bonding Demo Video)– Using your regular bracket adhesive, we recommend bonding the 1st molar

first. The ball/socket joint will then allow you to lay the distalizer down on to the cuspid for accurate placement. A bonding prep guide is available forthe cuspid for accurate placement. A bonding prep guide is available for more detail.

• What happens to the second molar? Third molar? – The second molar will distalize with the rest of the posterior segment.

There is no need to extract.

Distalizer FAQDistalizer FAQ• Will I have lower anterior flaring?

– Possibly depending on the source of anchorage chosen. With a lower lingual arch there can be some slight flaring of the lower anteriors In somelingual arch, there can be some slight flaring of the lower anteriors. In some cases, this may be wanted. If not, using an Essix or mini-screw will prohibit lower flaring.

• Can I use in a Uni-lateral Class II case?– Yes The distalizers come in a left and right and can be used together (bi-– Yes. The distalizers come in a left and right and can be used together (bi-

lateral) or separate (uni-lateral).• Can I use in Mixed Dentition?

– Mixed dentition Class II with fully erupted first molars, for first phase treatment.treatment.

• Can I use the Distalizer to treat a Class III by placing on lower?– No

Distalizer FAQDistalizer FAQ• How do I know what size Distalizer to use? (Distometer Picture)• Will I have extrusion of the canines?• What is the difference between this and using Class II elastics?

– Treatment time and correction of the first molar are the biggest differences. When using Class II elastics with braces, movement is slower because of the competing forces in the mouth. Since the distalizer is done pre-braces, th f li i t d d th di t li ti h hthose forces are eliminated and the distalization process happens much faster. Plus, the distalizer corrects the molar rotation for you at the same time. By treating the Class II first with the distalizer and then treating the Class I later, the doctor simplifies the case reducing time and increasing patient comfort.

• How far can I distalize the molars with this appliance? – Based on 60 case studies, average distalization was 4 mm. Maximum was

6 mm and min was 3 mm.• What happens with the pre-molars since they are not bonded?pp p y• Do I get tipping of the cuspid?

– No. It might seems sometime, but it does not• Can this be used with Invisalign? (Invisalign Demo Video)

What Doctors Are SayingWhat Doctors Are Saying• The Carriere Distalizer has become a routine appliance for

Class II correction in our office It is easy to place and veryClass II correction in our office. It is easy to place and very effective.- Dr. Clark Colville, Seguin, TXTh C i li i th i t t ffi i t d t l• The Carriere appliance is the easiest, most efficient dental Class II corrector I have ever used. We are now able to make most cases Class I before we apply their b Thi h t th ti t i bbraces. This shortens the time spent in braces dramatically. – Dr. Robert “Tito” Norris, San Antonio, TX

• Our results to date have been nothing short of miraculous! The Carriere Distalizer is now my first appliance of choice for Class II correction. – Dr. Fred Sterritt, Belle Mead, NJ (Testimonial Letter)

Questions and discussion….

2 carriere distalizer

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