Cl II

'Doesn't like how much her front teeth stick out' (excessive overjet)

Comprehensive orthodontic treatment involving a non-surgical and non-extraction plan, with segmental distalization of the maxillary arch with a class II Carriere Motion appliance followed by maxillary and mandibular braces with class II elastics. Re-evaluation for potential extractions would be made within the first 8-10 months of treatment, pending compliance with the Carriere and class II elastics (consideration would be given to extract #14 and 24).

Class II Carriere Motion with fixed upper and lower braces (0.022" bracket slot size)

Fixed upper and lower retainers with upper and lower essix for lifelong night time wear

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Moderately retrognathic mandible combined with mild protrusion of maxillary incisors contributing to the excessive overjet

• Bilateral class I occlusion
• Ideal overjet (correct excessive overjet)
• Ideal overbite (correct deep bite)
• Achieve symmetric midlines (shift lower midline to the left to be centered with upper dental midline)
• Aligned upper and lower arches
• Minimize/maintain gingival display on smiling (avoid increasing amount of gingival display on smiling)

Treatment started with the use of a class II Carriere Motion, bonded from #13-16 and #23-26, with a lower essix and brackets on #36 and 46. Heavy class II elastics were used for 6 months to help with segmental distalization of the right and left maxillary posterior dentition, while also allowing for mesial out rotation of #16 and 26, to help correct the class II buccal occlusion. Great compliance was achieved and by the end of the 6 months of the Carriere use, we had achieved a super class I occlusion (a few mm class III buccal occlusion in molar and canine). At this time, the Carriere appliance was removed and upper and lower fixed braces were placed - special attention was given to not extrude the maxillary incisors further. Class II elastics were used intermittently during treatment to maintain the class I occlusion achieved with the Carriere Motion. The deep bite was corrected by intrusion of the mandibular incisors and relative intrusion of the mandibular posterior dentition (extrusion of the premolars and molars). Detailing bends were used in the final stages to idealize the occlusion and esthetics.

Consideration was given to the two alternative options: 1) an extraction based treatment plan to correct the severe overjet and class II malocclusion with extraction of #14 and 24, and 2) a growth modification treatment plan as the patient is moderately retrognathic where a Twin Block followed by braces could have been used. Based on the patient's initial age (12y7m), and great compliance with the Carriere Motion for 6 months, it was decided that a high quality result could be achieved without the need for extractions.