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  1. 1. “ Add your company slogan ”BIONATOR LOGO AJITHESH KV
  2. 2. Contents1 Introduction2 History3 Treatment objectives4 Types of bionator5 Trimming of bionator6 Clinical management7 Modifications of Bionator8 References 2
  3. 3. INTRODUCTION FUNCTIONAL APPLIANCEDefinition 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 3
  4. 4. CLASSIFICATION FUNCTIONAL APPLIANCE Removable Fixed Activator BionatorTooth borne passive appliance (activator, bionator)Tooth borne active applianceTissue borne passive appliance - FR 4
  5. 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 5
  6. 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) 6
  7. 7. Balter QuotesThe equilibrium b/w the tongue and cheeks, especially 7
  8. 8. Treatment objectives Enlarge oral space & train tongue functions Bring incisors into edgeAccomplish 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 8
  9. 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 9
  10. 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 10
  11. 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 11
  12. 12. CONTRAINDICATIONS Class II – if caused by max prognathism Vertical growth pattern Labial tipping of mandibular incisors 12
  14. 14. THE STANDARD APPLIANCEConsists 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 15
  15. 15. 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 mucosaFunction- orients the tongue & mandible anteriorly by stimulating its dorsal surface with palatal bar 16
  16. 16. 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 17
  17. 17. WIRE COMPONENTS Anterior part - labial wire Lateral part - buccinator bendsObjectives 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 18
  18. 18. OPEN – BITE APPLIANCE Purpose of this appliance is to close the anterior space Acrylic part- The lower lingual part extendsinto the upper incisor region as a lingual shield , closing the anteriorspace without touching the upper teeth 19
  19. 19. Wire elements Labial bow runs between the upper and lower incisors at the height of lip closure. 20
  20. 20. 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 21
  21. 21. Palatal barRuns forward with loop extending asfar as dec 1st m or pmFunction – tongue to contactanterior portion of palate ,encouraging forward growth of thisarea. 22
  22. 22. Labial bow In front of lower incisors Wire slightly touches the labial surface lightly / it is at a paper thickness away 23
  23. 23. CONSTRUCTION BITEObjective 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 24
  24. 24. Construction biteIn 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 25
  25. 25. Following points to be considered (JCO 1985, Altuna& Niegel)Horizontal plane Advancing about one premolar width is tolerable Profile should be esthetically pleasinglateral plane Condyles on both sides move symmetrically. Midlines used as reference linesVertical plane 2-3 mm opening between C.I 26
  26. 26. TRIMMING OF BIONATOR As the volume of the appliance is reduced itsanchorage is difficult and trimming must be selectivebecause of simultaneous anchorage requirementsBalters has introduced certain terms1.Articular plane2.Loading area3.Tooth bed4.Nose5. ledge 27
  27. 27. 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 28
  28. 28. 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. 29
  29. 29. TOOTH BED Some parts of the loading areas are trimmed away to the articular plane 30
  30. 30. 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 31
  31. 31. 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 32
  32. 32. BALTERS REFERS prevention of eruption as loading or inhibition of growth stimulation of eruption as unloading or promotion of growth 33
  33. 33.  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 34
  34. 34. Ascher (1968)proposal Deciduous teeth if present are used as anchorage and Ascher (1968)proposed the following types of anchorage.Dentition Anchorage1,2,III-V,6 IV & V both U / L1,2,III-V,6 V & space after IV1,2,II-6 alveolar process-IV,V1,2,III,4-6 6 & alveolar process 35
  35. 35. ANCHORAGE OF APPLIANCE1. Acrylic cap over incisal margins of lower incisors2. Loading areas as cusps of teeth fit into respective grooves in acrylic3. Deciduous molars are used as anchor teeth4. Edentulous areas after early loss of primary molars5. Noses in the upper & lower interdental spaces6. Labial bow prevents posterior displacement 36
  36. 36. SELECTIVE TRIMMINGFor extrusion of posterior teethAcrylic 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 37
  37. 37. 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. 38
  38. 38. 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 39
  39. 39. 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 40
  40. 40. Modifications of Bionator 41
  41. 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 42
  42. 42. Modification by Schmuth Cybernator Normal labial bow in the max arch – from canine to canine Mand incisors covered with thin 2mm acrylic 43
  43. 43. BIO- M-SBY 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 44
  44. 44. BIO- M-S 45
  45. 45. BIO- M-S 46
  46. 46. Orthopedic corrector IWITZIG 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 47
  47. 47. 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 48
  48. 48. California bionator This type bionator helps in eruption of post teeth in patients with decreased vertical dimension 49
  49. 49. Teusher’s modification 50
  51. 51. 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 52
  52. 52. 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 53
  53. 53. 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 54
  54. 54. CONCLUSIONThe bionator is effective in treating functional or mild skeletalclass II malocclusions in the mixed and transitionaldentitions, provided that the appliance is chosen after acareful diagnostic study, it is made correctly and managedproperly by loading and unloading different areas asindicated during the eruption of the premolars , and thepatient complies in both daytime and night time wear. 55
  55. 55. 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 56
  56. 56. “ Add your company slogan ”Bionator is LOGO