Comparison between clear aligners and twin-block in treating class II malocclusion in children: a retrospective study

The study herein evaluated and compared the efficacy of Clear Aligners (CA) and Twin-Block (TB) appliances as the early orthodontic treatments of developing class II division 1 malocclusion. Twenty-four patients each for CA (11.73 ± 0.33 y) and TB (11.87 ± 0.34 y) groups were selected according to the inclusion and exclusion criteria. The cephalometric X-rays and intraoral photos were taken for the patients after nearly 12 months of treatment. Treatment impacts were evaluated by the molar correction and overjet reduction. The vertical and sagittal changes were analyzed through cephalometric measurements. Sella-nasion-point B angle (SNB), point A-nasion-point B angle (ANB), Wits Appraisal (AO-BO) and overjet were statistically significant regarding the sagittal changes analyzed before and after the treatments in both groups, respectively. So, no significant difference was noted in the sagittal changes between CA and TB groups. However, for the vertical changes, OP (occlusal plane) angle of CA group and OP angle, AFH (anterior facial height) and PFH (posterior facial height) of TB group were statistically significant. Moreover, the Z angle and cranial facial difficulty (C.F. difficulty) were also statistically significant in both groups. Class II children with retrognathic mandible are effectively treated by employing the CA, which has almost the same impact as of TB in sagittal and vertical changes. Resultantly, the patient profile is improved. The CA and TB treatments thus minimize the subsequent treatment difficulty by reducing the C.F. difficulty.

Twin-block appliance; Clear aligner; Cephalometric measurement; Overjet; Class II malocclusion

[1] Paduano S, Rongo R, Bucci R, Carvelli G, Cioffi I. Impact of functional orthodontic treatment on facial attractiveness of children with class II division 1 malocclusion. European Journal of Orthodontics. 2020; 42: 144–150.

[2] Khan MI, Neela PK, Unnisa N, Jaiswal AK, Ahmed N, Purkayastha A. Dentoskeletal effects of twin block appliance in patients with class II malocclusion. Medicine and Pharmacy Reports. 2022; 95: 191–196.

[3] Kirschneck C, Proff P, Lux C. Ideal treatment timing of orthodontic anomalies—a German clinical S3 practice guideline. Journal of Orofacial Orthopedics. 2022; 83: 225–232.

[4] Pastwa E, Haïm F, Gebeile-Chauty S. Relevance of class II interceptive treatments. Synthesis of the valid conventional means of study. L’Orthodontie Française. 2021; 92: 443–452. (In French)

[5] Wong KF, Chen W, Ren J, Yang Y, Lin Y. Effects of two-phase treatment with functional appliances followed by extraction versus one-phase treatment with extraction in class II growing patients: a case-control study. Journal of Clinical Medicine. 2022; 11: 7428.

[6] Cretella Lombardo E, Franchi L, Gastaldi G, Giuntini V, Lione R, Cozza P, et al. Development of a prediction model for short-term success of functional treatment of class II malocclusion. International Journal of Environmental Research and Public Health. 2020; 17: 4473.

[7] Kirtane RS, Wiltshire WA, Thiruvenkatachari B, Shah A, Bittencourt Dutra dos Santos P, Henrique de Sa Leitao Pinheiro F. Cephalometric effects of twin-block and van Beek headgear-activator in the correction of class II malocclusion. American Journal of Orthodontics and Dentofacial Orthopedics. 2023; 163: 677–689.

[8] Arponen H, Hirvensalo R, Lindgren V, Kiukkonen A. Treatment compliance of adolescent orthodontic patients with headgear activator and twin-block appliance assessed prospectively using microelectronic wear-time documentation. European Journal of Orthodontics. 2020; 42: 180–186.

[9] Baccaglione G, Rota E, Ferrari M, Maddalone M. Second class functional treatment: Andreasen activator vs twin block. International Journal of Clinical Pediatric Dentistry. 2020; 13: 144–149.

[10] Nogueira CQ, Galvão Chiqueto KF, Freire Fernandes TM, Castanha Henriques JF, Janson G. Effects of the forsus fatigue-resistant device and mandibular anterior repositioning appliance in class II malocclusion treatment. American Journal of Orthodontics and Dentofacial Orthopedics. 2022; 162: 814–823.

[11] Kwon O, Joury E, Colonio-Salazar F, Moussa-Pacha M, Johal A. A comparison of children’s experiences with fixed and removable functional appliances: a qualitative study. To be published in American Journal of Orthodontics and Dentofacial Orthopedics. 2023. [Preprint].

[12] Caruso S, Nota A, Caruso S, Severino M, Gatto R, Meuli S, et al. Mandibular advancement with clear aligners in the treatment of skeletal class II. A retrospective controlled study. European Journal of Paediatric Dentistry. 2021; 22: 26–30.

[13] Sabouni W, Hansa I, Al Ali SM, Adel SM, Vaid N. Invisalign treatment with mandibular advancement: a retrospective cohort cephalometric appraisal. Journal of Clinical Imaging Science. 2022; 12: 42.

[14] Galan-Lopez L, Barcia-Gonzalez J, Plasencia E. A systematic review of the accuracy and efficiency of dental movements with Invisalign®. The Korean Journal of Orthodontics. 2019; 49: 140–149.

[15] Feng X, Jiang Y, Zhu Y, Hu L, Wang J, Qi Y, et al. Comparison between the designed and achieved mesiodistal angulation of maxillary canines and posterior teeth and influencing factors: first premolar extraction treatment with clear aligners. American Journal of Orthodontics and Dentofacial Orthopedics. 2022; 162: e63–e70.

[16] Xie J, Zheng Y, Wu J. Three-dimensional dentoskeletal effects of the angelalign A6 clear aligners in a skeletal class II growing patient: a case report. International Orthodontics. 2023; 21: 100756.

[17] Tektas S, Thurnheer T, Eliades T, Attin T, Karygianni L. Initial bacterial adhesion and biofilm formation on aligner materials. Antibiotics. 2020; 9: 908.

[18] Barreto MB, Fonseca EM, Cunha AJLAD. A computerized system to conduct the Tweed-Merrifield analysis in orthodontics. Brazilian Oral Research. 2006; 20: 167–171.

[19] Pinho T, Gonçalves S, Rocha D, Martins ML. Scissor bite in growing patients: case report treated with clear aligners. Children. 2023; 10: 624.

[20] Vieira WA, Pecorari VGA, Gabriel PH, Vargas-Neto J, Santos ECA, Gomes BPFA, et al. The association of inadequate lip coverage and malocclusion with dental trauma in Brazilian children and adolescents—a systematic review and meta-analysis. Dental Traumatology. 2022; 38: 4–19.

[21] Koskela A, Neittaanmäki A, Rönnberg K, Palotie A, Ripatti S, Palotie T. The relation of severe malocclusion to patients’ mental and behavioral disorders, growth, and speech problems. European Journal of Orthodontics. 2021; 43: 159–164.

[22] Ravera S, Castroflorio T, Galati F, Cugliari G, Garino F, Deregibus A, et al. Short term dentoskeletal effects of mandibular advancement clear aligners in class II growing patients. A prospective controlled study according to STROBE guidelines. European Journal of Paediatric Dentistry. 2021; 22: 119–124.

[23] Wu Y, Yu Q, Xia Y, Wang B, Chen S, Gu K, et al. Does mandibular advancement with clear aligners have the same skeletal and dentoalveolar effects as traditional functional appliances? BMC Oral Health. 2023; 23: 65.