Treatment effects produced by the twin-block appliance and the FR-2 appliance of Fränkel compared with an untreated Class II sample

Abstract

This retrospective cephalometric study compares the treatment effects produced in 40 patients treated with the Twin-block appliance to those seen in a matched sample of 40 children treated with the FR-2 appliance of Fränkel and to changes undergone in 40 untreated Class II controls from The University of Michigan Elementary and Secondary School Growth Study. The average starting ages for the Twin-block, Fränkel, and control groups were 10 years 5 months, 10 years 2 months, and 9 years 11 months, respectively. The T(2) to T(1) observation period was adjusted to an average of 16 months for all groups. Significant decreases in overbite and overjet were observed at the end of treatment in the Twin-block and Fränkel groups. Compared with the untreated subjects, statistically significant increases in mandibular length were observed in both treated groups. The Twin-block patients achieved an additional 3.0 mm of mandibular length, whereas the Fränkel group increased 1.9 mm more than did the controls. No significant restriction of midfacial growth was observed in either functional appliance group relative to controls. A significant increase in lower anterior facial height was evident in both treatment groups. Vertical increase in the Twin-block patients was significantly greater than in the FR-2 group. In general, more extensive dentoalveolar adaptation was observed with the tooth-borne Twin-block appliance than with the more tissue-borne FR-2 of Fränkel. The Twin-block and FR-2 samples both showed significant retroclination and extrusion (eruption) of the maxillary incisors. The Twin-block patients also exhibited distal movement of the upper molars; however, there was no extrusion. Slight lower incisor proclination was noted in both treatment groups, and lower molar extrusion was found to be significantly greater in the Twin-block group compared with the other 2 samples. No horizontal differences were detected in the lower molars among groups. The present study suggests, therefore, that Class II correction with the Twin-block appliance is achieved through normal growth in addition to mandibular skeletal and dentoalveolar changes. Class II correction with the FR-2 is more skeletal in nature, with less dentoalveolar changes noted.