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Twin Block Functional Therapy: Applications in Dentofacial Orthopedics
William J Clark
CHAPTER 1:
The Art of Orthodontics
INTRODUCTION
DENTAL CHESS
ORTHODONTICS AND DENTAL ORTHOPEDICS
THE PHILOSOPHICAL DIVIDE
THE GENETIC PARADIGM
TREATMENT CONCEPTS
ORTHODONTIC FORCE
ORTHOPEDIC FORCE
DENTOFACIAL ORTHOPEDICS
CHAPTER 2:
Introduction to Twin Blocks
THE OCCLUSAL INCLINED PLANE
PROPRIOCEPTIVE STIMULUS TO GROWTH
Transverse Maxillary Development
TWIN BLOCKS
Treatment of Class II Division 2 Malocclusion
Treatment of Class III Malocclusion
DEVELOPMENT OF TWIN BLOCKS
Case Report: CG Aged 7 Years 10 Months
Case Report: CG
MODIFICATION FOR TREATMENT OF CLASS II DIVISION 2 MALOCCLUSION
Case Report: AK Aged 11 Years 1 Month
Case Report: AK
Case Report: AK
Angulation of the Inclined Planes
Bite Registration
Appliance Design—Twin Blocks for Correction of Uncrowded Class II Division 1 Malocclusion
THE TWIN BLOCK TECHNIQUE—STAGES OF TREATMENT
Stage 1: Active Phase
Stage 2: Support Phase
RETENTION
Timetable of Treatment: Average Treatment Time
RESPONSE TO TREATMENT
Case Report: CH Aged 14 Years 1 Month
Diagnosis, Skeletal Classification
Diagnosis, Dental Classification
Treatment Plan
Bite Registration
Appliances
Clinical Management
Duration of Treatment
Case Report: CH
Case Report: CH
CASE SELECTION FORSIMPLE TREATMENT
Case Report: JMcL Aged 12 Years
Diagnosis, Skeletal Classification
Diagnosis, Dental Classification
Treatment Plan
Appliances
Bite Registration
Clinical Management
Duration of Treatment
Case Report: JMcL
Case Report: JMcL
CHAPTER 3:
Form and Function
DEVELOPMENT OF FUNCTIONAL TECHNIQUE
The Emergence of Extraction Therapy
Therapeutic Limitations of theGenetic Paradigm
BONE REMODELING IN RESPONSE TO FUNCTIONAL STIMULI
Development of theTemporomandibular Joint
Evolution of FunctionalAppliance Technique
Limitations of Functional Appliance Design
The Schwarz Double Plate
OBJECTIVES OF FUNCTIONAL TREATMENT
BITE REGISTRATION INFUNCTIONAL THERAPY
Bite Registration in Twin Block Technique
Vertical Activation
Single or Progressive Activation
CONTROL OF THE VERTICAL DIMENSION
Opening the Bite
Closing the Bite
CHAPTER 4:
Growth Studies in Experimental Animals
HISTOLOGICAL RESPONSE TO ORTHODONTIC AND ORTHOPEDIC FORCE
THE OCCLUSAL INCLINED PLANE IN ANIMAL EXPERIMENTS
FUNCTIONAL REGULATION OF CONDYLAR CARTILAGE GROWTH RATE
CENTRAL CONTROL OF ADAPTIVE RESPONSE
Neuromuscular and Skeletal Adaptations
ADAPTATION IN BONE GROWTH IN RESPONSE TO FUNCTIONAL STIMULUS
THE INFLUENCE OF FUNCTIONAL APPLIANCE THERAPY ON GLENOID FOSSA REMODELING
A REVIEW OF THE PARADIGM OF GENETIC CONTROL
A Comparison of Twin Block Response with Animal Experiments
Muscle Response to the Twin Block Appliance–An Electromyographic Study
Effects of Twin Block Therapy onProtrusive Muscle Functions
Postural Emg Evaluation Shows no Significant Difference with or without Twin Blocks
Clenching in Contact with the Occlusal Inclined Planes Shows Highly Significant Differences in Muscle Activity, Representing a Positive Proprioceptive Stimulus in Emg Activity
A Prospective Study of Twin Block Appliance Therapy Assessed byMagnetic Resonance Imaging
SUMMARY
A Viscoelastic Hypothesis
CHAPTER 5:
Diagnosis and Treatment Planning
CLINICAL EXAMINATION
What You See is What You Get
Photographic Records
Case Records: SW Aged 14 Years 2 Months
Facial and Occlusal Changes before and after 11 Months with Twin Blocks
Orthodontic Records
EXAMINATION OF MODELS
Case Report Gd Aged 14 Years
Case Records: GD Aged 14 Years
Case Report: GD
DIFFERENTIAL DIAGNOSIS
Extraction or Nonextraction Therapy
Arch Length Discrepancy
The “Richter Scale”
TREATMENT PLANNING INCROWDED DENTITION
Lip Contour
NONEXTRACTION THERAPY
Extraction of Second Molars
CONTRAINDICATIONS FORTWIN BLOCK THERAPY
Case Report: CH Aged 11 Years 4 Months
Case Report: KJ Aged 13 Years
Case Report: CH
Case Report: KJ
Case Report: KI Aged 11 Years 8 Months
Case Report: JS Aged 13 Years 7 Months
Case Report: KI
Case Report: JS
CHAPTER 6:
The Clark Cephalometric Analysis
THE JIGSAW PUZZLE
VISION, BALANCE AND POSTURE
Facial Architecture
PARALLELISM IN DENTOFACIAL DEVELOPMENT
A REGISTRATION FRAMEWORK FOR CEPHALOMETRIC ANALYSIS
Ricketts Triangle: The Facial Wedge
THE FACIAL RECTANGLE
Horizontal Registration Plane
Frankfort Plane—Porion to Orbitale
BALANCED FACIAL PROPORTIONS
Skeletal Planes
Dental Planes
Soft-Tissue Planes
A CORRELATIVE CEPHALOMETRIC ANALYSIS
Angular Analysis
Dental Analysis
The Upper and Lower Incisors areRelated to the Anterior Vertical
Position of Dentition
Linear Factors
Soft-Tissue Analysis
Key Factors in Diagnosis andTreatment Planning
The Gradient of Growth of the Chin
Maxillary Convexity
Position of the Upper Dentition
Position of the Lower Dentition
DESCRIPTIVE TERMS INCEPHALOMETRIC ANALYSIS
Definition of Facial Type
Mesognathic
Prognathic
Retrognathic
Mesofacial
Brachyfacial
Dolichofacial
FACIAL CHANGES INTWIN BLOCK TREATMENT
Case Report: KH Aged 9 Years 7 Months
Case Report: KH
Case Report: KH
Case Report: ME Aged 13 Years
Case Report: ME
Case Report: ME
Case Report: PMcL Aged 11 Years 6 Months
Case Report: PMcL
Case Report: PMcL
Case Report: EF Aged 12 Years 9 Months
Case Report: EF
Case Report: EF
Case Report: WL Aged 10 Years 3 Months
Case Report: WL
Case Report: WL
Case Report: AF Aged 11 Years
Case Report: AF
Case Report: LC Aged 9 Years
Case Report: LC
Case Report: LC
Natural Head Position
CHAPTER 7:
Appliance Design and Construction
INTRODUCTION
EVOLUTION OF APPLIANCE DESIGN
STANDARD TWIN BLOCKS
Labial Bow
TWIN BLOCK CONSTRUCTION
THE DELTA CLASP
ADJUSTMENT OF THE DELTA CLASP
THE BASE PLATE
TWIN BLOCKS FOR ARCH DEVELOPMENT
Transverse Development
Occlusal Inclined Planes
The Position of the Inclined Plane
SAGITTAL DEVELOPMENT
Twin Block Sagittal Appliance
Transverse and Sagittal Development
Twin Blocks to Close Anterior Open Bite
Designer Twin Blocks
TREATMENT OF CLASS III MALOCCLUSION
Reverse Twin Blocks
SCREW ADVANCEMENT MECHANISMFOR PROGRESSIVE ACTIVATION OFTWIN BLOCKS
THE BITE GUIDE
TWIN BLOCK TOOL
INVISIBLE TWIN BLOCKS
CHAPTER 8:
Treatment of Class II Division 1 Malocclusion Deep Overbite
CLINICAL MANAGEMENT OFTWIN BLOCKS
Bite Registration
Instructions on Fitting Twin Blocks
FULL-TIME APPLIANCE WEAR
Temporary Fixation of Twin Blocks
MANAGEMENT OF DEEP OVERBITE
ESTABLISHING VERTICAL DIMENSION
The Intergingival Height
SOFT TISSUE RESPONSE
Case Report: LJ Aged 10 Years 9 Months
Bite Registration
Adjustment
Duration of Treatment
FUNCTIONAL ORTHOPEDIC THERAPY
Case Report: PK Aged 11 Years 4 Months
Treatment Plan
Appliances
Adjustment
Duration of Treatment
REACTIVATION OF TWIN BLOCKS
PROGRESSIVE ACTIVATION OFTWIN BLOCKS
SUMMARY—ADJUSTMENT ANDCLINICAL MANAGEMENT
Stage 1—Active Phase
Appliance Fitting
Initial Adjustment–after 10 Days
Adjustment Visit–After 4 Weeks
Routine Adjustment–Time Interval 6 Weeks
Stage 2—Support Phase
Retention
Advantages of Twin Blocks
ROBIN’S MONOBLOC: THE ORIGINAL SLEEP APNEA APPLIANCE!
Twin Blocks Increase the Airway
Treatment of Sleep Apnea andSnoring: Invisible Twin Blocks with Preformed Blocks
CHAPTER 9:
Treatment in Mixed Dentition
INTRODUCTION
APPLIANCE DESIGN
Case Report: FD Aged 9 Years 7 Months
Case Report: FD
TRANSVERSE DEVELOPMENT
TWIN BLOCKS FOR ARCH DEVELOPMENT
Case Report: AG Aged 9 Years 6 Months
OCCLUSOGUIDE APPLIANCE
TWO-PHASE TREATMENT IN MIXED AND PERMANENT DENTITION
Case Report: JC Aged 8 Years 9 Months
Response to Treatment
PEDODONTIC PRACTICE
Case Report: CW Aged 7 Years 6 Months
CHAPTER 10:
Combination Therapy
PERMANENT DENTITION
Case Report: CD Aged 11 Years 8 Months
Summary
CONCURRENT STRAIGHTWIRE AND THE TWIN BLOCK THERAPY
Timing is Everything
Case Report: ML Aged 12 Years 6 Months
CHAPTER 11:
The Twin Block Traction Technique
ORTHOPEDIC TRACTION
THE CONCORDE FACEBOW
TWIN BLOCKS COMBINED WITH ORTHOPEDIC TRACTION
TREATMENT OF MAXILLARY PROTRUSION
Case Report: KA Aged 9 Years 6 Months
DIRECTIONAL CONTROL OFORTHOPEDIC FORCE
Case Report: LG Aged 9 Years 1 Month
CHAPTER 12:
Treatment of AnteriorOpen Bite and Vertical Growth Patterns
INTRODUCTION
PITFALLS IN TREATMENT OFANTERIOR OPEN BITE
BITE REGISTRATION
Appliance Design: Twin Blocks toClose the Bite
Case Report: DP Aged 10 Years 10 Months
TREATMENT OF VERTICAL GROWTH
Case Report: HD Aged 12 Years 2 Months
Clinical Management
INTRAORAL TRACTION TO CLOSE ANTERIOR OPEN BITE
VERTICAL ELASTIC TO CORRECT ANTERIOR OPEN BITE
Case Report: BG Aged 8 Years 1 Month
TREATMENT OF ANTERIOR OPEN BITE AND VERTICAL GROWTH
Screw for Progressive Activationof Twin Blocks
Screw Advancement System for Progressive Activation
Kits for Progressive Screw Advancement (Figs. 12.19A and B)
RESPONSE TO TREATMENT OFANTERIOR OPEN BITE (FIGS. 12.20A TO C)
Introduction
Methods and Materials
Measurements
Summary and Conclusions
Magnetic Force
CHAPTER 13:
Treatment of Class II Division 2 Malocclusion
INTRODUCTION
Bite Registration
TWIN BLOCK SAGITTALAPPLIANCE—APPLIANCE DESIGN
Sagittal Development
Combined Transverse andSagittal Development
THE TWIN BLOCK SAGITTAL APPLIANCE
Case Report: HMcL Aged 14 Years 5 Months
Clinical Management
Case Report: HMcL
Case Report: HK Aged 14 Years 6 Months
Case Report: HK
Case Report: HK
Case Report: SW Aged 12 Years 9 Months
Bite Registration
Case Report: SW
Case Report: SW
THE CENTRAL SAGITTAL TWIN BLOCK FOLLOWED BY FIXED APPLIANCES
Case Report: SWn Aged 12 Years 6 Months
Case Report: SWn
Case Reports
Case Report: JC Aged 12 Years 6 Months
Case Report: JC
Case Report: JC
Case Report: EC Aged 11 Years 11 Months
Case Report: EC
Case Report: EC
Case Report: KC 12 Years 9 Months
Case Report: KC
Case Report: KC
CHAPTER 14:
Treatment of Class III Malocclusion
REVERSE TWIN BLOCKS
Case Selection
Bite Registration
TREATMENT OF CLASS III MALOCCLUSION WITH REVERSE TWIN BLOCKS
Case Report: SL Aged 11 Years
Case Report: SL
REVERSE TWIN BLOCKS:APPLIANCE DESIGN
REVERSE TWIN BLOCKS: MANAGEMENT
Lip Pads
Case Report: TC Aged 8 Years 2 Months
Case Report: TC
Case Report: TC
Case Report: AJ Aged 6 Years 11 Months
Case Report: AJ
Case Report: AJ
Case Report: ML Aged 7 Years 5 Months
Case Report: ML
Case Report: ML
EARLY TREATMENT OF SEVERECLASS III MALOCCLUSION WITHREVERSE TWIN BLOCKS
REVERSE PULL FACIAL MASK
CLASS III MALOCCLUSION WITH FACIAL ASYMMETRY (FIGS. 14.11A TO B1)
Nonsurgical Class III Correction (Figs. 14.12 and 14.13)
Before and after Reverse Twin Blocks(Figs. 14.14 and 14.15)
Occlusal Screw for Progressive Activation of Reverse Twin Blocks
Forward Maxillary Propulsion Combined with Arch Development
Petit Face Mask for Maxillary Protraction
Rapid Palatal Expander inClass III Treatment
CHAPTER 15:
Orthodontics, Orthopedics or Surgery?
INTRODUCTION
CASE REPORTS
Case Report: SG Aged 11 Years 8 Months
Case Report: SG
Case Report: SG
Case Report: TK Aged 14 Years 9 Months
Case Report: TK
Case Report: TK
Case Report: CM Aged 11 Years 5 Months
Case Report: CM
Case Report: CM
Case Report: AB Aged 12 Years 8 Months
Case Report: AB
Case Report: AB
Case Report: NM Aged 11 Years
Case Report: NM
Case Report: NM
Case Report: GK Aged 13 Years 2 Months
Case Report: GK
Case Report: GK
DISCUSSION
ADDITIONAL CASE STUDIES (COURTESY OF DR DILIP PATEL)
15 Months Twin Block Treatment (Figs. 15.7A to G)
In Support Phase after Twin Blocks (Figs. 15.8A to F)
12 Months Treatment with Twin Blocks (Figs. 15.9A to I)
12 Months Treatment with Twin Blocks (Figs. 15.10A to D)
Twin Blocks Achieve a Nonsurgical Face Lift (Figs. 15.11A to H)
CHAPTER 16:
Management of Crowding
NONEXTRACTION THERAPY
Interceptive Treatment Arch Development
Treatment Concept
Integration of Twin Blocks andFixed Therapy
COMBINATION FIXED/FUNCTIONAL THERAPY
Case Report: KC Aged 11 Years 2 Months
Case Report: KC
Case Report: KC
MANAGEMENT OF CROWDING: NONEXTRACTION THERAPY
Case Report: NK Aged 11 Years 11 Months
Clinical Management
Case Report: NK
Case Report: NK
Case Report: JS Aged 12 Years 6 Months
Case Report: JS
Case Report: JS
Treatment Concept
Case Report: AMcD Aged 12 Years 9 Months
Case Report: AMcD
Case Report: AMcD
COMBINATION THERAPY BY TWIN BLOCKS AND FIXED APPLIANCES
Case Report: TS Aged 14 Years 2 Months
Clinical Management
Case Report: TS
Case Report: TS
MANAGEMENT OF CROWDING WITH AN ANTERIOR OPEN BITE
Case Report: RG Aged 11 Years 6 Months
Case Report: RG
Case Report: RG
TREATMENT OF CONTRACTED ARCHFORM
Case Report: SM Aged 12 Years 5 Months
Case Report: SM
Case Report: SM
CHAPTER 17:
Extraction Therapy
INTRODUCTION
Case Report: KM Aged 11 Years 9 Months
Case Report: KM
Case Report: KM
TREATMENT OF PATIENTS WITH UNFAVORABLE SKELETAL AND DENTAL FACTORS
Case Report: GMcD Aged 12 Years 1 Month
Case Report: GMcD
Case Report: GMcD
Case Report: LC Aged 10 Years 9 Months
Clinical Management
Case Report: LC
Case Report: LC
CHAPTER 18:
Treatment of Facial Asymmetry
INTRODUCTION
CASE REPORT: M MCK AGED 10 YEARS 4 MONTHS
Bite Registration
Appliance Design
Clinical Management
Case Report: MMcK
Case Report: MMcK
CHAPTER 19:
Magnetic Twin Blocks
INTRODUCTION
MAGNETIC FORCE
ATTRACTING OR REPELLING MAGNETS
Attracting Magnets
Treatment of Facial Asymmetry
Repelling Magnets
Case Report: FH Aged 14 Years 11 Months
Case Report: FH
Case Report: FH
MAGNETIC FORCE IN THE CORRECTION OF FACIAL ASYMMETRY
CHAPTER 20:
Adult Treatment
INTRODUCTION
Case Report: HC Aged 42 Years 8 Months
Case Report: HC
Case Report: HC
TREATMENT OF A YOUNG ADULT
Case Report: PW Aged 17 Years 4 Months
Case Report: PW
Case Report: PW
Case Report: GJ Aged 27 Years 6 Months
Case Report: GJ
CHAPTER 21:
Temporomandibular Joint Pain and Dysfunction Syndrome
INTRODUCTION
THE IMPORTANCE OF OCCLUSION
Case Report: JK Aged 43 Years
Case Report: JK
Case Report: KW Aged 26 Years
RELIEF OF PAIN
Case Report: KW
CASE HISTORY AND DIAGNOSIS
Freedom of Mandibular Movement
The Reciprocal Click
The Closed Lock
Internal Derangement
Treatment Rationale
TEMPOROMANDIBULAR JOINT THERAPY
Splint Therapy
Twin Blocks in TemporomandibularJoint Therapy
Case Selection
APPLIANCE DESIGN
CLINICAL MANAGEMENT
Traction to Open the Bite
Stages of Treatment
Round Tripping
Case Report: RD Aged 36 Years
Case Report: RD
Case Report: RD
ANTERIOR OPEN BITE TEMPOROMANDIBULAR JOINT DYSFUNCTION
Case Report: ML Aged 38 Years
Case Report: ML
Case Report: LJ Aged 44 Years
Case Report: LJ
ACKNOWLEDGMENTS
CHAPTER 22:
Pitfalls and Problems: Contraindications for Functional Therapy
PITFALLS IN DESIGN AND MANAGEMENT OF TWIN BLOCKS
PITFALLS AND PROBLEM PATIENTS
Contraindications for Functional Therapy
Dolichofacial Class II Division I Malocclusion
Bimaxillary Dental Protrusion
Problem Patients
Severe Tongue Thrust
Unstable Occlusion after Mandibular Advancement
A “Sunday Bite”
Relapse due to Soft Tissue and Skeletal Factors
Limited Growth Response
A Late Developer
Incorrect Diagnosis
CHAPTER 23:
New Horizons in Orthodontics
INTRODUCTION
ARCH DEVELOPMENT
APPLIANCE DESIGN
Trombone and Lingual Arch Developer
Case Report: CS Aged 10 Years 1 Month
Case Report: CS
Case Report: SC Aged 8 Years
Case Report: SC
Case Report: AS Aged 7 Years 7 Months
Case Report: AS
Case Report: RW Aged 11 Years
Case Report: RW
INTERCEPTIVE TREATMENT OF CLASS II DIVISION 2 MALOCCLUSION
Case Report: LM Aged 8 Years
TRANSFORCE 2® SAGITTAL EXPANDER
Selecting the Correct Size of TransForce Sagittal Expander
Measure Sagittal Length
TRANSFORCE SAGITTAL ARCH DEVELOPMENT
Treated with Invisible Trans Force Appliances
Class III—Sagittal TransForce Appliance
Class III—Sagittal TransForce Appliance
TRANSVERSE ARCH DEVELOPMENT
TRANSFORCE 2® TRANSVERSE EXPANDER
TRANSFORCE TRANSVERSE ARCH DEVELOPMENT IN MIXED DENTITION
Transverse TransForce Appliances 8 Months
Fixed Appliances to Detail Occlusion
Transverse Arch Development
Adult Therapy—Arch Development
Fixed Appliances to Complete Treatment
Transverse and Sagittal Arch Development
SUMMARY
CHAPTER 24:
Fixed Twin Blocks
TREATMENT CONCEPTS AND PROTOCOL
DEVELOPMENT OF FIXED TWIN BLOCKS
EVOLUTION OF FIXED TWIN BLOCKS PHASE 1—2008
Preformed Occlusal Blocks
PHASE 1—INTEGRATION WITH FIXED APPLIANCES
INDIVIDUAL FIXED BLOCKS
PHASE 2—2010: ELIMINATES ATTACHMENT TO MOLAR BANDS
PHASE 3—2014: THE ULTIMATE SOLUTION
New Designs for Fixed Twin Blocks
FIXED TWIN BLOCKS PHASE 3—2014
The Ultimate Solution for Fixed Functional Therapy
GUIDELINES FOR CASE SELECTION
Orthopedic Correction
Orthodontic Correction
INTEGRATING ORTHODONTIC AND ORTHOPEDIC THERAPY
ARCH DEVELOPMENT BEFORE MANDIBULAR ADVANCEMENT
CONCURRENT ARCH DEVELOPMENT AND FIXED TWIN BLOCKS
INTEGRATED FIXED ANDFUNCTIONAL THERAPY
MANAGEMENT OF SEVERE CLASS II DIVISION 1 MALOCCLUSION
Fixed Twin Blocks in Mixed Dentition
Two Phase Treatment and Extraction Therapy
CONSTRUCTION BITE AND INDIRECT BONDING TECHNIQUE
LABORATORY PREPARATION OF TRANSFER POSITIONING TRAYS
INDIRECT TECHNIQUE FOR BONDING FIXED TWIN BLOCKS
FIXED TWIN BLOCKS IN CLASS IIDIVISION 2 MALOCCLUSION
POSITIONING TRAYS FOR CLASS II DIVISION 2 MALOCCLUSION
FIXED TWIN BLOCKS IN SEVERE DOLICHOFACIAL PATTERN
TRANSFORCE FIXED TWIN BLOCKS
FIXED TWIN BLOCKS AND SAGITTALARCH DEVELOPMENT
COMBINING FIXED TWIN BLOCKS AND FIXED APPLIANCES
Profile Change with Mandibular Advancement
Combining Fixed and Functional Therapy
FIXED TWIN BLOCKS IN POST-PUBERTAL STAGE
RETENTION
CHAPTER 25:
Fixed Functional Appliances
FORM AND FUNCTION
THE HERBST APPLIANCE
The Original Herbst Appliance
The Jasper Jumper
Fitting the Jasper Jumper (Figs. 25.3A to D)
EXAMPLES OF FIXED FUNCTIONAL APPLIANCES
Twin Force Bite Corrector
Class II Correction
Class III Correction
Arch Development andTwin Force Bite Corrector
Forsus Fatigue Resistant Device( Figs. 25.10 and 25.11)
Mild Class II Division I Forsus Appliance
Appliances for Mandibular Advancement
Intermaxillary Traction
Spring-Loaded Fixed Functional Appliances
CHAPTER 26:
Treatment of Sleep Apnea Using Mandibular Repositioning Appliances
INTRODUCTION
EVOLUTION OF INTRAORAL APPLIANCES
PATIENT SELECTION FORINTRAORAL APPLIANCES
POSSIBLE SIDE EFFECTS
DAILY EXERCISE TO STRETCH THE LATERAL PTERYGOID MUSCLE
STUDIES OF THE EFFECTIVENESS OF INTRAORAL APPLIANCES IN THE MANAGEMENT OF SNORING AND OSA
TYPES OF ORAL APPLIANCES FOR TREATMENT OF SNORING AND OSA
Tongue-Retaining Device
Devices for Lifting of the SoftPalate and Uvula Repositioning
OPAP Devices (Oral Pressure Appliance)
PROTRUSIVE BITE REGISTRATION
THE PHONETIC BITE
THE NEUROMUSCULAR BITE
THE MOSES APPLIANCE AND THE MOSES BITE
TWIN BLOCKS IN TREATMENT OFSLEEP APNEA
Robin’s Monobloc
TWIN BLOCKS INCREASE THE AIRWAY
TWIN BLOCKS IN CLASS II THERAPY
TWIN BLOCKS IN TREATMENT OF SLEEP APNEA
BREATHE EASY TWIN BLOCKS
Examples of Treatment with Twin Blocks by Dr Dillip Patel with Positive Changes in the Airway and Facial Aesthetics (Figs. 26.27 to 26.30)
SLEEP APNEA AND HEALTH
CHAPTER 27:
The Flat Earth Concept of Facial Growth
LIMITATIONS OFCEPHALOMETRIC ANALYSIS
RELEVANCE OF STATISTICAL EVIDENCE
THE FLAT EARTH CONCEPT OF FACIAL GROWTH
Two-Dimensional Representation of Mandibular Length
The Peripheral Length of the Mandible
Before Treatment
After Treatment
Comparison of Linear andVolumetric Values
Statistical Evaluation of Aesthetic Factors
VOLUMETRIC ANALYSIS OF FACIAL GROWTH BY IMAGING TECHNOLOGY
MORPHOMETRIC ANALYSIS
A Morphometric Analysis of Consecutively Treated Twin Block Patients
CONCLUSIONS
CHAPTER 28:
Growth Response to Twin Block Treatment
INTRODUCTION
THE TWIN BLOCK TRACTION TECHNIQUE
GROWTH RESPONSE TOTWIN BLOCKS WITH TRACTION
Control Groups
Control Group 1
Control Group 2
Material and Method
Cephalometric Analysis
Statistical Analysis Compared to Untreated Control Samples
Michigan Series Controls (Group 1)
Nijmegen Series Controls (Group 4)
Evaluation of Mean Growth Changes
Mandibular Growth Change in Boys
Growth in Facial Height
Mandibular Growth Change in Girls
Growth in Facial Height
Evaluation of Results
Discussion
TWIN BLOCKS VERSUS FIXED APPLIANCE
Bass, Bionator, Twin Block and Controls
TWIN BLOCKS AND MATCHEDNORMATIVE GROWTH DATA
TWIN BLOCKS FR-2 AND CONTROLS
TWIN BLOCK APPLIANCETREATMENT EFFECTS
Methods and Materials
Statistical Analysis
Treatment Effects on the Maxilla
Treatment Effects on the Mandible
DENTOALVEOLAR CHANGES
POST-TREATMENT STABILITY
Methods and Materials
Results
Maxillary Changes Post-Treatment
Mandibular Changes Post-Treatment (Table 28.5)
Dental Changes Post-Treatment
Conclusion
INTERPRETATION OF GROWTH CHANGES
TEMPOROMANDIBULAR JOINT ADAPTATIONS FOLLOWING TWO PHASE THERAPY: A MAGNETIC RESONANCE IMAGING STUDY
TWIN BLOCK THERAPY TREATMENT
SUMMARY
CONCLUSION
CHAPTER 29:
Art and Science in Orthodontics
DENTAL CHESS
THE ROLE OF SCIENCE IN ORTHODONTICS
TWIN BLOCK STUDIES
Retrospective Statistical Studies
LIMITATIONS OF STATISTICAL ANALYSIS
A Randomized Controlled Trial
PITFALLS IN DESIGN AND MANAGEMENT OF TWIN BLOCKS
Unaesthetic Appliances with Excessively Thick Occlusal BlocksClasps on Lower Molars Prevent Eruption for Vertical Control
ERRORS IN BITE REGISTRATION
Incorrect Bite Registration
Correct Bite Registration andAesthetic Appliance Design
CONTROL OF THE VERTICALDIMENSION
VERTICAL CONTROL OF DEEP OVERBITE
VERTICAL CONTROL OFANTERIOR OPEN BITE
THE ART OF ORTHODONTICS
ORTHODONTICS OR ORTHOPEDICS?
Two Typical Patients
AN ALLEGORY
The Ostrich, The Leopard and The Peacock
REVIEW OF FUNCTIONALTREATMENT OBJECTIVES
LIFE BEFORE TWIN BLOCKS
Piano Keys
INDEX
TOC
Index
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