Bionator and Frankl

drg Davin Sp.Ort

Bionator
 Bionator
• Bionator is an activator-derived device.

• It was introduced by Professor Wilhelm Balters of Germany(1950s).

• Balters bionator is also referred to as ‘skeletonized activator’.

• It is less bulky and elastic when compared to conventional activator.

• It permits day and night wear except as it is less bulky when

compared to conventional activator.
• The principle of treatment with bionator is not to activate the muscles
but to modulate muscle activity. This enhances normal development.

• The palatal arch in the appliance serves to stabilize the appliance and
also to encourage the tongue and mandible to adopt a normal posture.

• The buccinator loop prevents the cheek pressures from acting on the
buccal segments, which cause passive expansion of the arch.
• According to Balters’ philosophy,

• Class II malocclusions -> the result of a backward position of the tongue,

which, in turn, generates faulty deglutition and mouth breathing. The main
objective of Class II treatment with the bionator is to bring the tongue
forward. This is achieved partly by stimulation of the distal aspect of the
dorsum of the tongue by the posteriorly directed palatal archwire and
partly by anterior development of the mandible induced by the edge-to-
edge construction bite.

• Class III malocclusions, conversely, are ascribed to a forward position of

the tongue and, therefore, in the Class III bionator, the palatal arch is
inverted, with the round bend directed anteriorly.The rationale of this is
to train the tongue by proprioceptive stimuli to remain in a more
retracted position.
• The objectives of treatment with bionator are:

• - Elimination of lip trap and abnormal relationship between the lips and incisor
teeth.

• - Elimination of mucosal damage due to traumatic deep bite.

• - Correction of tongue malposition and associated mandibular retrusion.

• - Attainment of correct occlusal plane.

 Indication and
Contraindication
• Indications:

• 1. The bionator is useful in the treatment of Class II division1

malocclusions in the mixed dentition, particularly those associated with
habits and abnormal tongue function.

• 2. The bionator has an important role as a retention appliance:a.

Following correction of a Class II malocclusion in the mixed dentition
with a bionator, the same appliance is used for night-time retention b.
After correction of Class II malocclusions by conventional fixed
appliance therapy, the bionator maintains and protects the
dentoalveolar changes against disruption by post-treatment growth. The
bionator has greater patient acceptance in this application than the
activator, which, because of its bulk.
• 3. The bionator is useful in the treatment of open bite due to
functional causes.

• 4. It is useful in correction of Class III malocclusion due to

retrognathic maxilla.

• 5. Bionator can also be used to correct TMJ problems.

• Contraindications:

• 1. Labial flaring of lower incisors.

• 2. Anterior crowding.

• 3. In vertically growing patient.

 Standard Appliance

• Standard appliance consists of

• (1) acrylic component and

• (2) wire components.

• Construction Bite -> taken in edge-to-edge incisor contact, if

possible. In severe overjet, phased or incremental advancement is
advised.
 Screening Appliance
Bionator for Open Bite
Correction
• This appliance is used to inhibit the abnormal posture and
function of the tongue.

• The construction bite is as low as possible

• Unlike the standard appliance, the labial bow crosses the

interincisal area and the lingual acrylic extends into the upper
incisor region as a lingual shield to prevent the tongue
thrusting
 Class III Bionator
• This appliance is used to encourage the development of the
maxilla.

• Construction bite is taken in the most retruded position possible.

Lingual shield acrylic is extended behind the upper incisors to
guide them forward.

• The labial bow runs in front of the lower incisors instead of the
upper. The palatal bar runs forward instead of posteriorly as in
the standard appliance. The reasoning behind this is to stimulate
the tongue to remain in a retracted position.
 Construction Bite
• 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

• In Open Bite Bionator >> Construction bite-is as low as
possible.

• In Reverse Bionator>> Construction bite - taken in more

retruded position so as to allow labial movement of
maxillary incisors also to exert restrictive force on lower
arch
• Bionator must be worn day and night except while eating. Time
interval between successive appointments is about 3–5 weeks.

• Trimming of facets are done as required.

Frankel
 Frankel Appliance

• A new orthodontic philosophy and system of removable appliance

therapy was developed in East Germany in the late 1950s by
Professor Rolf Frankel.

• Synonyms: Functional corrector, vestibular appliances, Frankel

appliance, exercise device, oral gymnastics, orofacial orthopedic
appliance, functional regulator.
• In Frankel’s view, the primary aim of the functional therapy is to
recognize a faulty postural performance of the orofacial musculature
and to treat it by orthopedic exercises.

• The essential problem for him was to design and construct an ‘exercise
device’ that would interfere directly with the functional environment
and result in the correction of the poor postural behavior.
8
• Faulty muscle posture is seen as having an adverse environmental
effect on:

• 1. The spatial relationships of the maxilla and/or the mandible, that

is, the sagittal, vertical and transverse basal arch relationships.

• 2. The development in space of the dentoalveolar structures.

 Philosophy

• Philosophy of Frankel Appliance/Mechanism of Action of Frankel

Appliance :

• Actions of the FR -> change or regulate the muscular environment of

the face and teeth, to stretch facial musculature to normal
dimensions, prevent abnormal activity of the lips, tongue, and cheeks
and thus allow development of the jaws and teeth in all three plane.
• The major part of Frankel appliance is confined to the oral
vestibule.

• The buccal shields and lip pads hold the labial and buccal
musculature, the buccinator mechanism, from acting on the
dentition.
 FR 1

• The functional regulator (FR)

It is composed of two buccal
shields, two labial pads, one
lingual pad and wire parts. The
appliance consists of acrylic
parts and wire components.
 FR 1
• Buccal Shields

• They extend deep into the sulci in the

apical region of the maxillary first
premolar and tuberosity region. In
areas where expansion of the dental
arch and alveolar process is required,
the shields stand away from the
lateral aspects of teeth and alveolus.

• The thickness of the buccal shield

should be 2.5 mm
 FR 1
• Labial Pads/Pelot

• Lip pads are rhomboid-shaped and

the labial surface of the mandibular
frontal alveolar process.

• It is tear drop-shaped in cross-

section. This permits free seating of
the lip pads in the vestibule. There
should be 5 mm distance from the
upper edges of the lip pad to the
gingival margin.

• The distal edge of the lip pad should

not overlap the canine root
protuberance.
 FR 1
• Wire Component

• Vestibular Wires Lower labial wires or

vestibular wires are the connecting wires
between the labial pad and buccal shield.
It is made from 0.9 mm wire -> skeleton
for the lower lip pads.

• Maxillary Labial Bow Maxillary labial bow

is made from 0.9 mm wire and usually lies
in the middle of the labial surfaces of the
maxillary incisors. It runs gingivally at
right angles between the lateral incisor
and canine and forms a gentle curve
distally at the height of middle of canine
root and re-embedded in buccal shield.
•
FR
Wire Component
1
• Palatal Bow>> It crosses the palate with
a slight curve in a distal direction and
runs interdentally between the maxillary
first molar and second premolar or
deciduous second molar. Makes a loop
into the buccal shield and emerges to
form an occlusal rest in molar. It
provides maxillary anchorage and
stabilizing action.
 FR 1
• Wire Component

• Canine Loop It starts with its tags in

>>n

the buccal shield and runs palatally to

the lingual surface of the canine for a
distance of about 1 mm. It then
crosses the interproximal contact
between canine and lateral incisor.
The function of the canine loop is it
keeps the perioral activity away from
canine and provides passive expansion
in canine area.
• Differences Between FR Ia and Ic and FR II

• FR Ia: There is lower lingual wire loops instead of lingual shield.

• FR Ic: Buccal shields are split horizontally and vertically into two
parts for incremental advance.

• FR II: Addition of upper palatal protrusion bow behind upper

incisors; modified canine loop.
Terima Kasih :)