Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 32

Clinical Practice

Pearls of the Pacific

A Simple Way to Increase the
Activation Range of the Bionator for
Class II Correction

Dr. James Chen
San Francisco, CA
PCSO Bulletin Contributor

32	

Early interceptive orthodontic treatment is
usually targeted and focused at addressing major
occlusal discrepancies. One of the most common
malocclusions seen and treated in the mixed dentition is the Class II malocclusion. Treatment of
this malocclusion ranges from classical approaches such as headgear to more recent techniques
such as the Carriere Motion Appliance. We use
a functional appliance, the Bi-o-na-tor, for Class II
malocclusions in both maxillary protrusion and
mandibular retrognathic cases in my private
practice as well as in the community clinic where
I serve (Figure 1). We use this appliance because
of its ease of wear and effectiveness at correcting
the malocclusion.

eruption in open bite cases. The traditional Bi-o-
na-tor is often made with just a labial bow for the
upper anterior teeth and a transpalatal loop for
stability. The changes we have implemented into
our Bi-o-na-tor are Adams clasps for stability and
sagittal expansion screws to increase the amount
of correction one Bi-o-na-tor can provide.

In this pearl, I want to highlight some small additions we have learned to implement in our Bi-o-na-
tor that have improved some of its effects as well
as reduced the need to remake new ones once the
Bi-o-na-tor is no longer active during treatment. The
standard Bi-o-na-tor can be made to either facilitate
posterior eruption for deep bite cases or limit

We place Adams clasps on the upper first molars
(Figure 1) to improve the retention of the Bi-on
- a-
tor. While the retention arises mostly from the
patient biting into the Bi-o-na-tor, the additional
Adams clasps help to hold the Bi-on
- a-tor steady
during insertion. The second addition we have is
the sagittal expansion screws (Figures 1 and 2).
The Bi-o-na-tor is made by posturing the patient
forward into an edge-to-edge incisal relation.
More posturing is sometimes needed during the
course of treatment. In these situations, instead
of making a new Bi-o-na-tor, moving the anterior
portion of the Bi-o-na-tor (incisal caps) with sagittal
expansion screws gives the extra movement
some patients need at the end.

Figure 1. Modified Bionator buccal view

Figure 2. Modified Bionator occlusal view

PCSO Bulletin    Spring 2021



Pacific Coast Society of Orthodontists Bulletin Spring 2021

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Spring 2021

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