Simultaneous Dento-skeletal Correction Using Myofunctional Bionator Appliance in Malocclusion Skeletal Class II Division 1

Bionator is used for the correction of skeletal Class II malocclusion by modifying the direction of mandibular growth during the prepubertal period. The protrusive condition requires simultaneous skeletal and dental correction to immediately improve self-esteem. This case describes the management of simultaneous dento-skeletal correction using Bionator in a patient with class II division 1 skeletal malocclusion in the prepubertal stage. An 11-year-old girl was diagnosed with class II division 1 malocclusion with maxillary prognathism and mandibular retrognathism, protrusive upper teeth with 7.58 mm overjet, 5.09 mm overbite, palatal bite, and upper and lower diastemata. The cervical vertebral maturity index showed the patient was in growth stage II. It was decided to correct the dental and skeletal malocclusion simultaneously with Bionator. The patient was treated with 1 Bionator device with 35 times expansion activation without activating the labial arch. After 14 months of Bionator treatment, her overbite and overjet were significantly corrected, achieving a Class I dental and skeletal relationship. This dental and skeletal improvement was demonstrated by skeletal activation correction and growth direction modification. Bionator therapy during the pubertal growth spurt significantly improves the skeletal and dentoalveolar alignment simultaneously to a class I malocclusion. After myofunctional appliance therapy, a phase of fixed appliance therapy is recommended to improve the occlusion and stabilize the intermaxillary relationship. Successful treatment requires patient cooperation, especially during the growth period. © 2025 Elsevier B.V., All rights reserved.