Activator

Modifications of activator
Bionator

Dr Harsha Kidiyoor
Dept of orthodontics &
dentofacial orthopedics
Introduction and history
• Genes / perioral muscles / dentition
• Ortho- 3rd order of articulation-Moffett
• Fox–application of extra oral force-1803
• Kingsley –Jumping the bite –1880
• Hotz –Vorbissplatte
• Angle- Cl-II elastics –1907
• Robin-monobloc
Origin of activator
• Modified Kingsley plate retainer
• Biomechanic working retainer –Andresen
• Denmark to Oslo in Norway
• Karl Haupl & Viggo Andresen -activator
 Classification
Based on the kind of malocclusion
Activator is best suited for achieving gross
changes in growing patients
– Cl II div I,div II
– Cl III
– Open bite

• Based on various modifications

• Classification of views
 Classification of views
• Myotatic reflex activity and isometric contractions
induce musculoskeletal adaptation to new
mandibular closing pattern-Kinetic energy

– Andresen-Haupl –1938-based on ‘shaking of bone

‘hypothesis of Roux 1883
– Petrik 1957
– McNamera –1973
– Petrovic –1984
• Grude 1952-mismatch of bite & mechanism

• Viscoelastic property of muscle and stretching of

soft tissues -potential energy
• Emptying of vessels
• Pressing out of interstitial fluid
• Stretching of fibers
• Elastic deformation of bone
• Bioplastic adaptation of bone

• Selmer,Olsen,Herren 1953-incisal crossbite

• Woodside 1973 10–15 mm vertical opening
• Harvold 1974
• Transitional type of action
• Eschler 1952 muscle stretching method
• Cycle of isotonic and isometric contractions

• Ahlgren’s electromyographic research 1970

• Reiten 1951 –no special histologic results
from use of functional appliances
• Witt 1981, Scmuth 1994,
• Witt & Komposh 1979,
Mechanism of action of activator
The neuromuscular basis
 Mechanism of action of activator
• Force analysis
• Static force
• Gravity, posture, elasticity of soft tissues
• Dynamic force
• Swallow, mastication
• Rhythmic force
• Activator works by
• Force application
• Force elimination
3-D Skeletal & dentoalveolar effects
• Trimming-dental
• Construction bite
• Condylar cartilage
is secondary
type- Moss,
Woodside &
Petrovic-LPM
Stutzmann angle
• Factors which determine activator function
– Individual facial skeleton
– Growth status
– Nature of malocclusion
– Inter occlusal clearence, head posture
– State of mind ,level of consciousness
– Treatment goal - Constriction bite
Activator therapy
• Diagnostic preparation
• Treatment planning
• Bite registration
• Laboratory procedures
• Management of the appliance
– Trimming of activator
Diagnostic preparation
• History
• Growth status
• VTO -‘instant correction’
• Patient compliance
• Study models
• Molar relations
• Midlines
• Asymmetries
• Curve of spee
• Dental discrepancies
• Functional analysis
• Postural rest position in NHP
• ICP habitual occlusion
• path of closure-Prematurities
• Freeway space –inter occlusal clearence
• TMJ & RCP
• Respiration
• Cephalometric analysis
• Direction of growth
• Position & size of jaw bases
• Morphologic peculiarities of mandible
• Position &inclination of incisors
Treatment planning-constriction bite

• Low construction bite

with marked forward
positioning
H-activator

• High construction
bite with slight
anterior positioning
V-activator
• Construction bite without forward
mandibular positioning
– Vertical problems
• Deep overbite
• Open bite
– Crowding in mixed dentition
• Construction bite with opening &
posterior positioning of mandible
• Construction bite for asymmetries
• Exaggerated construction bite
• Step wise advancement of bite
Bite registration

• Mark the midlines, molar relation & desired

mesial shift on the cast
• Train the patient after seating him in a upright
& relaxed posture
• Soften a sheet of bees wax
roll it (1cm dia) shape it press
it on the lower arch and mark
the midline
• Transfer the wax to the patients
mouth & fit it on the mandible
• Move the mandible as previously
practiced
• Remove the wax chill it & remove
the excess
• Place it on the cast and check
• Replace the hard wax in patients
mouth and check after asking him
to bite hard
Vertical dimension during bite registration

• Postural rest
– Phonetic
– Command
– Non command
– Combined
• In occlusion
• Freeway space
• With the bite
Laboratory procedures
• Mounting the casts to a fixator
• Preparation of wire elements
• Labial bow –0.9 mm
• Additional wire elements
– Stabilizing wire
– Active springs
• Fixation of jackscrews and wire elements
• Fabrication of acrylic portion
• Finishing and polishing
 Management of the appliance
• Insert the appliance & give instructions
• Worn for 2-3 hrs day time in the 1st week
• Night wear & 1-3hrs day wear for 2nd week
• Patient recalled for check up on 3rd week
• Check up appointments every 6 weeks
• Trimming according to the plan
• Activation of wire elements
• Jackscrew activated by pt at 2 weeks interval
 Trimming for tooth guidance
• Force application and force elimination
• During use the acrylic areas that contact the teeth
are likely to become polished and shiny

• Acrylic surfaces that transmit the desired

intermittent force and contact the teeth are called
guide planes
 Trimming for 3-D control
• Trimming the activator for vertical control
– Intrusion of teeth
• Extrusion of teeth

• Selective trimming of activator

 Trimming for sagital control
• Incisors
• Protraction of incisors
• Loading
– entire lingual surface
– incisal 3rd of lingual surface
• Protraction springs
• Wooden pegs
• guttapercha
• Passive bow
• Active bow & its position
• Retrusion of incisors
– Interaction between labial bow and
acrylic decides the type of force and
tooth movement
• Incisal-C rtn at apex
• Gingival –C rtn junction of apex and middle
3rd
• Incisal with fulcrum- C rtn middle 3rd
Importance of lower incisors
• Activator loads the lingual surface of lower
incisors and tips them labially
• If this is necessary labial tipping further
enhanced by loading the lingual area
• Prevent labial tipping by relieving lingual acrylic
• Or by incisal capping
Sagital movement of posteriors
Movement of teeth in transverse plane
• Asymmetric constriction
bite
• Guide planes
loading & trimming
• Jack screw
• Wire elements
summery
• Cl II div I with hypodivergent jaw bases
H-activator
• Normodivergent
• Cl II div I with hyper divergent jaw bases
V activator
• Cl II div II
• Cl I ,Cl I with deep bite,Cl I with Open bite
• Cross bites
• Cl III
Modifications of activator
• Harvold-Woodside activator
• Herren-Shaye activator (LSU)
• Wunderer activator
• Bow activator- A.M.Schwarz
• U-bow activator –Karwetzky
• Kinetor –Stockfisch
• Propulsor-Muhlemann
• Cybernator-Schmuth
Modifications of activator

• Palate-free activator-Metzelder
• Elastic open activator-G.Klammt
• Combined activator and head gear
– Pfeiffer and Grobety therapy
– Stocklie and Teuscher therapy
– Stockfisch approach
– Hickham approach
• Bass appliance-Neville M Bass
• Bonded activator-Hamilton
Harvold-Woodside
activator –Cl-II
• Construction bite
– Vertical opening of
12-15 mm
• Flanges
• Labial arch wire
• Palatal contact and
expansion
Dislodging springs • Cl III
Herren-Shaye activator
• Paul Herren of Zurich
• L.S.U of Robert Shaye
• Mandible positioned 2-3 mm
beyond neutroclusion
• Incisal edges are 2-4 mm
apart
• Trangular arrow head clasps
• Lingual flanges
 Wunderer activator
• Used for Cl III malocclusion
• Appliance is split horizontally
• Screw is embedded in the
acrylic behind the incisors
• Occlusal surfaces are
covered with acrylic
• Weise screw
Bow activator- A.M.Schwarz
• Upper and lower parts are
connected by a elastic bow
• Transverse mobility is believed
to provide additional stimulus
• Independent expansion is
possible
• Step wise advancement is
possible
• Can be used in unilateral
distoclusion
• Distortion and breakages
common
 U-bow activator –Karwetzky

• Maxillary and
mandibular
active plates are
joined in the 1st
perm molar
region using a U
shaped bow
made of 1.1mm
ss wire
Kinetor –Stockfisch
Propulsor-Muhlemann
Cybernator-Schmuth
Palate-free activator-Metzelder
Elastic open activator-G.Klammt
Combined activator and head gear
therapy
• rationale
 Pfeiffer and Grobety therapy
• Labial bow has a spur
• Long and rolled out lingual flanges
Stocklie and Teuscher therapy
 Stockfisch approach
• Bands on first molar
with tubes to
receive head gear
• Clasp on the kinetor
snaps above the
buccal tube
assemblage
Hickham approach
• Hooks on labial bow to receive J hook
head gear
Bass appliance
-Neville M Bass
Bonded activator-Hamilton
• Mainly used in non compliant patients
• Used for expansion along with forward
positioning of jaws
 Bionator-Balters 1960
• Balters concept-position of
the tongue is decisive
• Equilibrium between tongue
and circumoral muscles is
responsible for shape of
dental arches and inter
cuspation
• Bite taken in an edge to edge
relation
– Dorsum of tongue in contact
with soft palate
– Lip closure
Appliance design
• Horse shoe shaped acrylic lingual plate
• Upper anterior part kept free for proper
tongue function
Labial bow with buccinator loops
Palatal bar
Basic Cl II appliance
Open bite appliance
Class III or reversed bionator
Other differences
• Less bulky more patient compliance
• Can be worn all time except during
meals
• Vulnerable to distortion
• Simultaneous requirement of
stabilization of the appliance and
selective grinding for eruption guidence
Ideal cases for bionator therapy
• Mild Cl II in mixed dentition
• Well aligned arches
• Abnormal muscle pattern
• Buccal teeth are in infraclusion,-large
freeway space
• Adults with TMJ problems
• Bruxism and clenching during REM
 Terminology used to
describe trimming of
bionator
• Articular plane
• Loading area
• Tooth bed
• Nose
• Ledge
Sequence of trimming of bionator
• Trimming of acrylic and elimination of
influence of tongue and cheeks allow
the teeth to erupt up to the articular
plane
• Sequence –lower molar & upper molar-
lower pre molars –upper premolars
• Additional anchorage from
– Lower incisal margins
– Deciduous molars and edentulous areas
– Noses
 references
• Dentofacial orthopedics with functional appliances-
Graber,Rakosi & Petrovic

• Removable orthodontic appliances-Graber & Neumann

• Orthodontics- current principles & technique-Graber & Swain

• Orthodontics- current principles & technique-Graber &

Vanarsdall

• Bass Orthopedic Appliance System Part 1 - Design and

Construction - Neville M Bass -JCO April 1987