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BIONATOR

LOGO AJITHESH KV
 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
2
 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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 CLASSIFICATION

FUNCTIONAL

APPLIANCE

Removable Fixed
Activator
Bionator

Tooth borne passive appliance (activator, bionator)

Tooth borne active appliance
Tissue borne passive appliance - FR
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 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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 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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 Balter Quotes

The equilibrium b/w the tongue and cheeks, especially

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 Treatment objectives

Enlarge oral space &

train tongue functions

Bring incisors into edge

Accomplish lip seal
to edge relationship
& bring dorsum
of tongue into To achieve elongation
contact with soft of mandible
palate

Improve relationships
of jaws, tongue &
teeth

It works by modulating muscle activity

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 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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 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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 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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 CONTRAINDICATIONS

 Class II – if caused by max prognathism

 Vertical growth pattern
 Labial tipping of mandibular incisors

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TYPES OF BIONATOR

1. THE STANDARD BIONATOR

2. THE OPEN BITE BIONATOR

3. CI III OR REVERSED BIONATOR

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 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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 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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 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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 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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 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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 Wire elements

 Labial bow runs between the upper and

lower incisors at the height of lip
closure.

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 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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 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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 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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 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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 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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 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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 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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 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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 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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 TOOTH BED

 Some parts of the

loading areas are
trimmed away to the
articular plane

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 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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 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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 BALTERS REFERS

 prevention of eruption as loading

or inhibition of growth
 stimulation of eruption as
unloading or promotion of growth

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 Appliance can be trimmed until teeth reaches desired
relationship with the articular plane
 Due to consideration for anchorage, appliance cannot
be trimmed in all areas at same time
 Periodic loading and unloading of same area done

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 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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 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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 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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 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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 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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 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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Modifications
of Bionator

41
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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 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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 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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BIO- M-S

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BIO- M-S

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 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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 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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California bionator

This type bionator helps in

eruption of post teeth in
patients with decreased
vertical dimension

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Teusher’s modification

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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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 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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 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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 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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 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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 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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