A twelve year old female patient came to our clinic with a chief complaint of forwardly placed upper and lower front teeth and incomplete lip closure. On Clinical and radiographical examination it was found that patient had Dental Class II malocclusion superimposed on Skeletal Class II pattern with orthognathic maxilla and retrognathic mandible, Constricted maxillary arch, proclined upper and lower front teeth. Soft tissue examination shows that incompetent upper and lower lip.

After all diagnostic procedures were performed, we decided to give twin block appliance therapy for mandibular arch growth and maxillary arch expansion as Phase 1 therapy for the patient. It was advised to open screw one turn after every 4th day for maxillary arch expansion. patient was instructed to wear appliance continuously for 24 hours. Patient compliance for twin block appliance was excellent so it was possible to achieve desired results of Phase 1 within 9 months and an additional 3 month for retention

Moving onto the Phase 2 of the treatment, the goal was to bring the excessively frontly flared upper and lower teeth backwardly. To achieve this, space was created by removal of all four premolars in both upper and lower jaws. The space closure for the same took another 9 months. after phase 2 got completed, patient's front teeth were aligned properly in the desired position with excellent treatment outcome.

Final detailing and finishing was done, and the patient has been immensely thankful for her beautiful new smile and added confidence to flaunt her perfect smile.

Pretreatment Photograph

Phase 1 : Twin block appliance

Phase 1 completed

Phase 2: Fixed mechanotherapy

Posttreatment Photograph