Activator

The activator is in orthodontics a removable brace for the upper and lower jaw in one piece. It is made of plastic and some wire elements, mostly an upper and lower labial bow. If necessary, additional wire elements against misaligned teeth, an adjuster or lip shields can be added while retaining clips are uncommon. He is the oldest and best known treatment means of the function Orthodontics ( FKO ). Unlike so-called active or orthodontic braces he uses as a power source exclusively oral muscle forces. Activators are used for treatment of bite abnormalities in the growth phase, primarily mandibular reserves with or without deep bite.

History and variations

In the 30s of the 20th century Viggo Andresen and Karl Häupl discovered in Oslo the influence of the oral musculature on the formation and healing of malocclusions. From this they developed the functional orthodontics and the activator as their basic treatment means to normalize aberrant jaw development by influencing jaw growth.

Function Orthodontics, unlike Orthodontics, a term coined in the German term. This painless new healing method spread rapidly, especially in Europe. Orthodontics for children based here for decades on active plates and activators, they complement both: Plates for 2 -dimensional correction of the dental arches in its plane, and functional appliances to achieve the appropriate jaw position for normal teeth and grow teeth in the occlusal plane to leave, which means a correction in the vertical third dimension. With active plates place was won when needed, ordered the teeth and made ​​Zahnbogenkongruenz. Then the bite was, where necessary, with activators furnished and lifted a deep bite when needed. If the change of teeth was already completed, this phase could last two years. Early treatments were preferred with strong distal occlusion or difficult malocclusions, as with open bite or mandibular prognathism, and running due to the stronger growth from quickly.

Activators were thick wall with the former manufacturing techniques and bulky and prevented much when speaking. Therefore, various more graceful braces have been developed from it, such as the following:

• Wilhelm Balters described the syndrome " Mundatmergebiss " and developed the Bionator for extended portability during the day by reducing the plastic body and the wire elements changed: a lip strap, which should lead the lips and side loops has that will keep the cheeks pressure and a palate forward -looking tongue bow to the orientation of the tongue. Thus equipped, the Bionator should not only normalize the oral cavity functions, but also strengthen the nasal airway and improve posture.
• The U-bow activator according Karwetzky consist of a plate-like maxillary and mandibular part, which are held together at the back of two U-shaped elements made ​​of thick wire. These U-bolts can be, bend to move the lower part to the upper part. So also strong reserves with only one device can be treated, and with modified brackets may instead be a push-back or pivoting of the lower jaw can be adjusted.
• Particularly delicate are the resilient denture shaper according Bimler. Your skeletonized mandibular part is also adjustable by bending and the upper jaw portion can be designed for expansion (pine elongation). Bimler discovered that even nocturnal wearing of dentures former achieved a sufficient effect, and wrote these effects increase the elasticity. This is confirmed by the other elastic braces, which are easier to manufacture with the present materials, such as assembled rail activators.
• The newer Maxillator after Hangl is a hybrid ( mixed), from the resilient Bimler - top and the stable part of the U-bolt activator, together with ironing.
• However, also activators can now build thin and delicate, and they (PMMA ) are still mostly made ​​of Plexiglas. Such small activators fall in the mouth a little to disturb hardly speaking and leave the roof of the mouth and also the front palate -free, where the tongue should be touching.

The difference between activator and Bionator became fluent, and there are mixed forms. The application spectrum of functional orthodontics is va supplemented by the separately developed function controller.

Construction and operation

The activator is an orthosis: he is devious growing bones and joints ( the jaw) before a overcorrected attitude, in order to " run properly " in the literal sense of " Orthopedics " again. For the production of an activator this correction effective jaw posture is impressed as so-called construction bite into a waking strand, in addition to plaster models of jaws. In this posture the chewing surfaces are molded in plastic at the activator, which despite its wearer jaw displacement gives a feeling of co- biting. While the actual activator effect is painless, the portion which lies within the lining of the jaws, causing pressure points. These zones would then be ground.

For the extent of such fundamental construction bite the literature is no single recommendation. Counter mandibular reserve one finds statements such as " bite head seeks," " two-thirds of the maximum feed distance " or " no more than 4 to 5 mm, schedule follow-up copy in more need of correction ." In the feed -adjustable functional appliances as above avoid this ambiguity. Another design parameter is bite the bite opening. Here is recommended, with more vertical cranial development to further open the bite in patients than to select for less at more horizontally growing, but their ( horizontal ) feed. Strong bite opening and powerful feed at the same time would make the activator also too uncomfortable.

The Kauflächenteil the activator is there specifically be ground, where teeth are to grow into a healthy tooth. With a deep bite, the lower premolars are often too deep, while the incisors to grow each other in an open bite. In well- toothed mandibular reserves the maxilla is often too narrow for normal mandibular position. For the mandibular position caused the position of the tongue and the tongue, the upper jaw development. In ancient literature the lower and upper jaw are sometimes compared with one foot in the slipper. Although activators normalize the position of the tongue, but for more targeted treatment for this activator screws have been developed only spread the maxillary part of a three-part activator. More recent multi-unit functional appliances that are graceful, but this also allow.

You can also find different information on whether the activator in the lower dental arch snap or loose should be in the mouth in the literature. By bulginess the lower molars it locks when they are not free grinds. There is also inconsistent observations, whether activators tilt the lower incisors before or not. This may be related with the non- locking or locking: if the lower jaw to fall back asleep, and press it against the teeth unintentionally Aktivatorrand or not.

A regularly worn activator oriented the masticatory muscles after a short time as to that of the lower jaw by itself continues to be held in front. This training effect is also called Sunday bite and disappears on discontinuation of the activator again. Through it reaches a daily wearing time of 12 to 15/24 h usually made because a residual effect also exists in the remaining hours of the jaw joints. After about 6 months, the desired correction jaw begins to manifest itself in hard tissue.

Success through additional targeted physiotherapy in the more difficult prognathism treatment with modified activators describes Satravaha 1993.