Let’s talk about the Carriere Motion appliance….
This is popular post 6. It is the first time that I wrote about the Carriere motion appliance. I first published this five years ago. It was the first time that I had a real go at this treatment and the KOLs who promoted it. This post has been read many times and is still attracting some attention. I was going to make some changes to it to bring it up to date. However, when I have re evaluated the evidence, this post is still up to date. That is there is no additional “positive” research about this appliance. So, here we go.
One of the new orthodontic developments is the Carriere Motion II appliance for Class II correction. This is getting a lot of publicity, so I thought I should look at it.
Welcome back, my friends, to the show that never ends!
Henry Schein Orthodontics market the Carriere Motion appliance. The theory behind the appliance is that it can be used to correct Class II problems in the first phase of treatment. They call this “sagital first.” This is a similar approach to using a functional appliance to initially correct a Class II occlusion followed by a phase of fixed appliance treatment. As a result, this is not new. The appliance is essentially an upper sectional and bonded bracket on the lower molars with various methods of increasing lower anchorage. The design allows us to use Class II elastics. Here is a cartoon of the appliance working. You can see that it moves the upper buccal segments back, moves the mandible forwards, does something to the TMJ, and increases the airway volume. It truly is a miracle!
We’re so glad you could attend
They make claims on their websites, that the appliance produces more predictable results and shorter treatment times by “up to four months”. (we have heard things like this before). Interestingly, the website also includes statements by the HOS KOLs, for example;.
“We correct the sagittal problem in 3 months and complete the whole treatment in 6-9 months”.
You’ve got to see the show, it is dynamo
They also produced a detailed workbook written by the inventor Luis Carriere. He states that the biomechanics are:
- Distalisation and derotation of the upper first molars
- Distalize maxillary segments
- Create a uniform biomimetric force to establish univectorial dental displacement. (I have absolutely no idea what this means!).
We can use the appliance to treat both adults and children.
You’ve got to see the show, it is rock and roll!
I also came across this short video
This was modestly called “How Sagital First changed orthodontics.” In the video, the HSO general manager, 3 KOLs, and Luis Carriere chatted about the appliance. It is a bit long, but these are some quotes:
“It’s all motion everyday”.
“We are changing faces with little effort”
“The old standard throughout the World was the Herbst, now the Carriere is the new standard”. I thought that this was nonsense…
“Appliance placement is simple with no bands”.
“Since we started using the appliance the patients are happier and the staff are happier”.
“Transformed my life”.
After I watched this, I got the impression that this appliance can do anything!
What did I think?
I think the appliance looks interesting, and some of the case reports look good.
Unfortunately, when I looked for independent case reports, case series, retrospective studies, prospective cohorts, and trials of this great new appliance, I found nothing.
However, I could not help thinking this was just another way of applying Class II mechanics. We can do this with functional appliances and/or elastics. I was also not clear why this appliance was different from simply fitting an upper sectional appliance? Would it change my life? I doubt it.
Would I try it on my patients? I think that I might. Would I tell them that I would be doing shorter, more comfortable, and less hassle treatment to grow their jaws? No, I would not.
Finally, when I look at the videos and marketing, I do not know whether to laugh or cry. What is becoming of orthodontics?
If someone can identify the mid-1970s song, I used for the subheadings they will get a special mention in the next post. Those with memories of the first post may still get this right. But we are all five years older.
Emeritus Professor of Orthodontics, University of Manchester, UK.
Have your say!
ELP Karn Evil 9 (but I don’t expect any fanfare for this common man!). As a wise Scottish man once said, “Ya canna break the laws a Physics”. There is no mechanical or biological reason why the dentition or supporting tissues would respond any differently to a couple of brackets with a trapped archwire supported by elastics. Why weren’t we seeing the same fanfare for the Wilson arch or is it just the marketing that has changed?
ELP Karn Evil 9(1st imp)
Do you think that the Carriere helps stabilise the canine during early class 2. i.e. reducing rotation?
thanks – thought provoking as always.
PS: Check out “Noddy’d Puncture” for a fabulous ELP tribute band based in the sunny Northwest.
Looks like the server had some trouble earlier, hope this link to the song works 😉
“Karn Evil 9” by Emerson Lake and Palmer. Sorry Jay Bowman gotta be faster!
Emerson, Lake & Palmer 😉
Karn Evil 9 from Brain Salad Surgery, Emerson Lake and Palmer?
Post treatment ceph overlay, always seems to have the lowers dentition moving forward as opposed the uppers retracting. Most of the correction appears to the upper molar de rotation
Yes but ceph superimpositions are soooooo outdated…It’s the motion 3D appliance! 2D measurements don’t apply ????
Emerson lake and palmer
Welcome to the Show
Welcome Back, My Friends, to the Show That Never Ends ~ Ladies and Gentlemen
Karn Evil 9 by Emerson Lake & Palmer
(first impression part 2)
from Brain Salad Surgery
It is Emerson Lake and Palmer : Karn Evil 9 1st Impression, Part 2!!!
Such a great song and so damn fitting for that piece of theatrics
It is Emerson Lake and Palmer : Karn Evil 9 1st Impression, Part 2!!!
Such a great song and so damn fitting for this piece of theatrics!
Karn Evil 9 by ELP
“Ladies and Gentlemen”
Emerson, Lake and Palmer
I reckon that’s a bit of Emerson, Lake & Palmer: Karn Evil 9 Lyrics
Karn Evil 9
It was also used as Jim Davidson’s theme tune
Song is by Emerson Lake and Palmer …”Karn Evil 9 1st Impression, Part 2
EMERSON LAKE AND PALMER
Pictures at an exhibition by ELP (Emerson Lake & Palmer)
I always enjoy reading your blog Kevin. I liked how you refer to Karn Evil 9: First Impression.
All the best from Berlin
ELP; Welcome to the Show; 1974. I remember it well
ELP Karn Evil 9
I love following your Blog Kevin. Funny how you referred to Karn Evil 9: First Impression.
All the best from Berlin
Looking forward seeing you at the AAO
Karnevil 9 first impression from Brain Salad Surgery by ELP I think 1974 I was in high school!
Ahh – a blast from the past – Emerson, Lake, Palmer. Great title for the post!
Didn’t know you were an ELP fan
Emmerson, Lake and Palmer
I do use the Carriere motion appliance among a number of other class II correction methods. I find it easy to use and assuming you have a compliant patient and control lower anchorage, it seems to work well. I do not like the hype, the word puffery comes to mind.
PS: Karn Evil by ELP
How can you possibly control lower anchorage with a set up like this?
Any treatment that pits the upper against the lower for CII correction will tend to move the condyle downward and forward.
It is pure dentoalveolar compensation treatment of Class II and / or Class III malocclusions. If diagnosis shows you you may do that: that’s fine… In a Class II it will tip your occlusal plane, bring you lower dentition forward, increase the lower incisor inclination and derotate you upper molars. And we all know that this is the fastest way to get a Class I occlusion out of a Class II occlusion. Apart from increasing the vertical dimension it will not change any skeletal features… If something sounds too good to be true it normally IS too good to be true…
You need a little history about the Carrier Father and Son power combination, to understand better the Motion Appliance. In 1984 I met Dr. Luis Carrier Sr. and started using his bracket system and design, which was ahead of its time in orthodontics. Later on with Luis Carrier Jr it became the Carrier “passive” self ligating system, when other big name Orthodontics company were modifying their passive self ligating brackets to Model 1 Model 2 Model 3 Etc. because the gate or door didn’t open, The Carrier Pasive SLB system worked like a charm. Now with HS and all their RD you better watch them Closely.
Let’s talk Motion appliance starting with a couple of questions.
Are the first upper molars rotated mesialy in a CL II malocclusion?
Are the first upper molars rotated mesialy in a CL III, yes CL III malocclusion?
I went to 2 years of Ortho school in the USA, 3 year fellowship in Orthognatic Surgery and the 2 year Roth TMJ in the USA with 35 years of practice with lots of Herbst, Pendulum and Surgery CL II patients and to me “the most practical” “clean cut” appliance in CL II that we have today in the market for teenage and adult patients is the Carrier Motion Apliance. It’s great how it rotates the molar back to where they belong, bring the mesial palatal cusp where it belongs and you don’t have to be dealing with all of this at the end of treatment.
I can keep going on and on about all the good things of the appliance but I don’t want to miss the BIG PICTURE, the real problem is poor diagnosis of the CL II, When is surgical, when is orthopedics and when extraction.
“The Carrier Family is a first class legacy in orthodontics”.
Publicity is publicity in the world of Ortho…don’t mix it. But I can tell you one thing, the orthodontic leadership of HS has been with the Carrier family since 1984, all this wasn’t borne yesterday.
Don’t get filled by the publicity or your “EGO” give it a good fair run “as you always do” with information.
I truly enjoy your writings even when I respectfully desagrupas with you.
And remember this old man… the real problem that we have with malocclusions is “DIAGNOSIS”.
I’ll tell you what transformed my life: this blog! In our crazy dental life we are so busy, things go so fast, every year is getting shorter, never seem to find the time to read and educate ourselves. So we often rely on salesman, companies, to « educate » us. This is why it is so reassuring to have your blog and to read it and see that what I think sometimes makes sense and that I am not out of line even though I sometimes have interesting « discussions » with colleagues about things like the Carriere for exemple.
« It always works! » they will say. To which my answer is always: « It means you don’t do enough! ». Nothing works all the time! A lot of things work most of the time. Dentist / orthodontist seem to mix clinical experience and scientific evidence. Not that clinical experience is bad; it’s just not the same thing. So the question is, whatever the product or technique we use: do I base my treatment choice on clinical experience or scientific evidence? If I can have both, it is even better! But this blog really helps in justifying all my clinical decisions. Thank you and long life to this project!
*if you find a reference to a famous UK music group in my post, you will probably get no mention of any kind…
Pink Floyd from Dark Side?
What else? 😉
Come inside! Come inside!
Where the forces are unaware of the beauty of the appliance or the happiness of the staff 🙂
Emerson, Lake and Palmer
Karni Evil 9 – first impression
ELO -Karn Evil 9
Emerson, Lake and Palmer…
Karn Evil Number 9
Brain Salad Surgery
And yes, I’m 55 and played guitar in a band in the late 70’s
Great post. And great headings as well… ELP, karn evil 9, first impression, pt. 2.
I agree that the way of presenting Carriere is somehow simplistic and a little too “magical”. By the way it couples with the personality of Luis Carriere, that I met in person and highly appreciated as a flamboyant and really generous person. I am part of those who integrated his motion appliance in his armamentarium for CLII and CLIII malocclusions. I like to cite the title of one of Jim McNamara’s lecture in AAO “CLII maliocclusion: many arrows in the quiver” and I judge it as a very useful arrow to manage. By being clinically very happy with the effect of the motion I am conscious that no literature exist for the moment. Jim McNamara is working to publish a paper on the dentoalveolar and skeletal effect of the motion appliance and I guess the literature will soon benefit of a sound contribution regarding this treatment regimen.
I agree with you Kevin that the way of presenting the appliance is very commercial. I also have to state that introducing the carriere in my CLII armamentarium (and CLIII also) has been extremely beneficial and a very good treatment alternative to other more invasive treatment modalities.
Nothing new under the sun: Calvin S. Case, the inventor of elastics in orthodontics in 1904, gave us the Span Hook in 1921.
“You could look it up.” from Bull Durham 1988.
So I commend you on calling them out on this. The reality in our office is it does work for mild class II in my hands. However, does it rival a Herbst for mandibular growth and severe class II correction? I don’t think so.
My better question I post to you….take a CBT immediately upon debonding. Take a second 18 months later and ask yourself, if it was correction of a full step class II, where is your incisal position, overjet, and condylar position. I see a lot of “motion” for sure, unfortunately I see it after debonding when the cases settle in, and I am a tyrant with retention applying fixed retention to the lower and fixed 2 to 2 or 3 to 3 plus removable full time on the upper for a min of 12-15 months followed by bedtime for a min of 2 more years. I tend to see a little slip in the AP correction, and it should be noted once I remove the motion appliance, I still end up in class II or vertical elastics to finalize the occlusion. Just some humble thoughts/observations from a guy deep in the trenches fighting the war against the evil malocclusion daily.
Dr. Carriere presented to a small group of orthodontists organised by Cerum Ortho in Vanouver earlier this year. The cases presented looked good with what appeared to be solid occlusions at finish. The unfortunate part of the presentation was that Dr. Carriere kept commenting on the improved airway following his treatment. We know from peer reviewed articles that airway volume cannot be accurately measured from lateral cephalograms. By throwing out such meaningless statements, the remainder of Dr. Carriere’s presentation was rendered meaningless.
Try the 2dappliance.com. Love for you to review it. Cheaper, no inventory needed too.
Thanks for all your postings. Appreciate your honest evaluations
Since the beginning of orthodontics there is a ‘fight’ to discover the miracle appliance that grows jaws. Each of us was supposed to memorize it during his/hers residency. Every few years the cycle move from the last one to the new one that become the last one since a new one arrives. All appliances, as Kevin says, are doing the same. IN most of them, cooperation is the key to success, however sometimes even with the best cooperation, it does not work and Class II remains Class II. I believe that soon, another appliance will be the star, but unfortunately, none of the appliances can work on the genes to induce mandibular growth. Until this happens, we are expected to see sometimes great results and sometimes huge failures, even with the motion appliance. Miracles belong to the biblical periods unfortunately not to the present times
Comments —As a Canadian ,I feel that US colleagues often give unjustified credence to tmnt.modalities that originate from Europe.
This modality has its place.HS is attempting to replicate Ormco,s success.KOL,s need to continually state there financial interest before ANY form of verblisation.The same KOL,s eg.Dr Graham ,seem to pop up across a variety of products.The “discussion”is full of knowledgable ,nodding in agreement ,buzzwords and gobbledygook .This “discussion “has taken pseudo -science to a Gyneth Paltrow like level.I have no problem with marketing but let’s include hard data and less flim -flam. Please justify how you can calculate that this is the “fastest growing “tmnt.modality “-I don’t think HS competitors provide you with sales figures for you to compare.This is a slippery slope we are on and a retrogressive one. All the more reason for folks like Kevin to keep us on point!
Ceph overlays are the true “evidenced based” proof of what is happening. The Carriere Motion overlays demonstrate correction is almost entirely due to mandibular re-positioning. Minimal (if any) de-rotation of the upper molars is evident.
The 5 ways to correct Cl II include:
2) dento-alveolar advancement
4) extractions (ironically to facilitate
5) mandibular re-positioning
Can we stipulate that all Cl II patients DO NOT need their mandibles positioned forward? All Cl II cases would be easy and stable if simply posturing the mandible forward was effective in correction of Cl II.
Objects move when forces are applied to them. The Carriere Motion appliance (formerly known as the Carriere “Distallizer”) used Cl II elastics force. a 6oz then an 8oz rubber band. That is the force applied. Overlays demonstrate correction of Cl II is due to mandibular re-positioning. What makes this better than Cl II elastics after leveling without dento-alveolar advancement still remains unexplained.
Is this Carriere motion system for class 3 malocclusion available in India?