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GROWTH MODIFICATION TREATMENT OF SKELETAL CLASS II MALOCCLUSION WITH RETROGNATHIC MANDIBLE USING TWIN BLOCK APPLIANCE

(Case Report)Chrisni Oktavia Jusup *

Endah Mardiati*** Orthodontic Resident, Dentistry Faculty of Padjadjaran University, Indonesia

** Lecturer, Department of Orthodontics, Dentistry Faculty of Padjadjaran University, Indonesia

Class II malocclusion with retrognathic mandible and normal maxilla in growing patients could be treated with growth modification. Twin Block Appliance is the most favourable to treat this case. Growth modification treatment is most effectively done in growth spurt period (Mc Namara,1998; Fishman, 1982).

• A 10-year-old female patient with chief complaint : upper teeth more forward than the lower teeth.

• Extra oral examination : leptoprosop facial type, convex facial profile, facial symmetry.

• Intra oral examination : overbite 5 mm and overjet 8 mm. • The cephalometric analysis : skeletal class II malocclusion with

retrognathic mandible (Steiner). • The hand-wrist assessment : SMI 4 (Fishman).• She hasn’t got menarche yet.

Class II dentoskeletal malocclusion with deepbite, upper anterior teeth protusion, convex profile, increased overjet, and retrognathic mandible.

• Bite registration in molar class I relation, bite opening 5 mm.• Insertion the Twin Block Appliance.• Patient instruction : wearing Twin Block minimally 16 hours

/day.• Control : every 3 - 4 weeks.

Parameter Pre treatment Post treatment

< SNA 81º 80º

< SNB 75º 76º

< ANB 6º 4º

I to NA (mm) 3 5

< I to NA 23º    23º

Ī to NB (mm) 8 7

 < Ī to NB 31º  35º 

Pg to NB (mm) 1 1

< I to I 117º 117 º

< Occl to SN 30º 29º

< Go-Gn to SN 36º 35º

• The Twin Block appliance forced and hold mandible forward. Growth modification treatment needs a proper diagnosis and treatment timing, in growth spurt period.

• Patient and parents cooperation played an important role.

• After 19 months of treatment, there were significantly changes on skeletal and dental.

• Treatment progress shows : skeletal class I, molar class I, canine left and right class II, deep bite and overjet was corected.

To correct the retrognathic mandible using Twin Block Appliance.

Class II maloclussion with retrognathic mandible in growing patients can be treated by growth modification treatment using Twin Block Appliance.

Diagnosis

Presented at 10th Asia Pacific Orthodontic Congress 2016, Bali, September 1-3, 2016

Before Treatment

Treatment ProceduresIntroduction

Aim of Treatment

Case ReportResults

Adductor sesamoid of thumb

After Twin Block Treatment

Treatment

Discussion

Conclusion