TREATMENT OF SKELETAL CLASS II WITH RETROGNATHIC MANDIBLE

IN YOUNG PATIENT USING MODIFIED SAGITTAL GUIDANCE TWIN-

BLOCK APPLIANCE (CASE REPORT)

SHERLIANA YANITA*, HILDA FITRIA LUBIS**, MUSLIM YUSUF**

*RESIDENT, DEPARTMENT OF ORTHODONTICS

**LECTURER, DEPARTMENT OF ORTHODONTICS, FACULTY OF DENTISTRY, UNIVERSITAS
SUMATERA UTARA, MEDAN, INDONESIA

INTRODUCTION
Class II malocclusion is one of orthodontic problems which require early intervention. Class II malocclusion usually causes esthetic
and functional problems. Functional assessment is performed during clinical examination especially in growing patients. The main
use of functional appliances is the treatment of Class II/1 malocclusion in growing individuals. They have the capability to reduce an
overjet and overbite, and achieve a Class I relationship, then finished with fixed appliances. In this case, we used a modified
sagittal-guidance Twin-block (SGTB) appliance for the 10-year-old girl with skeletal Class II malocclusion

CASE REPORT
ANAMNESIS TREATMENT METHOD
A 10-year-old girl patient with chief complaints were proclined upper This patient was treated using modified Sagittal
anterior teeth and crowding of the lower anterior teeth Guidance Twin-Block (SGTB) (Fig. 3&4). SGTB was actually
a fixed maxillary component with removable mandible
EXTRAORAL EXAMINATION
component. Her parents chose the removable type of
Normal and symmetry face; convex facial profile, (Fig. 1)
modified SGTB and willing to cooperate over the
treatment time. Appliance would be bonded if the patient
didn’t cooperative during the treatment time.

Fig. 1

INTRAORAL EXAMINATION Fig. 3 Fig. 4

Angle Class II molar relationships bilaterally; Class II canine
relationship on right side but Class I on left side. Overjet of 11/41 was 6
mm, 21/31 was 7 mm. Overbite of 11/41 was 3 mm and 21/31 was 6 mm.
The mandibular incisor were crowded and impinging on palatal
tissue when occlusion and midline was shifted to the right by 1 mm
(Fig. 2).
Fig. 2
TREATMENT RESULTS
After 12 months of treatment, overjet was reduced (11/41
2.5mm; 21/31 3mm); the impinging overbite was reduced;
overbite 11/41 2.5 mm and 21/31 3.5mm; lower anterior teeth
being more aligned; class I canine and molar
relationships were achieved at the both side but the
interdigitation was not occluded yet (Fig. 5,6). ANB
decreased 2.5º from 6º to 3.5º and Witts appraisal
decreased from 7.5mm to 0mm. The mandible was
positioned forward which shown by the SNB from 71º to
73.5º

CEPHALOMETRIC ANALYSIS
Class II skeletal pattern with retrognathic mandible where maxilla
Fig. 5
was normal (SNA 77º; SNB 71º; ANB 6º; Witts appraisal 7.5mm), high
mandibular plane angle (MP-SN 45º) and vertical growth pattern
(NSGn 72º). Inclination of both maxillary and mandible incisors were
normal (U1-SN 104º; L1-MP 89º).

DISCUSSION
Skeletal Class II malocclusion could be a
result of prognathic maxilla and normal
mandible, retrognathic mandible and
normal maxilla or a combination of both.
McNamara stated that mandibular
growth can be increased or decreased by
changing the postural position.
Functional appliances changed the
position of mandible by altering the
functional environment. Orthopaedic
Class II correction in pre-adolescent
period is more effective because the
tissues of the craniofacial complex may
be more adaptive at younger age.
CONCLUSION
Growth modification is a REFERENCES
successful approach for children
with retrognathic mandible
problem. Successful of treatment
depends on patient’s cooperation.
Although this modified functional
appliance corrected the overjet
and Witts appraisal significantly,
but this appliance couldn’t correct
the interdigitation, so we will
continue with fixed appliance
treatment for detailing occlusion.
Fig. 6
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