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
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PRINCIPLE OF BIONATOR
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Balter Quotes
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Treatment objectives
Improve relationships
of jaws, tongue &
teeth
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
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INDICATIONS
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CONTRAINDICATIONS
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TYPES OF 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
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OPEN – BITE APPLIANCE
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
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REVERSED BIONATOR
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
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Labial bow
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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 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
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ARTICULAR PLANE:
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LOADING AREA:
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TOOTH BED
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NOSE:
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LEDGE :
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BALTERS REFERS
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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
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ANCHORAGE OF APPLIANCE
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SELECTIVE TRIMMING
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CLINICAL MANAGEMENT
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Bionator and TMJ
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Bionator in Adult Patients
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Modifications
of Bionator
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Modification by Williamson &Hamilton
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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
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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
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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
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California bionator
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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 )
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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
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CONCLUSION
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REFERENCES
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