ACTIVATOR, BIONATOR

AND ORAL SCREEN

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ACTIVATOR

In 1880, KINGSLEY -"jumping the bite”- for

patients with mandibular retrusion.
HOTZ – used modified Kingsley plate –
VORBISSPLATTE- deep bite retrognathism
Impressed by Kingsley, ANDRESEN in 1908 used a
modified kingsley plate as a retainer for his
daughter over summer vacation. He called it
BIOMECHANIC WORKING RETAINER.

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ROBIN started using this retainer in patients with
glossoptosis and severe mandibular retrognathism
(pierre robin syndrome) and called it as
MONOBLOC.
Andresen moved from Denmark to Oslo met
HAUPL at University of Oslo. Both of them
teamed up to write about their appliance , called it
ACTIVATOR, because of its ability to activate
muscles.

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 Mode of action

1. Muscle contractions and myotatic reflex

A loosely fitted appliance Generate forces

Appliance stimulates the muscles and moving appliance

moves the teeth

Appliance works using kinetic energy

Appliance with low vertical dimension works with this concept

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 2. appliance squeezed between jaws(SPLINTING
ACTION)

Because of inherent tissue elascticity

Exerts forces to move teeth and stretch reflex is activated

Appliance works using potential energy

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 3. Transitional type

Uses muscle contractions and viscoelastic properties of

soft tissue

Activators with a high vertical dimension construction bite work

this way

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Gradually the whole chewing apparatus will adapt to
the jaw relationship prescribed by the appliance.

 Musculoskeletal adaptation occurs by inducing a new

pattern of mandibular closure

Condylar adaptation: growth in upward and backward

direction to maintain integrity of TMJ structures

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8
SKELETAL AND DENTOALVEOLAR EFFECTS OF
THE ACTIVATOR

1. Any skeletal effect from the activator depends on the

growth potential.
Two divergent growth vectors propel the jaw bases in
an anterior direction
a. The sphenoccipital synchondrosis moves the cranial
base and nasomaxillary complex up & forward.

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 b.The condyle translates the mandible in a downward
and forward direction.
 The activator is most effective in controlling the
lower vector or the downward and forward growth
of the mandible.

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FORCES EMPLOYED IN ACTIVATOR
THERAPY
1. STATIC
2. DYNAMIC
3. RHYTHMIC
Two principles are employed in modern activator:-
a. Force application – source is muscular
b. Force elimination – dentition is shielded from
normal and abnormal functional and tissue
pressures from pads, shields and wire configurations

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Forces can be categorized as:-
1. Natural forces – produced by growth potential
including eruption and migration of teeth
2. Muscular forces produced by muscle contractions
and stretching of soft tissues when mandible is
relocated by the appliance.
These forces act in three planes
a) Sagittal
b) Vertical
c) Transverse
3. Biomechanic type of force- by active elements
(springs and screws)

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 Low construction bite with marked forward positioning
(H-activator)

If forward position is great (7-8mm), vertical opening

should be minimum (2-4mm). Functional appliances
made with this bite are called H Activator
Indications :
 Class II functional retrusion cases

 Class II div 1 malocclusion with post. positioning of

mandible due to growth deficiency but with the
likelihood of horizontal growth pattern.
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High construction bite with slight anterior positioning (V-
activator)
 If vertical opening is extensive (>6mm) mandibular
advancement should be minimum (3-5mm).
 Patient adaptation with the appliance, lip seal is
difficult with high construction bite, which are
essential for successful functional appliance therapy.

Indication: Class ll div 1 malocclusion with vertical

growth pattern.

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Construction bite without forward mandibular positioning
Vertical problems
Deep overbite
Open bite

Crowding in mixed dentition

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Construction bite with opening & posterior positioning of mandible

 Functional appliance can correct pseudo Class III

malocclusion with forward path of closure.
Skeletal Class III malocclusion with straight path of
closure is not always amenable to correct by
functional appliance therapy.

 Bite is opened far enough to clear the incisal guidance that

is edge to edge incisal relationship with posterior teeth out
of contact, shifting the mandible downward &backward

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FABRICATION

LABORATORY PROCEDURES:-

 Acrylic component.
 Wire component.

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WIRE ELEMENTS
 Labial bows.

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 Fixation of the jackscrews and wire elements.

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ACRYLIC PORTION

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TRIMMING OF AN ACTIVATOR
The principles of force application in the trimming
process are determined by the type, direction, and
magnitude of force created by the loosely fitting
activator:
 Intermittent force, dynamic and rhythmic muscle forces to act
in concert; the appliance thus works by kinetic energy.
 The direction of the desired force is determined by selective
grinding of the acrylic surface that contacts the upper and
lower teeth
 The magnitude of the force delivered can be estimated by
determining the amount of acrylic contact with the tooth
surfaces
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 Acrylic surface that
transmit the desired
intermittent force and
contact the teeth are
called guide planes.
 The need for trimming
can be assessed with an
explorer or by observing
the shadows created on
the acrylic by undercut
surfaces.

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Trimming the activator for vertical control

Two movements occurs in activator therapy:–

1. Intrusion .
2. Extrusion.

Selective extrusion in the mixed dentition is an

important and valid treatment objective that can
affect both vertical and horizontal tooth relationships
if done properly.
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Intrusion of teeth
 Intrusion of incisors can
be achieved by loading
the incisal edges of these
teeth.

 If the simultaneous use

of an active labial bow is
indicated, the contact
between the bow wire
and incisors is below the
area of greatest convexity
or on the incisal third
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 Intrusion of molars is
performed by loading
only the cusps of these
teeth.

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Extrusion of teeth
 Extrusion of incisors requires loading their lingual
surfaces above the area of greatest concavity in the
maxilla and below this area in the mandible .
 Placing the labial bow above the area of greatest
convexity.

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 Extrusion of molars can
be facilitated by loading
the lingual surface of
these teeth above the
area of greatest convexity
in the maxilla or below
this area in the
mandible.
 Indicated in deep-bite
problems.

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SELECTIVE TRIMMING OF THE
ACTIVATOR

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Trimming the activator for sagittal control
Specific goals of protruding or retruding the incisors
and changing the molar sagittal relationship mesially
or distally can be achieved through judicious appliance
control.

o Protrusion and retrusion of incisors can be

accomplished :-
 grinding of the acrylic and guide planes .
 adjustment of the labial bow wires.

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o If the labial bow touches
the teeth, it can either tip
them lingually or retain
them in position. In
these cases, it is called an
active bow.
o If it is positioned away
from the teeth and
prevents soft tissues
contact, it termed a
passive bow.
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Protrusion of Incisors
 The incisors can be
protruded by loading
their lingual surfaces with
acrylic contact and
screening away the lip
strain with a passive labial
bow or lip pads.
 Loading can be achieved
by either of two
methods:-
1. the entire lingual
surface is loaded.
2. The incisal third of the
lingual surface is loaded. 31
 Incisor protrusion also
can be accomplished
using auxiliary
elements:-
1. Protrusion springs.

2. Wooden pegs.

3. Guttapercha

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Retrusion of incisors
 The acrylic is trimmed away from the backs of the
incisors to be retruded. The active labial bow, which
contacts the teeth during functional movements,
provides the force for moving the teeth.

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Movement of teeth in saggital plane
The molars can be moved
mesially or distally
according to the way the
guiding planes are made
to contact teeth.
For distal movements :
the guide planes load the
mesiolingual surface of
molars

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 Stabilizing wires or spurs
can also be used to
distalize the molars .

 Active open springs can

also distalize molars.

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In premolar extraction
cases distalizing of
canine is needed this is
done by various
methods:-
 Labial bows.
 Guide wires.
 Retraction springs.

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 Mesial movement:
Is accomplished by having
the acrylic guide planes
of the activator contact
the teeth on the
distolingual surfaces.

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Movement of teeth in transverse
plane
 Activator may be
trimmed to stimulate
expansion of the buccal
segment teeth,to achieve
transverse movement,
lingual acrylic surfaces
opposite the posterior
teeth must be in contact
with the teeth.

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 More effective expansion
is obtained by using
expansion type jackscrew
and trimming the
appliance to enhance the
expansion.
 The appliance can be
made with two
eccentrically placed
jackscrew in the upper
and lower portions.
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 If crossbite condition is
apparent for one or more
teeth,the malocclusion
can be corrected with
two springs and
corresponding grinding
of appliance.

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ACTIVATOR TRIMMING OF CLASS II
MALOCCLUSIONS
For incisors:-
o Acrylic capping is necessary to prevent extrusion from
occurring with the retrusion.
o In deep bite cases acrylic capping is used when
possible to prevent excessive labial inclination of these
teeth.

For posteriors:-
o Acrylic is trimmed away next to the lower posterior
teeth to guide eruption and level the curve of spee.
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o Stabilizing wires or spurs
also may assist in the
distalizing process as the
first molar teeth erupt.

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ACTIVATOR TRIMMING IN CLASS III
MALOCCLUSIONS
FOR INCISORS:-
o The upper incisors are loaded for protrusion and labial
bow is passive.
o The lower incisors should be retruded.the acrylic on
the lingual of the lower incisors is ground away,and a
labial acrylic cap is placed.The bow is active.
FOR POSTERIOR TEETH:-
o The guide planes for the upper posterior teeth are
trimmed for the mesial movement.

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o The lower posterior teeth
have guide planes
trimmed to contact the
mesiolingual cuspal
surfaces for posterior
vector stimulus as these
teeth erupt.

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ACTIVATOR TRIMMING IN VERTICAL
DYSPLASIA TYPE MALOCCLUSIONS
DEEP OVERBITE:-
o Incisor area is capped for intrusion.
o Molar area trimmed for extrusion.
o Labial bow active and contact the teeth at their incisal
third.

OPEN BITE:-
o Incisor area ground for extrusion.
o Molar area is loaded for intrusion.
o Labial bow active and contact the teeth at their gingival
third
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MODIFICATIONS
1. The Herren Shaye Activator.
2. The Bow Activator of A.M Schwarz.
3. The reduced activator or Cybernator Of
Schmuth.
4. The Karwetzky Modification.

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HERREN SHAYE ACTIVATOR
The principles of the Herren activator are based on the
theoretical considerations, research, and practical
experience of Paul Herren over a quarter of a century.

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 Research undertaken by Graf and Herren has shown
that an advanced position of the mandible caused by
the inserted activator will, by tendency of the
stretched muscle bring the mandible to the habitual
position again, exert a pressure on the upper teeth in
an occipital direction, and by means of reciprocal
action, a mesial component will occur on the lower
teeth.
 With every millimeter increase of the forward position
of the mandible the sagittal forces on the jaws will
increase too.
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The construction bite is
taken in a strong
mandibular propulsion,
reaching sometimes
almost the feasible
maximum.
The Herren activator,
therefore, is fixed by
clasps to the maxillary
dentition. Screws and
springs are employed as
with active plates.
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 THE BOW ACTIVATOR OF A.M
SCHWARZ
 Schwarz was intrigued
by the construction and
elastic properties of
Bimler’s appliance, and
he designed what he
called the bow activator.
 The upper and lower
halves of the bow
activator are connected
with an elastic bow.

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 With the treatment of
class-II, Division-1
malocclusions, beginning
can be made with a small
forward positioning,
increasing this gradually
by periodic adjustment.
 It has been shown by
Taatz that the appliance is
especially suited for the
treatment of Class-II,
Division 1 malocclusions
in the deciduous
dentition.
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 Treatment is discontinued if response or patient
compliance is unsatisfactory. Mixed dentition
treatment is probably better from both a growth
response and a patient compliance standpoint.

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THE REDUCED ACTIVATOR OR
CYBERNATOR OF SCHMUTH
 A simple but effective modification of the activator has
been designed by Professor G.P.F. Schmuth, of Bonn.

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 The acrylic part of the appliance is reduced in a
manner similar to that of the bionator.
 the customary labial bow with the activator is used as
well as most of the other simple parts of this and other
myofunctional appliances, including the Coffin spring,
made of 1.1 mm to 1.2 mm wire.
 Saving time and labor is only one of the advantages of
this construction.

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 The frequent breaking of the slender anterior acrylic
part is avoided by splitting it in the midline.
 The judicious use of the Coffin spring, keeping the
parts of the appliance in contact with the lateral teeth
without pressure will have a widening effect especially
when inserted during or soon after the eruption of the
lower incisors.
 Schmuth prefers the customary construction bite of
the activator, with an acrylic rim covering the lower
incisors.

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 It may be combined with
fixed appliances of
different kinds that can
be worn simultaneously.

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THE KARWETZKY MODIFICATION
 The U bow activator of Karwetzky is constructed quite
similarly to the Schwarz bow activator, but with an
improved technique and an apparently increased
efficiency.

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 The Karwetzky appliance
consists of maxillary and
mandibular active plates,
joined by U bow in the
region of the first
permanent molars. In
addition to acrylic
covering of the lingual
tissue aspects, gingiva,
and teeth, the plates also
extend over the occlusal
aspects of all teeth.

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 The height of the construction bite is that of the
interocclusal space or clearance, with the mandible in
postural rest for the Karwetzky appliance.
 In open bite problems, the construction bite slightly
exceeds the resting position.

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 In Class-II, Division-1
malocclusions, the
horizontal forward
positioning is only part
of the distance required
to establish a normal
inter digitations, usually
not more than half of the
anteroposterior
correction required.

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 In Class-III, mandibular
prognathism cases, the
construction bite is
taken in most posterior
positioning of the
mandible possible in
postural rest.

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 Depending on the placement of the ends of the U
bows, three types of the Karwetzky activator may be
created :-
The U bow has one longer and one shorter leg. The
shorter leg is embedded in the upper appliance,
whereas the longer leg is attached to the lower plate.

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With the activator Type I,
which is used for the
treatment of Class-II,
Division-1 And Division-2
malocclusions, the longer
lower leg is placed
posteriorly. By
constricting the bow, and
thus narrowing the U
bend, the lower plate,
which guides mandibular
horizontal movements, is
brought forward. This can
be done unilaterally by
squeezing the U bow on
one side only. 63
 Type II of the Karwetzky
action is made by inserting
the longer leg anteriorly in
the lower appliance. It is
used for treatment of Class-
III or mandibular
prognathism cases,
exerting a retrusive effect
on the mandible as the U
bow is constricted by
adjustments. Again,
unilateral action is possible,
or varied amounts of action
can be transmitted to each
side, depending on the
degree of loop constriction.
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 Type III is designed to
influence the mandible in a
transverse rather than a
sagittal direction,this is
accomplished by placing
the long lower U bow leg
anteriorly on one side and
posteriorly on the other
side. Consequently, the wire
construction will one side
and the mandible away
form the side on which the
long leg is placed
posteriorly.

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 Karwetzky feels that his design has inherent
advantages over other activator like appliances.

1. The appliance exerts a delicate influence on the

dentition and on the TMJ.
2. The mobility of the parts allows various
mandibular movements.
3. The delicate forces, plus the gradual and
sequential forward positioning of the lower jaw,
will avoid the exertion of undue pressure.

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Indications of activator :

It is primarily used in actively growing individuals

with favorable growth pattern.
The maxillary and mandibular teeth should be
well aligned.
The mandibular incisors should be upright over
the basal bone.

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The following are some of the indications
for the use of activator :

1. Class II, Division 1 malocclusion

2. Class II, Division 2 malocclusion
3. Class III malocclusion
4. Class I open bite malocclusion
5. Class I deep bite malocclusion
6. As a preliminary treatment before major
fixed appliance therapy to improve skeletal
jaw relations
 7. For post-treatment retention
 8. Children with lack of vertical
development in lower facial height. 68
Contra-indications of activator therapy
 1. The appliance is not used in correction of Class I
problems of crowded teeth caused by disharmony between
tooth size and jaw size,
 2. The appliance is contraindicated in children with excess
lower facial height and extreme vertical mandibular
growth.
 3. The appliance is not used in children whose lower
incisors are severely procumbent.
 4. The appliance cannot be used in children with nasal
stenosis caused by structural problems within the nose or
chronic untreated allergy.
 5. The appliance has limited application in non-growing
individuals.

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Advantages of activator therapy
1. It uses existing growth of the jaws.
2. During treatment the patient experiences
minimal oral hygiene problems.
3 .The intervals between appointments is long.

4. The appointments are usually short due to need

for minimal adjustments.
5. economical

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Disadvantagesof activatortherapy

1. Requires very good patient cooperation.

2. The activator cannot produce a precise detailing
and finishing of the occlusion.Thus post-treatment
fixed appliance therapy maybe needed for detailing
of the occlusion.
3. It may produce moderate mandibular rotation
(anteriorly downwards). Thus activators are not
used in cases of excessive lower face height.

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BIONATOR

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PRINCIPLE OF BIONATOR

 Less bulky than activator

 The essential part for Balter’s is the tongue
(which is the center of reflex activity in the oral cavity)

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 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.

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 Treatment objectives

Enlarge oral space & train

tongue functions

Accomplish lip seal &

 Bring incisors into
edge to edge
bring dorsum of
relationship
tongue into
contact with soft  To achieve elongation
palate of mandible

Improve relationships
of jaws, tongue &
teeth

It works by modulating muscle activity

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Advantages

 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

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Disadvantage

 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

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INDICATIONS

 Dental arches well aligned

 Mandible in posterior position
 Skeletal discrepancy not severe
 Labial tipping of upper incisors evident
 Deep bite with accentuated curve of spee
 Class III where reverse bionator can be used
 Open bite

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CONTRAINDICATIONS

 Class II – if caused by max prognathism

 Vertical growth pattern
 Labial tipping of mandibular incisors

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TYPES OF BIONATOR

1. THE STANDARD BIONATOR

2. THE OPEN BITE BIONATOR

3. Cl III OR REVERSED BIONATOR

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THE STANDARD APPLIANCE

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

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 WIRE COMPONENTS

 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

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WIRE COMPONENTS
 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

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WIRE COMPONENTS

 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

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OPEN – BITE APPLIANCE

 Purpose of this appliance is to

close the anterior space

 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

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Wire elements

 Labial bow runs between the upper and

lower incisors at the height of lip closure.

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REVERSED BIONATOR

 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

87
Palatal bar

Runs forward with loop

extending as far as deciduous
1st molar or premolar

Function – tongue to contact

anterior portion of palate ,
encouraging forward growth of
this area.

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Labial bow

 In front of lower incisors

 Wire slightly touches the labial surface
lightly / it is at a paper thickness away

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 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

90
Construction bite

In Open Bite Bionator

 Construction bite-is as low as possible with a
slight opening for interposition of posterior
bite blocks to prevent their eruption.

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

91
TRIMMING OF BIONATOR

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

92
ARTICULAR PLANE:

 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

93
LOADING AREA:

 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.

94
TOOTH BED

 Some parts of the

loading areas are
trimmed away to the
articular plane

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NOSE:

 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

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 LEDGE :

 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

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 BALTERS REFERS

 prevention of eruption as loading

or inhibition of growth
 stimulation of eruption as
unloading or promotion of growth

98
 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 done

99
ANCHORAGE OF APPLIANCE

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

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 SELECTIVE TRIMMING

 For extrusion of posterior teeth

Acrylic left interdentally 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

movt
 For intrusion in case of open bite –posterior teeth
are fully loaded

101
CLINICAL MANAGEMENT

 Appliance must be worn day and night except while

eating.
 Pt recalled after 1 wk to check sore points
 Interval b/w 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.

102
Bionator and TMJ

 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

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ORAL SCREEN

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 Oral screens are the appliances made up of acrylic
which lies in the vestibule. Thus it is also called as
Vestibular Shield
 Oral screen is a functional appliance by virtue of
the fact that it embodies no active elements
designed to produce forces acting on the teeth but
produces its effects by redirecting the pressures
of muscles and soft tissues of cheeks and lips

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 It was introduced in 1912 by Newell.

 It can be used for two purposes—

1. To apply the forces of the circum-oral
musculature to teeth
2. To relieve selective teeth from forces of the
circum-oral muscles

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 If the upper incisors are proclined and spaced,
then the screen is made such that it contacts only
proclinated teeth and apply lingual pressure.

 If the upper incisors are retroclined, screen is

made such that it does not contact upper teeth
and upper teeth are relieved from lip pressure but
are under influence of tongue, thereby
proclination occurs

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 Indication
 For interception of mouth breathing habit
 For correction of thumb sucking habit
 For application of forces on selective teeth for e.g.
correction of proclination of anteriors
 By extending the screen in buccal and labial sulcus,
a periosteal pull is created which will enhance the
osteoblastic activity, thereby resulting in expansion
of basal bone
 For peri-oral muscle exercises
 For correction of Mild Skeletal Class II.

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 Contraindication
 Careful clinical examination should be done to rule
out whether patient is having any naso-respiratory
obstructive disease.
 In such cases holes should be prepared in the
screen which are gradually filled up by cold cure
acrylic

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 Types
 Oral screen without metal ring
 Oral screen with metal ring (Hotz modification)
 Double oral screen
 Oral screen with holes
 Oral screen with additional acrylic portion in
anterior labial sulcus for hyperactive mentalis

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Oral screen with metal ring
(Hotz modification)
Double oral screen 112
 Special consideration in designing

 In designing an oral screen the

relation of lower lip to the labial
segments of arch is important

 In cases of increased overjet,

screen is gently curved inwards
towards the lower incisors
sufficiently to allow the lower lip
to slide easily upwards and
outwards.

 All the freni must be relieved

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 Method of application

 Initially screen is passive and should be worn only

for 2 hrs in first week
 Then the time is gradually increased till full night
time wear .

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Thank you

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REFERENCES
Graber, Newmann : Removable orthodontic applianc
es. 2nd edition, Philadelphia, WB Saunders
Graber, Rakosi , Petrovic : Dentofacial Orthopedics
with functional appliances.2nd edition, Mosby
G. Altuna S. Niegel : Bionators in class II treatment.
JCO 1985,19,3; 185-193
Py Owman-Moll Bengt Ingervall : Effect of oral screen
treatment on dentition, lip morphology, and function
in children with incompetent lips. AJO 1984:1; 37-46

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Carine Carels, Frans P. G. M. van der Linden: Concepts on
functional appliances mode of action AJO 1987;92:162-8
A. H. Mamandras and L. P. Allen : Mandibular response
to orthodontic treatment with the Bionator appliance
AJO 1990;97:113-20
Lorenzo Franchia; Chiara Pavonib; Kurt Faltin Jrc; James
A. McNamara Jrd; Paola Cozzae :Long-term skeletal and
dental effects and treatment timing for functional
appliances in Class II malocclusion. Angle Orthod
2013;83:334-40
Carina Ferlin Antunesa; Renato Bigliazzib; Francisco
Antonio Bertozc; Cristina Lu´ cia Feijo´ Ortolanid;
Lorenzo Franchie; Kurt Faltin, Jr : Morphometric analysis
of treatment effects of the Balters bionator in growing
Class II patients. 2013;83:455-59 117
Vergervik y, Harvold EP: Response to activator
treatment in Class II malocclusions. : Am J
Orthod. 1985 Sep;88(3):242-51
Türkkahraman and Sayın :Effects of activator and
activator headgear treatment: comparison with
untreated Class II subjects. Eur J Orthod. 2006
Feb;28(1):27-34.

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