Motion and aligners: An interview with Dr Luis Carrière
Dr Luis Carrière is the inventor of both the Carriere SLX Self-Ligating Bracket System and the Carriere Motion 3D Appliance. He travels the world to teach at several universities and lecture at different congresses on these products and other orthodontic topics. In this interview during the second Congress of the European Aligner Society in Venice in Italy, Carrière shared his thoughts and visions with Dental Tribune Online.
Dr Carrière, I believe that to do something well one has to really like what one does, even be passionate about it. How did you start? Did you always want to become an orthodontist?
Basically, I am a curious individual. I am curious about everything and always have had a need to know how things are done. My father is an orthodontist and I’ve always admired him, not only professionally, but also as a human being and for the lessons he taught me about life. He has been my reference in life, my mentor and my friend. I wanted to be like my father and therefore wanted to be an orthodontist. Another integral part of me is a need to find solutions to problems, whether in orthodontics or other areas of my life. I try to find easier ways to do something. This is the reason I had this urge to conceptualise the Carriere Motion appliance, the Carriere Self-Ligating Bracket and all the things I have done in the orthodontic field.
So, you always knew because of your father that this was the path for you?
Yes, and when I finished my studies in 1994, the first project I did was the first virtual reality program that gave the ability to visualise orthodontic treatment. When computers were still offering 2-D, we had made virtual reality a possibility. It was a big technological step between the state of the art and what we were delivering at that time.
That is one of the problems with new products. Often, if one presents a new product that is too advanced, it can be a failure technologically speaking. Our virtual reality program was amazing because it gave one the ability to see all types of malocclusions in virtual reality, in real time, and how they were treated and to interact completely in 3-D. That was in 1995.
Why do you think it was not successful?
We did a CD-ROM and it won a special mention at the Milia d’Or, multimedia awards, in 1996, but as a product to use in orthodontics, people did not have the platform to really use it and it did not sell well. Technologically, computers were in 2-D and we were interactive in 3-D, so there was a big gap. Today, it would fit in fantastically.
Can clear aligner treatment be sped up, and if so, how?
We came up with the Motion appliance, which was my second project. It is a means of speeding up the process of orthodontic treatment, not only in brackets but also in aligners. What speedup means is that with the Motion appliance, without brackets, a Class II or a Class III case is converted to a Class I case. From Class I, any case is much easier to treat. The same happens with aligners. A patient with aligners is a premium patient, since looking for transparency and elegance, he or she wants a premium treatment, which means no brackets and a short treatment time. As you saw in my lecture, we do two plans in ClinCheck to compare a case treated with or without the Motion appliance, and in the past, we saw that the difference in the number of aligners that we do not need to use if we use the Motion appliance ranges between 50 and 70 per cent less.
In orthodontics, there are two ways of speeding up the process with aligners. One of them is using the aligners with devices that are used to speed up the process, such as AcceleDent, Propel and OrthoPulse. They are used so that one can switch the aligners in less time, but if one wants to use those devices and decides to start with the Motion appliance, it allows one to convert a complex case into a simple Class I case. Then, the number of aligners needed in the second stage will be very low. If the dentist uses these accelerated orthodontic modalities and needs to use aligners for a shorter period, the treatment will be ultrashort, the patient will be satisfied, the dentist will spend less time on the cases and everybody will be satisfied.
This means the Motion appliance helps reduce treatment time with these systems?
The Motion appliance is a simplifier of the process, making easier what would be a long and complex procedure.
You have a partnership with Henry Schein. What are the advantages of working with the company?
I had the opportunity to work with the company and they have been fantastic with the engineers they have been bringing on board, using the best of their knowledge and abilities in order to develop the best product. We have thus been expanding the Motion appliance range. For Class II cases, we have the conventional appliance, a clear one and coloured ones for trendy kids or patients who want something else, more fashionable. And next, we will be introducing a clear Carriere bracket, the new Carriere SLX 3D bracket, which we are presenting at the Orthodontic Excellence and Technology Symposium in Scottsdale in Arizona in the US from 22 to 24 February.
Is Sagittal First a way to diminish the complexity of certain malocclusions to be able to treat them with aligners?
Dr Edward Angle, the pioneer of orthodontics, classified molar relationships into three malocclusions, Class I, II and III. Class I is closing in normal relation, Class II is when there is a retrusive mandible or a projected maxilla, and Class III are cases with a prominent mandible and a small maxilla. These relationships highlight a sagittal condition and this is therefore the most important thing to change in orthodontic treatment. The Motion appliance is a re-classifier; with it, the dentist converts a Class II or III case into a Class I case. From there, everything is easier.
You now have a clear Motion appliance. Does it work exactly the same way as the metal one?
Mechanically speaking, it is exactly the same appliance; the only difference is the invisibility of the appliance. In fact, the Motion appliance in 2008 won the ADI-FAD Delta gold award, one of the most prestigious industrial design awards. It is shown in the permanent exhibition at the Design Museum of Barcelona.
During the congress, several presenters talked about the fact that orthodontics is not just about straightening teeth. What do you think about this?
Aligners are fantastic and a great modality to have in orthodontics. Patients are very happy to be treated with them. One of the problems though is that when we treat a virtual reality model everything seems to be possible, but the reality is different. When we apply this virtual reality to the patient, we are faced with what is really possible or not. The problem is that some dentists may think that, as the virtual model shows, the problem is a matter of straightening teeth. However, we have to think that those teeth that we see on the model belong to a human being as a whole, with a face, joints, an airway, and this has to be balanced. The teeth are not independent from the face. The form of the face is sculpted by the position of the teeth underneath. The soft tissue is not self-supported; its appearance is based on the position of the underlying hard tissue, and it is important to be careful in the way we manage the whole.
Sometimes a small change in the lower incisors can completely ruin a face because we can diminish the concavity of the supramental. This sulcus, on top of the chin, makes somebody attractive or not. So, these small things can change completely not only the face of the patient but also his or her capacity to be happy, his or her self-confidence. Therefore, we know that orthodontics is not just about straightening teeth; it is also about accomplishing good function between the maxilla and the mandible, creating a good occlusion, ensuring a good airway, etc.
So, you are saying that a patient could come to you for reasons other than straightening his or her teeth?
Yes, a patient could come to me because he or she is not attractive or perhaps because he or she has sleep apnoea. Sleep apnoea, for example, results in cardiovascular problems, problems that can be prevented by orthodontic treatment. In a Class II relationship, the mandible is brought back and in doing so narrows the airway. Changing the ratio of the maxima and the mandible can solve this problem or at least diminish it.
Orthodontics to me is one of the most interesting and wide specialities. It covers not only the dental problem, but the skeleton, the joints, the airway, the face, the soul, so trying to reduce it to having to do only with dentistry is to me a mistake. We need to make the patient aware of the fact that we, as orthodontists, can help him or her in many different ways.
Dr Carrière, thank you so much for your time.