{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T07:52:07Z","timestamp":1780473127601,"version":"3.54.1"},"reference-count":22,"publisher":"The Angle Orthodontist (EH Angle Education & Research Foundation)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2010,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n        <jats:p>\n          <jats:bold>Objective:<\/jats:bold> To evaluate the long-term skeletal and soft tissue changes induced by the bionator in Class II subjects.<\/jats:p>\n        <jats:p>\n          <jats:bold>Materials and Methods:<\/jats:bold> The treatment sample consisted of 20 Class II patients (6 males and 14 females) treated consecutively with the bionator. The sample was evaluated at T1, start of treatment; T2, end of bionator therapy; and T3, long-term observation (including fixed appliances). Mean age at the start of treatment was 10 years 2 months (T1); at posttreatment, 12 years 4 months (T2); and at long-term follow-up, 18 years 11 months (CS 6). The control group consisted of 20 subjects (8 males and 12 females) with untreated Class II malocclusions. Lateral cephalograms were analyzed at the three time points for all groups. Student's <jats:italic>t<\/jats:italic>-tests were used for comparisons of starting forms, and of the T1\u2013T2 and T1\u2013T3 changes between groups.<\/jats:p>\n        <jats:p>\n          <jats:bold>Results:<\/jats:bold> The bionator group showed significant, favorable T1\u2013T2 changes both at the skeletal and dentoalveolar levels. The vertical dimension was increased. Significant modifications were assessed for the soft tissues as well. The treated group showed a final improvement in soft tissue pogonion of about 2.5 mm. Significant mandibular changes were noted in the treated group, with a net average 3.3 mm long-term increase in mandibular length compared with untreated Class II controls.<\/jats:p>\n        <jats:p>\n          <jats:bold>Conclusions:<\/jats:bold> This study suggests that bionator treatment of Class II malocclusion maintains favorable results over the long-term with a combination of skeletal, dentoalveolar, and soft tissue changes.<\/jats:p>","DOI":"10.2319\/031609-156.1","type":"journal-article","created":{"date-parts":[[2009,10,15]],"date-time":"2009-10-15T01:00:59Z","timestamp":1255568459000},"page":"10-17","source":"Crossref","is-referenced-by-count":31,"title":["Long-Term Dentoskeletal Effects and Facial Profile Changes Induced by Bionator Therapy"],"prefix":"10.2319","volume":"80","author":[{"given":"Luciana Abrao","family":"Malta","sequence":"first","affiliation":[{"name":"Private practice, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiziano","family":"Baccetti","sequence":"additional","affiliation":[{"name":"Assistant Professor, Department of Orthodontics, University of Florence, Florence, Italy; Thomas M. Graber Visiting Scholar, Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Franchi","sequence":"additional","affiliation":[{"name":"Assistant Professor, Department of Orthodontics, University of Florence, Florence, Italy; Thomas M. Graber Visiting Scholar, Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kurt","family":"Faltin","sequence":"additional","affiliation":[{"name":"Chair, Department of Orthodontics, School of Dentistry, University Paulista, Sao Paulo, Brazil; Invited Professor, Department of Facial Orthopedics, University of Ulm, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James A.","family":"McNamara","sequence":"additional","affiliation":[{"name":"Thomas M. and Doris Graber Endowed Professor of Dentistry, Department of Orthodontics and Pediatric Dentistry, School of Dentistry; Professor of Cell and Developmental Biology, School of Medicine; Research Professor, Center for Human Growth and Development, University of Michigan, Ann Arbor, Mich.; Private practice, Ann Arbor, Mich"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1164","reference":[{"key":"i0003-3219-80-1-10-b01","series-title":"Orthodontics and Dentofacial Orthopedics","first-page":"63","author":"McNamara\n              Jr, J. A.","year":"2001","unstructured":"McNamara\n              Jr, J. A. and W. L.Brudon. Orthodontics and Dentofacial Orthopedics. Ann Arbor, MichNeedham Press, Inc. 2001. 63\u201373."},{"key":"i0003-3219-80-1-10-b02","series-title":"Eur J Orthod","first-page":"586","article-title":"A systematic review of cephalometric facial soft tissue changes with the Activator and Bionator appliances in Class II division 1 subjects.","volume":"28","author":"Flores-Mir, C.","year":"2006","unstructured":"Flores-Mir, C. and P. W.Major. A systematic review of cephalometric facial soft tissue changes with the Activator and Bionator appliances in Class II division 1 subjects.Eur J Orthod2006. 28:586\u2013593."},{"key":"i0003-3219-80-1-10-b03","series-title":"Trans Eur Orthod Soc","first-page":"283","article-title":"A cephalometric study of the efficiency of the bionator.","volume":"53","author":"Janson, I.","year":"1977","unstructured":"Janson, I.\n          \n          A cephalometric study of the efficiency of the bionator.\n          Trans Eur Orthod Soc\n          1977. 53:283\u2013293."},{"key":"i0003-3219-80-1-10-b04","series-title":"Angle Orthod","first-page":"255","article-title":"Bionator treatment in Class II, division 1.","volume":"56","author":"Bolmgren, G. A.","year":"1986","unstructured":"Bolmgren, G. A. and F.Moshiri. Bionator treatment in Class II, division 1.Angle Orthod1986. 56:255\u2013262."},{"key":"i0003-3219-80-1-10-b05","series-title":"Am J Orthod Dentofacial Orthop","first-page":"113","article-title":"Mandibular response to orthodontic treatment with the Bionator appliance.","volume":"97","author":"Mamandras, A. H.","year":"1990","unstructured":"Mamandras, A. H. and L. P.Allen. Mandibular response to orthodontic treatment with the Bionator appliance.Am J Orthod Dentofacial Orthop1990. 97:113\u2013120."},{"key":"i0003-3219-80-1-10-b06","series-title":"Am J Orthod Dentofacial Orthop","first-page":"391","article-title":"The effect of early intervention on skeletal pattern in Class II malocclusion: a randomized clinical trial.","volume":"111","author":"Tulloch, J. F.","year":"1997","unstructured":"Tulloch, J. F., C.Phillips, G.Koch, and W. R.Proffit. The effect of early intervention on skeletal pattern in Class II malocclusion: a randomized clinical trial.Am J Orthod Dentofacial Orthop1997. 111:391\u2013400."},{"key":"i0003-3219-80-1-10-b07","series-title":"Am J Orthod Dentofacial Orthop","first-page":"40","article-title":"Anteroposterior skeletal and dental changes after early Class II treatment with bionators and headgear.","volume":"113","author":"Keeling, S. D.","year":"1998","unstructured":"Keeling, S. D., T. T.Wheeler, G. J.King, C. W.Garvan, D. A.Cohen, S.Cabassa, S. P.McGorray, and M. G.Taylor. Anteroposterior skeletal and dental changes after early Class II treatment with bionators and headgear.Am J Orthod Dentofacial Orthop1998. 113:40\u201350."},{"key":"i0003-3219-80-1-10-b08","series-title":"Eur J Orthod","first-page":"501","article-title":"A prospective evaluation of Bass, Bionator, and Twin Block appliances. Part I\u2014the hard tissues.","volume":"20","author":"Illing, H. M.","year":"1998","unstructured":"Illing, H. M., D. O.Morris, and R. T.Lee. A prospective evaluation of Bass, Bionator, and Twin Block appliances. Part I\u2014the hard tissues.Eur J Orthod1998. 20:501\u2013516."},{"key":"i0003-3219-80-1-10-b09","series-title":"Angle Orthod","first-page":"571","article-title":"National Institute of Dental and Craniofacial Research efficacy trials of bionator class II treatment: a review.","volume":"72","author":"Jacobs, T.","year":"2002","unstructured":"Jacobs, T. and P.Sawaengkit. National Institute of Dental and Craniofacial Research efficacy trials of bionator class II treatment: a review.Angle Orthod2002. 72:571\u2013575."},{"key":"i0003-3219-80-1-10-b10","series-title":"Am J Orthod Dentofacial Orthop","first-page":"599.e1","article-title":"Mandibular changes produced by functional appliances in Class II malocclusion: a systematic review.","volume":"129","author":"Cozza, P.","year":"2006","unstructured":"Cozza, P., T.Baccetti, L.Franchi, L.De Toffol, and J. A.McNamaraJr. Mandibular changes produced by functional appliances in Class II malocclusion: a systematic review.Am J Orthod Dentofacial Orthop2006. 129:599.e1\u2013599.e12."},{"key":"i0003-3219-80-1-10-b11","series-title":"Semin Orthod","first-page":"33","article-title":"Functional appliance therapy with the Bionator.","volume":"4","author":"Rudzki-Janson, I.","year":"1998","unstructured":"Rudzki-Janson, I. and R.Noachtar. Functional appliance therapy with the Bionator.Semin Orthod1998. 4:33\u201345."},{"key":"i0003-3219-80-1-10-b12","series-title":"Angle Orthod","first-page":"221","article-title":"Long-term effectiveness and treatment timing for Bionator therapy.","volume":"73","author":"Faltin, K. J.","year":"2003","unstructured":"Faltin, K. J., R. M.Faltin, T.Baccetti, L.Franchi, B.Ghiozzi, and J. A.McNamaraJr. Long-term effectiveness and treatment timing for Bionator therapy.Angle Orthod2003. 73:221\u2013230."},{"key":"i0003-3219-80-1-10-b13","series-title":"Am J Orthod Dentofacial Orthop","article-title":"Cephalometric comparison of two comprehensive treatment protocols for Class II malocclusion including the bonded Herbst and the headgear appliances: a double-blind study on consecutively-treated patients at puberty.","author":"Baccetti, T.","year":"In press","unstructured":"Baccetti, T., L.Franchi, and F.Stahl. Cephalometric comparison of two comprehensive treatment protocols for Class II malocclusion including the bonded Herbst and the headgear appliances: a double-blind study on consecutively-treated patients at puberty.Am J Orthod Dentofacial OrthopIn press."},{"key":"i0003-3219-80-1-10-b14","series-title":"Semin Orthod","first-page":"119","article-title":"The Cervical Vertebral Maturation (CVM) method for the assesment of optimal treatment timing in detofacial orthopedics.","volume":"11","author":"Baccetti, T.","year":"2005","unstructured":"Baccetti, T., L.Franchi, and J. A.Mc NamaraJr. The Cervical Vertebral Maturation (CVM) method for the assesment of optimal treatment timing in detofacial orthopedics.Semin Orthod2005. 11:119\u2013129."},{"key":"i0003-3219-80-1-10-b15","series-title":"Am J Orthod Dentofacial Orthop","first-page":"239","article-title":"Soft tissue cephalometric analysis: diagnosis and treatment planning of dentofacial deformity.","volume":"116","author":"Arnett, G. W.","year":"1999","unstructured":"Arnett, G. W., J. S.Jelic, J.Kim, D. R.Cummings, A.Beress, C. M.WorleyJr, B.Chung, and R.Bergman. Soft tissue cephalometric analysis: diagnosis and treatment planning of dentofacial deformity.Am J Orthod Dentofacial Orthop1999. 116:239\u2013253."},{"key":"i0003-3219-80-1-10-b16","series-title":"Mondo Ortod","first-page":"175","article-title":"Analisi cefalometrica in laterale del paziente in crescita e adulto.","volume":"29","author":"Silvestri, A.","year":"2004","unstructured":"Silvestri, A., L.Ferraris, and R.Vernucci. Analisi cefalometrica in laterale del paziente in crescita e adulto.Mondo Ortod2004. 29:175\u2013195."},{"key":"i0003-3219-80-1-10-b17","series-title":"Statistical Methods for Medical and Biological Students","author":"Dahlberg, A. G.","year":"1940","unstructured":"Dahlberg, A. G.\n          \n          Statistical Methods for Medical and Biological Students. London, UKBradford and Dickens. 1940."},{"key":"i0003-3219-80-1-10-b18","series-title":"Am J Orthod Dentofacial Orthop","first-page":"141","article-title":"Design flaws in some randomized controlled trials.","volume":"135","author":"Trenouth, M. J.","year":"2009","unstructured":"Trenouth, M. J.\n          \n          Design flaws in some randomized controlled trials.\n          Am J Orthod Dentofacial Orthop\n          2009. 135:141."},{"key":"i0003-3219-80-1-10-b19","series-title":"Am J Orthod Dentofacial Orthop","first-page":"125","article-title":"Longitudinal growth changes in untreated subjects with Class II Division 1 malocclusion.","volume":"134","author":"Stahl, F.","year":"2008","unstructured":"Stahl, F., T.Baccetti, L.Franchi, and J. 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A.McNamaraJr. Treatment and posttreatment effects of acrylic splint Herbst appliance therapy.Am J Orthod Dentofacial Orthop1999. 115:429\u2013438."}],"container-title":["The Angle Orthodontist"],"original-title":[],"link":[{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/view\/journals\/angl\/80\/1\/article-p10.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/downloadpdf\/journals\/angl\/80\/1\/article-p10.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/downloadpdf\/journals\/angl\/80\/1\/article-p10.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T00:49:06Z","timestamp":1747356546000},"score":1,"resource":{"primary":{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/view\/journals\/angl\/80\/1\/article-p10.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2010,1]]},"references-count":22,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.2319\/031609-156.1","relation":{},"ISSN":["0003-3219","1945-7103"],"issn-type":[{"value":"0003-3219","type":"print"},{"value":"1945-7103","type":"electronic"}],"subject":[],"published":{"date-parts":[[2010,1]]}}}