KOL Claim of the month: Carriere Motion in a post Covid19 World?
As we move through the terrible COVID 19 crisis, I have seen some discussion on the way that orthodontics may have to change in a post-COVID world. These discussions have involved the use of PPE, changes in cross infection control and greater protection against transmission in our practices. I did not think that anyone would suggest that orthodontic treatment would change. But then I came across this webinar by Dr Luis Carriere and Henry Schein Orthodontics. They suggest that one solution to orthodontic treatment in the future is increasing the efficiency of treatment by using the Carriere Motion appliance! This is, therefore, the KOL claim of the month for April.
These claims appeared in this video. Here is the link.
I am not going to be critical of Luis Carriere or Henry Schein. I am only going to quote from the video.
The presentation was called “Minimum touch orthodontics in time of pandemics”.
Here are the relevant quotes from his presentation.
“We need to work on how we are going to work during and after the C19 scenario”.
“In this period of C19, we have patients with continuous active appliances”.
“To be able to contain this pandemic, it is important to try to have appliances that really give us the possibility of the patient being the one that handles the action of the appliance”.
“Orthodontics will be completely different after this pandemic. Orthodontists will value techniques that are simple, minimal and highly efficient”.
“We will try to space the appointments as much as we can, and we will try to do the treatments as short as we can”.
“The key is to simplify the complexities of treatment”.
Guess what appliance we can use to do this? It is the Carriere Motion!
“We should diminish the number of appointments. To accomplish this, we need to work with technology to make treatments easier. The Motion appliance is an option that will help us amazingly convert complexities into simple things”.
“But then we need to have braces that are efficient. The Carriere SLX appliance with new wire sequences is a sequence that is minimal in number of appointments”.
“We do not need to see patients for activation because the system had fluid and easy-flow because of the low friction and the simple protocol”.
He illustrates the use of the Motion and the SLX appliance with a series of case reports.
The end of the webinar was an HSO video showing pictures of our now familiar KOLs looking lovingly at the HSO products. The video was framed with the slogan “Stay home”.
It is up to you to decide whether using the COVID 19 pandemic to promote the Carriere Motion appliance is acceptable. I was uncomfortable with the webinar. But am I being too sensitive?
Fact check of the KOL claims
I would also like to fact check the claims made in the video.
Currently, there is no good evidence that the Carriere Motion appliance reduces orthodontic treatment time. Neither does it produce anything other than dento-alveolar effects, which we would expect with Class II elastics. Elastics are also under the control of the patient and can be monitored remotely.
Perhaps we can have a comment from some of the other HSO KOLs or even the General Manager of HSO.
Emeritus Professor of Orthodontics, University of Manchester, UK.
I hope this is not only me but the arrival of a death dealing global pandemic seems to put having your teeth straightened into some sort of perspective. Faster and simpler treatment is a laudable goal but not really any sort of solution during the current crisis when the solution is NOT to do any treatment at all, fast or slow.
The Real Person!
The Real Person!
Thanks for your comments. You are right, I do use social media to publicise my blog posts. However, when I have tried to engage in the discussions, at times this has got unpleasant. I would prefer to have discussions about my posts on my blog comments section, as people are more polite when they comment here.
Frankly, I find this disingenuous, opportunistic, and in extremely bad taste given the current circumstances. For anyone to use these times to supposedly try gain some advantage in this way is inappropriate in the extreme.
Furthermore, it suggests that he is of the opinion that the treatment provided by the appliance is always correct and appropriate. This is certainly not the case and examples of this can be found. We are also aware that there are side effects of the appliance which do occur and are undesirable. The bracket is just another bracket and has no magical properties.
Hey Kevin, as everyone knows on this blog, I am a KOL, but not for Henry Schein, but rather their main competitor Ormco. I do however use the Carriere Motion Appliance in helping to correct Class II and Class III cases when I will be using Clear Aligners (I use Spark from Ormco, and yes, disclaimer, I am a KOL for Ormco–See, I’m learning 😉 ). Although I understand being sensitive about using the pandemic to market something, I don’t feel that is what is happening here. There have been literally hundreds of webinars, live facebook panels, everything you can imagine during this time. You could watch online 24 hours/day during this ‘shut down’ of our practices and still never see everything available online in orthodontic education right now. During this time, I feel we have to evaluate our practices and see what we can do to best treat patients moving forward in what will certainly be a changed world. Being able to ‘virtually’ check on our patients utilizing whatever virtual screening app you have decided to go with (I use Orthoscreening.com for mine) has been very beneficial for me during this time that we cannot see our patients in person. It has made me realize that for many appointments, we can do our checks virtually rather than have patients come into the office. This can be a positive both for the practice and for the patient. Wouldn’t it be nice as a patient to not have to leave school, or leave work, drive through traffic and then sit in the chair for a 30 second check? As a patient, I would appreciate being able to do this from my home, at my own time. Some patients would prefer to have that in person check, and we can do that once opened up again if they prefer. I plan on giving my patients the option moving forward.
So, what appliances, what treatments, are most easily monitored virtually? I would contend that appliances that need very little hands on adjustments by us are the best for this. Obviously clear aligners comes to mind first. But, for occlusal corrections, the motion appliance is very nice as we don’t have to change a wire on it. As long as it doesn’t break or come loose, we only have to monitor if the patient is wearing elastics and see if/how much the bite is changing. For remote virtual monitoring, Dr. Carriere is right, this fits very nicely in a virtual monitoring world.
In regards to efficiency and faster correction, etc.? I have no idea. I feel the appliance works and I see nice dental/alveolar changes as you mentioned and combine with clear aligners, it is a nice, efficient treatment.
During this time, let’s all try to see the positives in companies, doctors, KOL’s, Facebook groups, study clubs, etc. trying to help move us forward in our thinking during and coming out of this incredible time in our world. This pandemic has challenged our thinking in how we run and manage our practices. We will need to adjust some of what we do moving forward. I for one appreciate all the energy and work that so many doctors have put into trying to help us plan for the future once we can again treat our patients.
While there could be a handful of exceptions, I can only imagine that significant use of virtual monitoring in a post-COVID world would only diminish the quality of my services.
If orthodontic practitioners listened to the truth they could have a small fortune in supplies and lab bills. It seems like it is reasonable to almost correct a half cusp molar discrepancy with enough effort -anything more (to avoid jaw surgery) may be posturing which is FREE. I’m saddened to report the local dental authority’s body count in their attack on ‘quicker orthodontics’ continues to grow faster than the mandibles of Herbst believers. Fines and suspensions for advertising manufacturer’s claims- no patient harm involved. Lawyers are the new orthodontists. So far no mail order orthodontists have been caught/convicted. Oh…’FREE’ was a banned advertising term in this locale (Alberta, Canada) for a few years…professional misconduct- and ‘Quicker’ is a claim of superiority.
Similarly, there has been an unprecedented surge in interest from orthodontists/dentist regarding airway, breathing and sleep protocols.
Disclosure: Prof Dave Singh DMD PhD DDSc
Relationships with commercial interests: Founder, Director and Chief Medical Officer, Vivos Therapeutics, Inc., USA
Most of us are not and will not be in a position to make any significant difference using virtual techniques. We have to face it, we are in a nonessential, noncritical field that is very hands on. This is a double edged sword of course since it has kept us from having our work go offshore but the results ,in these times, is an inability to provide continuity of care for exactly the same reasons.
I recently attended the Moyers Symposium in Ann Arbor and there was a presentation of Carriere technique. One question was asked which I found the most important: “what if the patient is non compliant ?” The answer..” this technique is totally compliance dependent” .
I don’t know about others but the most difficult part of orthodontic practice (prior to our present Covid-19 issue) for me was compliance and, in my practice, the next bigger issue isn’t even in sight by comparison.
I think that if you already have been employing this technique and your demographics are amenable to compliance dependence you could partially and virtually stay open so to speak but as a technique to save your practice well, best of luck.
This ad for Carriere is no different than emails I’m getting from all the people who are “there for me” now in this crisis. Good or bad one must individually judge ,even if in poor taste and its possible effects and contribution exaggerated, if it is right for you.
I wish I could say that our profession is at a point where real evidence based practice carries the day but “it works in my hands” is the reality I’m afraid.
It is unfortunate to see Dr. Kevin O’Brien’s vitriolic orthodontic perspective, his bias and the distortion of the message I expressed in my webinar titled “Minimum Touch Orthodontics in Time of Pandemic” . Here is the actual link to the real and original webinar https://youtu.be/CLyLWcCVKBk
The objective has been to provide clinical information to my colleagues around the world during this unprecedented time for our profession.
I hope you all stay healthy and safe and maintaining social distance. All together we will win the battle to this virus.
The Real Person!
The Real Person!
Thanks for your comments. I will update the link. Can you let me know if the content of the webinar has changed? Can you also point me in the direction of high quality published research that supports the claims that you make about the shortened treatment times of the Motion and SLX bracket? This would be very helpful.
Let me please respectfully suggest you to do a Second Non-Biased Reading, in case this is possible, of the high quality research and scientifically impeccable article that University of Michigan and University of Florence published at the Angle Orthodontist Journal last November and titled:
Treatment effects of the Carriere® Motion 3D™ appliance for the correction of Class II malocclusion in adolescents
Angle Orthod (2019) 89 (6): 839–846.
https://doi.org/10.2319/121418-872.1
As a side, the treatment efficiency is always multifactorial, after the good and sounded diagnosis a clear, organized, simple, steady and predictable clinical approach cooperated with ultimate technology and goal oriented appliance designs will certainly boost treatment timings.
The Real Person!
The Real Person!
Thanks, I did a blog post about this paper and it can be found at https://kevinobrienorthoblog.com/carriere-appliance-does-work/
I did a careful review of this paper and I am not sure why you feel that my views were biased. The most compelling flaw with this study was that they excluded cases that took too long to finish Phase 1. That is they removed the cases that did not “do well”. In effect, they excluded 25% of the records. Do you really think that this was a scientifically impeccable study? Do you want to write a post for my blog explaining why you think that this was a good study?
Perhaps this new article in the Angle should also be considered. The CMA is no panacea or magic bullet and there is enough evidence regarding side effects.
https://meridian.allenpress.com/angle-orthodontist/article/doi/10.2319/080919-523.1/430027/The-Class-II-Carriere-Motion-appliance-A-3D-CBCT
The lack of diagnostic detail and consideration evident in the video is rather alarming and does not bode well for the specialty at any time. The suggestions in the video tend towards the belief that the CMA can even address TMD issues very simply. This is extremely alarming. Furthermore, it appears there is a dumbing down of what orthodontists do. This is rather perplexing for the future of the specialty. This opportunistic use of the pandemic to promote the CMA as “the latest and greatest that fixes everything” with scant respect for so many other issues is in extremely bad taste considering the reality