Mandibular Endochondral Growth Is Specifically Augmented by Nutritional Supplementation with Myo-Inositol Even in Rabbits.

Mandibular retrognathism occurs by insufficient mandibular growth and causes several issues, such as respiratory difficulty and diminished masticatory function. At present, functional orthodontic appliances are used for stimulating mandibular growth in pediatric cases. However, the effectiveness of functional appliances is not always stable in daily practices. A more effective, reliable, and safer therapeutic method for mandibular growth promotion would be helpful for growing mandibular retrognathism patients. As we previously discovered that nutritional supplementation of myo-inositol in growing mice specifically increases mandibular endochondral growth, we performed preclinical animal experiments in rabbits in this study. Briefly, six-week-old male Japanese white rabbits were fed with or without myo-inositol supplementation in laboratory chow until 25 weeks old, and 3D image analysis using micro CT data and histological examinations was done. Myo-inositol had no systemic effect, such as femur length, though myo-inositol specifically augmented the mandibular growth. Myo-inositol increased the thickness of mandibular condylar cartilage. We discovered that the nutritional supplementation of myo-inositol during the growth period specifically augmented mandibular growth without any systemic influence, even in rabbits. Our results suggest the possibility of clinical use of myo-inositol for augmentation of the mandibular growth in growing mandibular retrognathism patients in the future.

Assessment of the efficacy of various maxillary molar intrusion therapies: a systematic review.

AIMS: To systematically assess the efficacy of the various interventions used to intrude maxillary molars. Furthermore, to evaluate associated root resorption, stability of intrusion, subsequent vertical movement of mandibular molars, cost effectiveness, compliance, patient reported outcomes and adverse events. METHODS: A pre-registered and comprehensive literature search of published and unpublished trials until March 22nd 2023 with no language restriction applied in PubMed/Medline, Embase, Scopus, DOSS, CENTRAL, CINAHL Plus with Full Text, Web of Science, Global Index Medicus, Dissertation and Theses Global, ClinicalTrials.gov, and Trip (PROSPERO: CRD42022310562). Randomized controlled trials involving a comparative assessment of treatment modalities used to intrude maxillary molars were included. Pre-piloted data extraction forms were used. The Cochrane Risk of Bias tool was used for risk of bias assessment, and The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used for certainty of evidence appraisal. RESULTS: A total of 3986 records were identified through the electronic data search, of which 24 reports were sought for retrieval. Of these, 7 trials were included. One trial was judged at high risk of bias, while the others had some concerns. Based on individual small sample studies, maxillary molar intrusion was achieved using temporary anchorage devices (TADs) and rapid molar intruder appliance (RMI). It was also observed to a lesser extent with the use of open bite bionator (OBB) and posterior bite blocks. The molar intruder appliance and the posterior bite blocks (spring-loaded or magnetic) also intruded the lower molars. Root resorption was reported in two studies involving TADs. None of the identified studies involved a comparison of conventional and TAD-based treatments for intrusion of molars. No studies reported outcomes concerning stability, cost-effectiveness, compliance and patient-reported outcomes. Insufficient homogeneity between the included trials precluded quantitative synthesis. The level of evidence was very low. CONCLUSIONS: Maxillary molar intrusion can be attained with different appliances (removable and fixed) and with the use of temporary anchorage devices. Posterior bite blocks (spring-loaded or magnetic) and the RMI offer the additional advantage of intruding the mandibular molars. However, stability of the achieved maxillary molar intrusion long term is unclear. Further high-quality randomized controlled trials are needed.

Twenty-year follow-up of functional treatment with a bionator appliance (part 2): a retrospective cephalometric analysis of skeletal and dentoskeletal changes.

OBJECTIVES: To investigate skeletal and dentoskeletal changes 20 years after bionator treatment. MATERIALS AND METHODS: Analog lateral cephalograms of 18 subjects treated with a bionator appliance during growth were digitized with a transmitted light scanner. Inclusion criteria were: increased overjet (≥4 mm), skeletal Class II, available lateral cephalograms before (T0), after (T1), and 20 years after (T2) treatment with only a Bionator. To assess standard cephalometric parameters, the software ivoris analyze was used. Data were analyzed using Friedman's two-way analysis of variance by ranks followed by Dunn's post hoc tests (P ≤ .05). RESULTS: During therapy (T0-T1), ANB decreased significantly by 1.9° and remained unchanged long term. SNA slightly decreased (-0.6°) during treatment, SNB and SNPg increased (+1.4°, +1.7°). All three parameters showed a significant increase at T2 (+1.2°, +1.6°, +1.6°). Vertical measurements (ML-NL, ML-NSL, NL-NSL) remained almost unchanged during therapy. NL-NSL also was unchanged during the long-term interval; ML-NSL and ML-NL decreased significantly (-3.4°, -4.9°). During treatment, the maxillary incisors retroclined (OK1-NL: -1.6°, OK1-NA: -0.6°), the mandibular incisors proclined (UK1-ML: +3.5°, UK1-NB: +4.9°), neither significantly. Long term, there was a nonsignificant tendency toward proclination of upper (OK1-NL: +0.1°, OK1-NA: +0.7°) and retroclination of lower incisors (UK1-ML: -1.5°, UK1-NB: -5°). CONCLUSIONS: Changes of ANB after bionator treatment without additional fixed appliances remained stable after 20 years. The observed long-term changes are probably consequences of well-known physiological and age-related processes.

Three-dimensional evaluation of the effects of Bionator and Forsus appliances on oropharyngeal airway volume in patients with mandibular retrognathia.

OBJECTIVE: To evaluate whether there is a difference between the effects of Bionator and Forsus appliances on airway volume. METHODS: Forty patients with mandibular retrognathia were divided into two groups. The Bionator appliance was applied to Group 1, while the Forsus FRD EZ2 appliance was applied to Group 2. Three-dimensional images were captured before and after functional appliance use in both groups. Dolphin 3D software was used for airway measurements. RESULTS: No statistically significant difference was found between the groups in terms of volumetric and area measurements. There was a statistically significant difference between the minimum axial T and O-N border T measurements of the groups. CONCLUSION: The use of functional appliances may contribute to an increase in oropharyngeal airway dimensions, but there was no difference between the Bionator and Forsus groups in terms of volumetric measurements.

Efectividad del Bionator de California en la disminución del grado de severidad de los trastornos temporomandibulares / Effectiveness of the California Bionator in reducing the degree of severity of temporomandibular disorders

RESUMEN Fundamento: Existen modalidades de tratamiento para los trastornos temporomandibulares, una de ellas es la Ortopedia funcional de los maxilares. Objetivo: Evaluar la efectividad del Bionator de California en la disminución del grado de severidad de los trastornos temporomandibulares. Metodología: Se realizó estudio experimental, abierto, controlado y aleatorizado en el servicio de Prótesis Estomatológica de la Clínica Estomatológica de Fomento en el período de septiembre de 2019 a septiembre de 2021. Se seleccionaron 60 pacientes con trastornos temporomandibulares que cumplieron los criterios de selección, mediante asignación aleatoria se establecieron los grupos: Estudio (tratado con Bionator de California) y control (tratado con férula neuromiorrelajante). Se utilizaron métodos del nivel teórico, empírico y estadístico. La variable de respuesta principal fue: Efectividad del Bionator de California en el grado de severidad del trastorno temporomandibular. Resultados: Al inicio del estudio predominó la severidad moderada de trastornos temporomandibulares en ambos grupos, pero a los 6 meses de tratamiento predominaron los asintomáticos (66.7 %) en el grupo estudio y 36.7 % en el grupo control, con diferencia estadísticamente significativa entre ambos grupos. Conclusiones: El tratamiento con el Bionator de California fue efectivo porque se logró disminuir el grado de severidad de los trastornos temporomandibulares.

ABSTRACT Background: There are treatment modalities for temporomandibular disorders, one of them is functional orthopedics of the jaws. Objective: To evaluate the effectiveness of the California Bionator in reducing the degree of severity of temporomandibular disorders. Methodology: An experimental, open, controlled and randomized study was carried out in the Dental Prosthesis service at Fomento Dental Clinic from September 2019 to September 2021. 60 patients with temporomandibular disorders who met the selection criteria were selected. The groups were established by random assignment: Study (treated with Bionator from California) and control (treated with a neuromyorelaxant splint). Method theoretical, empirical and statistical levels were used. The main response variable was: Effectiveness of the California Bionator in the degree of severity of the temporomandibular disorder. Results: At the beginning of the study moderate severity of temporomandibular disorders prevailed in both groups, but after 6 months of treatment asymptomatic predominated (66.7%) in the study group and 36.7% in the control group, with a statistically significant difference between both groups. Conclusions: The treatment with the California Bionator was effective because the degree of severity of temporomandibular disorders was reduced.

Evaluation of the open-bite Bionator versus the removable posterior bite plane with a tongue crib in the early treatment of skeletal anterior open bite: A randomized controlled trial.

BACKGROUND: Several treatment approaches can be found in the literature about early treatment of open bite. However, no studies have addressed the use of a removable posterior bite plane with a tongue crib (RPBP/C), compared with functional appliances, for treating open-bite cases. The objectives of this trial was to compare the effectiveness of the open-bite Bionator (OBB) and the RPBP/C as an early intervention to correct skeletal open-bite cases in children, in terms of limiting excessive vertical growth of the craniofacial skeletal components and normalizing the developement of the anterior dentoalveolar region. MATERIALS AND METHODS: Two-arm, parallel-group randomized controlled trial was conducted. Forty patients with a skeletal anterior open bite (age range: 7.5-10.5 years) were treated at the University of xxxx School of Dentistry in xxxx, xxxx. They were distributed randomly into 2 equal groups: the OBB group (20 patients; mean age: 8.8 ± 1.5 years) and the RPBP/C group (20 patients; mean age: 8.6 ± 1.1 years). Randomization was based on a computer-generated sequence of random numbers. Primary outcome measures were the skeletal and dentoalveolar variables, whereas the secondary outcome measures were the soft-tissue parameters assessed on standardized lateral cephalograms collected before and after 12 months of treatment. Mann-Whitney U tests were used to detect significant differences between the 2 groups. RESULTS: Both the OBB and the RPBP/C appliances induced favorable dental effects. A statistically significant difference was found between the 2 groups in the overbite (P = 0.003). Open bite in the OBB group showed a mean closure of 4.91 mm (SD 0.4 mm), and a mean closure of 3.43 mm (SD 0.3 mm) was observed in the RPBP/C group. Dentoalveolar changes at the anterior region were evident, with statistically significant extrusion, and lingual tipping of the maxillary and mandibular incisors (P ≤ 0.05). The results showed no significant differences in the skeletal changes between the 2 groups. CONCLUSIONS: The OBB and the upper posterior bite plane with crib were both effective in the early treatment of the skeletal anterior open bite. However, closure of the anterior open bite was mainly due to the dentoalveolar changes at the anterior region of the dental arches.

Evaluation of head and cervical spine posture after functional therapy with Twin­Block and Bionator appliances: A pilot randomized controlled trial.

OBJECTIVE: Evaluation of head and cervical spine posture and estimation of sample size. METHODS: Thirty eligible participants who required functional therapy were randomly assigned to the Control group (C), Twin Block group (TB), or the Bionator group (B). Randomization was accomplished by means of blocks of fixed size stratified by sex and age, with the allocations concealed in opaque and sealed envelopes. RESULTS: Significant differences were identified between the pre -and post-functional SNB (p = 0.024) and ANB (p = 0.034) angles in the Twin Block group and SNA (p = 0. 019) and ANB (p = 0. 028) angles in the Bionator group. No statistically significant changes were seen in the head or cervical variables in the three groups. CONCLUSION: The functional appliance did not cause any statistical change in head posture or cervical spinal column in comparison with the non-treatment group.

Twenty-year follow-up of functional treatment with a bionator appliance: A retrospective dental cast analysis.

OBJECTIVE: To investigate changes in dental arch configuration, relationship, and malocclusion directly after Class II malocclusion treatment with a Balters bionator modified by Ascher as well as 20 years after treatment. MATERIALS AND METHODS: Orthodontic dental cast analysis of 18 patients with skeletal Class II treated with a bionator without any additional fixed therapy was performed with a digital caliper at three stages: before (T0), after (T1) and 20 years after (T2) treatment. Arch perimeter and depth, intermolar and intercanine distance, overjet, overbite, sagittal molar and canine relationship, mandibular incisor irregularity (Little's index), and malocclusion (PAR index) were assessed. RESULTS: During treatment (T0-T1), upper arch perimeter significantly increased with a significant decrease in the upper and lower arch perimeter long-term (T1-T2), whereas corresponding arch depths changed only slightly in both periods. Transverse intermolar width increased significantly during treatment, remaining almost constant from T1 to T2. Lower intercanine distance remained fairly unchanged during treatment, but decreased significantly during follow-up. Lower incisor irregularity improved slightly during treatment but increased significantly long-term. After treatment, sagittal molar relationships on both sides were improved, overjet and overbite reduced; these significant changes remained stable long-term. The peer assessment rating (PAR) index was significantly lower after treatment and increased insignificantly during follow-up. CONCLUSIONS: 20 years after bionator treatment without additional fixed appliances, the improved sagittal relationship and the reduced overjet and PAR index remained fairly stable. Long-term changes are most likely due to physiological aging processes and are not associated with bionator treatment.

Effect of Bionator and Farmand Appliance on the Treatment of Mandibular Deficiency in Prepubertal Stage.

OBJECTIVE: The present study aimed to compare dentoskeletal changes in mandibular-deficient patients treated with Bionator and Farmand appliances. METHODS: This study included 54 subjects treated for class II division I malocclusion. All subjects fulfilled the following criteria: ANB>5°, SNB<77°, and overjet >5 mm. The Bionator group consisted of 27 patients (15 girls, 12 boys) with the mean age of 11 (SD 1) years and the Farmand group consisted of 27 patients (17 girls, 10 boys) with the mean age of 11.1 (SD 1.4) years. Statistical analyses were performed using t-test, paired t-test, Wilcoxon, and Mann-Whitney test. RESULTS: In the Farmand group, SNB significantly increased from 74.3° (SD 1.7) to 77.6° (SD 2.3) and ANB decreased by 3.2° (SD 1.7) (p<0.001). In the Bionator group, SNB significantly increased from 75.5° (SD 0.9) to 79° (SD 0.9), and ANB decreased by 3.3° (SD 1.3) (p<0.001). The increase in IMPA showed that the lower incisors were significantly tipped using both appliances. T-test did not show any significant differences between the two groups. CONCLUSION: Despite the different designs of the appliances, both were successful in the treatment of class II division 1 malocclusion in mandibular-deficient patients.

Efeitos do bionator de balters na maxila de pacientes classe II nos diferentes tipos faciais / Balters bionator effects on the maxillae of class II patients on the different facial types

O objetivo desse estudo retrospectivo foi avaliar os efeitos esqueléticos do Bionator de Balters na maxila em pacientes portadores de maloclusão Classe II, divisão 1 de Angle nos diferentes tipos faciais. Foram obtidas radiografias em norma lateral de 60 pacientes divididos por tipo facial (sendo 15 pacientes dolicofaciais, 27 pacientes braquifaciais e 18 pacientes mesofaciais assim classificados, utilizando-se o índice VERT de Ricketts). Os pacientes com idades entre 7 a 12 anos foram tratados por um mesmo ortodontista com mais de 20 anos de experiência por um período médio de 26 meses. Um grupo de 15 pacientes portadores de maloclusão Classe II divisão 1, não tratados com idades entre 8 e 12 anos foi acompanhado por um ano e utilizado como grupo controle. Foram analisadas as medidas do ângulo Ba-Na-A, para avaliar a posição sagital da maxila, e do ângulo S-Na-PP, para avaliar a rotação da maxila. Nenhuma das medidas teve alteração clinicamente significante e também não houve diferenças significantes entre os grupos estudados. Baseado nesses resultados, conclui-se que o Bionator de Balters utilizado no tratamento da maloclusão Classe II de Angle não afeta a posição e inclinação da maxila durante o tratamento deste tipo de maloclusão.

The aim of this retrospective investigation was to evaluate the skeletal effects of the Balters Bionator on the maxillae of patients with Class II-1 malocclusion in the various facial types. Lateral radiographs of 60 patients classified according to the facial type (15 dolichofacial, 27 brachifacial and 18 mesofacial, according to Ricketts VERT index). The patients age ranged from 7 to 12 years and were treated by the same clinician who had more than 20 years of experience for a mean period of 26 months. A group of 15 patients with Class II malocclusion untreated and with age ranging from 8 to 12 years was observed for a year to be used as a control group. The angle Ba-Na-A was used for the evaluation of the sagittal position of the maxillae and the angle S-Na-PP, for the rotation. None of the measurements had any clinically significant change, and there were no statistically significant differences between the studied. Based on these results, it is concluded that the Balters Bionator used on the treatment of the Class II Angle malocclusion, does not affect the position and inclination of the maxillae during the treatment of this type of malocclusion.

Efecto de Bionator de California en los trastornos temporomandibulares / Effect of California Bionator in temporomandibular disorders

La ortopedia funcional de los maxilares es utilizada en el mejoramiento de las relaciones intermaxilares y de la articulación temporomandibular. Objetivo: identificar el efecto del Bionator de California en los pacientes con trastornos temporomandibulares. Metodología: Se realizó un estudio con diseño experimental en 32 pacientes entre 15 y 59 años del área Norte de Sancti Spíritus, de septiembre de 2011 a marzo de 2014, que acudieron al departamento de Prótesis Estomatológica de la Clínica Estomatológica Provincial de Sancti Spíritus. Se utilizaron métodos empíricos, estadísticos y procedimientos matemáticos. Resultados: El 56,2 porciento de los pacientes con trastornos temporomandibulares se encontraron en las edades de 24 a 32 años y el 75,0 porciento fueron del sexo femenino. Los contactos prematuros con un 78,1 porciento y las interferencias en el lado de balanceo con un 46,8 porciento, fueron las interferencias oclusales más representadas. Entre los signos y síntomas, los más representativos fueron: el ruido articular (71,8 porciento), la rigidez (68,7 porciento) y el cansancio muscular (65,6 porciento). A los seis meses de uso del aparato seis pacientes erradicaron el trastorno y los demás pasaron a categorías inferiores. En la evaluación al año, se eliminó el trastorno en el 34,3 porciento de los pacientes. Conclusiones: Los resultados obtenidos en la evolución del tratamiento con el Bionator de California ponen de manifiesto el cambio favorable de la mayoría de los pacientes con trastornos temporomandibulares, expresado en el cambio del grado severo a asintomático(AU)

The functional jaw orthopedics is utilized in improving jaw relationships and temporomandibular joint. Objective: To identify the effect of California Bionator in patients with temporomandibular disorders. Methods: An experimental design study was performed in 32 patients between 15 and 59 years from the North area of Sancti Spíritus, from September 2011 to March 2014, who attended the Department of Prosthodontics of the Provincial Dental Clinic of Sancti Spíritus. Empirical, statistical and mathematical methods were used. Results: 56.2 percent of patients with temporomandibular disorders were found in the age of 24 to 32 years, and 75.0 percent were female. Prematurities with 78.1 percent and interferences in the balancing side with 46.8 percent were the most represented occlusal interferences. Among signs and symptoms, the most representative were: joint noise (71.8 percent), stiffness (68.7 percent) and muscle fatigue (65.6 percent). After six months of using the device six patients eradicated the disorder and the others went to inferior cathegories. In the assessment year, the disorder was eliminated in 34.3 percent of patients. Conclusions: The results obtained in the treatment outcome with California Bionator demonstrate the favorable change in the majority of patients with temporomandibular disorders, expressed in the change of severe to asymptomatic degree(AU)

Efecto de Bionator de California en los trastornos temporomandibulares / Effect of California Bionator in temporomandibular disorders

Fundamento: La ortopedia funcional de los maxilares es utilizada en el mejoramiento de las relaciones intermaxilares y de la articulación temporomandibular. Objetivo: identificar el efecto del Bionator de California en los pacientes con trastornos temporomandibulares. Metodología: Se realizó un estudio con diseño experimental en 32 pacientes entre 15 y 59 años del área Norte de Sancti Spíritus, de septiembre de 2011 a marzo de 2014, que acudieron al departamento de Prótesis Estomatológica de la Clínica Estomatológica Provincial de Sancti Spíritus. Se utilizaron métodos empíricos, estadísticos y procedimientos matemáticos. Resultados: El 56,2 % de los pacientes con trastornos temporomandibulares se encontraron en las edades de 24 a 32 años y el 75,0 % fueron del sexo femenino. Los contactos prematuros con un 78,1 % y las interferencias en el lado de balanceo con un 46,8 %, fueron las interferencias oclusales más representadas. Entre los signos y síntomas, los más representativos fueron: el ruido articular (71,8 %), la rigidez (68,7 %) y el cansancio muscular (65,6 %). A los seis meses de uso del aparato seis pacientes erradicaron el trastorno y los demás pasaron a categorías inferiores. En la evaluación al año, se eliminó el trastorno en el 34,3 % de los pacientes. Conclusiones: Los resultados obtenidos en la evolución del tratamiento con el Bionator de California ponen de manifiesto el cambio favorable de la mayoría de los pacientes con trastornos temporomandibulares, expresado en el cambio del grado severo a asintomático.

Background: The functional jaw orthopedics is utilized in improving jaw relationships and temporomandibular joint. Objective: To identify the effect of California Bionator in patients with temporomandibular disorders. Methods: An experimental design study was performed in 32 patients between 15 and 59 years from the North area of Sancti Spíritus, from September 2011 to March 2014, who attended the Department of Prosthodontics of the Provincial Dental Clinic of Sancti Spíritus. Empirical, statistical and mathematical methods were used. Results: 56.2 % of patients with temporomandibular disorders were found in the age of 24 to 32 years, and 75.0 % were female. Prematurities with 78.1 % and interferences in the balancing side with 46.8 % were the most represented occlusal interferences. Among signs and symptoms, the most representative were: joint noise (71.8 %), stiffness (68.7 %) and muscle fatigue (65.6 %). After six months of using the device six patients eradicated the disorder and the others went to inferior cathegories. In the assessment year, the disorder was eliminated in 34.3 % of patients. Conclusions: The results obtained in the treatment outcome with California Bionator demonstrate the favorable change in the majority of patients with temporomandibular disorders, expressed in the change of severe to asymptomatic degree.

Tratamento precoce de más-oclusões esqueléticas de Classe II - comparação de três aparelhos ortopédicos funcionais: Bionator, Klammt, SN1 / Early treatment of skeletal Class II malocclusions – comparison of three functional appliances: Bionator, Klammt, SN1

Objetivo: comparar no plano sagital os efeitos esqueléticos e dentoalveolares para a maxila e mandíbula, como consequência do uso dos aparelhos Bionator, Klammt e SN1 no tratamento de más-oclusões esqueléticas Classe II. Material e métodos: foi realizado um estudo prospectivo de 21 crianças com má-oclusão esquelética de Classe II, tratadas com Bionator, Klammt ou SN1. Compararam-se mudanças no componente maxilar, mandibular e dentoalveolar através de medições e ângulos cefalométricos no plano sagital. Contrastaram-se as médias de longitudes e ângulos entre T1 e T2 pelas análises t student e wilcononox. Mediante Anova, foi contrastada a porcentagem da mudança nas medidas de interesse para os três grupos. Resultados: foram avaliadas 42 radiografias cefalométricas laterais (21 iniciais T1, 21 finais T2). Entre os participantes, 62% eram meninos e 38% eram meninas. A média das idades para início do tratamento foi 9,5 ± 1,2 anos. O SN1 apresentou a maior média de mudança na longitude mandibular Co-Pg (6,69 ± 3,3) e Co-B (6,59 ± 1,42). Encontrou-se a maior média de mudança relativa na altura do ramo mandibular no Bionator (9,52 ± 7,21). As mudanças dentoalveolares foram clinicamente relevantes para os três aparelhos. Conclusão: os aparelhos ortopédicos maxilares estimulam o crescimento mandibular sagital e vertical, controlam a posição sagital da maxila e geram mudanças dentoalveolares favoráveis para a correção de más-oclusões de Classe II.

Objective: comparing in the sagittal plane the skeletal and dento alveolar effects for the maxilla and the mandible as a result of the use of Bionator, Klammt and SN1 as a treatment of malocclusions class II skeletal. Material and Methods: a prospective study was realized on 21 boys and girls with skeletal Class II malocclusion under treatment with Bionator, Klammt or SN1, in which compare the changes in the maxillary, mandibular and dento-alveolar component by means of measurements and cephalometric angles in the sagittal plane. The averages of lengths and angles between T1y T2 was compare by t-student and wilcoxon tests. By Anova tests, contrasted the percentage of change in the measures of importance for the three groups. Results: 42 lateral skull radiographs were evaluated (21 initial-T1, 21 final-T2). 62% of participants were male and 38% were women. The average age for onset of treatment was 9.5 ± 1.2. The SN1 presented the highest average percent of change of the Co-Pg mandibular length (6.69 ± 3.3), Co-B (6.59 ± 1.42). A higher average relative change in the height of the ramus was found in Bionator (9.52 ± 7.21). Dento alveolar changes were clinically relevant for all three devices. Conclusion: orthopedic appliances stimulate mandibular sagittal and vertical growth, control the sagittal position of the maxilla, and generate favorable dento alveolar changes to correct class II malocclusions.

Avaliação cefalométrica das alterações do perfil facial naturais e induzidas pelos aparelhos de Herbst e Bionator no tratamento da má oclusão de Classe II, divisão 1ª / Cephalometric changes on facial profile due to natural growth and induced by the use of Herbst’s appliance and Bionator for treatment of Class II, division 1 malocclusion

O objetivo deste estudo foi avaliar as alterações do perfil facial induzidas pelos aparelhos de Herbst e Bionator no tratamento da má oclusão de Classe II, divisão 1ª. Uma amostra de 90 telerradiografias laterais de 45 indivíduos no estágio pré-pubertário foi subdividida em dois grupos experimentais e um controle. O primeiro grupo, composto por 15 indivíduos rasileiros, com idade média de 9,4 anos, foi tratado com o aparelho de Herbst por um período de 7 meses. O segundo grupo, composto por 15 indivíduos brasileiros, com 9,9 anos de idade em média foi submetido à bionatorterapia por um período médio de 21 meses. O grupo controle de 15 indivíduos, não tratados ortodonticamente, pareados quanto às idades óssea e cronológica dos grupos experimentais, provém do Burlington Growth Centre, Universidade de Toronto, Canadá. A comparação intragrupo foi realizada por meio do teste t de Student e a comparação intergrupos por meio da ANOVA complementada pelo teste de Bonferroni. Os resultados evidenciaram que apenas o grupo tratado com o aparelho de Herbst mostrou alterações significativas do perfil facial com melhora da convexidade do perfil facial e protrusão do lábio inferior.

The aim of this study was to evaluate the facial profile changes due to natural growth and induced by Herbst’ appliance and Bionator in the treatment of Class II, division 1 malocclusion. In order to do that, we used a sample of 90 lateral radiographs of 45 individuals in pre-pubertal stage, divided up in two experimental groups and one control. The first group, composed of 15 brazilian individuals, with initial mean age of 9.4 years, was treated with the Herbst appliance for a period of seven months. The second experimental group consisting of 15 brazilian individuals, initial mean age of 9.9 years has gone through bionator therapy for an average period of 21 months. The control group of 15 individuals, who were not treated orthodontically, comes up from the Burlington Growth Centre, University of Toronto, Canada. The intragroup comparison was performed using the Student t test and intergroup comparisons by ANOVA complemented by the Bonferroni test. The results have shown that only the group treated with the Herbst appliance presented significant changes in facial profile with improvement of its convexity and lower lip protrusion.

Avaliação da alteração do plano oclusal em pacientes dolicofaciais portadores de classe II mandibular que utilizaram o aparelho Bionator de Balters / Evaluation of occlusal plane changes in dolichofacial patients with mandibular class II malocclusion after Balters Bionator therapy

Objetivo: avaliar cefalometricamente a influência do Bionatorde Balters no plano oclusal em pacientes dolicofaciais portadoresde maloclusão de Classe II de Angle associadas ao retrognatismomandibular, durante a fase de crescimento. Metodologia:a amostra consistiu de 40 telerradiografias obtidas em doistempos (T1: inicial; T2: após bionatorterapia) de 20 pacientes,sendo 10 do sexo masculino e 10 do sexo feminino com idadesvariando entre 7 e 15 anos (média de 9,03). Resultados e Conclusões:constatou-se um controle bastante eficiente da inclinaçãodo plano oclusal, provocando sua rotação anti-horária, o que éconsiderado essencial na estabilidade dos resultados.

Aim: the purpose of this study is a cephalometric evaluationof the influence of the Balters Bionator on the occlusal plane indolichofacial patients with mandibular Class II malocclusionduring growth period. Methods: the sample comprised of 40 lateralcephalograms taken at two times (T1: initial; T2: after bionatortherapy)from 20 patients, 10 females and 10 males withage ranging between 7 and 15 years (average 9,03). Results andconclusions: an efficient control of the occlusal plane inclinationwas evidenced resulting counter clockwise rotation which wasessential for the achievement and stability of the results.

Tratamiento de maloclusion clase II con aparatología ortopédica funcional: Bionator: reporte de un caso / Treatment of malocclusion class II with orthopedic functional apliances: Bionator: a case report

La eficiencia en la corrección de la maloclusión de clase II, mediante la utilización de aparatos ortopédicos funcionales se ha reportado en la literatura desde tiempo atrás. Diferentes estudios han permitido esclarecer la forma en que los aparatos ortopédicos funcionales actúan sobre las estructura óseas, musculares, y dentales en pacientes que se encuentran en estadios previos al pico máximo puberal. Los aparatos ortopédicos funcionales aprovechan las fuerzas naturales del crecimiento y desarrollo, lo que logra una función normal del sistema estomatognático que garantiza adecuada masticación, deglución, fonación, mejora la estética y el autoestima del paciente en edades tempranas. El objetivo de este reporte de caso es mostrar los resultados satisfactorios que se logran con el tratamiento de maloclusiones clase II división 1 en pacientes jóvenes utilizando un aparato ortopédico funcional como el Bionator del Dr. Balters, también dar a conocer los cambios favorables tanto faciales, como dentales y cefalométricos, que fueron el resultado del diagnostico apropiado, selección adecuada del aparato ortopédico y excelente cooperación del paciente.

The efficiency of correction of Class II malocclusion, using functional appliances have been reported in the literature some time ago. Several studies have showed how functional orthopedic appliances act on bone, muscle, and dental structures of patients who are at stages prior to the pubertal growth peak. Functional appliances take advantage of the natural forces of growth and development which achieves a normal function of the stomatognathic system that ensures adequate chewing, swallowing, speech, aesthetics and improving patient’s selfesteem at early age. The purpose of this case report is to show how satisfactory results are achieved with the treatment of Class II division 1 malocclusion in young patients using a functional appliance as Dr. Balters Bionator. Also to present the positive facial, dental and cephalometric changes, which were the result of proper diagnosis, proper selection of the appliance and excellent cooperation of the patient.

Efetividade do aparelho ortopédico Bionator de Balters no tratamento do ronco e apnéia do sono / The effectiveness of the Balters Bionator orthopedic appliance for the treatment of the Obstructive Sleep Apnea Syndrome

OBJETIVOS: avaliar a efetividade do aparelho ortopédico Bionator de Balters no tratamento da Síndrome da Apnéia Obstrutiva do Sono (SAOS). METODOLOGIA: foram selecionados 16 pacientes (18,8 por cento do gênero feminino e 81,3 por cento do masculino) que apresentaram a SAOS mediante diagnóstico. Dos 16 pacientes que utilizaram o aparelho ortopédico Bionator de Balters, apenas 9 apresentaram boa aceitação (56,25 por cento) e concluíram o tratamento. Estes foram submetidos a nova polissonografia, realizada com o paciente fazendo uso do aparelho ortopédico Bionator de Balters, para avaliar a eficácia deste dispositivo no tratamento do ronco e da apnéia. A comparação entre os resultados do IDR (índice de distúrbio respiratório) inicial (11,5) e final (4,2) foi realizada utilizando-se o teste t pareado (α = 0,05). RESULTADOS: observou-se melhora estatisticamente significativa do IDR após a utilização do dispositivo. CONCLUSÕES: a utilização do aparelho ortopédico Bionator de Balters pode ser considerada um método de tratamento da SAOS em casos leves ou moderados, apesar de ser um método pouco tolerado pelos pacientes.

AIM: to assess the effectiveness of the Balters Bionator orthopedic appliance for the treatment of the Obstructive Sleep Apnea Syndrome (OSAS). METHODS: Sixteen patients (18.8 percent women and 81.3 percent men) that presented OSAS on diagnosis were selected. Of the 16 patients that used the Balters Bionator orthopedic appliance, only 9 presented good acceptance (56.25 percent) and concluded the treatment. They were submitted to another polysomnography exam, performed with the patients using the Balters Bionator orthopedic appliance, in order to assess the effectiveness of this device in treating apnea snoring. Comparison between the results of the initial (11.5) and final (4.2) RDI (respiratory disturbance index) was made by the paired t test (α = 0.05). RESULTS: A statistically significant improvement in the RDI was observed after the device was used. CONCLUSIONS: The use of the Balters Bionator orthopedic appliance may be considered as a method for treating OSAS in light or moderate cases, in spite of being a method hardly tolerated by patients.

Avaliação das alterações do plano oclusal em telerradiografias em norma lateral no tratamento de más oclusões de Classe II, 1ª divisão, com Bionator de Balters, em pacientes retrovertidos, neutrovertidos e provertidos / Evaluation of occlusal plane changes in retroverted, neutroverted and proverted patients, with Class II, division 1, malocclusion treated with Balters' Bionator

OBJETIVO: este trabalho objetiva verificar as alterações do plano oclusal funcional de Ricketts, utilizando as variáveis que orientam este plano nas análises cefalométricas de Ricketts e Schawrz-Faltin, em pacientes portadores de má oclusão de Classe II de Angle, 1ª divisão, associada ao retrognatismo mandibular, cuja terapêutica indicada tenha sido a Bionatorterapia. METODOLOGIA: a amostra coletada neste estudo retrospectivo consta de 128 telerradiografias em norma lateral de 64 indivíduos retrovertidos, neutrovertidos e provertidos, de ambos os gêneros, no estágio de desenvolvimento da oclusão em fase mista ou permanente jovem. A faixa etária dos indivíduos selecionados para o estudo variou entre 7 anos e 1 mês a 13 anos e 2 meses no momento T1, sendo a média inicial de 10 anos de idade. A média de duração do tratamento foi de 19,7 meses. RESULTADOS E CONCLUSÃO: os resultados mostraram comportamentos distintos do plano oclusal, conforme o tipo facial retrovertido, neutrovertido ou provertido. O controle do plano oclusal na Bionatorterapia, pelo manejo do Bionator conforme o tipo facial de cada paciente, por meio de desgastes seletivos no acrílico e conseqüente erupção diferenciada dos dentes, pode influenciar favoravelmente o crescimento geral da face em cada tipo facial.

AIM: This work aims to verify the changes of Ricketts functional occlusal plane making use of variables which guide this same plane in the cephalometric analysis of Ricketts and Schwarz-Faltin among patients with Class II, division 1 malocclusion, associated to mandible retrognathism, whose therapy indicated has been Bionatortherapy. METHODS: The sample collected in this retrospective survey has 128 lateral cephalograms of 64 retroverted, neutroverted and proverted individuals, of both genders, at the stage of developing occlusion, either in mixed phase or permanent young. The age scale of individuals selected by the survey goes from 7 years and 1 month up to 13 years and 2 months in the T1 moment, with an initial mean age of 10 years. The mean length of time of treatment has been of 19.7 months. RESULTS AND COONCLUSION: The overall results have been submitted to statistical analysis and have shown that in the group of retroverted patients the occlusal plane goes round clockwise, in the group of neutroverted ones, the occlusal plane did not show up any relevant alterations between moments T1 and T2, and in the group of proverted patients the occlusal plane goes round counterclockwise. The occlusal plane control in the Bionatortherapy through the handle of the Bionator according to the facial type of each patient, through selective worn out acrylic and consequent diversified eruption of the teeth, can indeed cause favorable influence towards the overall growing up of the face in every facial type.

Hard and soft tissue changes following the treatment of Class Ⅱ division 1 malocclusion using Bionator appliance / 实用口腔医学杂志

Objective:To study the treatment effects of 12 cases of Class II division 1 malocclusion using Bionator appliances. Methods:12 cases of Class II division 1 malocclusion were selected and treated with Bionator appliances. The changes of teeth, skeletal and facial appearance were analyzed by cephalometry before and after the treatment of Bionator appliances. Results:①Bionator appliances can hardly restrain the maxillary growth. ②Bionator appliances can promote the mandibular ramus and body growth and improve the soft tissue profile. ③Bionator appliances can reduce the labial inclination of upper incisors of Class II division 1 malocclusion and can increase the height of dental alveolar of upper and lower jaw. Conclusion:In Class II division 1 malocclusion treatment, Bionator appliances can obtain satisfactory effects.