Treatment of maxillary deficiency with facemask and TADs Peter Ngan. AAO June 2021. Episode 104

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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



·      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







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