Carriere 3 Treatment in minimally growing patients: How does it work? James McNamara
How does it work
· Rigid fixation canine to molar
· VFR upper arch
· Elastic from upper molar to the lower canine
Components C3
1. Bilateral flexible bonded bars
o Different size, 23, 25, 29, 31 mm = distance canine to 1st molar
o Can be 1st molar to 1st premolar
o Clear version
2. Bilateral bondable tubes and hooks to the upper 1st or 2nd molars
3. Maxillary anchorage appliance,
4. Intermaxillary elastics
o Force 1 and force 2 375-540g
CM3 and CM2 Protocol
o Photos
o Every 6/52
o Treatment usually compelte in 6 months (4-8 months)
o Complete case with aligners / fixed
o Posterior disocclusion (upper retainer, RME or occlusal build ups)
o Full time elastic wear, change elastics every 4 hours: 15 mins rule – elastic breaks maximum 15 minutes
Carriere study NcNamara 2021
· Retrospective
· 32 patients
· No significant AP statistical change, 2mm linear change
· 2.2mm increase in anterior face height
· Dento-alveolar changes
o Molar relationship improved 4.8mm
§ Mesial movement lower molars 1.9mm, Distal movement upper molar 1.8mm
Conclusion
· Mainly denoalveiolar appliance
· Increases vertical relationship
Management of the Carriere Motion Appliance for class 3 correction in the mixed and permanent dentition Laurie McNamara McClatchey
Clinical tip – ensure upper first molar with retainer has distal plastic coverage to prevent distal rotation
Side effects of CM3
· Mobility of lower canines
o If concerned stop use of elastics for 1 visit
· Extrusion of lower canines
o Resolved in fixed appliances
o Or combine with Carriere and continuous auxillary archwire
Mixed dentition
· Carriere with RME
· Bonded occlusal splint design
· Hook added to distal aspect of RME
· Expansion first
o 4/52 fit Carriere appliance – when no significant expansion required
· Case
o RME and hook
o Carriere to lower primary canine
o Molar correction, anterior teeth not retract
§ Solution fixed appliance to anterior teeth with powerchain
Extusion and mobility are expected side effects
Brackets and auxillary wire beneficial
