# Elastodontic Therapy with Oral Bioactivator Devices: A Review
## 4 Elastodontic Appliances
### Classification  
The devices come in various abbreviations and colours, which indicate their skeletal classes and arch shapes. They are built for the mouths of children, young adults, and adults, and are suitable for all ages from 3 years upwards. * Class I bioactivator: used in deciduous, mixed, and permanent dentition to correct arch deviations by correcting the midlines to correct bad habits; it determines a pre-alignment of the teeth and is also used as a restraint after multibracket therapy and basal skeletal disharmonies such as horizontal, transverse, and vertical deficits, such as open or deep bites, and is designed in two different occlusal planes: BASIC: equipped with a raised anterior plane suitable for deep bites and INTEGRAL: equipped with a uniform plane anteriorly and posteriorly used to treat alterations in occlusal curves. Four models can be distinguished based on the different arches and facial biotype forms: F for ogival arches in the dolicofacial arches, S for more rounded arches in the mesofacial, OS for square-shaped arches in the mesofacial, and C for wide dental arches in the brachifacial [5] (Figures 2 and 3):  
Figure 1: The structure of bioactivators. Figure 2: Type of bioactivity based on skeletal and dental class in mixed and permanent dentition. Class II SC bioactivator: Used for treating second skeletal class malocclusion. It has an anterior mandibular sliding plane that positions the head-to-head incisors. Restores good lip proficiency [5] (Figure 2); Class III TC bioactivator: Used for skeletal Class III and pseudo-Class III. It has an anterior sliding plane that guides the correct position of the upper incisors, and it exercises posterior pressure on the mandible to limit its excessive growth. It eliminates the centripetal force of the orbicular muscle and the tongue's centrifugal force to restore normal muscular function. [5] (Figure 2); ElastoOssa bioactivator: Made to clear the respiratory tract by reducing snoring at night and also indicated in cases of bruxism, neuromuscular tension problems, and muscle tension headaches. It has a guide to the lower arch, which is more protruded, a raised occlusal plane, and a lingual ramp that acts as a lingual elevator (accompanies the tongue towards the button in the palatine area) [5] (Figure 4); These elements allow the recovery of correct nasal breathing as they free the pharyngeal area; Open bioactivator: Indicated for the treatment of skeletal anterior open bites. The device has a raised rear surface as a specific thrust on the posterior molars. The plane has a \"fulcrum\" action causing an anteroflexion of the occlusal plane, restoring it horizontally. Contraindicated for ATM-specific problems [5] (Figure 4); Integral Plus bioactivator: It has a guide in the inner wall of the upper and lower flange for housing the brackets. It aims to improve the teeth's alignment and functional, skeletal, joint, and neuromuscular problems. It cannot be used with steel arches, reverse arches, inter-arch elastics, or in the presence of occlusal rises [5] (Figure 4); Bioactivator for deciduous teeth: Used in deciduous dentition, indicated to correct deviations of the dental arches, mono and bilateral crossbites, anterior open bites, correct bad habits, improve swallowing and breathing, and night grinding. There are two models: DC (with a pacifier) and D (without a pacifier) [5] (Figure 5). Figure 3: Type of first-class bioactivators based on facial biotype and form of arches. The transverse distance between the outermost point of the vestibular cusps of the first two upper molars is defined as the size of the bioactivator. The size of appliances can also be made through a wax bite (Figures 6 and 7), which is advantageous for young children because it avoids impression taking [10]. It makes bioactivators more comfortable than classic functional appliances; they can be used in patients at the age of 2.5 years [1]. Figure 4: Special bioactivators: elastoosas: in cases of bruxism, neuromuscular tension problems, and muscle tension headaches.