Elastic Activator For Treatment of Openbite Stellzig1999
Elastic Activator For Treatment of Openbite Stellzig1999
Elastic Activator For Treatment of Openbite Stellzig1999
To cite this article: A. Stellzig D.D.S., PH.D., G. Steegmayer-Gilde D.D.S. & E. K. Basdra D.D.S.,
PH.D. (1999) Elastic Activator for Treatment of Open Bite, British Journal of Orthodontics, 26:2,
89-92, DOI: 10.1093/ortho/26.2.89
Article views: 59
G. STEEGMAYER-GILDE, D.D.S.
E . K . B A S D R A , D . D . S ., P H . D .
Department of Orthodontics, School of Dental Medicine, University of Heidelberg, 69120 Heidelberg, Germany
Abstract. This article presents a modified activator for treatment of open bite cases. The intermaxillary acrylic of the lateral
occlusal zones is replaced by elastic rubber tubes. By stimulating orthopaedic gymnastics (chewing gum effect), the elastic
activator intrudes upper and lower posterior teeth. A noticeable counterclockwise rotation of the mandible was accom-
plished by a decrease of the gonial angle. Besides the simple fabrication of the device and uncomplicated replacement of the
elastic rubber tubes, treatment can be started even in mixed dentition when affixing plates may be difficult.
Index words: Elastic Activator, Functional Appliance, Open Bite, Reduction of Anterior Facial Height, Vertical
Malocclusion.
Refereed Paper
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Introduction ture. The kinetor consists of two places, that are connected
by a horizontal wire loop in the vestibulum and inter-
Correction of skeletal open bite is one of the most difficult changeable rubber tubes are fixed on the lateral occlusal
problems in orthodontic practice. In severe cases ortho- zones. Through tight fitting of the rubber tubes to the
dontic treatment alone may be insufficient (Subtelny and posterior teeth in rest position they exert an intrusive
Sakuda, 1964). Not only the growth pattern of the patient, vertical force when swallowing or chewing. This article
but also tongue habits and finger-sucking are regarded as presents a modified activator appliance for treating open
possible aetiological factors, and if there is persistent bite cases. In this activator, elastic posterior bite blocks are
imbalance between tongue and orofacial muscular activity, being incorporated.
treatment of open bite often fails. Numerous orthodontic
techniques have been proposed to obtain bite closure,
extrusion of the incisors, intrusion of the posterior teeth,
Fabrication
and mesialization of the posterior teeth, as well as upright-
ing the incisors after dental extractions (Nielsen 1991; Figure 1 shows details for construction of the elastic activ-
Rinchause, 1994; Enacar et al., 1996). In many cases, ator. The rigid intermaxillary part of the lateral occlusal
anterior dentoalveolar compensation of the malocclusion is zones is replaced by elastic rubber tubes which is pushed
undesirable for functional and aesthetic reasons. In order on a wire loop with a diameter of 8 mm and thickness of
to obtain autorotation of the mandible by intruding the 1·5 mm. It is advisable to use highly resilient wire to
posterior teeth orthopaedic appliances, such as high-pull avoid breakage during mastication. The rubber tubes are
headgears (Kuhn, 1976), bionators (Pearson, 1978), Fränkel exchanged every 2–3 months for maintaining continuous
functional regulators (Fränkel, 1980), and Teuscher activat- tension in the neuromuscular system. Furthermore, the
ors (Teuscher, 1978) have been used. Open bite correction design of the activator incorporates labial bows for control
using bite-blocks with repelling magnets on the upper and of the upper and lower anterior teeth. Facets cut in the
lower posterior teeth was also reported (Dellinger, 1989). acrylic help directing the eruption of the anterior teeth. The
However, besides precise impressions of the upper and upper and lower front teeth should be at least 2 mm away
lower jaw, this technique demands absolutely correct place- from the acrylic when the patient has the appliance in the
ments of the magnets. Since then, several modifications of mouth and bites on it with the maximum force (Figure 2).
this treatment method have been presented in which open The anteroposterior position is controlled with posterior
bite reduction has been attained partly by growth inhibition clasps pressing against the mesial surface of the first molars.
of the posterior segments (Kaira et al., 1989; Kiliarridis If there is a history of tongue hyperactivity a crib is incor-
et al., 1990; Breunig and Rakosi, 1992). In addition, spring- porated for behaviour modification by interfering with an
loaded bite-blocks in the lower jaw (Woodside and Linder anterior tongue position.
Aronson, 1986) were suggested for open bite correction as
they exert an intrusive force on the posterior teeth due to
the spring mechanism. One disadvantage of this technique Case CF (9 years 4 months, female)
may be the breakage of the springs as reported by Kuster
and Ingervall (1992). Clinical examination showed bilateral Angle Class I, well
The Stockfisch kinetor (Stockfisch, 1959), however, developed symmetric dental arches and no space defi-
remained largely unnoticed in the Anglo-American litera- ciency. The patient exhibited a median diastema with deep
insertion of the labial fraenum. Due to dummy use until the
Correspondence: Dr Angelika Stellzig, Poliklinik für Kiefer- age of 5 years, as well as tongue thrust swallow the patient
orthopädie, INF 400, 69120 Heidelberg, Germany. revealed an open bite of 3·5 mm, protruded maxillary
(a) (a)
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(b) (b)
FIG. 1 Elastic activator. FIG. 3 Case 1. 9-year-old female patient before treatment.
FIG. 2 Simulation of maximum bite force. FIG. 4 Case 1. Seated elastic activator.
incisors, and an increased overjet (Figure 3). Cephalo- occurred within the first 8 months after placement of the
metric analysis showed skeletal Class I with a slight vertical appliance. During this time the proclined maxillary incisors
growth pattern. were uprighted and overjet was corrected by activation of
Treatment objectives were: the upper labial bow (Figure 5). Besides requisite retrusion
of the protruded incisors, cephalometric analysis show
1. Elimination of habits.
slight autorotation of the mandible accomplished by a
2. Retrusion of upper front teeth and correction of the
decrease of the gonial angle from 129 to 127 degrees
overjet.
(Figure 6a,b,c,). The Jarabak percentage increased from 57
3. Treatment of open bite.
to 59 degrees, while the NS–Gn angle decreased from 66 to
4. Frenectomy and diastema closure.
64 degrees. At this point, treatment will be finished with
Therapy was started with an ‘elastic activator’ which should frenectomy and diastema closure using a fixed appliance in
be worn 14 hours per day (Figure 4). Closure to open bite the upper jaw.
BJO June 1999 Clinical Section Open Bite Correction 91
(a) (b)
(a) (b)
(c) F I G . 6 Case 1. (a) before treatment; (b) after elastic activator treatment;
(c) superimposition (— before, ---- after treatment).
Conclusions open bite correction. In the presented case, there was clear
evidence of anterior rotation of the mandible. This together
The presented design was highly reliable as breakage did with a marked uprighting of the incisors, resulted in closure
not occur in the clinical practice and the elastic activator of the open bite. The following advantages of the elastic
seems to be an efficient functional appliance in anterior activator are apparent:
92 A Stellzig et al. Clinical Section BJO Vol 26 No. 2
Stockfisch, H. (1959)
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