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BIONATOR
LOGO AJITHESH KV
2. Contents
1 Introduction
2 History
3 Treatment objectives
4 Types of bionator
5 Trimming of bionator
6 Clinical management
7 Modifications of Bionator
8 References
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3. INTRODUCTION
FUNCTIONAL APPLIANCE
Definition
Is one that changes the posture of the mandible,
holding it open or open and forward (proffit)
Graber and Neumann Classification
Those that displace the mandible to a moderate
degree and are intended to stimulate muscle
activity i.e. myodynamic – Bionator
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5. HISTORY
Norman Kingsley 1879 Vulcanite palatal plate
Pierre Robin 1902 Monobloc
Viggo Andresen 1908 Activator
Wilhelm Balter 1960 Bionator
Rolf Frankel 1967 FR
William Clark 1977 Twin block
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6. PRINCIPLE OF BIONATOR
Less bulky than activator
The essential part of robin’s concept is
function whereas for Balter’s it is the tongue
(which is the center of reflex activity in the oral cavity)
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7. Balter Quotes
The equilibrium b/w the tongue and cheeks,
especially b/w the tongue and lips in height, breadth
and depth in an oral space of maximum size and
optimal limits, providing functional space for the
tongue ,is essential for the natural health of the
dental arches and their relation to each other Every
disturbance will deform the dentition and during
growth that may be impeded too.
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8. Treatment objectives
Enlarge oral space &
train tongue functions
Bring incisors into
Accomplish lip seal
edge to edge
& bring dorsum
relationship
of tongue into
contact with soft To achieve
palate elongation of
mandible
Improve relationships
of jaws, tongue &
teeth
It works by modulating muscle activity
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9. Advantages
Reduced size
It can be worn both day and night
Action faster than activator –unfavorable forces
are avoided acting on dentition for longer time
Constant wear so more rapid adjustment of
musculature
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10. Disadvantage
Difficulty in managing it.
Difficult to stabilize and selective grinding of the
appliance .
It is vulnerable to distortion – because less
support in the alveolar & incisal region
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11. INDICATIONS
Dental arches well aligned
Mandible in posterior position
Skeletal discrepancy not severe
Labial tipping of upper incisors evident
Deep bite with accentuated c.o.s
Class III where reverse bionator can be used
Open bite
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12. CONTRAINDICATIONS
Class II – if caused by max prognathism
Vertical growth pattern
Labial tipping of mandibular incisors
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13.
14. TYPES OF BIONATOR
1. THE STANDARD BIONATOR
2. THE OPEN BITE BIONATOR
3. CI III OR REVERSED BIONATOR
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15. THE STANDARD APPLIANCE
Consists of
acrylic components
- lower horse shoe shaped
acrylic lingual plate from distal
of last erupted molar of one
side to other side
- Upper arch - lingual
extension that cover molar &
premolar region
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16. WIRE COMPONENTS
PALATAL BAR
LABIAL BOW WITH BUCCAL EXTENSION
PALATAL BAR
- 1.2 mm wire
- extents from a line connecting distal
surface of first permanent molars to
middle of 1st premolar’s
- ~ 1mm away from palatal mucosa
Function- orients the tongue & mandible
anteriorly by stimulating its dorsal surface
with palatal bar
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17. WIRE COMPONENTS
LABIAL BOW
-0.9 mm wire
- begins above contact point between canine and
upper 1st premolar –runs vertically
- labial portion of bow should be at a paper thickness
away from the incisors
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18. WIRE COMPONENTS
Anterior part - labial wire
Lateral part - buccinator bends
Objectives of buccinator bends
To keep soft tissue away from the cheeks –so the
bite is leveled & eruption proceed in buccal segment
Moves cheeks laterally , which favor expansion or
transverse development of dentition
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19. OPEN – BITE APPLIANCE
Purpose of this appliance is to
close the anterior space
Acrylic part-
The lower lingual part extends
into the upper incisor region as a
lingual shield , closing the anterior
space without touching the upper teeth
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20. Wire elements
Labial bow runs between the upper and
lower incisors at the height of lip
closure.
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21. REVERSED BIONATOR
Encourage development of max
Bite opened 2mm for this
purpose
Acrylic portion
Extends incisally from canine to
canine behind the upper incisors
Acrylic is trimmed away by 1mm
behind the lower incisors
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22. Palatal bar
Runs forward with loop extending as
far as dec 1st m or pm
Function – tongue to contact
anterior portion of palate ,
encouraging forward growth of this
area.
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23. Labial bow
In front of lower incisors
Wire slightly touches the labial surface
lightly / it is at a paper thickness away
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24. CONSTRUCTION BITE
Objective
To achieve a cIass I relation
Edge to edge relation of incisors – to
provide maximum functional space for
tongue
If overjet is too large – step by step
procedure is followed
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25. Construction bite
In Open Bite Bionator
Construction bite-is as low as possible with a
slight opening for interposition of posterior
bite blocks to prevent their eruption.
In Reverse Bionator
Construction bite- taken in more retruded
position so as to allow labial movement of
maxillary incisors &also to exert restrictive
force on lower arch
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26. Following points to be considered
(JCO 1985, Altuna& Niegel)
Horizontal plane
Advancing about one premolar width is tolerable
Profile should be esthetically pleasing
lateral plane
Condyles on both sides move symmetrically.
Midlines used as reference lines
Vertical plane
2-3 mm opening between C.I
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27. TRIMMING OF BIONATOR
As the volume of the appliance is reduced its
anchorage is difficult and trimming must be selective
because of simultaneous anchorage requirements
Balters has introduced certain terms
1.Articular plane
2.Loading area
3.Tooth bed
4.Nose
5. ledge
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28. ARTICULAR PLANE:
This plane extends from the
tips of the cusps of the upper
1st molars,premolars &
canines to the mesial
margins of the central
incisors , running parallel to
the ala-tragal line.
Used to assess the mode of
trimming
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29. LOADING AREA:
Palatal or lingual cusps
of the deciduous molars
(or premolars) are
relieved in the acrylic
part of the appliance.
The grinding enhances
the anchorage of the
appliance.
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30. TOOTH BED
Some parts of the
loading areas are
trimmed away to the
articular plane
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31. NOSE:
Between tooth bed
interdental acrylic
fingerlike projections
They serve as guiding
surfaces and provide
anchorage in the
sagittal and vertical
plane
NOSE mostly on the
mesial margin of lower
1st permanent molar
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32. LEDGE :
Depending on the tooth
movement required the
acrylic is trimmed and the
nose is reduced .
This reduced extension
placed only on the occlusal
3rd of the interdental area
is called a ledge.
LEDGES are b/w premolars
or deciduous molars
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33. BALTERS REFERS
prevention of eruption as loading
or inhibition of growth
stimulation of eruption as
unloading or promotion of growth
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34. Appliance can be trimmed until teeth reaches desired
Due to consideration for anchorage, appliance cannot
Periodic loading and unloading of same area done
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35. Ascher (1968)proposal
Deciduous teeth if present are used as anchorage
and Ascher (1968)proposed the following types of
anchorage.
Dentition Anchorage
1,2,III-V,6 IV & V both U / L
1,2,III-V,6 V & space after IV
1,2,II-6 alveolar process-IV,V
1,2,III,4-6 6 & alveolar process
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36. ANCHORAGE OF APPLIANCE
1. Acrylic cap over incisal margins of lower incisors
2. Loading areas as cusps of teeth fit into respective
grooves in acrylic
3. Deciduous molars are used as anchor teeth
4. Edentulous areas after early loss of primary
molars
5. Noses in the upper & lower interdental spaces
6. Labial bow prevents posterior displacement
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37. SELECTIVE TRIMMING
For extrusion of posterior teeth
Acrylic left between level of Articular plane –Tooth bed
Upper &lower molars trimmed first
Then lower premolar’s trimmed while molars loaded
Then upper premolar’s unloaded while lower premolar’s
&molars loaded
Occlusal surfaces of bionator trimmed for transverse movt
For intrusion in case of open bite –posterior teeth
are fully loaded
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38. CLINICAL MANAGEMENT
Appliance must be worn day and night except while
eating.
Pt recalled after 1 wk to check sore points
Interval b/w visits 3-5 weeks based on the eruption of
the teeth.
It takes 1- 11/2 yrs to achieve correction
Labial bow away from the incisors.
Buccinator loops away from 1st & 2nd molars, should
not irritate mucosa.
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39. Bionator and TMJ
Can be used for treating TMJ problems in adults
TMJ problems have coincident bruxism and
clenching during sleep.
The bionator relaxes the muscle spasm at LPM.
It prevents riding of the condyle over the posterior
edge of the disk which causes clicking.
Bionator positions the mand forward so prevents the
deleterious effects at night
Bionator & local heat application with muscle
relaxants provides immediate relief for patients
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40. Bionator in Adult Patients
Petrovic has shown that protracted wear in adults can
permanently shorten the LPM and thus help the
patient maintain a protracted mandibular posture
even during the day time
Thus clicking sound and pain disappears
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42. Modification by Williamson &Hamilton
3mm cover for max inc from L.I to L.I
This is to secure the position of max inc
This modification made from construction bite
This also prevents tipping of lower incisors
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43. Modification by Schmuth
Cybernator
Normal labial bow in the
max arch – from canine to
canine
Mand incisors covered
with thin 2mm acrylic
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44. BIO- M-S
BY ERICH & ANNETTE FLEISHER
MODIFICATIONS ARE-
Acrylic body reduced in size
Instead of long labial bow –
Maxillary buccolabial arch wire and
mand labial arch wire
Transpalatal bar opens in distal direction as in CI III
bionator
Wire spurs used to reinforce anchorage
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47. Orthopedic corrector I
WITZIG incorporated 2dimentional screws bilaterally to Schmuth’s bionator.
INDICATION
Cl II to cl I
Excellent result in
skeletal cl II cases
Mixed dentition or
permanent dentition
treatment
Upper incisors contact
lower incisor acrylic
capping
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48. Orthopedic corrector II
Correct Cl II to cl I without
vertical growth
in mixed dentition
Correct open bite
enlarges dental arches in
case of crowding
In mixed dentition –TMJ pain
patients – repositions
mandible without increasing
vertical height
To achieve forward growth of
mandible in open bite
tendency cases
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49. California bionator
This type bionator helps in
eruption of post teeth in
patients with decreased
vertical dimension
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51. COMBINATION OF BIONATOR AND HIGH PULL HEAD GEAR
Luciane closs, & Valmy Pangrazio ( A J O – 1996 )
THEY ARE USED IN CLASS II SKELETAL MALOCCLUSIONS
CHARACTERISED BY SLIGHT MANDIBULAR DEFICIENCY,
TIPPED UP PALATAL PLANE , ANTERIOR OPEN BITE AND
A VERTICAL GROWTH PATTERN.
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52. Skeletal and dento-alveolar effects of twin block
and bionator appliances in treatment of Cl II
malocclusion AJODO 2006
Both appliances was efficient in restricting forward
growth of maxilla, Both appliances restricted forward
movt of max molars
Both appliances resulted in mesial movt of mand
molars & helped in correction of molar relation –twin
block corrected more efficiently
Both reduced overjet but twin block appliance better
than bionator
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53. Treatment effects by bionator appliance –
comparison with an untreated cl II sample
Almeida et al EJO- 2004
No changes in forward growth of max in both groups
Increase of mand length in bionator group
Significant improvement in anteroposterior
relationship between max &mand in bionator group
Bionator produced- labial tipping of incisors
- retrusion of upper incisors
- increase in post dentoalveolar height due to
extrusion of lower posteriors, no extrusion of upper
molars seen
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54. Adaptive condylar growth and mand remodelling
changes with bionator appliance-an implant study
ARAUJO et al EJO 2004
Alters the direction of growth but not the amount of
growth
Produces greater than expected posterior drift of bone
in condylar and gonial region
Displaces mand anteriorly but limits the amt of true
mand forward rotation that would normaly occur
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55. CONCLUSION
The bionator is effective in treating functional or mild skeletal
class II malocclusions in the mixed and transitional
dentitions, provided that the appliance is chosen after a
careful diagnostic study, it is made correctly and managed
properly by loading and unloading different areas as
indicated during the eruption of the premolars , and the
patient complies in both daytime and night time wear.
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56. REFERENCES
Dentofacial orthopedics with functional appliances –
GRP
Removable orthodontic appliances –Graber &
Neumann
orthodontics and dentofacial orthopedics – James A
Mc Namara
Contemporary orthodontics – William R Proffit
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