Shifting compliance to create choices

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Dr. Ron Maddox discusses using the Carriere® Motion Appliance to create the perfect patient experience


From the first day that we enter in our respective graduate orthodontic programs, we possess a burning desire to learn everything we can about creating beautiful smiles. We study, research, and listen as our professors share their wealth of knowledge.

When we begin to apply these techniques clinically, we quickly realize that there is a major factor necessary to achieve the desired outcome: patient compliance. Without patient compliance, we learn that the best diagnosis and treatment planning will fall short of our desired outcome, especially when it involves bite correction. The most prevalent obstacle we will face is the correction of the Class II malocclusion. We learn many different techniques during our clinical training: headgear, elastics, intraoral springs, and a variety of functional appliances. We rarely have enough time during our residencies to fully understand the efficacy of each of these techniques. As we transition into private practice, we then must apply our knowledge and clinical experience to help our patients achieve the beautiful smiles that they desire.


One of the key lessons I’ve learned in private practice is keeping myself and my team focused on creating an exceptional patient experience. The way I stay focused is adhering to what I call the “3 C’s” — connection, commitment, and choices. We have all heard the famous quote from our professors and consultants, “Patients don’t care how much you know until they know how much you care.” We must focus on connecting with our patients and letting them know how deeply we care about them as individuals and how much we care about helping them achieve their oral health goals. “Commitment” is building the bridge of trust that gives our patients confidence that we will provide the best care for them. “Choices” is striving to give patients the best alternatives to reach their desired outcome. Quite frankly, over the years I have fallen short on providing choices. One becomes entrenched in the day-to-day operations of the practice and tends to streamline the choices in order to maintain efficiency.

Fortunately, a fellow colleague invited me to a study club meeting to listen to an orthodontist discuss the benefits of using the Carriere® Motion Appliance to correct Class II malocclusions. I tend to be skeptical about new techniques until I have seen the data and analyzed the clinical results. After listening to the first half-hour of the presentation, I realized that this would be an excellent way to provide new choices for my patients and greatly reduce my reliance on patient compliance at the end of treatment. One of the most important features about utilizing the Carriere Motion Appliance is that it shifted patient compliance to the beginning of treatment instead of the end when many patients are suffering from “burnout,” poor oral hygiene, or both.

From the outset I knew this would be a monumental change for my patients and my practice. I could enhance the ability to provide an exceptional  patient experience by providing my patients with more choices for tooth alignment. 

Carriere Motion Appliance

Utilization of the Carriere Motion Appliance in my practice was a very simple transition. Making treatment less complex for my patients has always been a key goal, and I strive to reduce the number of appointments for my patients while remaining laser-focused on achieving the optimal outcome. At the first appointment, I scan the lower arch, place separators for the molars, and measure the canine-to-molar distance to make sure that I have the perfect fit for the appliance. The patient is dismissed within 15 minutes and appointed for the cementation of the lingual arch and bonding of the appliance. By scanning the patient and uploading the file to our digital laboratory for fabrication of the lingual arch, we have omitted the extra appointment that is normally needed for fitting the bands, taking the impression, replacing the separators, and doing the lab work to send the model to the laboratory for fabrication. Eliminating these steps saves chair time, assistant time, and results in fewer appointments and discomfort for the patient. 

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When the patient returns, the lingual arch is cemented, and the pre-measured Carrier Motion Appliance is then bonded into place. Instructions for the elastic wear are reviewed with the patient and parent, and they are usually dismissed within 30 to 45 minutes. The following appointments are brief and require very little doctor time to assure that the patient is cooperating with the elastic wear and that the Class II correction is on track. Typically, I see the patient monthly to monitor his/her cooperation and progress. The normal treatment time is 3 to 5 months. Once the Class II correction is complete, I remove the appliance and the lingual arch, polish the teeth, and either bond the fixed appliances or scan for clear aligner fabrication. The transition into the tooth alignment stage is usually seamless based on the choices that were offered prior to the bite correction. The level of cooperation observed while correcting the bite is also a strong indicator of patient cooperation during treatment, which allows greater accuracy in predicting their estimated treatment time. Shifting compliance to the beginning of treatment when the patient is excited to start orthodontic treatment has drastically reduced issues with patient cooperation, reduced overall treatment time, and provided greater choices for the patients and parents on the method they may use to help achieve a beautiful smile.

Carriere Motion Appliance key advantages:

  • Efficient — Improves compliance and reduces overall treatment time
  • Effective — Corrects Class II malocclusion bilaterally or unilaterally
  • Discrete — Esthetically pleasing with a low profile design and is easy to clean
  • Fewer emergencies — No broken wires or springs
  • Enhanced choices — After bite correction, teeth may be aligned with clear aligners or braces


We all strive to be caring and committed orthodontists in our quest to create beautiful smiles, but providing alternative choices for our patients and their families greatly enhances our opportunity to provide an exceptional patient experience.

Shifting to the Carriere Motion Appliance has been one of the most significant treatment advances I have implemented over the past 5 years in my practice. Patients always desire to complete their treatment as quickly as possible, and with the Carriere Motion Appliance, I have been able to reduce the overall treatment time and significantly reduce the time that my patients are in clear aligners or braces. Most patients and parents comment on how little discomfort they experience and how surprised they are that it does not affect their speech while wearing the elastics. I have also seen much better oral hygiene than in patients with full fixed appliances. By shifting the time for the correction of the Class II malocclusion to the beginning of treatment, I have much happier patients that spend less time in treatment and that are much more willing to share their positive experience with their friends and co-workers.

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