COMPONENTS OF

ACTIVATOR AND
BIONATOR

MAYMA NATHASHA.M
 C
1 INTRODUCTION
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2 HISTORY AND EVOLUTION OF ACTIVATOR & BIONATOR N
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3 EFFICACY AND VIEWS OF ACTIVATOR
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4
FORCE ANALYSIS N
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5 COMPONENTS OF ACTIVATOR & BIONATOR
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6 MODIFICATIONS OF ACTIVATOR AND BIONATOR
The term “ Functional appliances “ refers to a variety of removable
appliances designed to alter the arrangement of various muscle groups that
influence the function and position of the mandible to transmit forces to the
dentition and basal bone.

Functional appliances falls into 4 broad categories (Proffit )

1.Passive tooth borne Eg : Activator , Bionator , Twin Block And Herbst
Appliances

2.Active tooth borne Eg: Modifications of activator and Bionator

3.Tissue borne Eg : Frankel’s functional regulator

4.Hybrid
ACTIVATOR
HISTORY AND EVLOUTION OF ACTIVATOR

• Kingsley introduced ‘Jumping of the bite’ in 1880 to correct sagittal

relationship between upper and lower jaws.

• Hotz modified the kingsley’s plate into a vorbissplate , used it in case

of deep bite retrognathism.

• From Kingsley’s concept , Vigo Andresen in 1908 developed a loose

fitting appliance on his daughter as a retainer during summer
vacations to correct distocclusion and called it as ‘biomechanical
working retainer’ .
• Years before Andresen started working on it , Robin created ‘monobloc’
to position mandible forward in patients with glossoptosis and severe
mandibular retrognathism.

• Andresen moved to Oslo university , Norway where he met Haupl ,a

periodontist and histologist who became impressed with results obtained
by Andresen’s functioning retainer. He was convinced that the appliance
induced growth changes in a physiologic manner . They called it as
Activator ( ability to activate muscles ) or Norwegian appliance.

• This paved way for series of modifications and an array of functional

appliances , which opened a new area in the field of functional jaw
orthopedics.
EFFICACY OF ACTIVATOR
• Activator induces musculoskeletal adaptation by introducing new
pattern of mandibular closure.

• Myotactic reflex activity is stimulated , causing isometric muscle

contractions . This muscle force transmitted by the appliance moves
the teeth by using kinetic energy.

• Condylar adaptation to the anterior positioning of mandible consists of

growth in an upward and backward direction to maintain the integrity
of the TMJ structures. This adaptation is induced by loose fitting
appliance.
CLASSIFICATION OF VIEWS
Views of various authors are classified into 3 groups

1.PETROVIC (1984) MC NAMARA (1973)

• Substantiate Andresen-Haupl concept ( within freeway space )

• Myotactic reflex and isometric contraction

• Induces musculoskeletal adaptation by introducing new pattern of

mandible closure

• Superior heads of lateral pterygoid – most important role in adaptation

2.SELMER-OSLEN , HERREN (1953) , HARVOLD (1974) AND
WOODSIDE (1973)

• Did not accept that myotactic reflex activity with isometric muscle
contractions induced skeletal adaptation.

• According to their views , viscoelastic properties of muscle and stretching

of soft tissues are decisive for activator action.

• Each application of force induces secondary forces in the tissues which

inturn introduces bioelastic process, which is important in skeletal
adaptation.

• Thus not only muscle contractions but viscoelastic properties of soft

tissues are also important.
Stages of Viscoelastic properties :

1. Emptying of vessels
2. Pressing out of interstitial fluid
3. Stretching of fibers
4. Elastic deformation of bone
5. Bioplastic adaptation

• Woodside opens the mandible with construction bite as much as 10-

15 mm beyond the postural rest position.
• Schmuth (1994) , Witt (1981) and Witt and Komposch (1979) –
displace the mandible 4-6mm below their intercuspal position .
Observed long periods of continuous pressure from mandibular teeth
against the activator .

• Eschler ( 1952) refers to opening the vertical dimension beyond 4mm

in construction bite as the muscle stretching method , which works
alternatively with isotonic and isometric muscle contractions.

3. COMBINATION
Between two extremes a number of authors state 4-6mm opening is the
ultimate decision as to whether the force delivered is kinetic energy
(isometric contractions) or potential energy (viscoelastic properties) or
combination.
MECHANISM OF STRETCH /
MYOTACTIC REFLEX :
Stimulus of stretch reflex is the stretch of
muscle.

When stretch reflex is elicited it causes

contraction of the stretched muscle.

Muscle stretch receptors are proprioceptive

nerve endings called muscle spindles.
 MUSCLE SPINDLES

CENTRAL OR NUCLEAR BAG

2-15 THIN INTRAFUSAL MUSCLE
REGION ( NON CONTRACTILE)
FIBRES
( STRIATED AND CONTRACTILE )

IMPULSES CONDUCTED BY GROUP 1A SENSORY

NERVE FIBRES
MYOTACTIC OR STRETCH REFLEX IS
THEREFORE A MONOSYNAPTIC REFLEX
ARC.
SENSORY NERVE FIBERS SYNAPSE WITH
FUNCTIONAL SIGNIFICANCE OF STRETCH MOTOR NEURON CALLED ALPHA EFFERENTS
REFLEX : ACTS IN MANDIBULAR
MUSCULATURE TO MAINTAIN POSTURAL
REST POSITION IN RELATION TO MAXILLA. SUPPLY EXTRAFUSAL MUSCLE FIBRES

CONTRACTION OF STRETCHED MUSCLE

 MECHANISM OF CLASP KNIFE REFLEX / AUTOGENIC
INHIBITION
Attempts to flex a spastic limb forcibly

Resistance develop ( hyperactive reflex contraction )

If carried out forcibly , muscle relax – No resistance

Receptor- Golgi tendon apparatus

Impulse conducted by group 1B sensory fibres

Acts on motor neuron of muscles

FUNCTIONAL SIGNIFICANCE
Protect overload by preventing damaging contraction against strong stretching force.
FORCE ANALYSIS IN ACTIVATOR THERAPY
When functional appliances activates the muscles , various types of forces
are created.

1. Static – Permanent and vary in magnitude and direction

Eg : Forces of gravity , posture , elasticity of soft tissues and muscles

2. Dynamic – Interrupted and appears simultaneously with movements of

head and body.
Higher magnitude than static forces.
Eg : Swallowing
3.Rhythmic – Associated with respiration and circulation
Mandible transmits rhythmic vibrations to maxilla.

Two principles are employed in modern activator

1.Force application – usually muscular

2.Force elimination – dentition is shielded from normal and abnormal

functional and tissue pressures by pads , shields and wire configurations.
COMPONENTS OF ACTIVATOR
1.Acrylic components
2.Wire components

ACRYLIC PORTION :

• Activator consists of upper , lower and interocclusal parts.

• In upper and lower parts – dental and ginigival portions can be
differentiated.
• Flanges for the upper part – 8-12 mm high
• Lower part – 5-12mm high
• After the placement of wire components , acrylic free areas are covered
with baseplate wax , upper and lower portions are molded from self cure
acrylic.

• The casts are placed on the fixator and upper and lower portions are
joined with endothermic acrylic at the interdental area. Dentaurum
fixator allows simultaneous acrylic application on the interocclusal part
from both lingual and buccal sides.

• After polymerization , the appliance is ground and polished. Necessary

trimming for specific tooth guidance is done with patient on chair.
WIRE COMPONENTS :

LABIAL BOW

Original appliance – combined upper and lower plate at occlusal plane with
only one wire element for upper anterior teeth.
• Primary wire elements are upper or lower labial bows.

• They consist of horizontal middle sections , two vertical loops and wire
extension through canine-deciduous first molar embrasure.

• Horizontal section contacts the labial surfaces of the four incisors.

• Depending on vertical dimension , wire crosses the incisors above or

below the area of greatest convexity.
• Bow can either be passive or active , depending on prescription.

• Active bow should touch the teeth. Gauge of the wire is 0.9mm.

• Passive bow influences the soft tissues without touching the teeth ,
similar to action of screening appliances. Gauge of the wire is 0.8mm .

• Vertical U shaped loops of upper labial bow start with a 90 degree bend
at the lateral incisor-canine embrasure.

• Lower bow is similar in configuration , except that middle horizontal

portion is longer because the bend for the vertical loops starts more
distally in the mesial third of the canine.
• Additional elements are added based on their prescription.
MODIFICATIONS OF ACTIVATOR

Broadly categorized into 2 types :

I.Appliances with one rigid acrylic mass for maxillary and mandibular
arches but with reduced volume or bulk.
II.Appliances consisting of two parts joined by wire bows.

1.ESCHLER’S MODIFICATION :
• Labial bow improved intermaxillary effectiveness.
• One part was active – moving the teeth
• Other was passive – holding soft tissues of lower
lip away and this enhancing tooth movement
desired.
2.ELASTIC OPEN ACTIVATOR :

• Klammt in 1955

• The appliances reduced in the anterior palatal region are called open
activators.

• Goal – restore exteroceptive contact between tongue and palate.

Consists of bilateral acrylic parts ,upper and lower labial wire , palatal arch
and guide wires for upper and lower anteriors.
3. BIONATOR :

• Balter , 1960

• These are appliances with reduced alveolar regions and with cross-
palatal wires instead of full acrylic plate.

• Labial bow eliminates the abnormal muscle pressure by extending into

the buccal vestibular area , opposite canine & premolar regions.
4. HERREN ACTIVATOR :

His concept was in complete opposition with kinetic concept of Andresen

Haupl.

Observations on sleeping patients revealed that there are few movements

of masticatory apparatus & therefore the appliance itself.

Slight unconscious lowering of the mandible will detach the activator from
the maxillary parts and lessen its effectiveness.

He advocated by fixing clasps to maxillary dentition & by maximum

forward positioning of the mandible.
5. L.S.U ACTIVATOR OF SHAYE :

• Modification of Herren activator.

• Lower incisors bite on a plane formed by the acrylic.

• Growth in occlusal direction is impeded.

• Freeing of occlusal aspects of posterior teeth by grinding away the

acrylic , will assist in eruption in molar and premolar region reducing
curve of Spee.

• Leveling of occlusion in thus achieved.

6. WUNDERER’S MODIFICATION :

Used for class III malocclusion.

Appliance is split horizontally and screw is

embedded in the acrylic behind the incisors.

Occlusal surfaces are covered with acrylic.

By opening the screw , maxillary portion is moved

anteriorly with a reciprocal backward thrust on
the mandibular portion.
7.BOW ACTIVATOR OF A.M.SCHWARZ :

He was influenced by the elastic properties of Bimler’s appliance and some

contributions from Wunderer’s appliance.

It consisted of activator split into half horizontally and connected by an

elastic metal bow with safety pin curve – to absorb shock of jaws during
closing.
8.REDUCED ACTIVATOR OR CYBERNATOR OF SCHMUTH :

Acrylic part is reduced in similar manner to that of bionator.

Consists of labial wire and coffins spring.

Slender acrylic part is split in the midline which avoids frequent breakages.

Construction bite is similar to that of activator , with acrylic rim covering

the lower incisors.
9.KARWETZKY MODIFICATION :

• Quite similar to the Schwarz bow activator.

• It consists of maxillary and mandibular active plates , joined by a U bow

in the region of first permanent molars.

• Height of construction bite is equal to interocclusal clearance.

• Depending on the placement of the ends of the U bows , 3 types have

been created :
1.Type I – For class II division 1 and 2
2.Type II – For class III or mandibular prognathism
• Type III – To influence mandible in transverse direction rather than
sagittal

• U bow has one longer and one shorter leg. Shorter leg imbedded in
upper appliance and longer leg is attached to the lower plate.
10.KINETOR :

It is also an elastic activator developed by Hugo Stockfish.

Combination of fuctional principles with incorporation of screws & springs.

11.PALATAL FREE ACTIVATOR :

Developed by Metzelder.

Combines bionator with original Andresen Haupl activator.

Mandibular part is same as activator.

Maxillary portion – acrylic covers only palatal or lingual aspect of buccal

teeth.

Palate remains free , making it easier for patient to wear.

12.PROPULSOR :

• This was conceived by Muhlemann and refined by Hotz.

• Described as ‘hybrid appliance’ , since it features both monobloc and

oral screen.

• Useful in maxillary dentoalveolar protrusion.

• No wire configurations.

• Acrylic between the occlusal surfaces of the first molars serves to

stabilize the appliance.
BIONATOR
INTRODUCTION
• Introduced by Wilhelm Balter in 1960

• Prototype of a less bulky appliance.

• Limitations of activator – Bulkiness

Night time wear

• Although the theoretical principles of Balter’s appliance is based on

Robin , Andresen & Haupl’s concepts. To overcome the
shortcomings , Bionator was made.
PHILOSOPHY :
According to Balter ,

“ the equilibrium between the tongue and circumoral

muscles is responsible for the shape of the dental arches
and intercuspation “
• Functioning space for tongue is essential for normal development of
orofacial region.

• Tongue ( center of reflex activity ) – most important factor in

treatment according to Balter.

• Discoordination in its function – leads to abnormal growth and

deformation.

• Purpose of bionator – Functional coordination

Eliminate deforming
growth restricting aberrations
 Bionator does not activate the muscles but modulate the muscle
activity thereby enhancing normal development of inherent growth
pattern and eliminates abnormal & potentially deforming environmental
factors.
ADVANTAGES :
• Reduced size – allows it to be worn during day and night

• Unfavorable external & internal muscle forces are prevented from

exerting undesirable effects on the dentition and supporting structures
for a long time , making its action faster than classic activator.

DISADVANTAGES :
• Difficulty in stabilisation of appliance and selective grinding .

• Vulnerability to distort due to less acrylic support exists in alveolar and

incisal region.
 Standard appliance

1
Open bite bionator

Reverse bionator for class III

TYPES OF
BIONATOR 2

3
 STANDARD APPLIANCE

Consists of -

ACRYLIC COMPONENTS

• Lower horseshoe-shaped acrylic lingual plate

extending from the distal of the last erupted
molar around to the corresponding point on the
other side.

• Upper – Posterior lingual extensions that cover

the molar and premolar regions.
• Anterior portion is open from canine to canine. Kept free to prevent
interference with tongue function.

• Upper and lower parts are joined interocclusally in the correct

construction bite , extend 2mm above and below the gingival margin.

• 2 wire configurations to guide the function and posture of lips and

cheeks
1. Palatal bar
2. Labial bow with buccal extensions
WIRE COMPONENTS :

1.PALATAL BAR

• 1.2 mm hard stainless steel wire

• Extending from upper margin of acrylic approximately opposite the

middle of first premolar.

• Follows contour of palate , about 1mm distance from mucosa.

• Arch forms a wide curve that reaches the line joining the distal surfaces
of the first permanent molars.
• The task of palatal arch ( by the theory of Balters ) is to stimulate the
distal aspect of the tongue. It is for this reason that the curve of arch is
directed posteriorly and should effect a forward orientation of tongue.
2.VESTIBULAR WIRE :

• 0.9mm hard stainless steel wire.

• It emerges from the acrylic below the contact point between the upper
canine and first premolar.

• It rises vertically and is bent at right angle to go distally along the middle
of crowns of the upper premolars.
• Just anterior to the mesial contact point of the first molar , wire is
fashioned in a round bend towards the lower dental arch.

• Labial portion of the wire is kept away from the surface of incisors by the
thickness of a sheet of paper. This position of wire produces a negative
pressure , with the wire supporting lip closure.

• Lateral portions of the wire are sufficiently away from the premolars to
allow for expansion of the dental arch.
• Anterior portion of wire is called labial wire and
lateral parts are called buccinator bends.

• Buccinator bends have two treatment objectives :

*Keeps away the soft tissues of the cheeks

*They actually move the surfaces of the orobuccal

capsule laterally , increasing the oral space by virtue
of the forward positioning of the mandible which
relaxes the musculature while the wire holds it away
from alveolar mucosa.
USES :

For treatment of class II division 1 conditions inorder to correct the

backward position of tongue .

For narrow dental arches of a class I . Through continuous exercise tongue

function is stimulated and mass of tongue is enlarged , thereby achieving lip
closure.
 OPEN BITE APPLIANCE

• Purpose of open bite appliance is to close the vertical space or open bite.

• Majority of the cases tongue is causing or perpetuating the infraocclusion

of maxillary and mandibular incisor teeth , allowing overeruption of the
buccal segments.
• Since there is little or no interocclusal clearance due to abnormal tongue
function , it is necessary to prevent the tongue from inserting into
aperture so the maxillary parts are joined anteriorly.

• The maxillary and mandibular acrylic portions are joined by bite block.

• Small occlusal bite block is used for stabilization has indentations on the
teeth surface.

• Purpose of lateral bite block is to prevent posterior teeth from erupting ,

whereas anterior teeth are allowed to erupt freely.

• Blocks must not be thick to prevent lip seal.

 WIRE COMPONENTS :

• The PALATAL BAR has same configuration as the standard bionator.

• The LABIAL BOW is similar in form to the standard bionator , only

differing in wire that runs approximately between incisal edges of the
upper and lower incisors.

• Labial part of the bow is placed at height of lip closure , thus stimulating
achieve a competent seal.

• Vertical strain on the lips tends to encourage the extrusive moment of

the incisors after eliminating the adverse tongue pressure.
CLASS III OR REVERSED BIONATOR

Used to encourage the development of maxilla.

ACRYLIC PART :

Similar to that of standard type.

Opening the bite should provide a space of less than 2 mm , to allow the
upper incisors to move labially past the lower incisors.

About 1mm thickness of acrylic is removed behind mandibular incisors ,

which blocks forward movement of tongue towards the vestibule.
The purpose is to teach the tongue by proprioceptive stimuli to remain
retracted and proper functional space.

It will contact the uncovered anterior portion of palate , stimulating

forward growth component.
WIRE COMPONENTS
Palatal arch
• Fabricated of 1.2mm wire.

• The round bend is placed in an inverted position , extending forward to

a line connecting the middle of the first premolars and posteriorly to
the distal surface of first molar where it enters the acrylic at right angle
bend.

Vestibular wire
• o.9mm in diameter , placed in front of lower incisors.

• Emerges from acrylic in the same manner as in standard , below the

contact point of upper canine and first premolar.
 MODIFICATIONS OF BIONATOR

1.BIOMODULATOR OF FLEISCHER OR MODIFIED BIONATOR :

Acrylic body is reduced in size , extending less along alveolar processes.

Single labial bow with buccinator loops replaced by maxillary buccolabial

arch wire and separate mandibular labial arch wire.

Transpalatal bar opens in distal direction as in class III bionator.

2. BIO-M-S APPLIANCE :

Consists of labial wire like the biomodulator .

Incorporates a metal occlusal bite plane 0.5mm thick , which provides a

functional occlusal plane to normalize the vertical dimension with
selective eruption or withholding of anterior and posterior teeth as desired.
REFERENCES

1.Dentofacial orthopedics with functional appliances – Thomas

M.Graber , Thomas Rakosi , Alexander Petrovic

2.Removable orthodontic appliances – T.M.Graber , Bedrich Neumann

3.Orthodontics-Current principles and techniques - T.M.Graber ,

Robert L.Vanarsdall