Esthetic Twin Block Approach for Correction of Developing Class II Division 1 Malocclusion of an 11-year-old Female Patient: A Case Report.

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An 11-year-old female patient with developing class II division 1 malocclusion having retrognathic mandible and crowding in the lower arch, horizontal growth pattern, with convex profile, hyperactive mentalis muscle, positive visual treatment objective (VTO) in cervical vertebral maturation indicator (CVMI) stage 4 was planned to be treated using modification of conventional twin block appliance. Though a wide variety of myofunctional appliances like activator, Bionator, and Frankel appliances can be delivered to the patient, twin block appliance being a mechanofunctional appliance is routinely preferred by operators due to simplicity of its design and construction in comparison to other appliances. One of the biggest challenges in management of growing patients with skeletal class II malocclusion is the compliance of patients in wearing the myofunctional appliances. Also, the wire framework of most of these functional appliances evokes stigma in young children due to peer pressure. An appliance that eliminates this wire framework can help to increase the duration of wear. Since twin block appliance is the most preferred myofunctional appliance by most of the operators, an attempt was made to make it more convenient to the patient by simplifying its design, especially in regards to the elimination of delta clasps and labial bow framework. Delta clasps were replaced by composite buttons bonded to buccal surface of mandibular first premolar and maxillary first molar. Labial bow framework was eliminated by inducing full coverage of teeth using Essix thermoformed sheets. It was observed that the elimination of the wire framework indeed helped increase the compliance of the patient. Thus, exercises combined with myofunctional appliance therapy helped correct the developing class II division 1 malocclusion prior to fixed mechanotherapy. In conclusion, thorough planning and meticulous execution of E-twin block therapy can achieve correction of developing class II division 1 malocclusion.

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Sawant HR, Jawdekar AM, Gangurde PV, Esthetic Twin Block Approach for Correction of Developing Class II Division 1 Malocclusion of an 11-year-old Female Patient: A Case Report. Int J Clin Pediatr Dent 2024;17(10):1181-1188.