Pacific Coast Society of Orthodontists Bulletin Summer 2020 - 67

Presentation Summary

use cone-beam computed tomography, consider
taking more progress radiographs, and try to use
lighter forces if possible. If you see 3 mm or greater resorption, stop active orthodontic treatment
for a period of four months. Check the patient at
six-week intervals, take new PAs, and proceed if
no further resorption is found during the hiatus.
Resumption of treatment at this point is not a
severe risk factor. Determine what remains in
your treatment plan and attempt to complete
it diligently with reasonable speed. After active
treatment is completed, inform the patient of any
resorption that has occurred and inform the other
appropriate dental professionals involved with
the patient's treatment. Assure the patient that
resorption stops in retention. Make sure that the
affected teeth are not in hyperocclusion (you can
equilibrate if needed) and that there is no need to
splint the affected teeth.
There is such a thing as invasive cervical EARR,
which can take place in vital teeth. Here, the pulp
is not affected, but resorption takes place at the
cervix of the tooth. This can occur when orthodontic treatment is followed by trauma. Because
it can advance rapidly, call for assistance from the
endodontist, who may be able to place a conservative glass ionomer in the affected area rather
than extracting the tooth.
What Happens With Long-Term Resorbed Roots?
The orthodontic literature suggests that many if
not most resorbed teeth are there years later, both
stable and nonmobile. A long-term prospective
study comparing patients with and without short
roots is yet to be conducted. Patients with resorption at the four-year postretention mark showed
no change in root status. Another study of patients
25 years after retention showed that teeth with
truly short roots may have slightly more mobility
but at a clinically inconsequential level. Remember that, long term, the teeth stabilize: there is
no need to indiscriminately extract and replace
with implants. Severe EARR is rare. Assess any
relevant genetic predisposition (especially Hispanic
ancestry), medical syndromes, and root shape as
potential increased risk factors. Keep good records,
take appropriate progress films, suspend active
tooth movement for four months if significant

Summer 2020    PCSO Bulletin	

resorption is noted, and use light force levels and
limited tooth movement objectives as appropriate
to complete the active orthodontic treatment.
Carriere Motion 3D Class II Corrector: Is There
Evidence of Success?
The Class II corrector is any special device used to
correct a Class II dental molar relationship (and
possibly also skeletal). The treatment effect is
more similar to a molar distalizer. Bodily movement is claimed, but significant tipping and rotation takes place. One frequently sees a treatment
effect fairly quickly. The appliance is somewhat
expensive compared with the use of elastics
alone, and some are easily broken. The Forsus appliance is one variety of Class II corrector and has
the challenges of patient difficulty with eating,
breakage, and cheek irritation. The Carriere appliance has a hinge on the buccal of the maxillary
first molars and is connected to the upper canine
(or first premolar). Attachments are used on the
buccal of the mandibular first molars for the use
of Class II elastics, along with a lower Essix-type
appliance. Maintain Class II elastic wear to try
to help reduce relapse potential. At this point,
we rely mainly on testimonials and case reports
with the Carriere, for which both stability and the
amount of bodily tooth movement and growth
effects are unknown. Comparisons of treatment
with the Carriere, Forsus, and Class II elastics only
showed that the treatment time of the Carriere was somewhat longer and not particularly
efficient. The maxillary first molars rotated, with
some distalization. A palatal bar to help stabilize
the maxillary first molars can be considered. The
Michigan group had somewhat better results
and conclusions. The Carriere may not be a true
Class II corrector, because it is a hybrid of a molar
distalizer with canine to molar distal tipping. The
mandibular incisors will procline if you do not use
a thick Essix. It may be that obtaining excellent
cooperation earlier in the treatment process with
Class II elastics and the Carriere (versus cooperation later in treatment often being less favorable
from patients) helps with the improvements. The
Carriere appliance can be considered for use in
patients with mild skeletal Class II problems (e.g.,
an ANB angle less than 5°), with the molars being
a half step or less Class II.

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Pacific Coast Society of Orthodontists Bulletin Summer 2020

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