• Journal of Technologic Dentistry
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• v.32 no.2
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• pp.105-109
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• 2010

• Journal of the korean academy of Pediatric Dentistry
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• v.25 no.1
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• pp.134-143
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• 1998

Twin Blocks are simple bite-blocks that effectively modify the occlusal inclined plane to induce favorably directed occlusal forces by causing a functional mandibular displacement. These devices use upper and lower bite-blocks that engage on occlusal inclined planes. Twin Blocks use the forces of occlusion as the functional mechanism to correct the malocclusion. To get an excellent result in the treatment by using the Twin Block appliances, proper case selection must be needed. Twin Block treatment is performed in two stages. Twin Blocks are used in the active phase to correct the anteroposterior relationship and establish the correct vertical dimension. Once this phase is accomplished, the Twin Blocks are replaced with an upper Hawley type of appliance with an anterior inclined plane, which is then used to support the corrected position as the posterior teeth settle fully into occlusion. The Twin Block is the most comfortable, the most esthetic ane the most efficient of all the functional appliances. Twin Blocks have many advantages compared to other functional appliances. Patients can wear Twin Blocks 24 hours per day and can eat comfortably with the appliances in place. From the moment Twin Blocks are fitted, the appearance is noticeably improved. There is less interference with normal function. Integration with conventional fixed appliances is simpler than with any other functional appliance. Twin Blocks allow independent control of upper and lower arch width. Appliance design is easily modified for transverse and sigittal arch development. The authors treated Class II malocclusion with Twin Blocks. and the results as follows; 1. Rapid profile improvement was achieved in 2-3 months. 2. There was excellent patient cooperation. 3. Severe overjet and overbite were reduced. 4. Class II molar relationship was changed to Class I.

• The korean journal of orthodontics
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• v.48 no.1
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• pp.11-22
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• 2018

Objective: The aim of this study was to determine cephalometric factors that help predict favorable soft-tissue profile outcomes following treatment with the Class II Twin-block appliance. Methods: Pre- and post-treatment lateral cephalograms of 45 patients treated with the Class II Twin-block appliance were retrospectively analyzed. Profile silhouettes were drawn from the cephalograms and evaluated by three orthodontists in order to determine the extent of improvement. Samples were divided into a favorable group (upper 30% of visual analogue scale [VAS] scores, n = 14) and an unfavorable group (lower 30% of VAS scores, n = 14). Skeletal and soft-tissue measurements were performed on the cephalograms and an intergroup comparison was conducted. Results: An independent t-test revealed that the following pre-treatment values were lower in the favorable group compared to the unfavorable group: lower incisor to mandibular plane angle, lower incisor to pogonion distance, point A-nasion-point B angle, sella-nasion line (SN) to maxillary plane angle, SN to mandibular plane angle, gonial angle, and symphysis inclination. The favorable group had a larger incisor inclination to occlusal plane. Moreover, the favorable group showed larger post-treatment changes in gonial angle, B point projection, and pogonion projection than did the unfavorable group. Conclusions: Class II malocclusion patients with a low divergent skeletal pattern and reduced lower incisor protrusions are likely to show more improvement in soft-tissue profile outcomes following Class II Twin-block treatment.

• The Journal of the Korean dental association
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• v.56 no.2
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• pp.103-112
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• 2018

The treatment of skeletal Class II growing patient is to move the mandible into the Class I molar positon via facilitating mandibular growth. The functional appliances are to be designed to exert three major functions such as palatal expansion, forward growth of mandible and increase of the posterior vertical dimension. One of the devices that can achieve both the palatal expansion and the eruption of the mandibular molar is the Twin-Block introduced by Clark in 1982. In this part, we present the treatment method with Twin-Block functional appliance for the correction of skeletal Class II growing patient.

• Journal of the korean academy of Pediatric Dentistry
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• v.21 no.2
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• pp.577-585
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• 1994

The Twin Blocks technique was developed by Dr. William Clark of Scotland during the early 1980's. Twin Blocks are an uncomplicated system that incorporates the use of upper and lower bite blocks. These blocks reposition the mandible and redirect occlusal forces to achieve rapid correction of malocclusions. They are also comfortable and the patients wear them full-time-inducing eating time. Occlusal forces transmitted through the dentition provide a constant proprioceptive stimulus to influence the rate of growth and the trabecular structure of the supporting bone. The features of Twin Blocks mean easier and quicker treatment. The occlusal inclined plane is the fundamental functional mechanism of the natural dentition. Twin blocks are bite blocks that effectively modify the occlusal inclined plane to induce favorably directed occlusal forces by causing a functional mandibular displacement. Upper and lower bite blocks interlock at a $45^{\circ}$ angle and are designed for full-time wear to take advantage of all functional forces applied to the dentition including the forces of mastication. The patients who were treated with modified Twin Blocks, and following results were observed: 1. Large overjet and deep overbite were corrected. 2. Class II molar relationship was changed into Class I. 3. Labial inclination of upper incisors was corrected by adjustment of labial bow of upper bite block. 4. The profiles of two patients were improved by anterior displacement of mandible.

• Journal of the korean academy of Pediatric Dentistry
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• v.47 no.3
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• pp.235-247
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• 2020

The purpose of this study was to evaluate the skeletal and dentoalveolar effects and optimal timing for treatment of class II malocclusion with functional appliances in children and adolescents. A group of 30 patients with class II malocclusion were divided into 3 groups according to their use of functional appliance: Twin block, Activator, Fränkel appliance. The group was also divided into 2 groups according to the cervical vertebrae maturation method. Lateral cephalometric radiographs were analyzed pretreatment (T0) and posttreatment (T1). Among the functional appliances, treatment with Twin block and Activator showed significant increase in the length of the mandible (Co-Gn) and the lower anterior facial height (ANS to Me), whereas the overjet and overbite were significantly reduced. Treatment with Fränkel appliance showed significant improvement in the relationship of maxilla and mandible. In addition, if the functional appliance was used during the period of pubertal growth peak, there was a significant increase in mandibular length, improvement in the relationship of maxilla and mandible, labial inclination of lower incisors and decrease in overjet compared to the treatment before pubertal growth peak. Therefore, this study indicates that using functional appliances for patients with class II malocclusion is effective and the optimal timing for using functional appliances is during pubertal growth peak.

• The korean journal of orthodontics
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• v.50 no.2
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• pp.86-97
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• 2020

Objective: To propose a three-dimensional (3D) method for evaluating temporomandibular joint (TMJ) changes during Twin-block treatment. Methods: Seventeen patients with Class II division 1 malocclusion treated using Twin-block and nine untreated patients with a similar malocclusion were included in this research. We collected their cone beam computed tomography (CBCT) data from before and 8 months after treatment. Segmentations were constructed using ITK-SNAP. Condylar volume and superficial area were measured using 3D Slicer. The 3D landmarks were identified on CBCT images by using Dolphin software to assess the condylar positional relationship. 3D models of the mandible and glenoid fossa of the patients were constructed and registered via voxel-based superimposition using 3D Slicer. Thereafter, skeletal changes could be visualized using 3DMeshMetric in any direction of the superimposition on a color-coded map. All the superimpositions were measured using the same scale on the distance color-coded map, in which red color represents overgrowth and blue color represents resorption. Results: Significant differences were observed in condylar volume, superficial area, and condylar position in both groups after 8 months. Compared with the control group (CG), the Twin-block group exhibited more obvious condyle-fossa modifications and joint positional changes. Moreover, on the color-coded map, more obvious condyle-fossa modifications could be observed in the posterior and superior directions in the Twin-block group than in the CG. Conclusions: We successfully established a 3D method for measuring and evaluating TMJ changes caused by Twin-block treatment. The treatment produced a larger condylar size and caused condylar positional changes.

• The korean journal of orthodontics
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• v.33 no.4 s.99
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• pp.247-257
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• 2003

Various methods have been used on patients with skeletal Class II division 1 malocclusion. The activator, Frankel appliance, headgear, Herbst appliance, and Twin-block appliance are some examples. The ideal treatment effect using these appliances would be to inhibit horizontal and vertical growth of the maxilla while promoting mandibular growth and obtaining optimum dentition. The Teuscher appliance has a simultaneous combined headgear effect with maxillary growth inhibition and an activator effect with mandibular growth promotion. The purpose of this study was to examine how well these effects were clinically obtained and the results are as follows. 1. The forward growth of the maxilla was effectively inhibited. 2. The downward-forward growth of the maxillary dentoalveolar complex was inhibited. 3. Growth promotion of the mandible was not observed. 4. The overjet, overbite, molar key were effectively improved. 5. The protruded upper lip and facial profile were unproved.

• Journal of the korean academy of Pediatric Dentistry
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• v.36 no.1
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• pp.108-113
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• 2009

The functional regulator(FR) appliances act to remove the restrictive forces that prevent the normal maturation of the maxilla and mandible. FR appliances are different from other functional jaw orthopedic appliances(e.g., the twin block, bionator, and activator). $Fr{\ddot{a}}nkel$ has based his treatment philosophy on the concept that the capacity to regulate growth residues in the soft tissue environment, and that adequate space must be available for the proper development of the hard tissue. In class II malocclusion with mandibular retrusion, FR-II treatment is not only the change in the postural position of mandible, but also expansion of the dental arches. By balancing the neuromuscular environment, not only can severe malocclusions be treated successfully, but also the tendency toward relapse is minimized because the neural and soft tissue factors associated with the skeletal malocclusion have been addressed as well. We report cases using by FR-II that is applicated in cases of Class II malocclusion without fixed appliance, only FR-II and space supervision.