In the case of a class II or III, when the functional treatment sometimes necessary is not simply overlooked by the practitioner, it is generally prescribed before the mechanical treatment. A waste of time for Skander Ellouze, an ODF specialist based in Tunis (CECSMO 86 in Bordeaux). After two years of research with Orthoplus, he has developed a functional education device that can be used in conjunction with the mechanical treatment. He presented it on the 26th of March in Paris in front of hundreds of orthodontists.

I recently heard a speaker at a conference say that functional education is useless. The worst part was that no one in the room reacted," said Skander Ellouze, opening his lecture. The functional and periodontal aspects should be systematically taken into account by orthodontists. Why has our patient come to this point? There is still a lot to be done to convince practitioners to work on dysfunctions, tongue placement or orofacial dysmorphoses. Like Olivier Setbon, who lives in the Paris region and was the afternoon's guest star speaker, he believes that "functional orthopedics is orthodontics".

Quite simply. The latter showed it well by exposing one of his cases, treated in the early 2000s, before he abandoned his "purely mechanistic vision of orthodontics": the infraclusion of a teenager, corrected with multiple attachments. "A textbook case, an optimal result," he explains as he scrolls through the photos. "I see her again 5 years later, the infraclusion has reappeared. I had not taken into account her functional disorder.

The Booster in attack of the class II treatment

However, as anyone who offers functional educators knows, results are not always forthcoming. Patients are often disappointed," says Skander Ellouze. They tell us, 'Is this all you can do? The times have changed. Our patients want comfortable and quick treatments. Hence the concept we have developed with Orthoplus. It allows for functional treatment to be performed at the same time as a Class II or III mechanical correction. The Class II Booster, as it is called, has a universal size and is equipped with a tongue guide to accompany the tongue against the palate during each swallow and to lead it to the right physiological position.

A "lip bumper" reinforces the muscle tone of the lower lip and the labio-chinese fold. An elevation will decompress the TMJ. Rounded and widened canals allow the patient to wear the appliance even with brackets and position the teeth in a parabolic arch form. Above all, the indentations in the right and left maxillary and mandibular parts allow the positioning of the traction elastics and their anchorage. This last aspect of the design is particularly important to allow the simultaneous use of the Class II Booster with the "Carrière Motion 3D" system presented by Skander Ellouze during this day.

For if our orthodontist, a leader in skeletal anchorage systems, has, of course,

presented some Class II cases involving tads, he elaborated at length on the "Motion", an innovative system for the treatment of classes II and III.

The Wow! Effect of Motion Career

"Here, we focus on the advancement of the mandible. We treat the vertical aspect first before the transverse aspect, this is the "Sagittal First". The system allows correction by distalizing the lateral sectors en masse while derotating the maxillary first molar around its palatal root and straightening it into a correct vertical position. The design of the braces prevents excessive rotation or distalization.

The results are spectacular. There is a real 'wow' effect, for both the patients and us," enthuses Skander Ellouze. In three to four months, provided that the patient has been diligent about wearing the elastics, we end up with a class I that we would normally treat with multiple attachments. The Carrière Motion was developed by Luis Carrière, a practicing orthodontist in Barcelona. This mechanism of intermaxillary elastics is composed of lateral arms (colored or transparent) connecting, on the right and on the left, canine and molar (3 to 6) or premolar and molar in cases with included canines (4 to 6). On milk canines, at least two thirds of the crown must be present. Equipped with a ball-and-socket joint in the anterior sector, these arms are attached to the maxilla for class II, to the mandible for class III. Elastics of variable strength (6 or 8 ounces), worn permanently (off meal), are anchored to molar brackets (on 6 or 7 low or high) and a thermoformed splint is also worn continuously. The elastic protocol is simple: the treatment is started with strength 1 elastics (6 ounces) for one month, then continued with strength 2 elastics (8 ounces). "For a short motion of 4 to 6 and an attachment on all 6 mandibles you should start with strength 2 elastics. And for the patients with a high bone density for whom there is no movement with the standard protocol you can position two elastics for one month", details Skander Ellouze.

The practitioner will have to be meticulous in his measurement. There are indeed 11 arm sizes from 13 to 23 mm. The measurements are taken from the median incisal point.

The bonding after etching is classic.

The Class I Stabilizer maintains

the Class I arch relationship

"I install the Motion, and I follow up with the patient 3 weeks later to place and adjust his Class II Booster if necessary," describes Skander Ellouze. When the Class II disappears, the Motion is removed and the Class I is treated with multi-attachments or aligners. This is where the Class I Stabilizer comes into play. An essential complement to the Class II Booster, this educator allows lingual correction to continue and maintains the Class I arch relationship by avoiding the use of elastics. It avoids immediate recurrence. With this dual system of functional educators coupled with the Motion Carrière, the entire treatment is usually completed within 12 to 15 months. Extractions are avoided, unless absolutely necessary. Patient cooperation is strengthened. "We orthodontists are always looking for simple, lightweight solutions for patients, and this is a great one," says Skander Ellouze, "It completes our arsenal and restores the medical performance of orthodontics.