Twinblock Therapy Combined with Incorporated Prosthesis - A Novel Approach for Simultaneous Treatment of Class II Skeletal Discrepancy and Rehabilitation of Missing Central Incisors

Twinblock appliance therapy is the most commonly and widely used myofunctional therapy employed for correction of Class II Skeletal pattern in the early growing stages of a patient before attaining maturation or puberty. It changes the typical convex profile of a patient into an almost straight or Orthognathic profile, a positive VTO ( Visual Treatment Objective) as we call it, thus eliminating or avoiding the need for an encroaching Surgery for skeletal correction later on in life. If the appliance delivered to the patient is used meticulously with proper instructions, myofunctional appliances manifest their results efficiently withing 6 to 7 months of treatment. Results are best attainable if the patient uses the appliance for maximum hours in a day. This Case Report is of a 13 years old female patient with a Class II Skeletal pattern and a retrognathic mandible, with positive VTO and missing upper central incisors. She visited with the chief complaint of missing upper front teeth and wanted replacement for the same, also the patient complained of a backwardly positioned lower jaw. A Novel treatment approach was advocated for this patient, as both her problems had to be addressed, i. e. the missing maxillary central incisors and the retruded mandible. So, as a new approach, we decided to address both the problems simultaneously as the patient had very less time left for completion of maturation, so the retruded mandibular fault had to be addressed immediately. Also since the chief complaint being missing upper front teeth, that too was a matter of immediate esthetic concern as the patient was a growing school going girl and was worried about her unesthetic looks. So, we decided to design an appliance which addressed both these issues simultaneously and quickly. A normal Standard twinblock was fabricated with its palatal acrylic extended more anteriorly to incorporate the upper missing central incisors, both of right and left side. This served both purposes. Firstly, the patients chief complaint of missing front teeth was addressed, secondly the patients remaining growth was utilized for correction of the retruded mandibular position which in turn improved the profile of the patient drastically. Twinblock with incorporated prosthesis served dual purposes.