Activator /certified fixed orthodontic courses by Indian dental academy

Activator
Modifications of activator
Bionator
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


Introduction and history
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Genes / perioral muscles / dentition
Ortho- 3rd order of articulation-Moffett
Fox–application of extra oral force-1803
Kingsley –Jumping the bite –1880
Hotz –Vorbissplatte
Angle- Cl-II elastics –1907
Robin-monobloc

Origin of activator
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Modified Kingsley plate retainer
Biomechanic working retainer –Andresen
Denmark to Oslo in Norway
Karl Haupl & Viggo Andresen -activator


Classification
Based on the kind of malocclusion
Activator is best suited for achieving gross
changes in growing patients
– Cl II div I,div II
– Cl III
– Open bite

• Based on various modifications
• Classification of views

Classification of views
• Myotatic reflex activity and isometric contractions
induce musculoskeletal adaptation to new
mandibular closing pattern-Kinetic energy
– Andresen-Haupl –1938-based on ‘shaking of bone
‘hypothesis of Roux 1883
– Petrik 1957
– McNamera –1973
– Petrovic –1984

• Grude 1952-mismatch of bite & mechanism
• Viscoelastic property of muscle and stretching of
soft tissues -potential energy
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Emptying of vessels
Pressing out of interstitial fluid
Stretching of fibers
Elastic deformation of bone
Bioplastic adaptation of bone

• Selmer,Olsen,Herren 1953-incisal crossbite
• Woodside 1973 10–15 mm vertical opening
• Harvold 1974

• Transitional type of action
• Eschler 1952 muscle stretching method
• Cycle of isotonic and isometric contractions

• Ahlgren’s electromyographic research 1970

• Reiten 1951 –no special histologic results
from use of functional appliances
• Witt 1981, Scmuth 1994,
• Witt & Komposh 1979,


Mechanism of action of activator
The neuromuscular basis


Mechanism of action of activator
• Force analysis
• Static force
• Gravity, posture, elasticity of soft tissues

• Dynamic force
• Swallow, mastication

• Rhythmic force

• Activator works by
• Force application
• Force elimination

3-D Skeletal & dentoalveolar effects
• Trimming-dental
• Construction bite
• Condylar
cartilage is
secondary typeMoss, Woodside
& Petrovic-LPM
Stutzmann angle

• Factors which determine activator function
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Individual facial skeleton
Growth status
Nature of malocclusion
Inter occlusal clearence, head posture
State of mind ,level of consciousness
Treatment goal - Constriction bite

Activator therapy
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Diagnostic preparation
Treatment planning
Bite registration
Laboratory procedures
Management of the appliance
– Trimming of activator


Diagnostic preparation
• History

• Growth status
• VTO -‘instant correction’
• Patient compliance

• Study models
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Molar relations
Midlines
Asymmetries
Curve of spee
Dental discrepancies

• Functional analysis
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Postural rest position in NHP
ICP habitual occlusion
path of closure-Prematurities
Freeway space –inter occlusal clearence
TMJ & RCP
Respiration

• Cephalometric analysis
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Direction of growth
Position & size of jaw bases
Morphologic peculiarities of mandible
Position &inclination of incisors

Treatment planning-constriction bite
• Low construction bite
with marked forward
positioning
H-activator
• High construction
bite with slight
anterior positioning
V-activator

• Construction bite without forward
mandibular positioning
– Vertical problems
• Deep overbite
• Open bite

– Crowding in mixed dentition

• Construction bite with opening &
posterior positioning of mandible
• Construction bite for asymmetries
• Exaggerated construction bite
• Step wise advancement of bite

Bite registration
• Mark the midlines, molar relation & desired
mesial shift on the cast
• Train the patient after seating him in a upright
& relaxed posture
• Soften a sheet of bees wax
roll
it (1cm dia) shape it
press it on
the lower arch
and mark the
midline

• Transfer the wax to the patients
mouth & fit it on the mandible
• Move the mandible as previously
practiced
• Remove the wax chill it & remove
the excess
• Place it on the cast and check
• Replace the hard wax in patients
mouth and check after asking him
to bite hard

Vertical dimension during bite registration
• Postural rest
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Phonetic
Command
Non command
Combined

• In occlusion
• Freeway
space
www.indiandentalacademy.comWith the bite
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Laboratory procedures
• Mounting the casts to a fixator


• Preparation of wire elements
• Labial bow –0.9 mm
• Additional wire elements
– Stabilizing wire
– Active springs


• Fixation of jackscrews and wire elements
• Fabrication of acrylic portion
• Finishing and polishing


Management of the appliance
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Insert the appliance & give instructions
Worn for 2-3 hrs day time in the 1 st week
Night wear & 1-3hrs day wear for 2 nd week
Patient recalled for check up on 3 rd week
Check up appointments every 6 weeks
Trimming according to the plan
Activation of wire elements
Jackscrew activated by pt at 2 weeks interval

Trimming for tooth guidance
• Force application and force elimination
• During use the acrylic areas that contact the teeth
are likely to become polished and shiny

• Acrylic surfaces that transmit the desired
intermittent force and contact the teeth are called
guide planes

Trimming for 3-D control
• Trimming the activator for vertical control
– Intrusion of teeth


• Extrusion of teeth

• Selective trimming of activator

Trimming for sagital control
• Incisors
• Protraction of incisors
• Loading
– entire lingual surface
– incisal 3rd of lingual surface

• Protraction springs
• Wooden pegs
• guttapercha

• Passive bow
• Active bow & its position

• Retrusion of incisors

– Interaction between labial bow
and acrylic decides the type of
force and tooth movement
• Incisal-C rtn at apex
• Gingival –C rtn junction of apex and
middle 3rd
• Incisal with fulcrum- C rtn middle 3rd

Importance of lower incisors
• Activator loads the lingual surface of lower
incisors and tips them labially
• If this is necessary labial tipping further
enhanced by loading the lingual area
• Prevent labial tipping by relieving lingual acrylic
• Or by incisal capping


Sagital movement of posteriors


Movement of teeth in transverse plane
• Asymmetric constriction
bite
• Guide planes
loading & trimming
• Jack screw
• Wire elements


summery
• Cl II div I with hypodivergent jaw bases
H-activator
• Normodivergent


• Cl II div I with hyper divergent jaw bases
V activator
• Cl II div II
• Cl I ,Cl I with deep bite,Cl I with Open bite
• Cross bites
• Cl III


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Harvold-Woodside activator
Herren-Shaye activator (LSU)
Wunderer activator
Bow activator- A.M.Schwarz
U-bow activator –Karwetzky
Kinetor –Stockfisch
Propulsor-Muhlemann
Cybernator-Schmuth

• Palate-free activator-Metzelder
• Elastic open activator-G.Klammt
• Combined activator and head gear
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Pfeiffer and Grobety therapy
Stocklie and Teuscher therapy
Stockfisch approach
Hickham approach

• Bass appliance-Neville M Bass
• Bonded activator-Hamilton

Harvold-Woodside
activator –Cl-II
• Construction bite
– Vertical opening of
12-15 mm

• Flanges
• Labial arch wire
• Palatal contact and
expansion

Dislodging springs • Cl III


Herren-Shaye activator
• Paul Herren of Zurich
• L.S.U of Robert Shaye
• Mandible positioned 2-3 mm
beyond neutroclusion
• Incisal edges are 2-4 mm
apart
• Trangular arrow head clasps
• Lingual flanges

Wunderer activator
• Used for Cl III malocclusion
• Appliance is split horizontally
• Screw is embedded in the
acrylic behind the incisors
• Occlusal surfaces are
covered with acrylic
• Weise screw


Bow activator- A.M.Schwarz
• Upper and lower parts are
connected by a elastic bow
• Transverse mobility is believed
to provide additional stimulus
• Independent expansion is
possible
• Step wise advancement is
possible
• Can be used in unilateral
distoclusion
• Distortion and breakages
common

U-bow activator –Karwetzky
• Maxillary and
mandibular
active plates are
joined in the 1st
perm molar
region using a U
shaped bow
made of 1.1mm
ss wire

Kinetor –Stockfisch


Propulsor-Muhlemann


Cybernator-Schmuth


Palate-free activator-Metzelder


Elastic open activator-G.Klammt


Combined activator and head gear
therapy
• rationale


Pfeiffer and Grobety therapy
• Labial bow has a spur
• Long and rolled out lingual flanges


Stocklie and Teuscher therapy


Stockfisch approach
• Bands on first molar
with tubes to
receive head gear
• Clasp on the kinetor
snaps above the
buccal tube
assemblage

Hickham approach
• Hooks on labial bow to receive J hook
head gear


Bass appliance
-Neville M Bass


Bonded activator-Hamilton
• Mainly used in non compliant patients
• Used for expansion along with forward
positioning of jaws


Bionator-Balters 1960
• Balters concept-position of
the tongue is decisive
• Equilibrium between tongue
and circumoral muscles is
responsible for shape of
dental arches and inter
cuspation
• Bite taken in an edge to edge
relation
– Dorsum of tongue in contact
with soft palate
– Lip closure

Appliance design
• Horse shoe shaped acrylic lingual plate
• Upper anterior part kept free for proper
tongue function


Labial bow with buccinator loops
Palatal bar


Basic Cl II appliance


Open bite appliance


Class III or reversed bionator


Other differences
• Less bulky more patient compliance
• Can be worn all time except during
meals
• Vulnerable to distortion
• Simultaneous requirement of
stabilization of the appliance and
selective grinding for eruption guidence

Ideal cases for bionator therapy
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Mild Cl II in mixed dentition
Well aligned arches
Abnormal muscle pattern
Buccal teeth are in infraclusion,-large
freeway space
• Adults with TMJ problems
• Bruxism and clenching during REM

Terminology used to
describe trimming of
bionator
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Articular plane
Loading area
Tooth bed
Nose
Ledge

Sequence of trimming of bionator
• Trimming of acrylic and elimination of
influence of tongue and cheeks allow
the teeth to erupt up to the articular
plane
• Sequence –lower molar & upper molarlower pre molars –upper premolars
• Additional anchorage from
– Lower incisal margins
– Deciduous molars and edentulous areas
– Noses

references
• Dentofacial orthopedics with functional appliancesGraber,Rakosi & Petrovic
• Removable orthodontic appliances-Graber &
Neumann
• Orthodontics- current principles & technique-Graber &
Swain
• Orthodontics- current principles & technique-Graber &
Vanarsdall
• Bass Orthopedic Appliance System Part 1 - Design
and Construction - Neville M Bass -JCO April 1987

Thank you
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Activator /certified fixed orthodontic courses by Indian dental academy

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