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References

Clark WJ. The twin block traction technique. Eur J Orthod. 1982; 4:129-138
McNamara JA, Franchi L. The cervical vertebral maturation method: a user's guide. Angle Orthod. 2018; 88:133-143
Clark W. Design and management of twin blocks: reflections after 30 years of clinical use. J Orthod. 2010; 37:209-216
Banks P, Wright J, O'Brien K. Incremental versus maximum bite advancement during twin-block therapy: a randomized controlled clinical trial. Am J Orthod Dentofac Orthop. 2004; 126:583-588
Yaqoob O, Dibiase AT, Fleming PS, Cobourne MT. Use of the Clark twin block functional appliance with and without an upper labial bow: a randomized controlled trial. Angle Orthod. 2012; 82:363-369
Trenouth MJ, Desmond S. A randomized clinical trial of two alternative designs of twin-block appliance. J Orthod. 2012; 39:17-24
Harradine N, Gale D. The effects of torque control spurs in twin-block appliances. Clin Orthod Res. 2000; 3:202-209
Noar JH, Evans RD. Rare earth magnets in orthodontics: an overview. Br J Orthod. 1999; 26:29-37
Gill DS, Lee RT. Prospective clinical trial comparing the effects of conventional twin-block and mini-block appliances: part 1. Hard tissue changes. Am J Orthod Dentofac Orthop. 2005; 127:465-472
Cobourne MT, DiBiase AT. Handbook of Orthodontics.London: Elsevier;
Parkin NA, McKeown HF, Sandler PJ. Comparison of twp modifications of the twin-block appliance in matched Class II samples. Am J Orthod Dentofac Orthop. 2001; 119:572-577
Van der Plas MC, Janssen KI, Pandis N, Livas C. Twin block appliance with acrylic capping does not have a significant inhibitory effect on lower incisor proclination. Angle Orthod. 2017; 87:513-518
Parekh J, Counihan K, Fleming PS, Pandis N, Sharma PK. Effectiveness of part-time vs full-time wear protocols of twin-block appliance on dental and skeletal changes: a randomized controlled trial. Am J Orthod Dentofac Orthop. 2019; 155:165-172
Lee RT, Barnes E, DiBiase A An extended period of functional appliance therapy: a controlled clinical trial comparing the twin block and Dynamax appliances. Eur J Orthod. 2014; 36:512-521
Meikle MC. Guest editorial: what do prospective randomized clinical trials tell us about the treatment of class II malocclusions? A personal viewpoint. Eur J Orthod. 2005; 27:105-114
O'Brien K, Wright J, Conboy F Effectiveness of early orthodontic treatment with the twin-block appliance: a multicenter, randomized, controlled trial. Part 1: dental and skeletal effects. Am J Orthod Dentofac Orthop. 2003; 124:234-243
Lund DI, Sandler PJ. The effects of twin blocks: a prospective controlled study. Am J Orthod Dentofac Orthop. 1998; 113:104-110
Jena AK, Duggal R, Parkash H. Skeletal and dentoalveolar effects of twin-block and bionator appliances in the treatment of Class II malocclusion: a comparative study. Am J Orthod Dentofac Orthop. 2006; 130:594-602
Yildirim E, Karacay S, Erkan M. Condylar response to functional therapy with twin-block as shown by cone-beam computed tomography. Angle Orthod. 2014; 84:1018-1025
Baysal A, Uysal T. Soft tissue effects of twin block and Herbst appliances in patients with Class II division 1 mandibular retrognathy. Eur J Orthod. 2013; 35:71-81
Salloum E, Millett DT, Kelly N Soft tissue changes: a comparison between changes caused by the construction bite and by successful treatment with a modified twin-block appliance. Eur J Orthod. 2018; 40:512-518
Batista KB, Thiruvenkatachari B, Harrison JE, O'Brien KD. Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children and adolescents. Cochrane Database Syst Rev. 2018; 3 https://doi.org/10.1002/14651858.CD003452.pub4
O'Brien K, Wright J, Conboy F Effectiveness of treatment for Class II malocclusion with the Herbst or twin-block appliances: a randomized, controlled trial. Am J Orthod Dentofac Orthop. 2003; 124:128-137
Caldwell S, Cook P. Predicting the outcome of twin block functional appliance treatment: a prospective study. Eur J Orthod. 1999; 21:533-553
Franchi L, Baccetti T. Prediction of individual mandibular changes induced by functional jaw orthopedics followed by fixed appliances in Class II patients. Angle Orthod. 2006; 76:950-954
Fleming PS, Qureshi U, Pandis N An investigation of cephalometric and morphological predictors of successful twin block therapy. Aust Orthod J. 2012; 28:190-196
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The twin-block appliance for correction of class II division 1 malocclusion

From Volume 48, Issue 7, July 2021 | Pages 579-583

Authors

Erfan Salloum

BDS, PG Cert(Orth), MFDRCSI, MFDSRCPS(Glag), DClinDent(Orth), MOrthRCSEd, FFDRCSI(Orth), IMOrthRCSEng

Specialist Orthodontist, Dublin Orthodontics, Dublin, Ireland

Articles by Erfan Salloum

Email Erfan Salloum

Declan T Millett

BDSc, DDS, FDSRCPSGlasg, FDSRCSEng, DOrthRCSEng, MOrthRCSEng, FHEA

Professor of Orthodontics/Consultant, Orthodontic Unit, Cork University Dental School and Hospital, University College Cork, Wilton, Cork, Republic of Ireland

Articles by Declan T Millett

Grant T McIntyre

BDS, FDSRCPSGlasg, MOrthRCSEd, PhD, FDSRCPSGlasg(Orth), FHEA, FDSRCSEd, FDTFed

Consultant Orthodontist and Honorary Senior Lecturer, Dundee Dental Hospital and School, 2 Park Place, Dundee, DD1 4HR, UK

Articles by Grant T McIntyre

Abstract

The twin-block appliance is a widely used functional appliance for the correction of Class II division 1 malocclusion in growing children and adolescents. This article outlines the indications and case assessment, the steps in clinical management and appliance design. Evidence regarding the mode of action, effects and prediction of treatment outcome of the twin-block appliance for Class II division 1 malocclusion are also presented.

CPD/Clinical Relevance: The twin-block appliance is a widely used functional appliance in the UK for the correction of Class II division 1 malocclusion in growing children and adolescents.

Article

The twin-block appliance (TBA) was developed by Dr William Clark and consists of interlocking upper and lower bite blocks to posture the mandible forward for overjet correction.1

TBA treatment is only successful in well-motivated and growing children and adolescents, typically at 10–13 years in girls or 11–14 years in boys. In addition, the following features should be present:

Extra-oral and intra-oral photographs, study models and appropriate radiographs including a lateral cephalogram are required for treatment planning (Figure 1). The lateral cephalogram should be analysed to assess the anteroposterior and vertical skeletal pattern, as well as the incisor inclinations. The cervical vertebral maturation (CVM) stage may also be assessed.2 Recording standing height at baseline and during treatment will also give an indication of growth rate.

Fully extended alginate impressions or an intra-oral scan with accurate recording of all standing teeth and supporting soft-tissues are required. The appliance is then manufactured according to the postured bite registration and prescription.

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