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Bionator – an overestimated appliance

William Balter’s Bionator was developed in the 1950s and was first introduced in 1964. It is actually nothing more than a smaller version of an Activator, i.e. a removable brace that encompasses both the upper and lower jaw (double brace) and is intended to ‘jump the bite’. It has exactly the same effect as the Activator, thus is not a very efficient appliance. It resembles the Activator so much that it cannot really be described as a completely separate appliance, but an activator modification. If one searches for “Bionator” in the archive of the American Journal of Orthodontics, the most important orthodontic journal in the world, the term “activator-like apparatus” is referred to.

Like all so-called “functional orthodontic appliances”, the Bionator is manufactured with a construction bite, in which the lower jaw is pushed far forward. Only in the less used Bionator for the protruded lower jaw, the lower jaw in the construction bite is moved slightly backwards. Incidentally, Balters called the construction bite a “functional bite,” which is the same and does not add anything new to the matter. If you then carry the finished Bionator in the mouth, the lower jaw must be pushed forward with every bite, resulting in small tooth movements with sufficient wear time and, with luck, a slight acceleration of jaw growth.

The Bionator is completely anchored to the teeth, so that it has a particularly strong effect on the teeth as it tilts them through the bone. For this reason we can expect only minimal skeletal effect or impact on facial growth from this appliance. This means that a significant influence on facial growth with the Bionator is not possible – which applies to all “functional orthodontic” double braces. Because of its name (‘Bionator’ can best be translated as ‘life reviver’), many believe that it is capable of producing all sorts of miracle results for which, however, no proof has ever been produced in clinical studies.

An original Bionator from the golden era of ‚Functional Orthodontics‘. Notice the audacious lugs to which Balters ascribed all kinds of magical effects.

The Bionator consists of an acrylic plate (polymethylmethacrylate = PMMA) with two wire lugs: the outer lip bow with the lateral buccal lugs and the inner lingual bow. Balters believed that if the lingual bow was open to the front this would lead to a protrusion of the tongue. According to Balters this feature would support the correction of mandibular retrognathism. In contrast, the reverse appliance has a lingual bow which is opened to the posterior to provoke a retrusion of the tongue and mandibula. However, scientific studies of the University of Freiburg have shown that both types of lingual bows don’t have any effect on neither retrognathism nor prognathism. Instead, Bionator treatment has the undesired effect of flattening the tongue position. Moreover, there’s the absurd idea of gently broadening the dental arches by the buccal lugs. – In real life without an expansion screw there will be no influence on the transverse growth of the dental arches. So it seems that Balters used to fantasise, without taking care of comprehensibility and traceability of his hypotheses.

Historical drawing of a Bionator: plastic block with religious charisma
Historical drawing of a Bionator: plastic block with religious charism

Orthodontics and Alternative Medicine

When Balters got older, he focused more and more on mysticism. He provided impressive, imaginative ‘holistic’ theories for his Bionator for which, however, there was no real scientific proof. For this, Balters has documented his treatments in a sloppy way even for the given conditions – with unusable models and without X-rays, and delegated the treatment partly to his dental technician Geuer. Balter’s hypotheses about the effectiveness of the Bionator as a “current and vibration modifier or lymph flow regulator” belong to the realm of myths without any justification. Equally incomprehensible is the claim that the Bionator has beside the well-known activator-like a “holistic” effect. Such statements can be classified as medical poetry without any reference to reality.

Balters seriously claimed that he could “re-create” his younger patients and actually give them their life back. He believed that, thanks to his ‘discoveries’ orthodontics – which, viewed objectively, had very low medical impact – was not only the most important branch of dentistry but was the most important branch of medicine in general. It is shocking that so many orthodontists have blindly accepted this rubbish about a simple orthodontic appliance. However, these very legends and mythology surrounding the Bionator have become the basis for its popularity amongst ‘alternative’, mostly academic circles. But it is the younger patients who have to pay for their parent’s fondness for ill-founded orthodontic treatment procedures by suffering excessively long treatment periods, adverse social effects and a 30%-50% failure rate. No wonder, because real-life studies have shown that children wear removable appliances – of whatever type and regardless of the orthodontist’s instructions – only 10 hours a day, and no more. This cannot really achieve much!

No Appliance for Children Today

Today, there is no reasonable indication to justify the use of a Bionator in orthodontics, because there are more effective and reliable orthodontic appliances available for every treatment procedure. As working with the Bionator requires neither in-depth knowledge, physical efforts nor any particular technical skill, it enjoys unfettered popularity amongst German orthodontists.

And we must not forget here, that removable appliances are the “cash cow“ of German orthodontists, so that against all medical reason economic interests are responsible for using them in orthodontic treatment.

The latest advice for patients and parents is: Stay away from the Bionator!


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