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Orthodontics

338 - A Novel Modified Reverse Twin Block Appliance - Trifecta

Saturday, May 23, 2026
1:00 PM - 1:15 PM PST
Has Audio
Abstract:

Purpose:
Class III malocclusion in the mixed dentition presents significant clinical challenges due to underlying skeletal discrepancies and compliance limitations associated with conventional treatment modalities. The purpose of this study was to clinically evaluate a novel modified reverse twin block appliance for early management of Class III malocclusion in growing children.



Methods:
Treatment was carried out on growing children with skeletal Class III malocclusion primarily due to maxillary deficiency using a modified reverse twin block appliance incorporating upper and lower bite blocks, a rapid maxillary expansion component using a Hyrax screw, intraoral hooks positioned in the maxillary permanent first molar and mandibular canine–lateral incisor regions, and intraoral elastics. Elastics were applied at 30° to the occlusal plane with an initial force of 150 g per side, increased to 250 g during treatment. Patients were instructed to wear the appliance full time except during meals and oral hygiene. Pre- and post-treatment clinical examinations and cephalometric analyses were performed. Average treatment duration ranged from 9 to 12 months.



Results:
All patients demonstrated correction of anterior crossbite and improvement in sagittal jaw relationship. Cephalometric analysis showed favorable maxillary advancement with controlled mandibular positioning. Patient compliance was high due to the fully intraoral design of the appliance.



Conclusions:
The modified reverse twin block appliance appears to be an effective and compliance-friendly option for early management of Class III malocclusion in the mixed dentition. This novel approach may reduce reliance on extraoral appliances and invasive treatment modalities.

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