S G D O R T H O D O N T I C:BIONATOR, ELSAA, ACCO RUHAIZAN AISHAH AHMAD ZULKHAIRI
Aims At the end of this lecture/presentation, we should be able to discuss about: • Definition • Component • Indication • Contraindication Of the following appliances, which are: • Bionator • ELSAA • ACCO
Introduction Functional appliance - One that changes the posture of mandible, hold it open, or make it open and forward Graber and Neumann Classification • Those that displace the mandible to a moderate degree and are intended to stimulate muscle activity i.e. myodynamic - Bionator
Classification FUNCTIONAL APPLIANCE Fixed Removable Activator Bionator • Tooth borne passive appliance (activator, bionator) • Tooth borne active appliance • Tissue borne passive appliance - FR
Definition • Activator and Bionator are loosely fitting acrylic that work mainly to covers the occlusal portion of teeth of both arches and the palate. • The only difference between these appliances is, in Bionator, the palatal coverage is eliminated to increase patient comfort and is replaced by a metal bar. • The reduce bulkiness allow for more normal speech patterns compared to Activator appliance. • Additional component can be added in order to prevent oral habit
Bionator has three components: • Acrylic base • Palatal bar • Labial bow
Palatal bar • 1.2 mm wire • Extend from a line connecting distal surface of 6 to middle of 4 • ~1mm away from palatal mucosa Fx -orients the tongue & mandible anteriorly by stimulating its dorsal surface with palatal bar
Labial bow • 0.9 mm wire • Begin above contact point between 3 and 4 – runs vertically • Labial portion of bow should be at a paper thickness away from incisor
Indications • Dental arches well aligned • Mandible in posterior position • Skeletal discrepancy not severe • Labial tipping of upper incisors evident • Class III where reverse bionator can be used • Open bite
Contraindications • Class II – if caused by max prognathism • Vertical growth pattern • Labial tipping of mandibular incisors
Anterior bite plane reduce OB
Palatal springs activated as the apliance is expanded → procline and align incisor
Midline screw allow expansion to prevent posterior crossbite developing during sagittal correction
Indications • To align and procline the upper labial segment in class II cases prior to functional appliance therapy. • Creating an overjet when the upper incisors are either upright or retroclined, which usually only takes a few months and then allows good posture of the mandible to be achieved with a functional appliance.
Adam’s Clasps • generally placed on maxillary first premolars to provide additional retention and support
Finger springs • Provide the distal tipping force on the maxillary first molars
Labial bow • It contacts the labial aspect of the maxillary incisors and acts as a form of anterior anchorage.
Palatal acrylic • Aids in retention and serves as a framework for other components to attach.
Others… • Anterior bite plate • It functions to disclude the posterior dentition, allowing movement of the maxillary first molar to occur.
Others… • Headgear • Counteracts anterior forces of ACCO and translates the maxillary first molars distally.
Indications • In Class II cases • to distalize the maxillary first molars into a Class I position • to restrict the growth of the maxilla when it is prognathic or the mandible is retrognathic.
Contraindications • The ACCO should not be used when patient compliance is questionable. • Since the ACCO is a removable appliance, it requires the patient to wear it willingly while also maintaining proper oral hygiene. • dental and skeletal open bite cases with a high mandibular plane angle and in patients with increased lower face height • ACCO has a tendency to open the bite by allowing the molars to erupt. This is due to the anterior bite plate which discludes the posterior dentition
References • Cobourne MT, DiBiase AT. Handbook of Orthodontics. • http://www.ota-uk.org/Default.aspx?tabid=76 • http://universal-dental-techniques.com/Web_page/ELSAA.html • http://jorthod.maneyjournals.org/content/28/4/271.full