Treatment of a severe class II division 1 malocclusion with twin-block appliance

This case report describes the management of a female with a severe Class II skeletal discrepancy, Class II molar and canine relationship bilaterally, a large overjet and an impinging overbite. As the patient was in CVMI stage 4, it was planned to make use of remaining growth for correction of skeletal discrepancy and so the treatment was initiated with a removable twin block. This promoted the growth of the mandible, restrained maxilla in anteroposterior direction which in combination with the fixed appliances for alignment and leveling of the dentition improved the convex soft tissue profile. Thus severe skeletal Class II discrepancy was successfully managed with the combination of functional correction along with comprehensive fixed mechanotherapy without any extraction resulting in acceptable soft tissue changes.