Class II Correction: Factors For Utilizing Twin Force Appliance In A Complex Orthodontic Case

Statistics show that over 90% of Class II Division 1 orthodontic patients have a normal anteroposterior (AP) position of the maxilla and maxillary anterior teeth combined with mandibular retrusion; yet, conventional orthodontic treatment has used retraction of the maxillary dentition and maxilla through cervical headgear to allow the mandible to “catch up” to the maxilla by retarding its forward growth or by retracting the maxillary dentition to achieve a Class I dental relationship.

Alternately, in patients with completed facial growth, extraction of upper first bicuspids has been used as a means to correct the Class II, Div. 1 dental malocclusion. Unfortunately, in such treatment, a price must be paid in facial esthetics and facial profile, as well as consequentially exacerbating the compromised upper airway that is present in a high percentage of these patients. This case was treated with the goals of enhancing facial profile by normalizing the AP position of the maxilla and mandible and their respective dentition, while encouraging the development of a healthy upper airway.

Class II Division 1 patients are typically deficient in the transverse dimension of the upper arch, causing the mandible to accommodate the narrow arch dimension by posturing posteriorly to allow a maximum intercuspation position to occur resulting in the Class II occlusion. These patients often have a clockwise growth pattern that further exacerbates the Class II malocclusion and they often suffer from upper airway dysfunction that exacerbates the clockwise growth pattern.

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Jeffrey Dahm

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