Success with Eruptive Guidance Biotrainers- Can they Replace RPE? Active vs Passive Wear
Introduction
Dr. Amanda from StraightSmile Solutions discusses pre-orthodontic treatment with biotrainers and eruptive guidance appliances. Eruptive guidance biotrainers are showing promise for accurately guiding and regulating exercise intensity. By providing direct muscle feedback, these devices may reduce reliance on the subjective RPE scale. However, more research is needed to evaluate biotrainer effectiveness and user acceptance for both active and passive wear applications across various exercise modalities.
I. Overview
A. Pre-treatment orthodontic appliances like biotrainers can work to straighten teeth if used correctly

B. Success depends on several factors:
1. Starting age – earlier is better (ages 2-6 ideal)

2. Severity – works better for milder cases

3. Wear time
a. Must be worn actively 4-6 hrs/day plus overnight
b. Passive overnight wear alone has limited effect
C. Not a standalone treatment for all orthodontic issues
1. Won’t expand palate or split midline suture
2. May need supplemental treatment (e.g. myofunctional therapy)
II. Using Biotrainers for Early Intervention
A. Goal is to guide eruption of incoming teeth
B. Appliance features eruption guidance slots
C. Progressive series of appliances as child grows
D. Can help avoid future orthodontic treatment
E. Success factors
1. Compliance with wear time
2. Starting very early around age 2-5
III. Limitations
● Extremely time-consuming and difficult compliance, especially for older kids
● Most patients unwilling or unable to wear appliances actively during day
● Not a standalone treatment for more significant orthodontic issues
● Will not expand palate sutures or correct breathing/airway problems
IV. Appropriate use and billing
A. Can work for the right patient if worn properly
B. Should be affordable, not $4000-6000
C. Doctors should not bill insurance for these
D. Set patient expectations – no promises or guarantees
V. Considerations in Clinical Practice
A. Set realistic expectations about effectiveness
B. Bill cash not insurance for these appliances
C. No guarantees of results given variability in compliance
D. Consider supplemental therapies as needed
Summary
Biotrainers and early orthodontic guidance appliances can be an affordable option for mild alignment issues in some pediatric patients but have limitations in more severe clinical situations. Starting very early and maintaining patient compliance with wear time is critical to success. Supplemental treatments may still be needed depending on the clinical factors present in each unique case. While early treatment can work for the right patient who is extremely compliant, it is not a miracle cure-all. Most cases still require traditional orthodontics or adjunctive care from other specialists.