Dentoskeletal effects of Twin Block appliance in patients with Class II malocclusion

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Abstract

Background and aim

Class II malocclusions are most commonly seen in orthodontic practice and in the recent times Twin Block appliance has been the most popular and widely used among removable functional appliances for the correction of Class II malocclusion in growing patients. The aim of this retrospective study was to evaluate the dentoskeletal effects produced by the Twin Block appliance for the correction of Class II division 1 malocclusion with retrognathic mandible.

Methods

Pre-treatment (T1) and post-treatment (T2) lateral cephalograms of 30 patients treated with Twin Block appliance (mean age = 10.8 ± 1.2 years) for the correction of class II division 1 malocclusion were compared with the 30 untreated class II control patients (mean age 11.2 ± 0.8 years) who did not undergo any treatment during this period. Both the groups were evaluated for the dentoskeletal changes using 24 angular and linear cephalometric measurements. The differences between the pre and post-treatment were calculated using a paired t-test.

Results

The cephalometric analysis revealed that the Twin Block appliance stimulated mandibular growth and statistically significant differences were found between the two groups. Twin Block patients showed a statistically very high significant (p<0.001) increase in mandibular length (6.02 mm) compared with the control group (0.3 mm). “Headgear effect” on the maxilla, increase in lower anterior facial height, significant reduction of overjet, overbite and Class I molar relationship were achieved in the Twin Block group. However, no significant changes appeared in the control group.

Conclusion

The results of the present study conclude that the Twin Block appliance is effective in the treatment of Class II malocclusion and this is due to a combination of skeletal and dentoalveolar changes in both the arches.

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Most cited references 34

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Components of class II malocclusion in children 8-10 years of age.

J A McNamara (1981)

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Treatment timing for Twin-block therapy.

T Baccetti, Amy Toth, Spencer Franchi … (2000)

This cephalometric study evaluated skeletal and dentoalveolar changes induced by the Twin-block appliance in 2 groups of subjects with Class II malocclusion treated at different skeletal maturation stages in order to define the optimal timing for this type of therapy. Skeletal maturity in individual patients was assessed on the basis of the stages of cervical vertebrae maturation. The early-treated group was composed of 21 subjects (11 females and 10 males). Mean age of these subjects at time 1 (immediately before treatment) was 9 years +/- 11 months, and at time 2 (immediately after discontinuation of the Twin-block appliance) was 10 years 2 months +/- 11 months. According to the cervical vertebrae maturation staging at times 1 and 2, the peak in growth velocity was not included in the treatment period for any of the subjects in the early group. The late-treated group consisted of 15 subjects (6 females and 9 males). Mean age of this group was 12 years 11 months +/- 1 year 2 months at time 1 and 14 years 4 months +/- 1 year 3 months at time 2. In the late group, treatment was performed during or slightly after the onset of the pubertal growth spurt. Both treated samples were compared with control samples consisting of subjects with untreated Class II malocclusions also selected on the basis of the stage in cervical vertebrae maturation. A modification of Pancherz's cephalometric analysis was applied to the lateral cephalograms of all examined groups at both time periods. Linear and angular measurements for mandibular dimensions, cranial base angulation, and vertical relationships were added to the original analysis. Annualized differences for all the variables from time 1 to time 2 were calculated for both treated groups and contrasted to the annualized differences in the corresponding untreated groups by means of nonparametric statistics. The findings of this short-term cephalometric study indicate that optimal timing for Twin-block therapy of Class II disharmony is during or slightly after the onset of the pubertal peak in growth velocity. When compared with treatment performed before the peak, late Twin-block treatment produces more favorable effects that include: (1) greater skeletal contribution to molar correction, (2) larger increments in total mandibular length and in ramus height, and (3) more posterior direction of condylar growth, leading to enhanced mandibular lengthening and to reduced forward displacement of the condyle in favor of effective skeletal changes. The importance of the biological evaluation of skeletal maturity in individual patients with Class II disharmony to be treated with functional appliances is emphasized.

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Early treatment for Class II Division 1 malocclusion with the Twin-block appliance: a multi-center, randomized, controlled trial.

Kevin O'Brien, Jean Wright, Frances Conboy … (2009)

The aim of this study was to evaluate the effectiveness of early orthodontic treatment with the Twin-block appliance for the treatment of Class II Division 1 malocclusion. This was a multi-center, randomized, controlled trial with subjects from 14 orthodontic clinics in the United Kingdom. The study included 174 children aged 8 to 10 years with Class II Division 1 malocclusion; they were randomly allocated to receive treatment with a Twin-block appliance or to an initially untreated control group. The subjects were then followed until all orthodontic treatment was completed. Final skeletal pattern, number of attendances, duration of orthodontic treatment, extraction rate, cost of treatment, and the child's self-concept were considered. At the end of the 10-year study, 141 patients either completed treatment or accepted their occlusion. Data analysis showed that there was no differences between those who received early Twin-block treatment and those who had 1 course of treatment in adolescence with respect to skeletal pattern, extraction rate, and self-esteem. Those who had early treatment had more attendances, received treatment for longer times, and incurred more costs than the adolescent treatment group. They also had significantly poorer final dental occlusion. Twin-block treatment when a child is 8 to 9 years old has no advantages over treatment started at an average age of 12.4 years. However, the cost of early treatment to the patient in terms of attendances and length of appliance wear is increased.

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Author and article information

Journal

Journal ID (nlm-ta): Med Pharm Rep

Journal ID (iso-abbrev): Med Pharm Rep

Journal ID (publisher-id): Med Pharm Rep

Title: Medicine and Pharmacy Reports

Publisher: Iuliu Hatieganu University of Medicine and Pharmacy

ISSN (Print): 2602-0807

ISSN (Electronic): 2668-0572

Publication date (Print): April 2022

Publication date (Electronic): 28 April 2022

Volume: 95

Issue: 2

Pages: 191-196

Affiliations

[1 ]Department of Orthodontics & Dentofacial Orthopedics, Oxford Dental College, Bangalore, India

[2 ]Department. of Orthodontics & Dentofacial Orthopaedics, Kamineni Institute of Dental Sciences, Narketpally, Andhra Pradesh, India

[3 ]General Dental Practice, Bangalore, India

[4 ]Department. of Orthodontics & Dentofacial Orthopaedics, BJS Dental College, Ludhiana, Punjab, India

[5 ]General Dental Practice, Max Dental Specialties, Bangalore, India

[6 ]Welcare Dental Clinic, Kalyani-Nadia, West Bengal, India

Author notes

Address for correspondence: drirfankhanmds@ 123456gmail.com

Article

Publisher ID: cm-95-191

DOI: 10.15386/mpr-1989

PMC ID: 9176299

PubMed ID: 35721032

SO-VID: 33a171e5-d69b-41c6-850c-89b65736804f

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License

Dentoskeletal effects of Twin Block appliance in patients with Class II malocclusion

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Abstract

Background and aim

Methods

Results

Conclusion

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Most cited references 34

Components of class II malocclusion in children 8-10 years of age.

Treatment timing for Twin-block therapy.

Early treatment for Class II Division 1 malocclusion with the Twin-block appliance: a multi-center, randomized, controlled trial.

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