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BALTER’S BIONATOR IN 1956
PHILOSOPHY :
THE TONGUE AND THE CIRCUMORAL MUSCLES
ARE RESPONSIBLE FOR THE SHAPE OF THE DENTAL
ARCHES AND INTERCUSPATION.
THE TONGUE AS THE CENTRE OF THE REFLEX
ACTIVITY WAS THE MOST IMPORTANT FACTOR

TREATMENT OBJECTIVES
• TO ACCOMPLISH LIP SEAL AND
BRING BACK THE TONGUE INTO
CONTACT WITH THE SOFT PALATE.
• TO ENLARGE THE ORAL SPACE.
• TO BRING THE INCISORS INTO AN
EDGE TO EDGE RELATIONSHIP.
• TO ACHIEVE THE ELONGATION OF THE
MANDIBLE.

TMJ RESPONSE
# Anterior region of the
posterior part of the Glenoid
fossa
# Posterior part of the
Condyle

TMJ RESPONSE
. PERSONS HAVING SMALL MANDIBLE
(determined by comparison with published
growth standards ) MAY BENEFIT MORE
FUNCTIONAL THERAPY THAN THE
PATIENTS WITH NORMAL SIZED
MANDIBLE
Mamandras & Allen ( AJO 1990)

THE SUBJCTS WITH DELAYED
GROWTH MAY EXPERIENCE MORE
MANDIBULAR DEVELOPMENT
THAN THOSE WITH AVERAGE
GROWTH DURING TREATMENT
UNDER THE FAVOURABLE GROWTH
ENVIRONMENT CREATED BY THE
FUNCTIONAL APPLIANCE THERAPY

BIONATOR - TYPES
• THE STANDARD APPLIANCE
• THE OPENBITE APPLIANCE
• THE REVERSE [OR] CLASS III
APPLIANCE

THE STANDARD APPLIANCE
• THIS APPLIANCE WAS PRIMARILY
DESIGNED FOR USE IN CLASS II
CASES WITH RETROGNATHIC
MANDIBLE

STANDARD BIONATOR

CONSTRUCTION OF THE
STANDARD APPLIANCE

BITE REGISTRATION
• HORIZONTAL PLANE:
CAN TOLERATE 7 TO 8 mm ADVANCEMENT.
• LATERAL PLANE :
THE CONYLES ON BOTH THE SIDE SHOULD
MOVE SYMMETRICALLY.
• VERTICAL PLANE :
THE BITE OPENING IS ABOUT 2 TO 3 mm.

PARTS OF THE CLASSIC BIONATOR
# ACRYLIC BODY
# OMEGA LOOP .043” [1.1mm] S.S WIRE
# BUCCAL ARCH WIRE .03” [.8mm] S.S

TRIMMING OF THE APPLIANCE
UNLOADING – STIMULATION OF ERUPTION
LOADING -- PREVENTION OF ERUPTION
MAXILLA -- UNLOADING IN DISTO OCCLUSAL
SURFACE OF
POSTERIORS MANDIBLE –
UNLOADING IN THE OCCLUSAL SURFACE
NOSES (OR) ZUNGE – INTERDENTAL ACRYLIC
PROJECTIONS . INSTEAD GUIDING WIRE OF
0.8 TO 0.9 mm S.S IS USED

EDENTULOUS ERUPTING TEETH
ACRYLIC CONTACT ZUNGE

ANCHORAGE
• ACRYLIC EXTENDING OVER THE
INCISAL MARGIN OF LOWER
ANTERIORS.
• LOADING AREAS, SINCE THE CUSP FITS
INTO THE GROOVES IN THE ACRYLIC.
• EDENTULOUS AREA AFTER THE
PREMATURE LOSS OF THE DECIDIOUS.
• NOSES (OR) ZUNGE.

CASE REPORT
Patient A Age: 8yrs Sex : Female
Diagnosis : Dento-alveolar class II div.1
malocclusion on a class II
Skeletal base with an
average growth pattern
Treatment Plan : Phase I - Balter’s Bionator
Phase II- Fixed appliance
for final finishing

EXTRA-ORAL VIEW
PRE-OP

BIONATOR

PT. WITH APPLIANCE

INTRA-ORAL VIEW
PRE-OP POST-OP

CEPHALOMETRIC ANALYSIS
STIENERS / BJORKS
SNA 75 DEG. 74 DEG.
SNB 69 DEG. 72DEG
Go Gn to SN 32 DEG. 34DEG.
_1_ to NA 38 DEG. 35 DEG.
L .1 to NB 26 DEG. 27 DEG
SUM of angl. 396DEG. 398DEG.
PRE - OP POST - OP

CEPHALOMETRIC ANALYSIS
RICKETTS / TWEEDS
FACIAL ANGLE 85 deg 88 deg.
FACIAL AXIS 84 deg 87 deg.
U. lip to E plane +1 mm 0 mm
L .lip to E plane -- 1 mm 0 mm
FMA 25 deg. 27 deg.
IMPA 92 deg 94 deg.
Pre - op post -op

EXTRA-ORAL VIEW
POST-OP

OPENBITE APPLIANCE
• THE MAXILLARY ACRYLIC PORTION IS
MODIFIED,WITH ACRYLIC EXTENDING
UP BEHIND THE MAXILLARY INCISORS
WITH THE SAME LEVEL AS IT DOES FOR
THE POSTERIOR TEETH.
• VESTIBULAR SCREEN MAY BE ADDED.

OPEN-BITE BIONATOR

CLASS III (OR) REVERSE BIONATOR
• USED IN MID FACIAL DISCREPANCY.
• BITE IS TAKEN IN MOST RETRUDED
POSITION POSSIBLE.
• PALATAL BAR RUNS FORWARDS
INSTEAD POSTERIORLY.
• ACRYLIC PLATE EXTENDS TO THE TIP
OF MAX CANINES AND 2mm BEYOND
THE INCISAL EDGES OF THE MAX
ANTERIORS.

REVERSE BIONATOR

BIO-M-S-THERAPY BY ERIC & FLIESCHER
FUNCTIONAL INTERCEPTOR
APPLIANCES [FIA] BY G.P.F. SCHMUTH
ORTHOPEDIC CORRECTOR I BY WITZIG

CHANGES SEEN IN BIO-M-S-APPLIANCE
# ACRYLIC BODY IS REDUCED
# NO SINGLE LABIAL BOW
# TRANS PALATAL ARCH OPENS IN DISTALLY
# WIRE SPURS
#METAL OCCLUSAL BITE PLATE

BIO-M-S-THERAPY

LABIAL BOWS
• MAXILLARY BOW-(0.9mm) s.s WIRE
U-LOOP 6mm diameter directed downwards
BUCCAL WIRE 10 mm diameter extends
upto last erupted molars –stands 2-3mm away.
• MANDIBULAR BOW-(0.9mm) s.s WIRE
U-LOOP 8mm diameter – To reduce irritation
it is UNDULATED (OR) ACRYLIC may be
added

# MAXILLARY STOPS (OR) SPURS 0.9 mm
wire – mesial to the max molars – 3mm loop
towards the gingival margin- sagittal anchorage.
# ‘C-STOPS’-0.9mm wire –mesial side of max
canine, distal side of mand canine.
# SOFT ELASTOPLASTIC SHIELD-10-15 mm
wide –between upper & lower arches.
# ‘L-STOPS’ –0.6-0.7mm thick – passive - for
sagittal stabilisation.

MODIFICATIONS OF U/L
LABIAL BOWS

“ C” -STOPS

ELASTOPLASTIC SHIELD

METAL PLATE

CORRECTION OF CLASS II DIV II

“L” STOPS

SCHMUTH’S MODIFICATION [FIA]
# INCORPORATED SCREWS IN THE MID
LINE OF THE LINGUAL PART.
# GUIDE BOW
# VERTICAL OPENING 2 TO 10 mm
# LINGUAL RETENTION WIRE
# ANTERIOR CAP

GUIDE BOW
• Guides the mandible –proprioceptive sensory
nerves of the maxillofacial complex.
• Distal drive of the max posteriors.
• Pulls the premaxilla down.

FUNCTIONAL
INTERCEPTOR APPLIANCE
(FIA) -BY SCHMUTH

BIONATOR WITH SCREWS

MODIFICATIONS OF FIA

WITZIG’S MODIFICATION
• WITZIG incorporated 2dimentional screws
bilaterally to Schmuth’s bionator.
ORTHOPEDIC CORRECTOR I
ORTHOPEDIC CORRECTOR II
ORTHOPEDIC CORRECTOR III

ORTHOPAEDIC
CORRECTOR I
BY
WITZIG

COMBINATION OF BIONATOR AND
HIGH PULL HEAD GEAR
THEY ARE USED IN CLASS II SKELETAL
MALOCCLUSIONS CHARACTERISED BY
SLIGHT MANDIBULAR DEFICIENCY,
TIPPED UP PALATAL PLANE , ANTERIOR
OPEN BITE AND A VERTICAL GROWTH
PATTERN.
Luciane closs, & Valmy Pangrazio ( A J O – 1996 )

SOFT TISSUE CHANGES
D.William Lange & Varun Kalra (AO 1995) compared 2 groups
of individuals with class II div I Malocclusion , one group
treated with bionator and other left untreated. They concluded
that :
•ANB decreased by 1.97 deg.
•Anterior facial height increased by 3.35 mm.
•Soft tissue profile convexity decreased by 2.22 deg.
•MENTO LABIAL ANGLE IS INCREASED BY 17.4 Deg.

BIONATOR IN TMJ PROBLEMS
• Especially in adults having coincidence bruxism &
clenching during the period of sleep.
• Relaxes the spasm of the lateral pterygoid.
• Prevents the riding of the condyle over the
posterior edge of the disk.
• Bite is opened slightly, lower incisors are capped,
upper & lower segments are loaded.

Bionator is
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