Description :
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.for more details please visit
www.indiandentalacademy.com
Frankles appliance Is a myofunctional appliance
Functional appliance are removable or fixed appliances that aim to utilize eliminate or guide the forces arising from muscle function,tooth eruption and growth inorder to alter skeletal and dental relationship
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.for more details please visit
www.indiandentalacademy.com
Description :
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.for more details please visit
www.indiandentalacademy.com
Frankles appliance Is a myofunctional appliance
Functional appliance are removable or fixed appliances that aim to utilize eliminate or guide the forces arising from muscle function,tooth eruption and growth inorder to alter skeletal and dental relationship
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.for more details please visit
www.indiandentalacademy.com
Description :
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.for more details please visit
www.indiandentalacademy.com
Description :
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.for more details please visit
www.indiandentalacademy.com
Bionator and its modification /certified fixed orthodontic courses by Indian ...Indian dental academy
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
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.for more details please visit
www.indiandentalacademy.com
Functional appliances
Prepared by:
Dr Mohammed Alruby
الوفاء غالي جدا فلا تتوقعه من رخيص
Functional orthodontic appliances
Definition: loose, usually removable intra-oral device which alter the muscle force against the teeth and cranio-facial skeleton.
They are dynamic appliance depend on altered neuro-muscular action to affect bony growth and occlusal development and also in maxilla than mandible
They are usually used in mixed dentition (ADA 1992)
Growth modification: making limited change in size of the cranio-facial complex
Time treatment: depend on growth spurt that differ in boys and girls
= early treatment usually involves two phase of treatment:
1- Functional phase
2- Fixed phase
=early start treatment can effect on the improvement of malocclusion so decrease the psychological impact
Types of occlusion treatment with functional appliances
- Class II div 1
- Class I div 2
- Class III
- Open bite
How functional appliance work
Functional appliance influence four principle regions
1- Oro-facial soft tissue:
Teeth sit between the tongue on one side and the lips and cheeks on the other side
Correction can occur by improve the soft tissue environment surrounding the dentition
Incorporating oral screens or shields constructed in wires or acrylic as part of appliance
2- Muscles of mastication:
Forward positioning the mandible results in stretch and alteration in the activity of muscles of mastication, particularly involved in elevation and retraction of mandible
The force transmitted to the dentition via the appliance
electo-myographic studies shown hyperactivity of the lateral pterygoid on protrusion of the mandible ( Mac-Namara 1973)
3- Dentition and occlusion:
Forward position of mandible also generate an inter-maxillary force directed between the maxillary and mandibular dentition
= class II component force aid in reduction of overjet by tipping of teeth
= change in mandibular position also associate with change in the vertical dimension, that facilitate eruption of buccal teeth
= this eruption can be controlled by capping of the teeth in buccal segment
4- Jaw skeleton;
The force affects the bone -------- remodeling
The force affects the condyle ------- growth changes
a- Additional over growth of the mandible
b- Accelerate growth of the mandible
c- Change the direction of growth
d- Restricted growth of maxilla
e- Change the position of condyle and glenoid fossa
= studies of functional appliance like Herbest shown forward movement in the glenoid fossa through bony remodeling. The overall treatment time is usually in the region of 9 to 12 months depending on the size of initial overjet, the average overjet reduction is approximately 1mm / year
Classification:
1- Myotonic: depend on the muscle mass for their action, large mandibular opening 8 – 10 mm worked by passive muscle stretch as Harvold
2- Myodynamic: depend on muscle activity for their function, median mandibular opening > 5mm
Work by stimul
Description :
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
Biomechanics of open bite correction /certified fixed orthodontic courses by ...Indian dental academy
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
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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3. • 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
4. Functional appliances are considered to be primarily
orthopedic tools to influence the facial skeleton of the
growing child. The uniqueness of these appliances lies in
the fact that instead of applying active forces, they transmit,
eliminate and guide the natural forces (e.g. muscle activity,
growth, tooth eruption) to eliminate the morphological
aberrations and try to create conditions for the harmonious
development of the stomatognathic system.
Most of the functional appliances are intraoral devices,
and nearly all of them are tooth borne or supported by
teeth.
4
7. Norman Kingsley 1879 Vulcanite palatal plate
Pierre Robin 1902 Monobloc
Viggo Andresen 1908 Activator
Wilhelm Balter 1960 Bionator
Rolf Frankel 1967 FR
William Clark 1977 Twin block
7
8. 8
The bionator, developed by Balters, is a
functional jaw orthopedic appliance. Its primary
purpose is to stimulate growth of a deficient
mandible, but it can also stimulate alveolar
growth in deep overbite cases, gain space in
moderately crowded cases in mixed dentition,
as well as correction of open bite cases in
mixed dentition.
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)
9. It is similar in design to the activator but
much less bulky, the bionator can be worn
day and night except during meals. Studies
have shown greater orthopedic effect on the
growing jaws with full time wear, whereas
part time wear results primarily in dental
change. Therefore, full time use of the
bionator makes possible the improvement
of deformed faces and jaw structure in the
growing child that was previously not
possible with the use of fixed appliances or
part time orthopedic devices.
9
Activator
Bionator
10. Quoted by Balter
10
“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.”
12. It works by modulating muscle activity
12
Enlarge oral space
& train tongue
functions
To achieve
elongation of
mandible
Bring incisors into
edge to edge
relationship
Accomplish lip
seal & bring
dorsum of tongue
into contact with
soft palate
Improve
relationships of
jaws, tongue &
teeth
13. 13
Reduced size
It can be worn both day and night
Action faster than activator –unfavorable forces
are avoided acting on dentition for longer time
Constant wear so more rapid adjustment of
musculature
14. 14
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
15. 15
Dental arches well aligned
Mandible in posterior position
Skeletal discrepancy not severe
Labial tipping of upper incisors
evident
Deep bite
Class III where reverse bionator
can be used
Open bite
16. 16
Class II – if caused by maxillary prognathism
Vertical growth pattern
Labial tipping of mandibular incisors
19. 19
1. THE STANDARD BIONATOR (Bionator I)
2. THE OPEN BITE BIONATOR (Bionator II)
1. CIass III OR REVERSED BIONATOR (Bionator III)
20. The standard Baltrers Bionator appliance, used in
the treatment of class II, division I malocclusions
with excessive overjet and deep overbite.
20
21. 21
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
22. WIRE COMPONENTS
22
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
23. WIRE COMPONENTS
23
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
24. WIRE COMPONENTS
24
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
25. 25
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.
*The purpose of this appliance is to close
the anterior space.
26. Wire elements
26
Labial bow runs between the upper and
lower incisors at the height of lip
closure.
27. The Bionator II (to close bite):
The Bionator II is designed to correct
anterior Open bites in Class I and
Class II malocclusions.
The posterior teeth are covered with
acrylic to prevent their eruption. The
acrylic is kept
away form the incisors to allow closure
of the open bite. The midline
expansion screw can
be used for arch development when it
is indicated
27
28. 28
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
29. Palatal bar
29
Runs forward with loop
extending as far as decduous 1st
molar or permanent premolars.
Function – tongue to contact
anterior portion of palate ,
encouraging forward growth of this
area.
Wire elements
30. Labial bow
30
In front of lower incisors
Wire slightly touches the labial surface
lightly.
Wire elements
34. 34
Def: is one of a group of functional, removable, tooth-
borne appliances that depend on the stretch of soft
tissue caused by mandible being positioned forward
and downward together with muscle activity generated
by the mandible attempting to return to its original
position to achieve the desired dental and skeletal
effects.
{orthodontics principle and practice -Phulari}
36. Standard Bionator:
used in the treatment of class II, division
I malocclusions with excessive overjet
and deep overbite orients the tongue &
mandible anteriorly by stimulating its
dorsal surface with palatal bar.
36
37. Labial bow: begins above contact point between canine and upper 1st
premolar –runs vertically
37
38. Openbite Bionator:
• Posterior teeth are covered
with acrylic to prevent their
eruption. The acrylic is
kept away form the incisors to
allow closure of the open bite.
38
39. Labial bow runs between
the upper and lower
incisors at the height of lip
closure.
39
40. Reverse Bionator:
• Correction of class III
Tongue contact anterior portion of palate ,
encouraging forward growth of the
maxilla.
40
42. Bionator general indication
• The dental arch is well aligned originally
• The mandible is in a posterior position
• The skeletal problem is not too severe
• A labial tipping of the upper incisors is
evident
• Note: labial bow: 0.9mm st.st wire
Palatal bar: 1.2mm st.st wire
42
44. CONSTRUCTION BITE
44
Def: it is an intermaxillary wax record used to relate the
mandible to the maxilla in the 3 dimensions of space, they are
used to reposition the mandible in order to improve the
skeletal inter-jaw relationship.
45. 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.
45
46. • The bite registration involves
repositioning the mandible in a forward direction as
well as opening the bite vertically.
• In most cases the mandible is advanced by 4-5 mm
and the bite is opened to the extent of 2-3mm.
46
47. • General consideration for construction bite:
1- in case the overjet is too large, forward
positioning is done step wise in 2-3 phases.
• 2- in case of forward
positioning of the
mandible by 7-8 mm,
the vertical opening
should be slight to
moderate i.e: 2-4mm.
• 3- if the forward positioning is not more that 3-
5mm, then the vertical opening can be 4-6mm
47
48. Various techniques are now used to record the bite to the
favoured mandibular position:
1- Horseshoe waxblock. 2- Exactobite / Projet bite .
3- George gauge. 4- Andra Gauge…etc.
48
49. Steps for bite registration
49
• 1- the amount of sagittal and
vertical advancement is
planned.
• 2- a horse shaped wax block
is prepared for insertion
between upper and lower
teeth. It should be 2-3mm
thicker than the planned
vertical opening. Should be
heated in warm water bath.
•
50. • *NOTE*: other materials may be used; e.g: heavy putty
base impression material is used and allowed to set for 2
minutes, or injectable registration material, e.g: FUTAR,
O-Bite .
50
51. • 3- The patient is made to sit in an upright relaxed
position.
• 4- Guiding the mandible into planned sagittal position
without force or pressure.
• 5- patient is asked to practice placement of jaw at the
desired position few times before registration of bite.
• 6- The wax block is placed on the lower jaw and patient
is asked to close in desired sagittal position.
51
52. • 7- Remove the wax
registration and chill the wax
under cold running water, cut
away the wax as shown in the
canine/premolar region
• 8- Place back into the mouth
to check the registration is
correct - the lateral opening
and that the center lines are
correct.
52
54. Exactobite.
• Use either a thick or thin 'bite fork'.
The 'ProJet' bite forks are available
in thick for when an overbite needs
reducing and thin for normal or
reduced overbites.
*the thick one is yellow
and the thin is blue.
• Explain to the patient what is
required, ie that they posture
forward to the required occlusion.
54
55. • Place the bite fork into the mouth
and ask the patient to practice biting
into the required position
NB Do not over posture the patient
or place them into a class III
relationship. Place the single notch
down and the middle notch to locate
the upper teeth (this is opposite to
the ProJet instructions, but is much
easier for patient and operator)
55
56. • Soften a sheet of pink modeling wax in
hot water, folding them into the bite fork
to give 3-4 layers on both sides, top and
bottom, but keeping the notches clear..
• Place the bite fork and soft wax into the
mouth asking the patient to close into the
postured position. Excess wax can be
moulded to aid location of the bite for the
laboratory. You must ensure that the
center lines are correct.
56
57. • Remove the bite fork and chill the wax
under cold running water.
• Place back into the mouth to check the
registration is correct.
57
64. Construction bite
64
In Open Bite Bionator
Construction bite-is as low as possible with
minimal vertical opening for interposition of
posterior bite blocks to prevent their eruption.
65. • In Reverse Bionator
Construction bite- taken in more
retruded position so as to allow
labial movement of maxillary
incisors, the bite is opened to
clear the bite & also to exert
restrictive force on lower arch.
Generally, a vertical opening of
5mm and a posterior positioning
of about 2 mm is required.
65
66. 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 Central incisors
66
69. TRIMMING OF BIONATOR
69
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
71. ARTICULAR PLANE:
71
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
72. LOADING AREA:
72
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.
73. TOOTH BED
73
Some parts of the
loading areas are
trimmed away to the
articular plane
74. NOSE:
74
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
75. LEDGE :
75
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
77. BALTERS REFERS
77
prevention of eruption as
loading or inhibition of growth
stimulation of eruption as
unloading or promotion of
growth
78. 78
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
is done
79. SELECTIVE TRIMMING
79
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
movement
For intrusion in case of open bite –posterior teeth
are fully loaded
80. Why Trimming ???
1.vertical control
• For dolichofacial patients:intrude molars,
extrude incisors
• For branchfacial patients: intrude incisors,
extrude molars
80
83. Ascher (1968)proposal
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
83
Deciduous teeth if present are used as anchorage
and Ascher (1968)proposed the following types of
anchorage.
84. ANCHORAGE OF APPLIANCE
84
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
6. Labial bow prevents posterior displacement
87. CLINICAL MANAGEMENT
87
Appliance must be worn day and night except while
eating.
Pt recalled after 1 week to check sore points
Interval between 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.
89. Treatment of Angle Class II malocclusions with a
newly modified bionator combined with headgear
J Dent Sci 2009;4(2):87−95
Yen-Chun Lin, Hsiang-Chien Lin
Case 1
The patient was an 11-
year 6-month-old boy.
He had a Class II
division 1 type
malocclusion with a
hypodivergent facial
type, a half cusp
distoclusion of the
posterior segments,
and an overjet of 10mm
89
90. • There was no crowding in the lower arch, but mild
crowding of the upper anterior teeth was noted. The
upper deciduous second molars were retained, and the
upper and lower permanent second molars had not yet
erupted.
90
91. • An initial lateral cephalometric evaluation showed a
Class II skeletal relationship characterized by a A
point−nasion−B point (ANB) angle of 7.3,؛ due to
maxillary prognathism and mandibular retrognathism.
91
92. His treatment plan involved both
upper and lower molar distalization
and forward advancement of the
mandible using the newly modified
bionator combined with high-pull
headgear, with approximately 450 g
of force adapted to the tubes in the
appliance. During the active phase of
treatment, the patient was instructed
to wear the headgear 10 hours a day
at night and the bionator appliance
24 hours a day, except during meals.
92
93. After Bionator
The patient was
advised to keep
his lips together to
form a lip seal
when the
appliance was
being worn. At
each monthly
visit, the occlusion
was checked for
correction of the
arch relationships.
93
94. During the retention
phase, the patient was
instructed
to wear a tooth
positioner every night
tobed, approximately
10 hours each day, for
2 years.
94
After retention
96. Long-term Effectiveness and
Treatment Timing for Bionator
Therapy.
FALTIN, FALTIN, BACCETTI, FRANCHI
Angle Orthodontist, Vol 73, No 3, 2003
((Of a study on Bionator therapy followed by fixed appliances in class-II
patients indicate that this treatment protocol is effective and stable
when it is initiated immediately before the pubertal growth spurt.
Optimal timing to start treatment with the Bionator is when a concavity
is evident at the lower borders of both the second and the third cervical
vertebrae (CVMS II).
In the long term, the amount of significant supplementary elongation of
the mandible in subjects treated with the Bionator during the pubertal
growth spurt is 5.1 mm more than that in untreated subjects with class-
II malocclusion.))
96
98. The functional treatment of anterior-
open bite: three case reports
Banu Dinçer* / Serpil Hazar**
J Clin Pediatr Dent 25(4): 275-286, 2001
Case 2
A patient whose skeletal age is 9 years 2
months and chronological age is 10 years 3
months was presented to the clinic.
The patient had the typical facial characteristics
of the open bite anomaly with the dolicephalic
face, convex facial profile and the increase of
the inferior facial height. It was noted that he
had difficulty closing his mouth from the
wrinkling of the muscles in mental region when
he closed his mouth.
98
99. He had a finger sucking habit. He was
advised to quit the sucking habit.
Nevertheless, when this was not
sufficiently accomplished, the patient
worked with a child psychologist to quit
the habit.
Diastemas in lower and upper teeth
region were observed as well as 4 mm.
open-bite. Together with this, he had
an overjet of 7.5 mm. The
cephalometric evaluation showed
Class II skeletal pattern (ANB=7).
99
100. The patient wore the open-
bite bionator. He used the
appliance a minimum of 18
hours a day. In 10 months,
the elimination of the open-
bite was obtained and a
2mm normal overbite
relation was achieved,
which was 4 mm
open-bite before the
treatment.
100
101. a decrease in the vertical development was obtained. The
patient began to close his mouth more easily. The difficulty
in muscles were eliminated
101
103. The cephalometric super impositions before and
after using the appliances
103
- - - - - - After ttt
Before ttt
104. “Long-Term Dentoskeletal Effects and Facial
Profile Changes Induced by Bionator
Therapy”
- The bionator appliance, over a long-term period, did not induce a restraining
effect on the maxilla, while it produced a significant enhancing effect on
mandibular length (3.3 mm more than untreated Class II controls).
- The bionator improved significantly the overjet and the molar relationship,
with a significant reduction of the overbite associated with an increase in
LAFH.
- The soft tissue profile was favorably altered by bionator therapy in the long
term: the chin was advanced 2.5 mm more than that of untreated controls.
Luciana Abrao Maltaa; Tiziano Baccettib.
Angle Orthodontist, Vol 80, No 1, 2010
104
106. Pseudo-Class III malocclusion
treatment with Balters’ Bionator
Journal of Orthodontics, Vol. 30, 2003, 203–215
A. Giancotti, A. Maselli
Case 3:
A female patient, age 8 years
10 months, presented with an
anterior crossbite from the
upper right deciduous canine
to the upper left deciduous
canine and a 1-mm deviation
of the mandibular midline to
the right. The patient had a
good profile with a slight mid-
face convexity and the lower
lip appeared protruded.
106
107. The upper anterior teeth were retroclined and the upper
right lateral incisor was missing, while the lower anterior
teeth were protrusive. The molars were in a Class I
relationship. The lower arch was in the late mixed dentition
and ‘E’ space was present.
107
108. Pre-treatment cephalometric analysis
showed an increased mandibular plane
angle (40 degrees), with a normal ANB,
but a high Wits measurement (6 mm)
and the lower incisor inclination was 29
degrees to NB. Angular and linear
measurements of mandibular skeletal
growth were normal. Clinical evaluation
of the occlusal relationship in centric
relation showed an early interference of
the upper left central and lower left
central incisors
108
109. • An early treatment goal was to eliminate
the mandibular displacement and
treatment was initiated with a Balters’
Bionator III. In order to construct the
Bionator a wax bite was taken by distally
repositioning the mandible in centric
relation. This use of the Bionator III thus
enabled the tongue to move freely in the
anterior part of the palate, pushing it
against the upper front teeth. The vertical
thickness of the bite was 3–4 mm with
sliding guides in the posterior zone.
109
**The patient had to
wear this Bionator for
16 hours a day.
110. The incisors were beyond edge-to-edge after 9 weeks, but
use of the Class III Bionator was continued. Eleven months
after the beginning of treatment the patient had a normal
occlusion with 2-mm overjet and a Class I molar
relationship.
110
111. Final records showed
excellent occlusal and
aesthetic results, and the
profile was relatively
normal with a good lower
lip position.
111
113. Bionator and TMJ
113
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
114. Bionator in Adult Patients
114
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
118. 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
118
119. Modification by Schmuth
119
Cybernator
Normal labial bow in the
max arch – from canine to
canine
Mandibular incisors
covered with thin 2mm
acrylic
120. BIO- M-S
120
BY ERICH & ANNETTE FLEISHER
MODIFICATIONS ARE-
Acrylic body reduced in size
Instead of long labial bow –
Maxillary buccolabial arch wire and mandibular labial
arch wire. Aid in correction of deep bite.
Transpalatal bar opens in distal direction as in CI III
bionator
Wire spurs used to reinforce anchorage.
124. Orthopedic corrector I
124
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
WITZIG incorporated 2dimentional screws bilaterally to Schmuth’s bionator.
125. Orthopedic corrector II
125
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
128. 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
128
129. Treatment effects by bionator appliance – comparison
with an untreated cl II sample
Almeida et al EJO- 2004
129
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
130. 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
130
131. CONCLUSION
131
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.