Welcome to The Golden Age of Orthodontics, the podcast for orthodontic professionals eager to stay at the forefront of innovation and patient care. Today, hosts Dr. Leon Klempner and Amy Epstein are joined by the esteemed Dr. Luis Carriere, member of the Editorial Review Board for the American Journal of Orthodontics and Dentofacial Orthopedics (AJODO) and contributing editor of the Journal of Clinical Orthodontics (JCO). Dr. Carriere will share his expertise on improving patient and parent communication, particularly with young patients, to foster a sense of responsibility in their orthodontic journey. This approach boosts compliance and eases anxiety, transforming the patient experience. Plus, we'll dive into the mechanics and advantages of the motion appliance, including its role in dental alveolar movement and its long-term impact on growth. Get ready to explore practical tips, insights on the latest orthodontic tools, and a vision of future innovations—because there has never been a better time to be an orthodontist.

IN THIS EPISODE: 

• [2:50] Dr. Luis Carriere explains his approach to talking to young patients about their orthodontic journey
• [10:23] The importance of treatment plans that engage young patients and improve their cooperation
• [18:03] How to attract other patients to your practice by communication
• [22:31] A deep dive into the motion appliance: its function and focus on dental alveolar changes rather than skeletal modification
• [33:19] Dr. Carriere shares his insights on the future innovations

KEY TAKEAWAYS: 

• Encourage young patients to take responsibility for their orthodontic treatment by treating them as young adults. Understanding the "why" behind their role enhances cooperation
• Educational tools and proactive communication build trust and establish credibility with patients and families, making your practice a trusted authority
• The motion appliance primarily works through dental alveolar movements, creating a stable environment for growth in the correct sagittal and anterior direction, thus promoting long-term effectiveness

RESOURCE LINKS

People + Practice  - Website 

Dr. Leon's - Email

Amy Epstein's - Email

People + Practice - Email

Carriere System - Website

Dr. Luis Carriere - Facebook

Dr. Luis Carriere - LinkedIn

BIOGRAPHY:   Luis Carriere DDS. MSD. PhD.

Dr. Luis Carrière obtained his dental degree from the University of Complutense in Madrid in 1991. He then attended the University of Barcelona, where he completed his Orthodontic training and received his Master of Science in Orthodontics in 1994. In 2006, he received his Doctorate in Orthodontics, Cum Laude, from the University of Barcelona.

Dr. Carrière won the “Joseph E. Johnson Award” in 1995 and the International Design Award Delta Gold ADI-FAD 2009 for the “Carriere Distalizer MB.” Dr. Carrière is a Member of the Editorial Review Board for the American Journal of Orthodontics and Dentofacial Orthopedics (AJODO) and a contributing editor of the Journal of Clinical Orthodontics (JCO). 

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How will digital orthodontics, artificial intelligence, clear aligner therapy, remote monitoring, in house printing, and more. And other innovations change the way you practice. Join your host, Dr. Leon Klempner and Amy Epstein each month as they bring you insights, tips, and guest interviews focused on helping you capitalize on the opportunities for practice growth.

And now welcome to the Golden Age of Orthodontics with the co-founders of people and practice, Dr. Leon Klempner and Amy Epstein.

Dr. Leon Klempner: Welcome to the Golden Age of Orthodontics. I'm Leon Klempner, retired board certified orthodontist. Director of orthodontics, Mount Sinai hospital, part time faculty at Harvard.

Amy Epstein: hello, good to see everyone happy to be here. I'm Amy Epstein. I have 20 years of marketing and public relations experience working with large brands and brand development, logo development, brand identity, development, public relations, um, and then bringing all that in partnership with my dad to orthodontist so that they can better position them in the markets that themselves in the markets that they serve to be able to, Articulate what makes them different from other practitioners in their area, why patients should come to see them.

He then attended the University of Barcelona, where he completed his orthodontic training and received his Master of Science. In orthodontics in 1994 and then his doctorate in orthodontics cum laude from the University of Barcelona. Dr. Carrier was the winner of the Joseph E. Johnson Award in 1995 and the International Design Award Delta Gold for the Carrier Distallizer, which I think many of our listeners have used.

Does it this, does it that? And, you know, most of the time I say, Talk to grandpa and he'll have a look and tell you when it's time or, or whether it's going to hurt. But, you know, what part of what we'll talk about with Dr. Carrier today, I think is, you know, how to communicate to parents and, and, uh, patients themselves when they're children about how they can participate in their own orthodontic journey and how that changes compliance and, uh, changes anxiety levels and all of that.

Um, so dad, she's going to be. Peppering you with some questions the next time you're here. I'm just warning you. She's

Uh, reaching out to some of the Facebook, uh, groups before getting on this podcast to get some input from the community in terms of. Any concerns or, or anything they'd like me to talk about. And one of the topics had to do with cooperation and, you know, while Maya is, we would expect her to be compliant.

Luis Carriere DDS. MSD. PhD.: First of all, uh, Leon, uh, Amy, it's a pleasure. It's an absolute pleasure to be in your podcast. I have been following you many years. You were doing a great, great, uh, interviews with Oscar podcast. So I have been very much entertained and learning a lot on many, many, many interviews that you have done in the past and a waiting.

I mean, uh, and class two Occlusion is a patient that your son or daughter.

Amy Epstein: Exactly. Maya,

Luis Carriere DDS. MSD. PhD.: Maya. Sorry about that. So, but, uh, your daughter is, uh, uh, that these class two, uh, normally, uh, what I talk when I talk with them, when I talk with them and I go one after the other, and then I will. Focus on the, on the, on the cooperation.

So they understand and they want to be a part of it. This is very important. And secondly, uh, we, I like to talk about the importance and if you want, we can later, uh, brainstorm a little bit deeper on that, but a brainstorm about the importance of the orthodontics in life, uh, Why? Because I always tell them, you look, you now, you are a kid, you are a baby, you are a girl, you are a boy and you look very fancy with your tooth coming out here in front and it's fun and you look so cute and very nice.

In this moment of life that everything will be much easier, but we need, we need, We will give you a treatment that will be very small, very simple, very minimalistic, but has only one element that needs cooperation, like a car that is a beautiful car needs gasoline. To be working, this is an authentic appliance that needs its gasoline to work, which means that it's the last.

absorbing the information of the orthodontist, and the patient was not supposed to ask many questions. But today, uh, we change. The patients are used to answers. Answers in their telephones, answers in their, uh, everywhere. So they need to have information. So, I think the era [00:11:00] of having patients just accepting the prescription of the orthodontist without having any kind of Comment or question or too many questions, uh, is not, is not correct.

Now, we need to explain properly and explain properly what we need, which is the treatment action, which is, what is what we expect. to accomplish, the timings in which we pretend to accomplish and the targets and the steps to follow to the end. So once we explain everything properly to a young kid, it's super easy to have their cooperation.

They don't understand which will be the benefit for them. They don't understand anything. So well, they will never comply with you. So I think that argumentation, that good communication with the patient, the parents, the doctors, are spectators of the conversation, but the one is the patient. So, uh, again, instead of talking with the parents, we have to focus on the patient as a small adult that we are giving them the, Hey, here is the trophy of the being for the first time in your life and a small adult.[00:13:00]

Dr. Leon Klempner: Yeah, it makes a whole lot of sense. And, uh, you know, and I understand the frustration that many of my colleagues have about Uh, treating with appliances that require a cooperation because it depending on, you know, the communication styles and the skill sets of the orthodontist, they may not have, you know, uh, as compassionate a, a communication approaches you do, Luis, for example, you know, in my experience, it doesn't have to be the orthodontist that does the explanation.

So that that's worked well for me and I'm pretty good communicator, but there was some kids I just wasn't getting through to, but. Somebody on my staff was able to get through. I've also found, and I'm curious, uh, uh, uh, your opinion, Luis, is that the younger patients are much more compliant than the older patients.

Uh, the young ones tend to want to please, you know, so for Maya, for example, I think she'll want to make the orthodontist happy. Um, I think that, you know, that, that, you know, in her instance and in other, other kids, typically, I did a lot of early treatment in my practice. Those kids typically, you know, want to go on the ride with you if you make it playful and make sure it doesn't hurt, obviously, uh, they'll, they'll, they'll go with you.

What's your go to appliance or what do you do next?

Luis Carriere DDS. MSD. PhD.: Yeah, normally, uh, I am, uh, very persuasive. What this means, what this means that, uh, I might, They just take more time, but they keep, they end up cooperating. Uh, I have been, I have had patients over one year with emotion without cooperation. And then suddenly they click and they They kill it in three months.

So I removed the appliance and I said, Hey, you know what? We will take in another moment when you are ready, we are going to, uh, treat you in, in, in the future. Okay? So this has been the story of this appliance. At the end, it's an appliance that has been simplified so much the, uh, the, the treatment. And I, uh, uh, I look forward, uh, having, uh, long term stability results, but I never will go, for instance, for extractions in cases that, that, uh, I, I, I wanted to solve it, uh, without the [00:17:00] need of, uh, removing to upper bicuspids, and then I ended up removing to upper bicuspids because then what you do is to reduce volumetrically The three dimensions, the maxilla, and this is affecting negatively on the final profile of the patient.

So, uh, this, I prefer to stop and, and, and, and, and go back.

Dr. Leon Klempner: Okay. Understood.

Um, to the practice,

Luis Carriere DDS. MSD. PhD.: you know, Amy, uh, one of the things that I use, I have done many videos, uh, and animations of the treatments from the beginning to the end, step by step. And they are super useful to show them to the patient, to show them to the, uh, to the parents for both, uh, for the first appointment and after.

Also, I send them by, uh, airdrop or by, uh, any other way for, uh, by WhatsApp or whatever the, what they use, I send them to their phones in order to have, they have the treatment protocol and explain very clearly the steps that we are going to follow. And this is very important. Uh, I have seen that talking and explaining save a lot of time to the orthodontist.

And this has been my experience at this point.

When it comes down to it, and even when we help our practices advertise to communities to bring in more patients, it's all about education and communication. Because when you explain things, that's when the people understand that they have fewer questions. They're made more comfortable. They, they can see you as someone who is an authority on what you're talking about in all of that lens credibility.

Uh, and authenticity to your practice and makes people want to come to see you.

Luis Carriere DDS. MSD. PhD.: Absolutely. Amy, you're coming from the marketing and communication is all about sending the message. Do you imagine sending a message without communication?

Luis Carriere DDS. MSD. PhD.: Well, it's trying to make my life easier and brainstorm what I would like as a patient, and that's it.

Dr. Leon Klempner: So, Luis, I am interested in your views of aligners and some of the appliances that you're using in your own practice in conjunction with the motion appliance. But I want to just circle back into another issue that I see coming up from.

Are we, are we treating a skeletal problem or, or is the correction primarily dental alveolar? So I wonder if you could just clear it up for the audience, cause I know that, that it comes up and, and I haven't really seen a lot of advertising that, that, uh, promotes skeletal changes with, with the motion appliance, but maybe you have a different view.

Okay. So, uh, by, uh, the motion appliance, um, when I conceptualize motion appliance, I was very much, uh, deeply studying long term stability. Long term stability, and which was the key for having a good occlusion of molars, uh, for the years to come and having, uh, the canines and pre molar occlusion for the, for many years in class one.

Okay? So, uh, what I did is to go to the Mother Nature and imitate what Mother Nature, what was, had created. What I did is to imitate the coxofemoral joint. The coxofemoral joint that was with this. Uh, ball and socket to rotate and upright. I needed to upright because Moller's, uh, Henry did a beautiful article studying thousands of malocclusions, and he saw in 1954 in American Journal of Orthodontics, and he saw that, uh, The 83 percent of our malocclusions, they have excessively majorly inclined molars, majorly inclined molars, and majorly rotated molars.

easily in a short run. So upwriting is super important. This is why I did the motion appliance side specific. Okay. So biomechanically speaking is, uh, is that motion appliance is to rotate the molars, upright the molars, move the posterior segments, uh, as a block to accomplish class one at the beginning of the drilling.

Why is it universal? Why they did it universal? Because they don't know what is the thinking behind, what is the thinking behind, of biomechanics. When I conceptualize the motion and they just simplified by copying without, without knowing what was the biomechanicals behind, probably engineers. Now, what is this about?

An incorrect positioning of the disc. The disc is shifted forward. There is a beautiful article of a Swedish group, uh, that, uh, they studied MRIs of class 2s and class 3s, and they saw that the discs were shifted forward, and the condyle was back and up. So the motion of lines is changing the occlusal plane, changing the occlusal plane.

By changing the occlusal plane, helps into the distraction of the condyle from the deepest part of the fossa. And this distraction, this This, uh, distraction, this dislocation of this condom from the deepest part of the fossa helps into a spontaneous reposition of the disc and a spontaneous reposition of the mandible fold.

Okay? So, uh, when you, uh, start with a retruded mandible, you accomplish an adequate position of the mandible, but this is not going to be growth. It's going to be a reestablishment of the function and the relation in between the maxilla And amazingly, this is going to be super stable because today, one of my, my courses is all about long term stability.

And before you were telling me the, uh, about, I am pointing out a little bit on the different questions that you have been, uh, Placing because, um, going back and forth, but you were saying, well, some of my colleagues are concerned about these, these appliance. If these is going to do big cooperation. Well, this appliance is appliance that is the fastest appliance to accomplish the correction of the malocclusion.

And there is something in common of the overall, uh, Okay. Already hundreds of case of articles published on the motion appliance. Today, there is a little big evidence based behind published American Journal published in the angle journal angle, orthodontist at the J. C. O. and several other journals that has been published today and all of them.

Dr. Leon Klempner: So yeah, so just, just to wrap it up and just to be clear, where other than, Uh, some possible repositioning of the mandible if the, if it's retreated. Uh, other than that, we're primarily talking about dental alveolar changes, the teeth moving through the bone, um, in segments, we're not, uh, growing a mandible.

We're not, uh, preventing growth in a class three, uh, we're, we're primarily doing dental alveolar movements. Is that a fair assumption?

This is locking everything in class one in this new anterior posterior relation of the mandible forward in relation to the maxilla. In the maxilla, and then the growth that is going to come is going to come in the adequate direction, will redirect the growth into the direction of this new stable scenario, sagittal and anterior position of the manual sagittal correction that is stable and this, the growth is going into this direction.

Okay, so, uh, this. What we are talking when we are seeing articles about mandible growth of herbs, appliances, or this, their growth is about millimeter, millimeter and a half, two millimeters, two millimeters. They don't make the difference in a mandible position. They don't make the difference. You cannot see two millimeters change.

This is why we are giving an absolute nice alternative to surgery in class three cases. And this is something that I would like to brainstorm a little bit if we have time.

Dr. Leon Klempner: Well, we'll, we'll, we'll definitely have to schedule another podcast. Time goes by, uh, so quickly. Um, but Amy, I know you had something that you wanted to bring up.

We have the AIO coming up again in late April, I think this year. Um, we'll be giving some talks there and I am sure you are always doing lecture around the world. I'm sure you're going to be giving a talk there too. Tell us a little bit about what we can look to expect.

Luis Carriere DDS. MSD. PhD.: Yeah. Well now, uh, I think I am in a moment in which I am, uh, a little bit more creative.

Uh, there are moments in life, no. And, and, uh, now I'm, I'm working, uh, a lot on how to diminish the number of appointments. What do we call Minimal touch, orthodontic. And, uh, what we want is to, uh, make life easy for our patients. And, uh, this unit, an appliance. For like the motion, for instance, that helps you and you position it and you remove it.

Well, we have the carrier SX bracket that is a passive ultra, ultra, uh, uh, efficient in terms of, uh, uh, of rotation because is a full size slot covering with the sliding door and this, and with the three wire sequence. And this is giving us the possibility. The possibility of diminishing the number of appointments because we squeeze the capacity of the wires to accomplish.

Uh, it was something was ruining all the project of the minimum touch orthodontics. What was that? The elastic chain, the elastic chain that we place, uh, elastics to close, uh, uh, certain spaces in between incisors. And then suddenly you place the elastic chain and this chain is losing power and it gets dead.

And then you need to change it, change it, change it. It means several appointments to change an elastic chain because it is not closing as you expect because they it's suffering what it's called a creeping the generation of the properties because there is pressure, moisture and temperature. So I said, hey, we need to figure out something.

This infinity loop has a memory shape and closes the spaces in one step. Now this, this means that, uh, uh, it's, Completely, it's completely, um, uh, it's completely eliminating the number of appointments in between. And amazingly, as it has memory of shape, the appliance, once has the gaps or the spaces closed, gets totally passive because has the original form.

ligatures, substituting the elastic rings by elastic nightly ligatures. This is the next project. And then I have also, uh, that an appliance that this year also I am pleased I am coming with this innovation, but it's not, it was not going to be yet in the market, but it will be, I will be. Talking about that, this is a premier, uh, that is going to be, uh, cat, uh, temporary, temporary anchorage device, but how with [00:38:00] an active abutment and the abutment will be of night time.

So now the one doing the job. Obtraction will be the active abutment of the temporary anchorage device. Instead of having the anchorage device as a passive receiver of an elastic, elastic chain, that is going to be super, uh, um, uh, inefficient. Now we can just then reposition the tip. Of this, uh, temporary correct device and this will bank move everything, uh, with the memory of shape again.

If our listeners would like to learn more or ask you a question or have a follow up, how might they be able to reach you?

Luis Carriere DDS. MSD. PhD.: Well, uh, well, there is a lot of information at career system. com career system. com and this is, uh, very much information and, uh, also in my website. Uh, at career you have more information.

Amy Epstein: Okay.

That's very helpful. We'll go ahead and we'll share that link when we post this, um, podcast live. again for joining us today and we'd love to have you back and we look forward to seeing you soon.

Luis Carriere DDS. MSD. PhD.: Thanks. Thank you. It's a pleasure, an honor, and looking forward to your next, next podcasts that I'm thirsty of it, of them.

Amy Epstein: We're glad to hear it. And you know, for, for you and for all of our listeners that enjoy this episode and are also looking forward to other episodes, you can download them or subscribe to the golden age of orthodontics on Apple podcasts, on Spotify. SoundCloud, YouTube, or wherever you get your podcasts.

And there's this little chat at the bottom. If you. Type in your, say a little message or whatever. It actually goes right over to my dad's cell phone and he'll, he'll write back to you there. I'll text you right back. So thanks everyone for watching and listening.

Dr. Leon Klempner: So, uh, someday I want to be as smooth as Luis in terms of, uh,

Amy Epstein: you have

Dr. Leon Klempner: communication.

I mean, I don't know how, I don't know how, uh, how you get any sleep. Do you, do you sleep at all? Yeah, I'll tell you

Luis Carriere DDS. MSD. PhD.: something. I am very bad sleeper. This is one of my issues. I

Dr. Leon Klempner: have long nights, very long ones. All right. Well, that's probably where the, uh, innovation and ingenuity comes into play. So, so I want to thank everybody for watching and listening.

So, we are in the Golden Age, and we'd like you to take advantage of it. So until next time, see ya.

Narrator: Thank you for tuning in to the Golden Age of Orthodontics. Subscribe now on Apple Podcasts, Spotify, or visit our website at thegoldenageoforthodontics. com for direct links to both the audio and video versions of this episode.