THE BIONATOR
&
ITS MODIFICATIONS
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
w...
“A functional appliance harnesses natural forces
which it transmits to the teeth and alveolar bone in a
pre determined dir...
Functional appliances

Fixed
Ex : jasper jumper

Removable

Active
Ex : inclined plane

www.indiandentalacademy.com

Passi...
www.indiandentalacademy.com
The bionator is a functional
appliance developed by Balters in
1956.
The bionator is a generic term that
refers to a famil...
Activator----------------Bionator

www.indiandentalacademy.com
Principles

The theoretical principles of Balters
are based on the works of Robin,
Anderson and Haupl but it differs
from ...
“The equilibrium b/w the tongue
and cheeks, especially b/w the
tongue and lips in height, breadth
and depth in an oral spa...
Every disturbance will deform the
dentition and during growth that
may be impeded too.The tongue is
the essential factor f...
-the

functional space for the tongue
is essential for normal development
of the orofacial system.
-the equilibrium b/w th...
-a discoordination of its function could
lead to abnormal growth & actual
deformities

www.indiandentalacademy.com
www.indiandentalacademy.com
Winders (1958)-the tongue exerts
3-4 times more force on the
dentition than the buccal and
labial musculature and these
fi...
Lip seal importance

Balters technique requires lip
closure for treatment of all kinds of
malocclusion.
It’s a preconditio...
Tongue and malocclusions

classI-weak tongue compared with the
strength of the buccinator mechanism.
classII-backward posi...
Objectives for treatment of various
malocclusions are,
classI-muscular training to make the tongue
stronger.
classII/I-bri...
Balters constructed his appliance to achieve
the following,
-accomplish lip seal & bring dorsum of tongue
into contact wit...
The principle of the bionator is not to
activate the muscles but to
• modulate muscle activity,
• enhance normal developme...
www.indiandentalacademy.com
Construction bite registration
Horizontal considerations:
1-incisors in edge to edge relationship/

molars in classI
2-exc...
Vertical considerations:
1-bite is not opened/incisors in
edge to edge
2-high construction bite
impairs tongue function an...
Lateral considerations:
1-condyles on both sides should move
symmetrically in the glenoid fossa
/reference lines-upper and...
Types of appliances:
1-The Standard Bionator
2-Class-III / Reverse
Bionator
3-The Open Biteappliance
www.indiandentalacade...
www.indiandentalacademy.com
The standard appliance:
1-Acrylic part
-Horse shoe shaped lower lingual plate
-upper arch –lingual extensions to cover
the...
www.indiandentalacademy.com
Wire elements:
Palatal bar1.2 mm s.steel wire
Extends from middle of 1st premolar to a line
joining distal of 1st perm-mol...
www.indiandentalacademy.com
www.indiandentalacademy.com
The vestibular wire:
0.9mm s.steel wire.
Anterior part-labial wire
Lateral part-buccinator bends
-keep the cheeks away thu...
Skeletal, Dentoalveolar and Soft tissues
changes with the standard bionator.(Varun
Kalra AJO-95)
Skeletal changesMandible-...
Indications for standard bionator:

Actively growing children with the following
malocclusions
classII / I in mixed dentit...
Indicated in deep bite cases due to infra
occlusion of molars and premolars
because of lateral tongue posture.
Not indicat...
www.indiandentalacademy.com
Class III / Reverse Bionator
Is used to encourage development of the
maxilla.
Construction bite-taken in the most retruded...
Acrylic partlower acrylic part extended incisally from canine
to canine behind the upper incissors
.acrylic is trimmed awa...
www.indiandentalacademy.com
Rakosi et al (1997)-palatal bar only
flattens the dorsum of the tongue but does
not move it forward.
Reverse appliance onl...
www.indiandentalacademy.com
The Open Bite Appliance
Construction bite-is as low as possible with a slight
opening for interposition of posterior bite ...
www.indiandentalacademy.com
Trimming of the bionator

The basic purpose of the appliance is to
correct function,proper trimming of the
acrylic can aff...
Balters introduced the
following terms:
1-ARTICULAR PLANE
2-LOADING AREA
3-TOOTH BED
4-NOSE
5-LEDGE

www.indiandentalacade...
ARTICULAR PLANE:
This plane extends from the tips of the
cusps of the upper 1st molars,premolars &
canines to the mesial m...
www.indiandentalacademy.com
LOADING AREA:
The palatal or lingual cusps of the
deciduous molars (premolars) are
relieved in the acrylic part of the
app...
www.indiandentalacademy.com
TOOTH BED :
Some parts of the loading areas are
trimmed away to the articular plane.

www.indiandentalacademy.com
NOSE:
The interdental acrylic fingerlike
projections b/w tooth beds .
They serve as guiding surfaces
and provide anchorage...
www.indiandentalacademy.com
Ledge :
Depending on the tooth movement required
the appliance acrylic is trimmed and the nose
is reduced .
This reduced e...
www.indiandentalacademy.com
Anchorage of the appliance:
1-acrylic cap over incisal margins of lower
incisors
2-loading areas as cusps of teeth fit int...
Deciduous teeth if present are used as anchorage
and Ascher (1968)proposed the following types of
anchorage.
Dentition

An...
Trimming of the occlusal surfaces is
essential to allow certain teeth to erupt
further, while fully erupted teeth are
prev...
The types of teeth eruptions possible
by planned trimming of the bionator
are,
Vertical eruption
Buccal eruption
Mesial or...
Vertical eruption of the buccal segments.
Some acrylic is left at the level of the
occlusal plane (tooth bed) interdentall...
Acrylic projections b/w the teeth are
left untouched or are replaced with
selfcure acrylic becos they serve as
stabilizing...
DISTAL ERUPTION .

For distal eruption of the buccal segments
the eruptive path is inclined distally.
Acrylic should touch...
www.indiandentalacademy.com
www.indiandentalacademy.com
EXPANSION OF THE BUCCAL
SEGMENTS:
The eruptive path of maxillary &
mandibular molars is trimmed with a
buccal slope.
When ...
Clinical management:
Appliance must be worn day and night
except while eating.
Interval b/w visits 3-5 weeks based on
the ...
According to the plan on anchorage and
growth promotion,loading and unloading
of acrylic is done.
In first stage of treatm...
These rapid changes lead to open
bite in posterior segments.
Articular and dentoalveolar
adaptation occur following
neurom...
Bionator modifications
Minor
Major- Bio-M-S Appliance
-Bionator I,II,II
-Orthopedic corrector I,II
www.indiandentalacademy...
Minor modifications :
1-Williamson & Hamilton
3 mm wide cover for max.incisors
2-Teusher (1978)
Face bow tubes
Lower lip p...
www.indiandentalacademy.com
Major modifications:
Bio-M-S appliance -Erich & Annette
Fleischer
acrylic body reduced in size
maxillary buccolabial arch ...
www.indiandentalacademy.com
Construction bite:
improvement in soft tissue profile
tolerable and acceptable to the patient.
If edge to edge bite result...
Modified bionator of Schmuth
(reduced activator of Schmuth)
acrylic part similar to bionator
labial guide bow of the origi...
CALIFORNIA BIONATOR

www.indiandentalacademy.com
www.indiandentalacademy.com
Bionator I
acrylic part similar to bionator
labial guide bow of the original
Anderson-Haupl
lingual retention wire
midline...
Orthopedic corrector
-I:
side screws
permits forward
repositioning of the
front half .
www.indiandentalacademy.com
www.indiandentalacademy.com
Bionator II

www.indiandentalacademy.com
Orthopedic corrector II

www.indiandentalacademy.com
Bionator II – is used to close open bite
in the anterior region due to
protruding pre maxilla and labially
flared incisors...
The Bionator and TMJ problems
Its been very successful in treating TMJ
problems especially adults.
TMJ problems have coinc...
Clinically check habitual occlusion
and then the mandible is
positioned forward to determine
the amount of forward placeme...
Petrovic has shown that
protracted wear in adults can
permanently shorten the LTM
and thus help the patient
maintain a pro...
Disadvantages of theBalters Bionator
-indications are reduced because there is no
allowance for vertical component except
...
Advantages of Balters Bionator.
It can be worn both day and night.
It has a constant influence on the tongue and
perioral ...
Conclusion:
• The bionator is effective in treating functional or
mild skeletal class II malocclusions in the mixed
and tr...
Thank you
For more details please visit
www.indiandentalacademy.com

www.indiandentalacademy.com
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Bionator and its modification /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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Bionator and its modification /certified fixed orthodontic courses by Indian dental academy

  1. 1. THE BIONATOR & ITS MODIFICATIONS INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. “A functional appliance harnesses natural forces which it transmits to the teeth and alveolar bone in a pre determined direction”. (White, Gardiner, Leighton) “Functional appliances are passive (loose fitting) appliances by themselves, which make use of the naturally occurring forces generated by the orofacial & masticatory muscles and the forces of occlusion to bring about changes in dento alveolar & craniofacial structures”. These appliances Guide, Eliminate, or Transmit these naturally occurring forces to bring about correction. www.indiandentalacademy.com
  3. 3. Functional appliances Fixed Ex : jasper jumper Removable Active Ex : inclined plane www.indiandentalacademy.com Passive Ex: activator
  4. 4. www.indiandentalacademy.com
  5. 5. The bionator is a functional appliance developed by Balters in 1956. The bionator is a generic term that refers to a family of appliances used to treat malocclusions characterized in part by mandibular deficiency. www.indiandentalacademy.com
  6. 6. Activator----------------Bionator www.indiandentalacademy.com
  7. 7. Principles The theoretical principles of Balters are based on the works of Robin, Anderson and Haupl but it differs from that of the activator. The essential part of Robin’s concept is function and Balters is the role of the tongue. www.indiandentalacademy.com
  8. 8. “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. www.indiandentalacademy.com
  9. 9. Every disturbance will deform the dentition and during growth that may be impeded too.The tongue is the essential factor for the development of the dentition and it is the centre of reflex activity in the oral cavity” www.indiandentalacademy.com
  10. 10. -the functional space for the tongue is essential for normal development of the orofacial system. -the equilibrium b/w the tongue and circumoral muscles is responsible for the shape of the dental arches and intercuspation. www.indiandentalacademy.com
  11. 11. -a discoordination of its function could lead to abnormal growth & actual deformities www.indiandentalacademy.com
  12. 12. www.indiandentalacademy.com
  13. 13. Winders (1958)-the tongue exerts 3-4 times more force on the dentition than the buccal and labial musculature and these findings support Balters thesis, provided resting forces and other factors are not considered. www.indiandentalacademy.com
  14. 14. Lip seal importance Balters technique requires lip closure for treatment of all kinds of malocclusion. It’s a precondition for the free development of growth potential that’s been impeded by abnormal function.. www.indiandentalacademy.com
  15. 15. Tongue and malocclusions classI-weak tongue compared with the strength of the buccinator mechanism. classII-backward position of the tongue classIII-low anterior displacement Open bite-hyperactivity of forward posturing of the tongue www.indiandentalacademy.com
  16. 16. Objectives for treatment of various malocclusions are, classI-muscular training to make the tongue stronger. classII/I-bring the tongue forward/achieved by stimulating the distal part of the dorsum of the tongue. classIII-get the tongue to into a more backward and higher position. www.indiandentalacademy.com
  17. 17. Balters constructed his appliance to achieve the following, -accomplish lip seal & bring dorsum of tongue into contact with softpalate -bring incisors into edge to edge relationship - enlarge oral space & train tongue functions -improve relationships of jaws,tongue&teeth -designed to help patients learn normal functional patterns www.indiandentalacademy.com
  18. 18. The principle of the bionator is not to activate the muscles but to • modulate muscle activity, • enhance normal development of the inherent growth pattern and • eliminate abnormal and deforming environmental factors. www.indiandentalacademy.com
  19. 19. www.indiandentalacademy.com
  20. 20. Construction bite registration Horizontal considerations: 1-incisors in edge to edge relationship/ molars in classI 2-excessive overjet-step wise posturing of the mandible 3-edge to edge with lateral incisors when centrals are mal positioned. www.indiandentalacademy.com
  21. 21. Vertical considerations: 1-bite is not opened/incisors in edge to edge 2-high construction bite impairs tongue function and or acquire tongue thrust habit. www.indiandentalacademy.com
  22. 22. Lateral considerations: 1-condyles on both sides should move symmetrically in the glenoid fossa /reference lines-upper and lower midlines & frena. 2-midline deviations due to functional / dental / skeletal problems have to be analyzed and diagnosed first. www.indiandentalacademy.com
  23. 23. Types of appliances: 1-The Standard Bionator 2-Class-III / Reverse Bionator 3-The Open Biteappliance www.indiandentalacademy.com
  24. 24. www.indiandentalacademy.com
  25. 25. The standard appliance: 1-Acrylic part -Horse shoe shaped lower lingual plate -upper arch –lingual extensions to cover the molars & premolars / anterior part free 2-wire elements -palatal bar -labial bow with buccal extensions www.indiandentalacademy.com
  26. 26. www.indiandentalacademy.com
  27. 27. Wire elements: Palatal bar1.2 mm s.steel wire Extends from middle of 1st premolar to a line joining distal of 1st perm-molars Egg shaped and the curve is directed distally To stimulate the distal part of the tongue and effect forward orientation of the tongue and mandible. www.indiandentalacademy.com
  28. 28. www.indiandentalacademy.com
  29. 29. www.indiandentalacademy.com
  30. 30. The vestibular wire: 0.9mm s.steel wire. Anterior part-labial wire Lateral part-buccinator bends -keep the cheeks away thus leveling the bite and allows eruption to proceed in this region. -favors expansion / transverse development of maxillary dentition. www.indiandentalacademy.com
  31. 31. Skeletal, Dentoalveolar and Soft tissues changes with the standard bionator.(Varun Kalra AJO-95) Skeletal changesMandible-pt.B is moved forward -length of mandible (Ar-Go) is increased DentitionOverjet and overbite is decreased Soft tissuesFacial convexity is decreased Uncurling of the lower lip. www.indiandentalacademy.com
  32. 32. Indications for standard bionator: Actively growing children with the following malocclusions classII / I in mixed dentition classI malocclusion with classII/I symptoms with lip trap In classII/I -dental arches - well aligned -the mandible in posterior position -the skeletal discrepancy not very severe www.indiandentalacademy.com
  33. 33. Indicated in deep bite cases due to infra occlusion of molars and premolars because of lateral tongue posture. Not indicated if Class II due to prognathic maxilla Labially tipped lower incisors Vertical growth pattern Not used in deep bite cases with strong horizontal growth pattern www.indiandentalacademy.com
  34. 34. www.indiandentalacademy.com
  35. 35. Class III / Reverse Bionator Is used to encourage development of the maxilla. Construction bite-taken in the most retruded position possible to allow labial movement of the maxillary incisors and simultaneously exert a slight restrictive influence on mandible. Bite opened slightly –2mm between incisal edges. www.indiandentalacademy.com
  36. 36. Acrylic partlower acrylic part extended incisally from canine to canine behind the upper incissors .acrylic is trimmed away by 1mm behind the lower incissors www.indiandentalacademy.com
  37. 37. www.indiandentalacademy.com
  38. 38. Rakosi et al (1997)-palatal bar only flattens the dorsum of the tongue but does not move it forward. Reverse appliance only tips the maxillary incisors labially and does not stimulate basal bone forward. Its indicated in pseudo-class III problems with the upper incisors tipped lingually causing anterior mandiblular displacement on closure from postural rest to habitual occlusion. www.indiandentalacademy.com
  39. 39. www.indiandentalacademy.com
  40. 40. The Open Bite Appliance Construction bite-is as low as possible with a slight opening for interposition of posterior bite blocks to prevent their eruption. Acrylic partThe lower lingual part extends into the upper incisor region as a lingual shield , closing the anterior space without touching the upper teeth Wire elementsLabial bow runs between the upper and lower incisors at the height of correct lip closure. . www.indiandentalacademy.com
  41. 41. www.indiandentalacademy.com
  42. 42. Trimming of the bionator The basic purpose of the appliance is to correct function,proper trimming of the acrylic can affect tooth eruption and position. Since the volume of the appliance is reduced its anchorage is a major concern and trimming must be selective because of simultaneous anchorage requirements. www.indiandentalacademy.com
  43. 43. Balters introduced the following terms: 1-ARTICULAR PLANE 2-LOADING AREA 3-TOOTH BED 4-NOSE 5-LEDGE www.indiandentalacademy.com
  44. 44. 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. www.indiandentalacademy.com
  45. 45. www.indiandentalacademy.com
  46. 46. LOADING AREA: The palatal or lingual cusps of the deciduous molars (premolars) are relieved in the acrylic part of the appliance. The grinding of the acrylic here enhances the anchorage of the appliance. www.indiandentalacademy.com
  47. 47. www.indiandentalacademy.com
  48. 48. TOOTH BED : Some parts of the loading areas are trimmed away to the articular plane. www.indiandentalacademy.com
  49. 49. NOSE: The interdental acrylic fingerlike projections b/w tooth beds . They serve as guiding surfaces and provide anchorage in the sagittal and vertical plane. www.indiandentalacademy.com
  50. 50. www.indiandentalacademy.com
  51. 51. Ledge : Depending on the tooth movement required the appliance 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. The nose is mostly on the mesial margin of 1st perm.molar & ledges are b/w premolars or deciduous molars. www.indiandentalacademy.com
  52. 52. www.indiandentalacademy.com
  53. 53. Anchorage of the appliance: 1-acrylic cap over incisal margins of lower incisors 2-loading areas as cusps of teeth fit into respective grooves in acrylic 3-deciduous molars are used as anchor teeth 4-edentulous areas after early loss of primary molars 5-noses in the upper & lower interdental spaces www.indiandentalacademy.com 6-labial bow prevents posterior displacement
  54. 54. Deciduous teeth if present are used as anchorage and Ascher (1968)proposed the following types of anchorage. Dentition Anchorage 1,2,III-V,6 1,2,III-V,6 IV & V both U / L V & space after IV 1,2,II-6 alveolar processIV,V 1,2,III,4-6 6 & alveolar process www.indiandentalacademy.com
  55. 55. Trimming of the occlusal surfaces is essential to allow certain teeth to erupt further, while fully erupted teeth are prevented from eruption through contact with acrylic. Balters refers to stimulation of eruption as unloading or promotion of growth & prevention of eruption as loading or inhibition of growth. www.indiandentalacademy.com
  56. 56. The types of teeth eruptions possible by planned trimming of the bionator are, Vertical eruption Buccal eruption Mesial or distal eruption of the buccal segments Mesial migration of anterior teeth. www.indiandentalacademy.com
  57. 57. Vertical eruption of the buccal segments. Some acrylic is left at the level of the occlusal plane (tooth bed) interdentally Upper and lower molars are unloaded 1st Lower premolars are unloaded while U / L molars are loaded Upper premolars are unloaded while U /L molar and L-premolar regions are loaded. www.indiandentalacademy.com
  58. 58. Acrylic projections b/w the teeth are left untouched or are replaced with selfcure acrylic becos they serve as stabilizing spurs. The noses in the lower molar region must be well defined to prevent the mandible from dropping back www.indiandentalacademy.com
  59. 59. DISTAL ERUPTION . For distal eruption of the buccal segments the eruptive path is inclined distally. Acrylic should touch the mesial aspect of the teeth and the distal part is free. Mesial eruption. The eruptive path is mesially inclined and acrylic should touch the distal part of the teeth. www.indiandentalacademy.com
  60. 60. www.indiandentalacademy.com
  61. 61. www.indiandentalacademy.com
  62. 62. EXPANSION OF THE BUCCAL SEGMENTS: The eruptive path of maxillary & mandibular molars is trimmed with a buccal slope. When trimmed for transverse movement cusp tips should be in contact with tooth bed on closure. In open bite cases posterior teeth are fully loaded for intrusion. www.indiandentalacademy.com
  63. 63. Clinical management: Appliance must be worn day and night except while eating. Interval b/w visits 3-5 weeks based on the eruption of the teeth. Labial bow away from the incisors. Buccinator loops away from buccal segments. www.indiandentalacademy.com
  64. 64. According to the plan on anchorage and growth promotion,loading and unloading of acrylic is done. In first stage of treatment rapid horizontal and vertical changes in mandibular position are common. The 1st change is muscular adaptation to new position with shortening of the lateral pterygoid (petrovick et al 1972). www.indiandentalacademy.com
  65. 65. These rapid changes lead to open bite in posterior segments. Articular and dentoalveolar adaptation occur following neuromuscular adaptation. Open bite in the deciduous molars persist until the premolars are guided into occlusion. www.indiandentalacademy.com
  66. 66. Bionator modifications Minor Major- Bio-M-S Appliance -Bionator I,II,II -Orthopedic corrector I,II www.indiandentalacademy.com
  67. 67. Minor modifications : 1-Williamson & Hamilton 3 mm wide cover for max.incisors 2-Teusher (1978) Face bow tubes Lower lip pads www.indiandentalacademy.com
  68. 68. www.indiandentalacademy.com
  69. 69. Major modifications: Bio-M-S appliance -Erich & Annette Fleischer acrylic body reduced in size maxillary buccolabial arch wire mandibular labial arch wire wire spurs metal occlusal bite plane. www.indiandentalacademy.com
  70. 70. www.indiandentalacademy.com
  71. 71. Construction bite: improvement in soft tissue profile tolerable and acceptable to the patient. If edge to edge bite results in unfavorable increase in LFH then mandibular incisors should be in contact with lingual surfaces of maxillary incisors. www.indiandentalacademy.com
  72. 72. Modified bionator of Schmuth (reduced activator of Schmuth) acrylic part similar to bionator labial guide bow of the original AndersonHaupl midline jack screw in the lower lingual plate acrylic side plates anterior cap www.indiandentalacademy.com
  73. 73. CALIFORNIA BIONATOR www.indiandentalacademy.com
  74. 74. www.indiandentalacademy.com
  75. 75. Bionator I acrylic part similar to bionator labial guide bow of the original Anderson-Haupl lingual retention wire midline jack screw in the lower lingual plate acrylic side plates & anterior cap www.indiandentalacademy.com
  76. 76. Orthopedic corrector -I: side screws permits forward repositioning of the front half . www.indiandentalacademy.com
  77. 77. www.indiandentalacademy.com
  78. 78. Bionator II www.indiandentalacademy.com
  79. 79. Orthopedic corrector II www.indiandentalacademy.com
  80. 80. Bionator II – is used to close open bite in the anterior region due to protruding pre maxilla and labially flared incisors. Bionator III- is a lower arch advancing appliance. Its purpose is to advance the mandible from class II to class I www.indiandentalacademy.com
  81. 81. The Bionator and TMJ problems Its been very successful in treating TMJ problems especially adults. TMJ problems have coincident bruxism and clenching during sleep. The bionator relaxes the muscle spasm. It prevents riding of the condyle over the posterior edge of the disk which causes clicking. www.indiandentalacademy.com
  82. 82. Clinically check habitual occlusion and then the mandible is positioned forward to determine the amount of forward placement to eliminate clicking on the opening maneuver. Bionator therapy with local heat application and muscle relaxants can provide immediate relief for the patients.. www.indiandentalacademy.com
  83. 83. Petrovic has shown that protracted wear in adults can permanently shorten the LTM and thus help the patient maintain a protracted mandibular posture even during the day time. Clicking and other unfavorable TMJ sequelae disappear www.indiandentalacademy.com
  84. 84. Disadvantages of theBalters Bionator -indications are reduced because there is no allowance for vertical component except allowing posterior teeth to erupt. -abnormal tongue function can be secondary ,adaptive or compensatory because of skeletal mal development. Difficulty in correctly managing it. A correct differential diagnosis is essential. www.indiandentalacademy.com Chances for distortion.
  85. 85. Advantages of Balters Bionator. It can be worn both day and night. It has a constant influence on the tongue and perioral muscles Action is faster than the activator. Constant wear results in rapid sagittal adjustment of the musculature to forward mandibular position www.indiandentalacademy.com
  86. 86. 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. www.indiandentalacademy.com
  87. 87. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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