Early class III management in deciduous dentition using reverse twin block

Abstract

Class III malocclusion poses a challenging dilemma for the clinician because these children have of growth patterns that differ from that of children with class I malocclusion. The mandible grows more rapidly than the maxilla, exacerbating the class III malocclusion as the child go through adolescence. Ever since Clark described a version of the twin block, it has steadily gained popularity in the management of early class III malocclusion in children. However, not many cases are reported in the literature on its use in deciduous dentition. This article tries to provide an insight into the reverse twin block appliance and reports two cases of early class III malocclusion treated using reverse twin block.

Treatment of Class III Malocclusion with Reverse Twin Block in the Growing Child (Case Report)

“…Bolton-Brush Growth study conducted by Guyers and co-workers showed considerable skeletal variability in the Class III malocclusion, with the following characteristics being noted on cephalometric analysis: mandibular prognathism alone 18,7%; maxillary retrusion alone 25%; maxillary retrusion/mandibular protrusion 22%; increased lower anterior face height 41% [1][2][3][4].…”

“…If left untreated, Class III malocclusion in the growing children will become worse with age, presented by the growth of the mandible exceeding the growth of the maxilla [1,2,5]. This unfavourable growth can also occur late in adolescence or in early adulthood, especially in relation to mandibular prognathism.…”

“…However, this appliance has also been reported to be used in the treatment of Class III malocclusion by some clinicians. Indeed, for every Class II functional appliance, there is usually a modification for the treatment of Class III malocclusion [1,2,7].…”

Versatile functional appliance- Twin block

“…Reverse twin blocks enhance maxillary development by action of reverse occlusal inclined planes placed at angulation of 70 degrees, driving maxillary teeth forward by occlusal forces and restrict forward mandibular development. 6 Chugh et al revealed considerable improvement in soft tissue profile of patient after treatment with combination of reverse twin block and face mask. They found sagittal advancement of maxilla by 2.5 mm, increased SNA angle from 76 to 81 degrees and increase in vertical dimension also.…”

“…Clark described version of twin block appliance that can be used for treatment of class III malocclusion, referred as class III twin block appliance or reverse twin block. 6 …”