2 carriere distalizer


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矯正案例: 利用distalizer將上顎後牙後退

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2 carriere distalizer

  1. 1. The Carriere Distalizer™
  2. 2. Meet 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, www.carriere.es i• Inventor of the Carriere Distalizer and Carriere SLB Bracket• Worldwide Lecturer and internationally recognized expert f t ti Class II i d t for treating Cl occlusion• Winner of Joseph E. Johnson Awards (AAO, 1995) and the Milia D’or (Festival Milia, Milia 1996)• Member of Editorial Review Board of American Journal of Orthodontics• Author of numerous articles published in the American JCO and Journal of the ADA Interview with Dr. arriere C
  3. 3. 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 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
  4. 4. The Carriere Distalizer
  5. 5. The 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 occlusion• Bonded from cuspid to first molarHow does it work?• It is used to (1) bodily di t li maxillary posterior segments while i dt b dil distalize ill t i t hil correcting (2) upper first molar rotation and (3) uprighting.• Produces a distal rotational movement of the maxillary first molars around their palatal roots when necessary roots,• Simultaneously, produces a light and uniform force for distal molar movement.• 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
  6. 6. Molar pad: Ball that Characteristics articulates in a socket Hooks on pad: for the attachment of the Cl th Class II elasticsMold InjectedMetal (MIM),made of Nickel Arm: runsFree Stainless posteriorly over Canine pads = AllowSteel the two upper the distal movement premolars in a of the canine along slight curve the alveolar ridge without tipping.
  7. 7. The Carriere Distalizer – What is it?• Direct bond appliance to cuspid and first molar used to bodily distalize maxillary posterior segments while correcting upper first molar rotation and uprighting. i hi• Requires a lower source of anchorage such as a lingual arch or essix and activated with ¼ i h h ti t d ith inch heavy elastic. l ti• Goal is to treat and correct the Class II at the beginning of treatment BEFORE brackets are placed in mo th lea ing mouth leaving doctor with Class I platform.
  8. 8. 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 p p g g popular ClassOne p product.• 3 JCO articles released.
  9. 9. How it Works• The Carriere Distalizer mimics a human ball/socket jointallowing the first molar to rotate and upright.• Built in stops engineered in the appliance keep the molarfrom over-rotating or distal tipping. g pp g
  10. 10. How it Works• The stiff arm maintains exact space bet een e act between pre-molars during distalization.• The cuspid pad is fixed and will not allow the cuspid to tip.
  11. 11. The Objective• Th di t li ti of the posterior The distalization f th t i maxillary segments in a block, from canines t molars. i to l
  12. 12. Concept• To provide a rotation mo ement of the pro ide movement maxillary first molars around their palatal root and at the same time receive a distalization impulse to achieve a posterior occlusion in….⇒Class I Platform
  13. 13. Class I PlatformIs the kind of occlusal relationship in which,the patient exhibits a perfect matching patient,intercuspidation in Class I, between themolars and the canines. At the same timecentric relation is coincident with centricocclusion.
  14. 14. Class I Platform
  15. 15. Class I Platform
  16. 16. Class I Platform
  17. 17. Distalizer MDi t li Movement t
  18. 18. 3 Type of Molar Movements• Uprighting of the crown, if it is mesially inclined• Distal rotation around the palatal root.
  19. 19. Molar Self E i M l S lf Engineered M d Movements t Uprighting + RotationSelf-Expressed Molar Self-Expressed Molar Uprighting U i hti Rotation
  20. 20. 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 rotation
  21. 21. Biomechanics of the Distalizer Molar UprightingFollowing uprighting: (2) Rotation.Collision points prevent the distalinclination of the molar crown Beyond this point: (3) Distalization. Collision points prevent the distalThe device gives Freedom & Looseness inclination of the molar crownfor (1) upritghting the molar
  22. 22. Biomechanics of the Distalizer Molar RotationThe joint between distal base andmesial arm, permits the easybonding on mesially rotated molars Collision point between mesial arm and posterior base. Shoulder stop prevents the distal over-rotation once corrected the mesial rotation of the th molar. l
  23. 23. Biomechanics of the Distalizer Molar Rotation
  24. 24. Biomechanics of the Distalizer Molar RotationSelf expressed molar rotation around palatal root
  25. 25. Biomechanics of the Distalizer
  26. 26. Biomechanics of the Distalizer
  27. 27. Biomechanics of the Distalizer Synchronic Movements Rotation + Upriting
  28. 28. Biomechanics of the Distalizer
  29. 29. Biomechanics of the Distalizer With only one activation it p y produces a multiple, p simultaneous and self expressed movement. 1. 1 Translation in canine. canine 2. Translation in p premolars. 3. Uprighting, rotation and translation in the molar
  30. 30. Biomechanics of the Distalizer Passive Appliance Without Elastics
  31. 31. Patient Compliance• Patient compliance very high beca se er because distalizer is used at beginning of treatment when patient cooperation is best best.• Non-invasive look/feel makes distalizer easy choice for patient and parents.• Use model and patient video during consultation to properly educate p p p y patient.• Show patient choices of other non-compliant appliances such as Herbst. pp
  32. 32. Class II Elastic Recommendations• Strength: 6 ½ ounces, ¼ inch ounces inch. – O2 Part Number: 407-042S (Rhino)• Wearing time: 1. Low angle: 24h/except eating time. 2. High angle: night time, if p g g g , possible 14h/including p g part of daytime.
  33. 33. Sources of Anchorage for g Mandible• Traditional Lingual Arch• Preformed Fixed Lingual Control g Arched (p/n 032-060 kit)• Full 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
  34. 34. Sample Case 1
  35. 35. Sample Case 1
  36. 36. Sample Case 1Distalizer B d dDi t li Bonded
  37. 37. Sample Case 1Class I Pl tfCl Platform A hi Achieved i 3 1/2 M th d in Months
  38. 38. Sample Case 1Before (Top) and After (Bottom)B f (T ) d Aft (B tt )
  39. 39. Sample Case 1Finished CaseFi i h d C
  40. 40. Sample Case 1Before (Top) and After (Bottom)B f (T ) d Aft (B tt )
  41. 41. Sample Case 2
  42. 42. Sample Case 2
  43. 43. Sample Case 2Distalizer B d dDi t li Bonded
  44. 44. Sample Case 2Class I Pl tfCl Platform A hi Achieved i 2 &1/2 M th d in Months
  45. 45. Sample Case 2Before (Top) and After (Bottom)B f (T ) d Aft (B tt )
  46. 46. Sample Case 2 p
  47. 47. Sample Case 2Finished CaseFi i h d C
  48. 48. Sample Case 3
  49. 49. Sample Case 3
  50. 50. Sample Case 3Distalizer B d dDi t li Bonded
  51. 51. Sample Case 3ClassOne Platform Achieved in 3 Months
  52. 52. Sample Case 3 pClassOne Platform Achieved
  53. 53. Sample Case 3Carriere SLB Bonded
  54. 54. Sample Case 3Carrirere SLB Bonded
  55. 55. Sample Case 3Carriere SLB Bonded
  56. 56. Sample Case 3Carrière SLB Bonded
  57. 57. Sample Case 3Carriere SLB Bonded
  58. 58. Sample Case 3Finished Case
  59. 59. Sample Case 3Finished CaseFi i h d C
  60. 60. Sample Case 3Before (Top) and After (Bottom)B f (T ) d Aft (B tt )
  61. 61. Sample Case 3Finished CaseFi i h d C
  62. 62. Carriere Distalizer Study N=60 Consec ti e Patients Consecutive 33 Women (55%) 27 Men (45%) Average age at the beginning of g g g gtreatment: 14.35 years (std = 5.35) Range: 9 83 to 40 67 years 9.83 40.67
  63. 63. Carriere Distalizer Study y Treatment Time• All Class II Patients Patients.• Fully erupted permanent dentition 6 to 6.• Treatment need: distalization of maxillary posterior segments, Canine to Molars into Class I.• Use of Distalizer as the first and only appliance for distalization.• Treatment plan: Non extraction in maxilla maxilla.
  64. 64. Carriere Distalizer Study y Treatment Time• L t l cephalograms t k b f Lateral h l taken before, (T1) and d after Distalization “Class I Platform” accomplished, accomplished (T2)• Mean time for Class I Platform is 4.27 months (std = 1.38)• Range: between 2 to 8 months
  65. 65. Carrière Distalizer Study52 subjects (86.7%) had presence of third molars in x-rays. None 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. J. Orthod.1993;104:556-65
  66. 66. Carriere Distalizer Study y Anchorage• 95% of the patients used a Lingual Arch anchorage. g• The remaining 5% use either a Full Bond, or Essix & Hooks anchorage.
  67. 67. Carriere Distalizer Study Compliance pLevel of Cooperation in the use of Elastics:• 70% of subjects were completely complying (100% p.t.)• 26 7% of subjects were hi hl complying ( 20% p.t.) 26.7% f bj t highly l i (-20% t )• 3.3% of subjects were complying on average (-40% p.t.)
  68. 68. Carriere Distalizer Study y Compliance 80 60 40 20 ntagePercen 0 total high average Level of cooperation i the use of elastics L l f i in h f l i
  69. 69. Carriere Di t li C i Distalizer St d Study Oral Hygiene• 50% of subjects were acceptable• 50% of subjects were excellent
  70. 70. Carriere Distalizer Study y Molar Distalization Uppe o a Upper Molar Distalization ( sta at o (mm) ) 60 50 40 30 20 tage 10Percent 0 3.00 4.00 5.00 6.00 Upper Molar Distalization (mm)
  71. 71. Carrière Distalizer Study Conclusions• Distalizer has a significant effect on the distalization of g 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 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 to obtain because of the motivation, patient understanding the logics of the project, and because it is l i placed on th fi t d of t t d the first day f treatment.t
  72. 72. Appliance Placement
  73. 73. Instruction for use (cast)Measurements: Using a distometer measure from the midpoint 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. (Distometers included in Distalizer case).Selections: Find the correct length Distalizer — using distometer. Using finger pressure, adjust the Distalizer bar to maximize conformity of the cuspid pad t the surface of the cuspid. M d to th f f th id Many O th d ti t Orthodontists find it easier to fit the Distalizer to a recent cast.
  74. 74. Measurement Intra Oral Intra-Oral
  75. 75. Bond Preparation• Mark Embrasure: Place marks at embrasures mesial to 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 j enhance stability of intraoral bonding (be careful not to get any wax on bonding pad) pad).
  76. 76. Prep Bonding• Coat: Cover the entire Distalizer pads with light cure composite.• 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 Distalizer pads coated with light cure composite.
  77. 77. Prep PatientIsolate: Using lip retractor,dry triangle, single cotton roll, and/or lowvolume suction ensure adequate intraoral suction,access while minimizing moistureEtch: Enamel acid etch the surface of the firstmolar and cuspid as appropriate for the materialselected.
  78. 78. Prep• Air Burst: Apply brief air burst to surface of etched cuspid and molar.• B f Before B di Bonding, A l S l Apply Sealant: A li i of Application f a filled resin primer is recommended for maximum tensile bond strength
  79. 79. Placement of the Distalizer• 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 mark using l ki h k i locking hemostat, or f forceps. P h molar Push l pad into the correct position:• OCCLUSAL/GINGIVAL - Place pad on gingival third of molar. Remove excess ‘flash’ from tooth surface. Fully cure molar pad.
  80. 80. 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 third forceps. 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 the molar, 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 Distalizer Distalizer.• Mandibular Arch: Can be anchored to the Orthodontist’s preference (lower lingual arch, fixed appliances, Essix lower appliance, or mini implant). implant)
  81. 81. Final Distalizer Procedures• Re-check 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.• 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 Distalizer. Distalizer• Instruction of Patient on: Elastic Wear - (22/7): Remove when eating. “Wear elastics at all other times.”
  82. 82. Sample Case 4
  83. 83. Sample Case 4
  84. 84. Sample Case 4
  85. 85. Sample Case 4Distalizer B d dDi t li Bonded
  86. 86. Sample Case 4Class I Pl tfCl Platform A hi Achieved i 4 months d in th
  87. 87. Sample Case 4Before (Top) and After (Bottom)B f (T ) d Aft (B tt )
  88. 88. Sample Case 4 p
  89. 89. Sample Case 4Carrière SLB Bonded
  90. 90. Sample Case 4CarrièreC iè SLB B d d Bonded
  91. 91. Sample Case 4Carrière SLB Bonded
  92. 92. Sample Case 4Finished CaseFi i h d C
  93. 93. Sample Case 4Finished CaseFi i h d C
  94. 94. Sample Case 4Before (Top) and After (Bottom)B f (T ) d Aft (B tt
  95. 95. Sample Case 4 pFinished Case
  96. 96. Sample Case 4Before and AfterB f d Aft
  97. 97. Carriere Distalizer Product Information• 3 Main Sizes for 3 to 6 Bonding – C DA23 – 23 mm – C DA25 – 25 mm – C DA27 – 27 mm• 3 Smaller Sizes for 4 to 6 Bonding – C DA16 – 16 mm – C DA18 – 18 mm – C DA20 – 20 mm• Custom Sizes Available• Starter Kits Available – C DAKIT – 23mm, 25mm, 27mm – C DAMKIT – 16 16mm, 18 18mm, 20 20mm, 2323mm, 25 25mm, 27 27mm• Rulers, Storage Tray, Bonding Prep Guide, Syllabus, Patient Video, Patient Literature, and Elastics also available
  98. 98. Distalizer 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 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; 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 treatment 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 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.
  99. 99. Distalizer 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 some arch anteriors. 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. lateral) or separate (uni-lateral).• Can I use in Mixed Dentition? – Mixed dentition Class II with fully erupted first molars, for first phase treatment.• Can I use the Distalizer to treat a Class III by placing on lower? – No
  100. 100. Distalizer 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, those f th forces are eliminated and th di t li ti process h li i t d d the distalization happens much h 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 p pp pre-molars since they are not bonded? 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)
  101. 101. What Doctors Are Saying• The Carriere Distalizer has become a routine appliance for Class II correction in our office It is easy to place and very office. effective. - Dr. Clark Colville, Seguin, TX• Th Carriere appliance i th easiest, most efficient d t l The C i li is the i t t ffi i t dental Class II corrector I have ever used. We are now able to make most cases Class I before we apply their braces. Thi shortens th ti b This h t the time spent in b t i 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)
  102. 102. Questions and discussion….