2 carriere distalizer

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

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

The Carriere Distalizer
What 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 molar
How 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

Molar pad: Ball that Characteristics
articulates in a
socket

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

Mold Injected
Metal (MIM),
made of Nickel Arm: runs
Free Stainless posteriorly over Canine pads = Allow
Steel the two upper the distal movement
premolars in a of the canine along
slight curve the alveolar ridge
without tipping.

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.

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.

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 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.

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

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

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

Distalizer M
Di t li Movement
t

3 Type of Molar Movements

• Uprighting of the crown, if it is mesially
inclined
• Distal rotation around the palatal root.

Molar Self E i
M l S lf Engineered M
d Movements
t
Uprighting + Rotation

Self-Expressed Molar Self-Expressed Molar
Uprighting
U i hti Rotation

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

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

Beyond this point: (3) Distalization.
Collision points prevent the distal
The device gives Freedom & Looseness inclination of the molar crown
for (1) upritghting the molar

Molar 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-rotation
once corrected the mesial rotation of
the
th molar.
l

Molar Rotation

Molar Rotation

Self expressed molar rotation around palatal root

Synchronic Movements
Rotation + Upriting

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

Passive Appliance Without Elastics

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

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.

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

Sample Case 1
Distalizer B d d
Di t li Bonded

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

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

Sample Case 1
Finished Case
Fi i h d C

Sample Case 2
Distalizer B d d
Di t li Bonded

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

Sample Case 2

Sample Case 2
Finished Case
Fi i h d C

Sample Case 3
Distalizer B d d
Di t li Bonded

Sample Case 3
ClassOne Platform Achieved in 3 Months

Sample Case 3
p
ClassOne Platform Achieved

Sample Case 3
Carriere SLB Bonded

Sample Case 3
Carrirere SLB Bonded

Sample Case 3
Carrière SLB Bonded

Sample Case 3
Finished Case
Fi i h d C

Sample Case 3

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

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.

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

Carrière Distalizer Study

52 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

y
Anchorage

• 95% of the patients used a Lingual Arch
anchorage.
g
• The remaining 5% use either a Full Bond, or
Essix & Hooks anchorage.

Compliance
p
Level 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.)

y
Compliance
80

60

40

20
ntage
Percen

0
total high average

Level of cooperation i the use of elastics
L l f i in h f l i

Carriere Di t li
C i Distalizer St d
Study
Oral Hygiene

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

y
Molar Distalization
Uppe o a
Upper Molar Distalization (
sta at o (mm) )
60

50

40

30

20
tage

10
Percent

0
3.00 4.00 5.00 6.00

Upper Molar Distalization (mm)

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

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.

Measurement Intra Oral
Intra-Oral

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).

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.

Prep Patient

Isolate: Using lip retractor,
dry triangle, single cotton roll, and/or low
volume suction ensure adequate intraoral
suction,
access while minimizing moisture
Etch: Enamel acid etch the surface of the first
molar and cuspid as appropriate for the material
selected.

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

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.

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)

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.”

Sample Case 4
Distalizer B d d
Di t li Bonded

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

Sample Case 4

Sample Case 4
Carrière SLB Bonded

Sample Case 4
Carrière
C iè SLB B d d
Bonded

Sample Case 4
Finished Case
Fi i h d C

Sample Case 4
B f (T ) d Aft (B tt

Sample Case 4
p
Finished Case

Sample Case 4
Before and After
B f d Aft

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

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.

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

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)

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)

2 carriere distalizer

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