ACTIVATOR

1 ) Soft tissue evaluation of functional therapy in growing patients with Class

II malocclusion: a long-term study.
- Gazzani F, Franchi L, Lione R, Cozza P, Pavoni C ; Eur J Orthod. 2021 Mar

Objective: The objective of this study was to analyse the soft tissue changes produced by
the functional treatment of mandibular advancement in growing Class II patients.

Materials: The treated group consisted of 25 Caucasian patients (12 females and 13 males)
with dento-skeletal Class II malocclusion treated with functional therapy (Activator). All
patients were evaluated before treatment (T1; mean age, 9.9 years), at the end of functional
treatment phase (T2; mean age, 11.9 years), and at a post-pubertal follow-up observation
(T3; mean age, 18.5 years). The treated group was compared with a matched control group
of 25 untreated subjects (13 females, 12 males) with untreated Class II division 1
malocclusion. Statistical comparisons between the two groups were performed with
independent samples t-tests (P < 0.05).

Results: Significant improvements were found during the long-term interval for mandibular
sulcus (9.9°) and the profile facial angle (9.8°) in the treated group. No significant effects
were found in terms of lower face percentage between the two groups.

Conclusion: Removable functional appliances induced positive effects on the soft tissue

profile in Class II growing subjects with good stability in the long-term.

2 ) A Prospective Study Comparing Adolescent and Post-Adolescent Periods

Regarding Effects of Activator Appliance in Patients with Class II Mandibular
Retrognathia by Using 3dMDface Analysis and Cephalometry
- Yüksel Coşkun E, Esenlik E. ; Med Sci Monit. 2020 Jun 26

BACKGROUND The purpose of this prospective study was to compare adolescent and post-
adolescent growth periods regarding the effectiveness of conventional activator appliance in
patients with Class II mandibular retrognathia by using lateral cephalometric radiographs
and three-dimensional photogrammetry (3dMDface).

MATERIAL AND METHODS We enrolled 2 groups: 15 patients in the adolescent growth

period and 17 patients in the post-adolescent growth period. All patients had Class II
anomaly with mandibular retrognathia and were treated with conventional activator
appliances. Lateral cephalometric radiographs and three-dimensional photogrammetric
views were obtained at the beginning and end of the activator treatment of Class II patients.
Maxillomandibular discrepancy, mandibular protrusion and lengths, convexity angles, facial
heights, and dental measurements were evaluated cephalometrically. Projections of the lips
and the chin and volumetric measurements of the lip and the mandibular area were
assessed using three-dimensional photogrammetry.

RESULTS Conventional activator therapy resulted in similar effects in both growth periods
regarding improvements in the mandibular sagittal growth and maxillomandibular
relationship (ANB° and the SNB° angles). Mandibular effective length was increased (Co-Gn
length) and the maxillary horizontal growth was restricted (decreased SNA° angle) in both
groups following the treatment. Treatment duration was significantly longer in the post-
adolescent group. Increases in the projections of menton, pogonion, and sublabial points
were observed in the three-dimensional photogrammetric views. Total lip volume was
reduced while the mandibular volume was significantly increased in both groups. Lower
gonial angle showed a greater increase in the post-adolescent group.

CONCLUSIONS Correction of Class II anomaly with mandibular retrognathia was achieved

with a combination of dental and skeletal changes in both growth periods. Conventional
activator therapy may be an alternative treatment approach in the late growth period as it
led to significant skeletal and dental changes.

3 )A cephalometric analysis of skeletal and dental changes contributing to

Class II correction in activator treatment
- Pancherz H ;Am J Orthod. 1984 Feb;85(2):125-34

(1) The improvement in occlusal relationships in the molar and incisor segments was
about equally a result of skeletal and dental changes.

(2) Overjet correction averaging 5.0 mm was a result of 2.4 mm more mandibular
growth than maxillary growth, a 2.5 mm distal movement of the maxillary incisors,
and a 0.1 mm mesial movement of the mandibular incisors.

(3) Class II molar correction averaging 5.1 mm was a result of 2.4 mm more mandibular
growth than maxillary growth, a 0.4 mm distal movement of the maxillary molars,
and a 2.3 mm mesial movement of the mandibular molars.

(4) Activator treatment seemed to inhibit maxillary growth, move the maxillary incisors
and molars distally, and move the mandibular incisors and molars mesially.

(5) Mandibular growth appeared not to be affected by activator treatment.

4) Functional appliances: A review - Bishara, S. E., & Ziaja, R. R. (1989) ; American
Journal of Orthodontics and Dentofacial Orthopedics, 95(3), 250–258

EFFECTS OF ACTIVATOR THERAPY ON THE DENTOFACIAL STRUCTURES :

1.MANDIBLE :

 Increased amount of condylar growth and a remodeling of the articular fossa.

 to 2.0 mm incremental increases in the growth of the mandible after the use of
activators.
 Condylar growth during the 10 month period of activator treatment increased 1.1
mm and was redirected 12” in a more posterior direction

2. MAXILLA :

 Increased posterior maxillary vertical height resulted in a backward rotation of the

mandible and pogonion.
 Significant decrease of the SNA angle
 Inhibited the horizontal growth of the maxilla by 2 mm.

3. DENTITION :

 Maxillary incisor flaring

 Maxillary incisor lingual tipping
 Mandibular incisor labial tipping

4. SOFT TISSUE :

 Upper lip retrusion.

 Nose - forward growth
 Soft-tissue pogonion was significantly further anterior.

5) Soft- and hard-tissue changes following treatment of Class II division 1

malocclusion with Activator versus Trainer: a randomized controlled trial -
Idris G, Hajeer MY, Al-Jundi A ; Eur J Orthod. 2019 Jan 23

Objectives: To evaluate soft- and hard-tissue changes following 12 months of Class II

division 1 treatment in growing patients with a conventional functional appliance (a
modified Activator) versus a myofunctional Trainer system (T4K®).

Results: Improvement in the Class II skeletal and dentofacial characteristics were

significantly greater in the Activator group when compared with the T4K® group.
The improvement was evident in a significant decrease in the skeletal angle ANB , a
significant greater increase in the facial convexity angle and a significant reduction in the
overjet .

Conclusions: The results of the current study indicated that the Activator was more effective
than the T4K® in treating Class II division 1 growing patients.

6) Orthodontic forces exerted by activators with varying construction bite

heights.
- Noro T, Tanne K, Sakuda M. Am J Orthod Dentofacial Orthop. 1994 Feb;105(2):169-79.

• The present study was conducted to investigate the nature of forces induced with
activators by measuring strains, electromyogram (EMG) and electroencephalogram
(EEG) during a 2-hour sleep period.

• Duration of forces generated by passive tension was most significantly longer than
that of active contraction of the jaw closing muscles, irrespective of the construction
bite heights.

• It is concluded that passive tension, derived from viscoelasticity of soft tissues, plays
a more important role in inducing changes than phasic stretch reflex during jaw
orthopedic therapy with activators

7) Effects of activator and high-pull headgear combination therapy: skeletal,

dentoalveolar, and soft tissue profile changes.
- Marşan G ; Eur J Orthod. 2007 Apr;29(2):140-8. 

Activator and high-pull headgear combination treatment in these growing patients resulted in
• A correction of the skeletal class II relationship),
• A restriction of maxillary growth,
• An advancement of the mandibular structures,
• An increase in lower face height,
• A correction of the overjet ,
• An improvement in overbite,
• Uprighting of the maxillary incisors,
• Protrusion of the mandibular incisors,
• A correction of the dental class II malocclusion.

The soft tissue profile changes were

• A correction of facial convexity
• An increase in lower antero-posterior and lower vertical soft tissue dimensions.
• The mentolabial fold depth also significantly decreased.
The activator and high-pull headgear combination appliance was effective in treating growing
patients with maxillary prognathism, mandibular deficiency, and facial convexity by a combination of
skeletal and dentoalveolar changes and improvement in the soft tissue facial profile.