Orthodontic Before and After Dubai: Class II Correction with Twin Block & Braces (14‑Year‑Old Female)

This 14-year-old patient in Dubai was concerned about prominent upper front teeth, irregular teeth and a recessed-looking chin. The diagnosis included a Class II bite pattern. Treatment combined a Twin Block functional appliance with fixed metal braces: the first phase addressed the bite relationship during growth, and the braces phase aligned the teeth and refined the final bite.

The published outcome shows improved tooth alignment, bite relationships and facial profile. Retainers and follow-up form part of maintaining the result.

The first consultation included an examination, photographs and cephalometric records. The treatment goals, options, expected stages and hygiene responsibilities were explained to the patient and her parents.

• Skeletal: skeletal Class II pattern, Class II Division 1 due to reduced mandibular growth (not excessive maxillary growth).

• Dental: increased overjet (~6 mm), deep overbite, bilateral scissors bite, crowding of upper teeth and lower front teeth; no severe crowding requiring extractions.

• Soft tissue: convex profile with a retrusive chin and strain on the lower lip.

• Class II and Class III describe different bite relationships; diagnosis also considers the teeth, jaws and growth.

The goals were to reduce the overjet, correct the deep bite and scissors bite, align both arches and improve the profile where possible. The two phases were selected for this patient’s diagnosis and remaining growth. Early or two-phase treatment is not necessary for every child and does not automatically reduce total treatment time.

Phase 1 — Functional Orthopedics (6 months)

• Twin Block: a custom functional appliance that postures the lower jaw forward to address a selected Class II bite during growth.
• The appliance changes the relationship between the upper and lower teeth while it is worn; dental and growth-related responses vary.
• This patient’s functional-appliance phase lasted approximately 6 months.
• Prescribed wear, hygiene and reviews were important. The phase was followed by fixed braces to complete alignment and bite detailing.

Phase 2 — Comprehensive Fixed Appliances (≈16 months)

• Fixed metal brackets and archwires aligned the teeth and coordinated the upper and lower arches.
• Class II elastics helped refine the bite relationship as prescribed.
• Finishing adjustments addressed tooth position and contacts.
• The reported retention plan included a bonded lower retainer and an upper removable retainer.

Clear aligners and other options were discussed. For this patient’s diagnosis, Twin Block followed by braces was the selected plan. Some aligner systems incorporate mandibular-advancement features, but suitability depends on the individual case. More severe skeletal Class II discrepancies may need surgical assessment after growth; this case was completed without jaw surgery or premolar extractions.

Pre-treatment frontal view

• Widened upper arch
• Scissors bite on both sides
• Overjet of approximately 5–6 mm
• Upper dental midline shift

Post-treatment frontal view

• Midline aligned

• All scissors' bites corrected

• Lower arch well aligned with upper arch

• Right and left arches are balanced

Pre - Treatment Right occlusal view

• End on Canine Relationship

• End on Molar Relationship

• Scissors bite

Post - Treatment Right occlusal view

• Class I Canine Relationship

• Class I Molar Relationship

• Ideal occlusal contacts

Pre - Treatment left occlusal view

• End on canine

• End on molar

• Scissors bite

Post - Treatment left occlusal view

• Cross bites corrected

• Class I Canine Relationship

• Class I Molar Relationship

• Ideal occlusal contacts

Pre‑treatment maxillary arch

• 2nd premolars are labially placed

• Crowding in the anteriors

Post‑treatment maxillary arch

• Balanced upper arch

• Corrected upper midline

• Achieved ideal U-Shaped arch form

Pre‑treatment mandibular arch

• Mild Crowding

Post‑treatment mandibular arch

• Corrected crowding

• Well aligned lower teeth

• Achieved ideal arch form

• Precisely Placed lower fixed retainer

• Overjet & Overbite : overjet reduced from ~6 mm to ideal; deep overbite normalized. Addressing the overbite protects the teeth and gums and supports overall oral health.

• Bite : from Class II malocclusions to Class I molar relationship and stable posterior contacts; bilateral scissors bite corrected.

• Alignment: upper front teeth, lower front teeth, and adjacent teeth aligned; arch forms coordinated.

• Profile : improved chin projection and balanced profile; better harmony between lips and teeth.

• Smile : broader, brighter smile with improved incisor display—an authentic new smile the patient and family are proud of.

• Treatment time: ~22 months total (6 + 16), with regular reviews to protect oral health and reinforce treatment goals.

Overjet is the horizontal distance between the upper and lower front teeth. Overbite is their vertical overlap. A large overjet and deep overbite may occur together in a Class II bite. Treatment is chosen according to the measured problem, dental health and stage of development.

Twin Block is a functional appliance used for selected Class II problems in growing patients. It holds the lower jaw forward during wear and can help reduce prominent upper front teeth through dental and growth-related changes. Fixed braces may then be needed for alignment and detailing. Response and total treatment time vary.

• Upper retainer worn full-time for 6 months, then nights only

• Patient educated on hygiene, retainer use, and follow-up schedule

• Can braces alone fix this type of case? That depends on the dental and skeletal findings, remaining growth and goals. This patient’s plan used Twin Block first, followed by fixed braces; it is one possible sequence, not a rule for every Class II bite.

• Is early treatment necessary for most children? No. Some developing bite problems benefit from earlier care, while others are monitored until a later stage. The decision follows examination and growth assessment.

• Will aligners work if we want discreet treatment? Some growing patients can be considered for aligner-based treatment, including systems with mandibular-advancement features. The plan must fit the diagnosis; Twin Block and fixed braces were selected for this case.

• How do you protect oral health during treatment?
  We coach oral hygiene at every visit to limit plaque around teeth and appliances and reduce risk of gum disease. Good care supports long term dental health after treatment.

Dr. Sree, MDS (Orthodontics)
Specialist Orthodontist • Teen & complex cases • Since 2010 • 3,000+ cases

WhatsApp/Call: +971 58 596 3637
Book: Free consultation at Dubai (Deira)