title: Clarifying the mechanism of effect of the Bionator for treatment of maxillary protrusion: A percentile growth study.
abstract: OBJECTIVE
  The reported effects of Bionator treatment in patients with mandibular retrognathism are conflicting. This study evaluated the changes in craniofacial morphology resulting from treatment with a Bionator, based on measurement percentiles previously reported, to clarify the mechanism of the effect of this commonly used functional device.
  
  
  METHODS
  Study Design: Retrospective.
  
  
  METHODS
  A private orthodontic clinic.
  
  
  METHODS
  Forty-two children (mean age, 10.13 years) requiring treatment with a Bionator for Class II malocclusion (mandibular retrognathism). Children were randomly assigned to a Bionator group with or without an expansion screw. Measurements on lateral cephalometric radiographs were taken before and upon completion of Bionator treatment. All parameters measured were characterised according to the measurement percentiles previously reported. Each parameter was compared before and after treatment for all patients and for each treatment group using Wilcoxon's test.
  
  
  RESULTS
  No significant differences in cranial length or mandibular body length were seen in any of the 3 groups, but anterior cranial base length and maxillary length were significantly decreased while mandibular ramus height and mandibular length were significantly increased after treatment in the Bionator with expansion screw group and in the all-patient group.
  
  
  CONCLUSIONS
  The findings suggest that treatment with a Bionator with expansion screw during the growth and development stage results in increased mandible length and ramus height and inhibits the growth of the maxilla and anterior cranial base bone.
authors.affiliation: Division of Orthodontics, Department of Comprehensive Dentistry, Yokohama Clinical Education Center, Kanagawa Dental University, Yokohama, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Oda
authors.affiliation: Private Practice, Kiryu, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Sandou
authors.affiliation: School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei , Taiwan.
authors.forename: C-M
authors.initials: CM
authors.lastname: Lin
authors.affiliation: Private Practice, Fujisawa, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Kamata
authors.affiliation: Orthodontic Science, Division of Oral Science, Graduate School, Kanagawa.
authors.forename: T
authors.initials: T
authors.lastname: Kawata
mesh_terms: D000202:Activator Appliances; D000293:Adolescent; D059925:Anatomic Landmarks / Q000254:growth & development / Q000473:pathology; D002508:Cephalometry / Q000379:methods; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008312:Malocclusion, Angle Class II / Q000628:therapy*; D008334:Mandible / Q000254:growth & development / Q000473:pathology; D008335:Mandibular Condyle / Q000254:growth & development / Q000473:pathology; D008437:Maxilla / Q000254:growth & development / Q000473:pathology; D009295:Nasal Bone / Q000473:pathology; D016382:Orthodontic Appliance Design; D056739:Pterygopalatine Fossa / Q000473:pathology; D063173:Retrognathia / Q000628:therapy*; D012189:Retrospective Studies; D012658:Sella Turcica / Q000473:pathology; D019291:Skull Base / Q000254:growth & development / Q000473:pathology