C.F. Hamilton*, H. Saltaji**, C. B. Preston***, C. Flores-Mir****, S. Tabbaa***** *Private Practice, Milford, Massachusetts, USA **School of Dentistry, University of Alberta, Edmonton, Canada ***School of Dental Medicine, State University of New York at Buffalo, Buffalo, USA ****Division of Orthodontics, School of Dentistry, University of Alberta, Edmonton, Canada *****School of Dental Medicine, State University of New York at Buffalo, Buffalo, USA e-mail: [email protected]

Adolescent patients' experience with the Carriere distalizer appliance abstract Aim To examine adolescent patients’ experience with the Carriere Distalizer Appliance (CDA) and compare it with that of the Forsus Fatigue Resistant Device (FFRD). Materials and methods A survey was administered to 42 patients treated with the CDA and 70 patients treated with the FFRD. Amount of time required to become accustomed to the appliance, how many patients experienced side effects as well as the degree of discomfort were explored. Results The overall experience with the device was significantly better for the CDA group than for the FFRD group. Both groups felt that delivery and removal of the appliance was quick and easy, the appliance was noticeable to some extent, and the majority became accustomed to it within two weeks with a maximum of one month. In general, associated discomfort and effects on daily life and activities were less for the CDA group than for the FFRD group. Side effects decreased over time for both groups, often more so for the CDA group. The major side effects experienced by the CDA group were difficulty eating and sore teeth, and these improved significantly over time. Soreness from the appliance rubbing on the cheek or lip was significantly less for the CDA group. Conclusion The CDA appears to be more comfortable, offers a more positive overall experience, and has fewer negative comfort-related side effects compared to FFRD.

Keywords Class II malocclusion; Fixed functional appliances; Orthodontics.

Introduction The treatment of patients with Class II malocclusions represents a significant percentage of cases treated in an orthodontic office. According to the National Health and Nutrition Estimates Survey III, 55.1% of the population aged 12-17 years have a Class II malocclusion [Proffit et al., 1998]. Moreover, approximately 90% of all Class II Division 1 malocclusions have rotated maxillary molars to some degree, resulting in an increased clinical appearance of a Class II relationship [Lamons and Holmes, 1961; Henry, 1956]. Current orthodontic methods utilized for Class II correction include fixed or removable intra-maxillary appliances, fixed or removable inter-maxillary appliances, extraction protocols, and surgical repositioning techniques. A category of intermaxillary appliances frequently used in growing patients is referred to as the functional appliance (fixed or removable). Fixed functional appliances can be further divided into flexible fixed functional appliances, rigid fixed functional appliances and hybrid fixed functional appliances (e.g., the Forsus Fatigue Resistant Device, FFRD) which are a combination of both flexible and rigid forms [Ritto and Ferreira, 2000]. More recently the Carriere Distalizer Appliance (CDA) has been introduced with qualities similar to the flexible fixed functional appliance group [Carriere, 2004]. The CDA may be used for treatment in growing and non-growing patients and has shown to be more effective in treating nonextraction Class II malocclusion cases [Rodriguez, 2011]. One of the major factors for a successful orthodontic treatment is patient acceptance of the orthodontic procedures being used. Evaluation of patient experiences during orthodontic treatment will allow clinicians to better select a modality of treatment that will be best accepted by their patients. Currently, there is no published data to assess patient experiences with the CDA. Therefore, the overall goal of this study was to examine patients’ perception of the CDA via survey. A supplementary objective of this study was to compare current results to those of a similar survey previously developed and used by the authors to assess patients’ experience with the FFRD, another Class II functional appliance [Bowman et al., 2012]. Clinicians using CDA or FFRD may find this information useful in preparing a patient who will be treated using either one of these devices.

Materials and methods Informed consent was obtained from the participants’

European Journal of Paediatric Dentistry vol. 14/3-2013

219

Hamilton C.F. et al.

Question

Carriere

Forsus

P-value

Q6: “I was given a complete description of the Carriere appliance before wearing it.” Q7: “When I first saw it, the Carriere appliance looked scary/ overwhelming.” Q8: “The appointment the Carriere was placed was quick and easy.” Q9: “I was given instructions for wear and care of the Carriere appliance.” Q10: “How noticeable was the Carriere (not your braces, if you have braces) to friends and family?” *statistically significant, P