Treatment of pseudo class III using Bionator

1. Treatment of pseudoclass III
with Balter’s bionator
Giancotti
Maselli
Mampiere
spano
Goutam Nookala
I MDS

2. contents
• Introduction
• Aetiology
• Dental features and Diagnosis
• Management
• Case reports
• conclusion

3. Features and diagnosis
• Mesio-occlusion is an anteroposterior dentoalveolar
relationship characterized by a more anterior position of the
mandibular dentition compared to the maxillary dentition.
• Types;
• 1.True class III
• 2.pseudo,functional or apparent
• Pseudo class III-habitual established crossbite of anterior
teeth,resulting in the functional forward positioning /shift of
the mandible

4. • Moyers ;
• pseudo-Class III relationship is a positional malocclusion with
an acquired neuromuscular reflex, and considered that the
positional relationship in ‘apparent Class III’ may occur with
an early interference with the muscular reflex of mandibular
closure.

5. Aetiology
1.Dental factors;
• Ectopic eruption of maxillary central incisors
• Premature loss of deciduous molars
2.Functional factors;
• Anomalies in tongue position
• Neuromuscular features
• Naso-respiratory or airway problems
3.Skeletal factors;
• Minor transverse maxillary discrepancy

6. • However, anterior crossbite and negative overjet are
constantly present due to the anterior mandibular
displacement.
• Usually, the soft tissues tend to camouflage the skeletal
discrepancy and the patient’s profile appears normal or
slightly concave in centric occlusion.

7. Pseudo class III true class III
occlusal prematurties heriditary
Lower anteriors are
forwardly inclined
lower anteriors are lingually
inclined
Forward path of closure normal path of closure
normal gonial angle increased gonial angle

8. • Functional appliance
• Is one that changes the posture of the mandible, holding it
open or open and forward (proffit)
• Graber and Neumann
Those that displace the mandible to a moderate degree
and are intended to stimulate muscle activity i.e. myodynamic
– Bionator

9. • Bionator-Wilhelm balter (1950)
• Types
 Standard
 Open bite
 Reverse

10. • Components;
• Acrylic portion-extends incisally from canine to canine in
upper incisiors and acrylic is trimmed 1mm behind lower
incisiors
• Palatal bar-Runs forward with loop extending as far as dec 1st
m or pm
• Function – tongue to contact anterior
portion of palate , encouraging
forward growth of this area.
• labial bow

11. • Modifications;
• Lingual wire -tongue position
• Labial wire -middle of the lower teeth
• Acrylic component

12. Case report 1
pretreatment Post treatment

13. Case report 2
pretreatment Post treatment

14. Case report 3
pretreatment Post treatment

15. conclusion
• The use of the Bionator III in this kind of malocclusion enabled
the correction of a dental malocclusion in a few months and
therapeutic stability of a mesially-positioned mandible
encouraging favourable skeletal growth
• Advantages
• prevents unfavourable growth especially mandible
• Bruxism
• eliminates the need for using bands and brackets
• Disadvantges
• final alignment of the teeth, is impossible without fixed
appliance
• cooperation

16. Diagnostic criteria for pseudo–Class III
malocclusion (Am J Orthod Dentofacial Orthop 2000)
Compared with the Class I malocclusion group, subjects in the
pseudo–Class III malocclusion group are characterised by
 Decreased mid-face length
 Increased maxillary-mandibular difference
 Retroclined upper incisor
 Retrusive upper lip.