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The aim of this study was to evaluate changes in the facial profile resulting from the use of a twin block (TB) functional appliance. The sample comprised 38 patients (24 males and 14 females) with a Class II division 1 malocclusion. Nineteen subjects were treated with a functional appliance while the remaining 19, who did not undergo any intervention, served as the control. The mean age of the treated group was 9.5 years (SD 10 months) and of the control group 9.9 years (SD 13 months). Lateral cephalograms were obtained for all subjects at the initial consultation and again after one year. The changes in facial profile, resulting from treatment with the TB, were analysed after the influence of growth had been taken into account. The results showed a significant improvement in the facial profile, which closely followed the underlying dentoskeletal changes. Thus, the most significant effects were a total facial profile improvement, retraction of the upper lip and anterior movement of soft tissue pogonion (P < 0.05). Subjects treated with a TB appliance achieved improved facial harmony, but such changes were not observed in the control group.

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There is convincing evidence that (sleep-related) bruxism can be induced by esophageal acidification and also that it has an important relationship with smoking in a dose-dependent manner. Disturbances in the central dopaminergic system are also implicated in the etiology of bruxism.