Twin block 2/ dental crown & bridge courses

Twin BlockTwin Block
Part IIPart II
INDIAN DENTAL ACADEMY
Leader in continuing Dental
Education
www.indiandentalacademy.comwww.indiandentalacademy.com

CONTENTSCONTENTS
 TREATMENT OF CLASS II DIVISION 1 MALOCCLUSIONTREATMENT OF CLASS II DIVISION 1 MALOCCLUSION
 TWIN BLOCK FOR TRANSVERSE DEVELOPMENTTWIN BLOCK FOR TRANSVERSE DEVELOPMENT
 BITE GUIDEBITE GUIDE
 TREATMENT IN MIXED DENTITIONTREATMENT IN MIXED DENTITION
 TREATMENT IN CROWDINGTREATMENT IN CROWDING
 ANTERIOR OPEN BITE WITH VERTICAL GROWTH PATTERNANTERIOR OPEN BITE WITH VERTICAL GROWTH PATTERN
 TREATMENT OF CLASS II DIVISION 2TREATMENT OF CLASS II DIVISION 2
 TWIN BLOCK FOR SAGITTAL DEVELOPMENTTWIN BLOCK FOR SAGITTAL DEVELOPMENT
 TWIN BLOCK FOR CORRECTION OF OPEN BITETWIN BLOCK FOR CORRECTION OF OPEN BITE
 TREATMENT OF CLASS III MALOCCLUSIONTREATMENT OF CLASS III MALOCCLUSION
 TREATMENT OF ASYMMETRYTREATMENT OF ASYMMETRY
 DESIGNER TWIN BLOCKDESIGNER TWIN BLOCK
 REFERENCESREFERENCES

INTRODUCTIONINTRODUCTION

STANDARD TWIN BLOCKSTANDARD TWIN BLOCK

TREATMENT OF CLASS IITREATMENT OF CLASS II
DIVISION 1 MALOCCLUSIONDIVISION 1 MALOCCLUSION
DEEP OVERBITEDEEP OVERBITE
 BITE REGISTRATIONBITE REGISTRATION
‘Full home’ bitewww.indiandentalacademy.comwww.indiandentalacademy.com

TRANSVERSE DEVELOPMENTTRANSVERSE DEVELOPMENT
SCHWARZ & GARZINGER 1966

Jackson 1887

Crozat 1920

FULL TIME APPLIANCE WEARFULL TIME APPLIANCE WEAR

REACTIVATION OF TWIN BLOCKREACTIVATION OF TWIN BLOCK

Indications of Progressive activationIndications of Progressive activation
 Larger overjetLarger overjet
 Full correction not achievedFull correction not achieved
 Vertical growthVertical growth
 Adult treatmentAdult treatment
 TMJ dysfunctionTMJ dysfunction

BITE GUIDE & BITE RAMPBITE GUIDE & BITE RAMP
BITE GUIDE BITE RAMP

OCCLUSOGUIDE APPLIANCEOCCLUSOGUIDE APPLIANCE
BY ORTHO-TAIN

TREATMENT IN MIXEDTREATMENT IN MIXED
DENTITIONDENTITION
 TREATMENT OF SKELETAL DISCREPANCYTREATMENT OF SKELETAL DISCREPANCY
SHOULD NOT BE DELAYED UNTIL THESHOULD NOT BE DELAYED UNTIL THE
PERMANENT DENTITION HAS BEENPERMANENT DENTITION HAS BEEN
ESTABLISHED.ESTABLISHED.
 INTERCEPTIVE TREATMENT IS FREQUENTLYINTERCEPTIVE TREATMENT IS FREQUENTLY
INDICATED IN MIXED DENTITION TO RESTOREINDICATED IN MIXED DENTITION TO RESTORE
THE NORMAL FUNCTION AND CORRECT ARCHTHE NORMAL FUNCTION AND CORRECT ARCH
RELATIONSHIP BY MEANS OF FUNCTIONALRELATIONSHIP BY MEANS OF FUNCTIONAL
APPLIANCE THERAPY.APPLIANCE THERAPY.

CROWN CONTOURS (TRUAX)CROWN CONTOURS (TRUAX)

COMBINATON THERAPYCOMBINATON THERAPY
 A fundamental question that we mustA fundamental question that we must
address in diagnosis is: ‘ Does this patientaddress in diagnosis is: ‘ Does this patient
require Orthodontic treatment or Orthopedicrequire Orthodontic treatment or Orthopedic
treatment or a combination of both and totreatment or a combination of both and to
what degree?’what degree?’

1. Preliminary stage of treatment with fixed appliances before1. Preliminary stage of treatment with fixed appliances before
fitting twin blocksfitting twin blocks
 If upper and lower arch form does not matchIf upper and lower arch form does not match
 Crowding is moderate or severeCrowding is moderate or severe
 Alignment and leveling is needed before functional correction.Alignment and leveling is needed before functional correction.
 In cases with vertical growth pattern (high mandibular angle)In cases with vertical growth pattern (high mandibular angle)
with deep bite, VTO does not improve as functional protrusionwith deep bite, VTO does not improve as functional protrusion
further increases facial height. In these cases anteriorfurther increases facial height. In these cases anterior
intrusion is done initially with fixed appliance to reduce theintrusion is done initially with fixed appliance to reduce the
overbite and then twin blocks are used to advance theoverbite and then twin blocks are used to advance the
mandible.mandible.
2. As no anterior wires are used in twin blocks, brackets may be2. As no anterior wires are used in twin blocks, brackets may be
fitted in the anterior segment and the anteriors aligned with afitted in the anterior segment and the anteriors aligned with a
sectional wire during twin block stage of treatment.sectional wire during twin block stage of treatment.
3. A full lower fixed appliance may be fitted during the support3. A full lower fixed appliance may be fitted during the support
phase.phase. www.indiandentalacademy.comwww.indiandentalacademy.com

TWIN BLOCK TRACTIONTWIN BLOCK TRACTION
TECHNIQUETECHNIQUE
INDICATIONSINDICATIONS
 In the treatment of severe maxillaryIn the treatment of severe maxillary
protrusionprotrusion
 To control a vertical growth pattern. HighTo control a vertical growth pattern. High
pull headgear may be used. This restrainspull headgear may be used. This restrains
vertical maxillary growth and appliesvertical maxillary growth and applies
intrusive force on upper posteriors.intrusive force on upper posteriors.
 In adult treatment where mandibularIn adult treatment where mandibular
growth cannot assist the correction ofgrowth cannot assist the correction of
severe malocclusion.severe malocclusion.www.indiandentalacademy.comwww.indiandentalacademy.com

CONCORDE FACE BOWCONCORDE FACE BOW
CLARK 1982

EXTRAORAL
INTERMAXILLARY

HIGH PULL TRACTION
ORTON 1990 www.indiandentalacademy.comwww.indiandentalacademy.com

TREATMENT OF ANTERIOR OPENTREATMENT OF ANTERIOR OPEN
BITEBITE
 Reduced overbite and anterior open bite areReduced overbite and anterior open bite are
often related to a vertical tendency ofoften related to a vertical tendency of
growth with increased lower facial height.growth with increased lower facial height.
 In these patient's careful management isIn these patient's careful management is
needed to prevent posterior eruption and tryneeded to prevent posterior eruption and try
to achieve intrusion of posterior teeth.to achieve intrusion of posterior teeth.

Bite RegistrationBite Registration
 Activation must not exceed 70% of totalActivation must not exceed 70% of total
protrusive path.protrusive path.
 Yellow Projet or Exactobite is designed toYellow Projet or Exactobite is designed to
register a 4 mm interincisal clearance,register a 4 mm interincisal clearance,
resulting in approximately 5mm clearanceresulting in approximately 5mm clearance
between the cusps of first premolars orbetween the cusps of first premolars or
deciduous molars.deciduous molars.

APPLIANCE DESIGNAPPLIANCE DESIGN

PITFALLSPITFALLS

INTRAORAL TRACTIONINTRAORAL TRACTION
Dr. CHRISTINE MILLS IN VANCOUVER

TREATMENT OF CLASS IITREATMENT OF CLASS II
DIVISION 2DIVISION 2

BITE REGISTRATIONBITE REGISTRATION
 INCISORS IN EDGE TO EDGEINCISORS IN EDGE TO EDGE
RELATIONSHIPRELATIONSHIP
 WHEN THE OVERBITE IS EXCESSIVE,WHEN THE OVERBITE IS EXCESSIVE,
THE CLEARANCE BETWEEN THETHE CLEARANCE BETWEEN THE
POSTERIOR TEETH IS INCREASED.POSTERIOR TEETH IS INCREASED.

SAGITTAL DEVELOPMENTSAGITTAL DEVELOPMENT
 SAGITTAL APPLIANCESSAGITTAL APPLIANCES
WERE USED INWERE USED IN
ANTEROPOSTERIRANTEROPOSTERIR
DEVELOPMENT OFDEVELOPMENT OF
ARCH FORM ( WITZIG &ARCH FORM ( WITZIG &
SPAHL 1987) AS ANSPAHL 1987) AS AN
INITIAL STAGE OFINITIAL STAGE OF
TREATMENT TOTREATMENT TO
IMPROVE ARCHFORM.IMPROVE ARCHFORM.
 20-80% RATIO (SPAHL20-80% RATIO (SPAHL
1993)1993)

TREATMENT OF CLASS IIITREATMENT OF CLASS III
MALOCCLUSIONMALOCCLUSION
 Reversing the angulationReversing the angulation
of the inclined planes andof the inclined planes and
harnessing occlusalharnessing occlusal
forces as the functionalforces as the functional
mechanism to correctmechanism to correct
arch relationship byarch relationship by
maxillary advancementmaxillary advancement
while using the lower archwhile using the lower arch
as anchorageas anchorage

 IN TREATMENT WITHIN TREATMENT WITH
REVERSE TWIN BLOCKREVERSE TWIN BLOCK
THE OCCLUSAL FORCETHE OCCLUSAL FORCE
EXERTED ON THEEXERTED ON THE
MANDIBLE IS DIRECTEDMANDIBLE IS DIRECTED
DOWNWARDS ANDDOWNWARDS AND
BACKWARDSBACKWARDS
 THE FORCE VECTOR INTHE FORCE VECTOR IN
THE MANDIBLE PASSESTHE MANDIBLE PASSES
THROUGH THE LOWERTHROUGH THE LOWER
MOLARS TOWARDS THEMOLARS TOWARDS THE
GONIAL ANGLE.GONIAL ANGLE.
 THIS IS THE AREA OFTHIS IS THE AREA OF
MANDIBLE BEST ABLE TOMANDIBLE BEST ABLE TO
ABSORB OCCLUSALABSORB OCCLUSAL
FORCESFORCES www.indiandentalacademy.comwww.indiandentalacademy.com

CASE SELECTIONCASE SELECTION
 WHETHER OR NOT THE PATIENT CANWHETHER OR NOT THE PATIENT CAN
OCCLUDE SQUARELY EDGE TO EDGE ONOCCLUDE SQUARELY EDGE TO EDGE ON
THE UPPER AND LOWER INCISORS.THE UPPER AND LOWER INCISORS.
 THE EASE WITH WHICH THE PATIENT CANTHE EASE WITH WHICH THE PATIENT CAN
ACHIEVE THIS IS AN INDICATION OF THEACHIEVE THIS IS AN INDICATION OF THE
PROGNOSIS OF CORRECTION.PROGNOSIS OF CORRECTION.
 MOST FAVOURABLE ARE THE POSTURALMOST FAVOURABLE ARE THE POSTURAL
CLASS III WHERE THE INCISORS CAN MEETCLASS III WHERE THE INCISORS CAN MEET
COMFORTABLY EDGE TO EDGE BUT THECOMFORTABLY EDGE TO EDGE BUT THE
PATIENT IS FORCED TO MOVE MANDIBLEPATIENT IS FORCED TO MOVE MANDIBLE
FORWARD FOR THE POSTERIORS TOFORWARD FOR THE POSTERIORS TO
OCCLUDE.OCCLUDE. www.indiandentalacademy.comwww.indiandentalacademy.com

 LESS SCOPE OF DISTALLESS SCOPE OF DISTAL
DISPLACEMENT OF MANDIBLE.DISPLACEMENT OF MANDIBLE.
 2 MM INTERINCISAL CLEARENCE WITH2 MM INTERINCISAL CLEARENCE WITH
BLUE EXACTOBITEBLUE EXACTOBITE
 MAXIMUM RETRUDED POSITION.MAXIMUM RETRUDED POSITION.
 IN CASE OF BRACHYFACIAL CLASS IIIIN CASE OF BRACHYFACIAL CLASS III
ADDITIONAL VERTICAL ACTIVATIONADDITIONAL VERTICAL ACTIVATION
USING YELLOW EXACTOBITE FOR 4 MMUSING YELLOW EXACTOBITE FOR 4 MM
INTERINCISAL CLEARANCE.INTERINCISAL CLEARANCE.www.indiandentalacademy.comwww.indiandentalacademy.com

LIP PADSLIP PADS

MANAGEMENT OF CROWDINGMANAGEMENT OF CROWDING
BIHELIX TO IMPROVE THE LOWER ARCHwww.indiandentalacademy.comwww.indiandentalacademy.com

TREATMENT OFTREATMENT OF
ASYMMETRYASYMMETRY
 OCCLUSAL INCLINED PLANE IS AN IDEALOCCLUSAL INCLINED PLANE IS AN IDEAL
FUNCTIONAL MECHANISM FOR UNILATERALFUNCTIONAL MECHANISM FOR UNILATERAL
ACTIVATIONACTIVATION
 THE SAGITTAL TWIN BLOCK IS THETHE SAGITTAL TWIN BLOCK IS THE
APPLIANCE OF CHOICE FOR CORRECTONAPPLIANCE OF CHOICE FOR CORRECTON
OF ASYMMETRY BECAUSE THE SAGITTALOF ASYMMETRY BECAUSE THE SAGITTAL
DESIGN ALLOWS UNILATERAL ACTIVATIONDESIGN ALLOWS UNILATERAL ACTIVATION
TO RESTORE SYMMETRY IN BUCCAL ANDTO RESTORE SYMMETRY IN BUCCAL AND
LABIAL SEGMENTS.LABIAL SEGMENTS.

 INCISORS IN EDGE TO EDGEINCISORS IN EDGE TO EDGE
RELATIONRELATION
 INTERINCISAL CLEARANCE OF 2 MMINTERINCISAL CLEARANCE OF 2 MM
 COINCIDANT MIDLINES.COINCIDANT MIDLINES.
 THE OBJECTIVE IS TO CORRECT THETHE OBJECTIVE IS TO CORRECT THE
DISTAL OCCLUSION AND ASYMMETRYDISTAL OCCLUSION AND ASYMMETRY
AT THE SAME TIME.AT THE SAME TIME.

DESIGNER TWIN BLOCKDESIGNER TWIN BLOCK
ORTHOLAB, MELBOURNEwww.indiandentalacademy.comwww.indiandentalacademy.com

REFERENCESREFERENCES
 William J Clark: Twin block functional therapy,William J Clark: Twin block functional therapy,
applications in dentofacial Orthopaedic Mosby Companyapplications in dentofacial Orthopaedic Mosby Company
22ndnd
edition.edition.
 Mills and Mcculloch AJODO 1998 JulyMills and Mcculloch AJODO 1998 July
 Graber, Rakosi Petrovic: Dentofacial orthopaedics withGraber, Rakosi Petrovic: Dentofacial orthopaedics with
functional appliances Mosby Company 2functional appliances Mosby Company 2ndnd
edition pg no.edition pg no.
268-298268-298

Twin block 2/ dental crown & bridge courses

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