Date post: | 09-Jun-2015 |
Category: |
Health & Medicine |
Upload: | ajithesh-kv |
View: | 4,942 times |
Download: | 46 times |
LOGO
“ Add your company slogan ”
BIONATOR
AJITHESH KV
Contents
Introduction1
History2
Treatment objectives3
Types of bionator4
Trimming of bionator5
6 Clinical management
References
7 Modifications of Bionator
82
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
3
CLASSIFICATION
FUNCTIONAL
APPLIANCE
FixedRemovableActivator Bionator
Tooth borne passive appliance (activator, bionator)Tooth borne active appliance Tissue borne passive appliance - FR
4
HISTORY
Norman Kingsley 1879 Vulcanite palatal platePierre Robin 1902 MonoblocViggo Andresen 1908 ActivatorWilhelm Balter 1960 BionatorRolf Frankel 1967 FRWilliam Clark 1977 Twin block
5
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
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.
7
It works by modulating muscle activity 8
Treatment objectives
Accomplish lip seal & bring dorsum of tongue into
contact with soft palate
Enlarge oral space & train tongue functions
Bring incisors into edge to edge relationship
To achieve elongation of
mandibleImprove relationships
of jaws, tongue & teeth
Advantages
Reduced size It can be worn both day and nightAction faster than activator –unfavorable forces
are avoided acting on dentition for longer timeConstant wear so more rapid adjustment of
musculature
9
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
INDICATIONS
Dental arches well alignedMandible in posterior positionSkeletal discrepancy not severeLabial tipping of upper incisors evidentDeep bite with accentuated c.o.s
Class III where reverse bionator can be usedOpen bite
11
CONTRAINDICATIONS
Class II – if caused by max prognathismVertical growth patternLabial tipping of mandibular incisors
12
TYPES OF BIONATOR
1. THE STANDARD BIONATOR
2. THE OPEN BITE BIONATOR
3. CI III OR REVERSED BIONATOR
14
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
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 mucosa
Function- orients the tongue & mandible anteriorly by stimulating its dorsal surface with palatal bar
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
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
18
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
19
Wire elements
Labial bow runs between the upper and lower incisors at the height of lip closure.
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
Palatal bar
Runs forward with loop extending as far as dec 1st m or pmFunction – tongue to contact anterior portion of palate , encouraging forward growth of this area.
22
Labial bow
In front of lower incisors Wire slightly touches the labial surface
lightly / it is at a paper thickness away
23
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
24
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
25
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
26
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
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
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
TOOTH BED
Some parts of the loading areas are trimmed away to the articular plane
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
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
BALTERS REFERS
prevention of eruption as loading or inhibition of growth
stimulation of eruption as unloading or promotion of growth
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
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
35
ANCHORAGE OF APPLIANCE
1. 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
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
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
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
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
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
42
Modification by Schmuth
Cybernator Normal labial bow in the max arch – from
canine to canine Mand incisors covered with thin 2mm acrylic
43
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
44
BIO- M-S
45
BIO- M-S
46
Orthopedic corrector I
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
WITZIG incorporated 2dimentional screws bilaterally to Schmuth’s bionator.
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
California bionator
This type bionator helps in eruption of post teeth in patients with decreased vertical dimension
49
Teusher’s modification
50
51
COMBINATION OF BIONATOR AND HIGH PULL HEAD GEAR
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.
Luciane closs, & Valmy Pangrazio ( A J O – 1996 )
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
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
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
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.
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
LOGO
“ Add your company slogan ”
Bionator is