Dr. Luis Carriere is the inventor of the Carriere 3D motion appliance. At various times it has been referred to as a Carriere Appliance, Carriere 3D Appliance, Carriere Motion Appliance, 3D Motion Appliance or just a Motion Appliance. Most people refer to it as a Carriere Appliance or a Motion Appliance. In this Blog, we will refer to it as a Motion Appliance, but want to give Dr. Carriere credit and respect for his invention. When the motion appliance was introduced to orthodontics, it brought with it a shift in philosophy and the way treatment is approached. Traditionally, treatment began with straightening the teeth and getting them all on the same level, then once that was complete, the overbite would be corrected. With the Motion Appliance, that protocol gets reversed and the bite/overbite is corrected first, then the front teeth are straightened and leveled.
A majority of the time, the most difficult and time consuming part of orthodontic treatment is fixing the bite. Braces and aligners can be very efficient and effective at straightening the teeth, and this can happen relatively quickly. However, the braces and aligners are not capable of correcting the bite on their own. The orthodontist can straighten the teeth, but the patient has to fix the bite. The bite is fixed by wearing elastics, or rubber bands. If the patient is very good about wearing the elastics constantly and consistently, the bite will correct with consistent progress and in a short period of time. If the elastics are worn sporadically, inconsistently, or not in the manner prescribed, little to no progress is made, treatment time is extended, and the risks of white spotting, gum disease, and root resorption all increase. Nothing good comes from wasting time during treatment, and poor elastic wear is the most common cause of overly extended treatment times.
By turning treatment protocols upside down and getting the bite fixed first, the hardest and most time consuming part of treatment is completed first thing while the patient is fresh and ready to go, and compliance is at its’ best. Another advantage to this protocol is that brushing and flossing the teeth is much easier with the Motion Appliance and a clear removable retainer. It allows the patients to get used to brushing with orthodontic appliances in the mouth, but without the same time and effort it takes to meticulously clean a full mouth of braces. The transition from cleaning the Motion Appliance to full braces is straight forward and more intuitive.
Most patients have an excessive overbite. Only a few patients have an underbite, but there are Motion Appliances specifically made to fix both overbite and underbite. Since overbite is by far the most common, only the overbite correcting Motion Appliance will be discussed in the Blog. When the upper front teeth protrude ahead of the lower front teeth, people call this an overbite. Many things can cause an overbite. Both genetics and environmental factors influence facial and dental development. One of the strong influencers that is often ignored is mouth breathing. If the patient is unable to breathe through their nose due to allergies, or other issues, the mouth breathing habit can detrimentally affect facial growth and jaw relations. A compromised airway can be very detrimental to overall health, growth, and development. Facial growth and development is extremely complicated, and there is still much to learn in this area of health and medicine.
The Motion Appliance corrects the excessive overbite by stabilizing the lower teeth and using them as an anchor point for elastics which will move the upper side teeth back and encourage the lower jaw to posture forward if it is held back. The Motion Appliance is fabricated with a hinge at the molar. This important design feature is what really allows the upper molars to move backwards effectively. As the molars rotate rearward, the bite corrects, and they take up less space in the jaw which allows the other teeth to move into a proper bite relationship. As the bite corrects, the spaces created by the backward rotation of the molars and the migration of the other teeth involved with the Motion Appliance, move to the front of the mouth. Once the Motion Appliance has completed the bite correction and spaces have moved to the front of the mouth, the Motion Appliance can be removed and braces started.
The Motion Appliance is removed and braces placed at the same visit. The elastics that were worn with the motion appliance to correct the bite need to be continued with the braces, although lighter forces from the elastics may be indicated. The elastics will support the bite correction achieved with the Motion Appliance, and good constant wear is crucial to maintaining the bite correction. Teeth always want to move the wrong direction faster and easier than in the desired direction, so don’t slack off on great elastic wear!
With spaces close to the front teeth, they can be straightened and pulled back to get rid of the excess overbite. If the bite correction has been made with the Motion Appliance, and the correction successful held in place, the bite on the sides should mesh like teeth on gears with the top tooth just behind the corresponding bottom tooth. If the bite is correct, once all the front teeth are straight and all the spaces are closed, the overbite should be fixed and the front teeth should have a normal minimal amount of overbite and overlap.
Some people have been given the erroneous impression that the front teeth should not have any overbite and should meet by hitting on the edges of the lower front teeth. If an edge-to-edge bite were established, it would lead to excessive wear of the front teeth, as they are not made to carry the weight of the bite and function. This is the job of the back teeth. That type of bite also carries with it a significant risk of causing the front teeth to chip or crack. The front teeth are supposed to guide the bite and protect the back teeth from hitting in an awkward manner. In order for them to accomplish this, they need to have some overbite as well as some overlap. The normal ideal is to have the upper front teeth overlap about 10-35% of the lower front teeth. There should be minimal visible overbite at the edges of the upper front teeth, and the front teeth should have minimal light contact when biting. Although there are other factors that affect the visible overbite, the amount of visible overbite is primarily dependent upon the amount of overlap of the front teeth. The more the front teeth overlap, the greater the overbite becomes. With a normal overlap of 10-35% there is usually about 2mm to 3mm of visible overbite.
The Motion Appliance treatment philosophy has become much more popular for several reasons. By fixing the bite and making space to fix the overbite as the first thing accomplished in treatment, it not only turns the typical practice protocols upside down, it has several favorable consequences. One of the best findings is that treatment time can be reduced significantly. It is estimated that treatment is reduced by an average of 6 months compared to traditional treatment. Some of this can be attributed to the improved patient compliance with elastic wear. It’s easier to wear elastics early in treatment, and the more constant and consistent elastic wear pays huge dividends. Getting the bite fixed earlier, faster, and easier in treatment is a win for everyone! The motion Appliance is one of many technological advancements in the world of orthodontics that makes treatment better for the patients and helps keep the cost of treatment favorable for everyone.