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Influence of fixed appliances on two-phase orthopedic-orthodontic treatment


Angle Class II. Activator appliances. Orthodontics

How to Cite

Neves LS, Canuto LFG, Cançado RH, Janson G, Drummond AF, Henriques JFC. Influence of fixed appliances on two-phase orthopedic-orthodontic treatment. Braz. J. Oral Sci. [Internet]. 2018 Dec. 6 [cited 2023 May 28];17:e18922. Available from:


Aim: The purpose of this retrospective study was to investigate the effects of phase 2 with fixed appliances, after phase 1 Bionator treatment of Class II division 1 malocclusion, as compared to a matching control group. Methods: The experimental group consisted of 20 patients who were evaluated after orthodontic treatment with fixed appliances subsequently to functional therapy with the Bionator in phase 1.  A control group consisting of 20 Class II, division 1 individuals. Results: During phase 1 there was significant forward growth restriction in the maxillary complex, improvement of the maxillomandibular relationship and decrease in facial convexity.  There was also significant reduction of the maxillary incisor proclination and protrusion, protrusion of the mandibular incisors, and vertical development of the mandibular molars.  The overjet was significantly reduced and the molar relationship was significantly improved.  Treatment during phase 2, with fixed appliances, resulted in significant maxillary forward growth restriction and facial convexity reduction. Conclusion:  Major Class II skeletal and dentoalveolar anteroposterior correction was obtained during phase 1, with the Bionator.  Phase 2, with fixed appliances only produced a significant maxillary forward growth restriction and facial convexity reduction, without any significant dentoalveolar change.


Nelson C, Harkness M, Herbison P. Mandibular changes during functional appliance treatment. Am J Orthod Dentofacial Orthop. 1993 Aug;104(2):153-61.

O'Brien K, Wright J, Conboy F, Sanjie Y, Mandall N, Chadwick S et al. Effectiveness of early orthodontic treatment with the Twin-block appliance: a multicenter, randomized, controlled trial. Part 1: Dental and skeletal effects. Am J Orthod Dentofacial Orthop. 2003 Sep;124(3):234-43; quiz 339.

Neves LS, Janson G, Cançado RH, de Lima KJRS, Fernandes TMF, Henriques JFC. Treatment effects of the Jasper Jumper and the Bionator associated with fixed appliances. Prog Orthod. 2014;15:54. doi: 10.1186/s40510-014-0054-9.

Oda H, Sandou M, Lin CM, Kamata M, Kawata T. Clarifying the mechanism of effect of the Bionator for treatment of maxillary protrusion: A percentile growth study. Eur J Paediatr Dent. 2016 Sep;17(3):213-219.

Santamaría-Villegas A, Manrique-Hernandez R, Alvarez-Varela E, Restrepo-Serna C. Effect of removable functional appliances on mandibular length in patients with class II with retrognathism: systematic review and meta-analysis. BMC Oral Health. 2017 Feb 1;17(1):52. doi: 10.1186/s12903-017-0339-8.

Op Heij DG, Callaert H, Opdebeeck HM. The effect of the amount of protrusion built into the bionator on condylar growth and displacement: a clinical study. Am J Orthod Dentofacial Orthop. 1989 May;95(5):401-9.

Jakobsson SO, Paulin G. The influence of activator treatment on skeletal growth in Angle Class II: 1 cases. A roentgenocephalometric study. Eur J Orthod. 1990 May;12(2):174-84.

DeVincenzo JP. Changes in mandibular length before, during, and after successful orthopedic correction of Class II malocclusions, using a functional appliance. Am J Orthod Dentofacial Orthop. 1991 Mar;99(3):241-57.

Mills JR. The effect of functional appliances on the skeletal pattern. Br J Orthod. 1991 Nov;18(4):267-75.

Ghafari J, King GJ, Tulloch JF. Early treatment of Class II, division 1 malocclusion - comparison of alternative treatment modalities. Clin Orthod Res. 1998 Nov;1(2):107-17.

Illing HM, Morris DO, Lee RT. A prospective evaluation of Bass, Bionator and Twin Block appliances. Part I - The hard tissues. Eur J Orthod. 1998 Oct;20(5):501-16.

Keeling SD, Wheeler TT, King GJ, Garvan CW, Cohen DA, Cabassa S et al. Anteroposterior skeletal and dental changes after early Class II treatment with bionators and headgear. Am J Orthod Dentofacial Orthop. 1998 Jan;113(1):40-50.

Francisconi MF, Henriques JFC, Janson G, Freitas KMS, Santos PBD. Stability of Class II treatment with the Bionator followed by fixed appliances. J Appl Oral Sci. 2013 Nov-Dec;21(6):547-53. doi: 10.1590/1679-775720130002.

Madurantakam P. Fixed or removable function appliances for Class II malocclusions. Evid Based Dent. 2016 Jun;17(2):52-3. doi: 10.1038/sj.ebd.6401171.

Chadwick SM, Aird JC, Taylor PJ, Bearn DR. Functional regulator treatment of Class II division 1 malocclusions. Eur J Orthod. 2001 Oct;23(5):495-505.

Dolce C, Schader RE, McGorray SP, Wheeler TT. Centrographic analysis of 1-phase versus 2-phase treatment for Class II malocclusion. Am J Orthod Dentofacial Orthop. 2005 Aug;128(2):195-200.

Dolce C, McGorray SP, Brazeau L, King GJ, Wheeler TT. Timing of Class II treatment: skeletal changes comparing 1-phase and 2-phase treatment. Am J Orthod Dentofacial Orthop. 2007 Oct;132(4):481-9.

Tulloch JF, Proffit WR, Phillips C. Outcomes in a 2-phase randomized clinical trial of early Class II treatment. Am J Orthod Dentofacial Orthop. 2004 Jun;125(6):657-67.

Wheeler TT, McGorray SP, Dolce C, Taylor MG, King GJ. Effectiveness of early treatment of Class II malocclusion. Am J Orthod Dentofacial Orthop. 2002 Jan;121(1):9-17.

Vargervik K, Harvold EP. Response to activator treatment in Class II malocclusions. Am J Orthod. 1985 Sep;88(3):242-51.

Nelson G. Phase I treatment. Am J Orthod Dentofacial Orthop. 1997 Feb;111(2):239-40.

Livieratos FA, Johnston LE, Jr. A comparison of one-stage and two-stage nonextraction alternatives in matched Class II samples. Am J Orthod Dentofacial Orthop. 1995 Aug;108(2):118-31.

Courtney M, Harkness M, Herbison P. Maxillary and cranial base changes during treatment with functional appliances. Am J Orthod Dentofacial Orthop. 1996 Jun;109(6):616-24.

Faltin KJ, Faltin RM, Baccetti T, Franchi L, Ghiozzi B, McNamara JA, Jr. Long-term effectiveness and treatment timing for Bionator therapy. Angle Orthod. 2003 Jun;73(3):221-30.

Dahlberg G. Statistical methods for medical and biological students. London: George Allen & Unwin; 1940. p.122-32.

Almeida MR, Henriques JF, Almeida RR, Almeida-Pedrin RR, Ursi W. Treatment effects produced by the Bionator appliance. Comparison with an untreated Class II sample. Eur J Orthod. 2004 Feb;26(1):65-72.

Dermaut LR, van den Eynde F, de Pauw G. Skeletal and dento-alveolar changes as a result of headgear activator therapy related to different vertical growth patterns. Eur J Orthod. 1992 Apr;14(2):140-6.

Janson G, Caffer DC, Henriques JF, Freitas MR, Neves LS. Stability of Class II, division 1 treatment with the headgear-activator combination followed by the edgewise appliance. Angle Orthod. 2004 Oct;74(5):594-604.

Pollard LE, Mamandras AH. Male postpubertal facial growth in Class II malocclusions. Am J Orthod Dentofacial Orthop. 1995 Jul;108(1):62-8.

Palomo JM, Hunt DW, Jr., Hans MG, Broadbent BH, Jr. A longitudinal 3-dimensional size and shape comparison of untreated Class I and Class II subjects. Am J Orthod Dentofacial Orthop. 2005 May;127(5):584-91.

Righellis EG. Treatment effects of Frankel, activator and extraoral traction appliances. Angle Orthod. 1983 Apr;53(2):107-21.

McNamara JA Jr., Howe RP, Dischinger TG. A comparison of the Herbst and Frankel appliances in the treatment of Class II malocclusion. Am J Orthod Dentofacial Orthop. 1990 Aug;98(2):134-44.

Wieslander L, Lagerstrom L. The effect of activator treatment on Class II malocclusions. Am J Orthod. 1979 Jan;75(1):20-6.

McNamara JA Jr., Bookstein FL, Shaughnessy TG. Skeletal and dental changes following functional regulator therapy on Class II patients. Am J Orthod. 1985 Aug;88(2):91-110.

Tulley WJ. The scope and limitations of treatment with the activator. Am J Orthod. 1972 Jun;61(6):562-77.

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