Activator , functional appliance in orthodontics / orthodontics training

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Activator , functional appliance in orthodontics / orthodontics training

  1. 1. Activator Modifications of activator Bionator www.indiandentalacademy.com INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
  2. 2. 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 www.indiandentalacademy.com
  3. 3. Origin of activator • Modified Kingsley plate retainer • Biomechanic working retainer –Andresen • Denmark to Oslo in Norway • Karl Haupl & Viggo Andresen -activator www.indiandentalacademy.com
  4. 4. 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 www.indiandentalacademy.com
  5. 5. 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 www.indiandentalacademy.com
  6. 6. • 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 www.indiandentalacademy.com
  7. 7. • Transitional type of action • Eschler 1952 muscle stretching method • Cycle of isotonic and isometric contractions • Ahlgren’s electromyographic research 1970 www.indiandentalacademy.com
  8. 8. • Reiten 1951 –no special histologic results from use of functional appliances • Witt 1981, Scmuth 1994, • Witt & Komposh 1979, www.indiandentalacademy.com
  9. 9. Mechanism of action of activator The neuromuscular basis www.indiandentalacademy.com
  10. 10. www.indiandentalacademy.com
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  13. 13. 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 www.indiandentalacademy.com
  14. 14. 3-D Skeletal & dentoalveolar effects • Trimming-dental • Construction bite • Condylar cartilage is secondary type- Moss, Woodside & Petrovic-LPM Stutzmann angle www.indiandentalacademy.com
  15. 15. • 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 www.indiandentalacademy.com
  16. 16. Activator therapy • Diagnostic preparation • Treatment planning • Bite registration • Laboratory procedures • Management of the appliance – Trimming of activator www.indiandentalacademy.com
  17. 17. Diagnostic preparation • History • Growth status • VTO -‘instant correction’ • Patient compliance • Study models • Molar relations • Midlines • Asymmetries • Curve of spee • Dental discrepancies www.indiandentalacademy.com
  18. 18. • 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 www.indiandentalacademy.com
  19. 19. Treatment planning-constriction bite • Low construction bite with marked forward positioning H-activator • High construction bite with slight anterior positioning V- activator www.indiandentalacademy.com
  20. 20. • 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 www.indiandentalacademy.com
  21. 21. 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 www.indiandentalacademy.com
  22. 22. • 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 www.indiandentalacademy.com
  23. 23. Vertical dimension during bite registration • Postural rest – Phonetic – Command – Non command – Combined • In occlusion • Freeway space • With the bite www.indiandentalacademy.com
  24. 24. Laboratory procedures • Mounting the casts to a fixator www.indiandentalacademy.com
  25. 25. • Preparation of wire elements • Labial bow –0.9 mm • Additional wire elements – Stabilizing wire – Active springs www.indiandentalacademy.com
  26. 26. • Fixation of jackscrews and wire elements • Fabrication of acrylic portion • Finishing and polishing www.indiandentalacademy.com
  27. 27. 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 www.indiandentalacademy.com
  28. 28. 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 www.indiandentalacademy.com
  29. 29. Trimming for 3-D control • Trimming the activator for vertical control – Intrusion of teeth www.indiandentalacademy.com
  30. 30. • Extrusion of teeth • Selective trimming of activator www.indiandentalacademy.com
  31. 31. Trimming for sagital control • Incisors • Protraction of incisors • Loading – entire lingual surface – incisal 3rd of lingual surface • Protraction springs • Wooden pegs • guttapercha www.indiandentalacademy.com
  32. 32. • Passive bow • Active bow & its position • Retrusion of incisors – Interaction between labial bow and acrylic decides the type of force and tooth movement • Incisal-Crtn at apex • Gingival –Crtn junction of apex and middle 3rd • Incisal with fulcrum- Crtn middle 3rd www.indiandentalacademy.com
  33. 33. 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 www.indiandentalacademy.com
  34. 34. Sagital movement of posteriors www.indiandentalacademy.com
  35. 35. Movement of teeth in transverse plane • Asymmetric constriction bite • Guide planes loading & trimming • Jack screw • Wire elements www.indiandentalacademy.com
  36. 36. summery • Cl II div I with hypodivergent jaw bases H- activator • Normodivergent www.indiandentalacademy.com
  37. 37. • 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 www.indiandentalacademy.com
  38. 38. 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 www.indiandentalacademy.com
  39. 39. 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 www.indiandentalacademy.com
  40. 40. Harvold-Woodside activator –Cl-II • Construction bite – Vertical opening of 12- 15 mm • Flanges • Labial arch wire • Palatal contact and expansion www.indiandentalacademy.com
  41. 41. Dislodging springs • Cl III www.indiandentalacademy.com
  42. 42. 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 www.indiandentalacademy.com
  43. 43. 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 www.indiandentalacademy.com
  44. 44. 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 www.indiandentalacademy.com
  45. 45. 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 www.indiandentalacademy.com
  46. 46. Kinetor –Stockfisch www.indiandentalacademy.com
  47. 47. Propulsor-Muhlemann www.indiandentalacademy.com
  48. 48. Cybernator-Schmuth www.indiandentalacademy.com
  49. 49. Palate-free activator-Metzelder www.indiandentalacademy.com
  50. 50. Elastic open activator-G.Klammt www.indiandentalacademy.com
  51. 51. Combined activator and head gear therapy • rationale www.indiandentalacademy.com
  52. 52. Pfeiffer and Grobety therapy • Labial bow has a spur • Long and rolled out lingual flanges www.indiandentalacademy.com
  53. 53. Stocklie and Teuscher therapy www.indiandentalacademy.com
  54. 54. www.indiandentalacademy.com
  55. 55. Stockfisch approach • Bands on first molar with tubes to receive head gear • Clasp on the kinetor snaps above the buccal tube assemblage www.indiandentalacademy.com
  56. 56. Hickham approach • Hooks on labial bow to receive J hook head gear www.indiandentalacademy.com
  57. 57. Bass appliance -Neville M Bass www.indiandentalacademy.com
  58. 58. Bonded activator-Hamilton • Mainly used in non compliant patients • Used for expansion along with forward positioning of jaws www.indiandentalacademy.com
  59. 59. 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 www.indiandentalacademy.com
  60. 60. Appliance design • Horse shoe shaped acrylic lingual plate • Upper anterior part kept free for proper tongue function www.indiandentalacademy.com
  61. 61. Labial bow with buccinator loops Palatal bar www.indiandentalacademy.com
  62. 62. Basic Cl II appliance www.indiandentalacademy.com
  63. 63. Open bite appliance www.indiandentalacademy.com
  64. 64. Class III or reversed bionator www.indiandentalacademy.com
  65. 65. 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 www.indiandentalacademy.com
  66. 66. 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 www.indiandentalacademy.com
  67. 67. Terminology used to describe trimming of bionator • Articular plane • Loading area • Tooth bed • Nose • Ledge www.indiandentalacademy.com
  68. 68. 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 www.indiandentalacademy.com
  69. 69. 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 www.indiandentalacademy.com
  70. 70. www.indiandentalacademy.com Thank you For more details please visit www.indiandentalacademy.com

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