TWIN BLOCK

APPLIANCE DESIGN AND CONSTRUCTION

YUVASHREE S R
1st YEAR PG
 PATIEN
COMFO AESTH T
RT ETIC FRIEND
LY
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Occlusal inclined plane
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A midline screw to expand the upper arch

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Clasps on upper premolars and molars.
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Clasps on lower premolars and incisors

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A labial bow to retract the upper incisors
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Springs to move individual teeth and provision for
extraoral traction
• A common modification to appliance design
preferred by some orthodontists is the addition of
incisal capping over the lower incisors.
• The reasoning is to prevent proclination of the
lower incisor.
• Although the lower incisors procline by up to 5°
during the Twin Block stage, they upright during
the support stage. After treatment no significant
proclination of lower incisors occurs.
• They also observed decalcification of the tips of
the lower incisors in a few cases where the oral
hygiene was poor. So the incisal capping was
abondoned thereafter.
LABIAL BOW
• In the early stages of development, the upper Twin Block
invariably incorporated a labial bow.
• But retracting upper incisors prematurely limits the scope
for functional correction by mandibular advancement.
This led to the conclusion that a labial bow is not always
required unless it is necessary to upright severely
proclined incisors.
• An alternative design by McNamara and Mills
have gained popularity with acrylic pad labial to
the lower incisors as an additional means of
retention and control.
OCCLUSAL INCLINED PLANE
• During the evolution of the technique, the angulation
of the inclined plane varied from 90° to 45° to the
occlusal plane, before arriving at an angle of 70° to
the occlusal plane.
• Drawback of 90° – Posterior open bite.
• The angulation was finally changed to steeper angle
of 70° to the occlusal plane to apply a more
horizontal component of force.
• An angle of 45° may be used for patients who have
more difficulty in maintaining a forward mandibular
posture.
OCCLUSAL INCLINED PLANE
• The inclined plane on the lower bite block is angled from
the mesial surface of the second premolar or
deciduous molar.
• The lower block should extend distally to the buccal cusp
of the lower second premolar or deciduous molar,
stopping short of the distal marginal ridge.
• Buccolingually, the lower block
covers the occlusal surface
of the lower premolars or
deciduous molars.
OCCLUSAL INCLINED PLANE
• The upper inclined plane is angled from the mesial
surface of the upper second premolar to the mesial
surface of the upper first molar.
• The flat occlusal portion then passes distally over the
remaining upper posterior teeth.
• Since the upper arch is wider than the lower, it is
only necessary to cover the
lingual cusps of the upper
posterior teeth, rather than
the full occlusal surface.
DELTA CLASP
• Designed by William J Clark.
• Similar to Adams clasp.
• Originally – triangular (delta).
• Loops may also be circular or ovoid.
ADVANTAGES
THE CLASP DOES NOT OPEN WITH REPEATED INSERTION AND
REMOVAL

MAINTAINS ITS SHAPE BETTER

REQUIRES LESS ADJUSTMENT

LESS SUBJECT TO BREAKAGE

EXCELLENT RETENTION
OTHER RETENTIVE COMPONENTS
• Ball-ended clasps are routinely employed mesial
to lower canines and in the upper premolar or
deciduous molar region to gain interdental
retention from adjacent teeth.
• C-clasps are useful in mixed dentition where
they can be used for peripheral clasping on
deciduous molars and canines.
BASE PLATE

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Additional strength
HEAT CURE
and accuracy

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Speed and easier
COLD CURE manipulation
 TWIN BLOCK
FOR ARCH
DEVELOPME
NT

TRANSVERS
E
DEVELOPME
NT

FOR SAGITTAL
ANTERIOR DEVELOPME
OPEN BITE NT

TRANSVERSE
AND
SAGITTAL
DEVELOPMEN
T
TRANSVERSE DEVELOPMENT
• It is now possible to combine transverse arch development
simultaneously with sagittal and vertical correction of arch
relationships by combining Twin Block and Schwarz
Appliances.

• Screws may be incorporated in the upper and lower

Twin Blocks to develop the archform in mixed dentition.
• The Twin Block Crozat appliance (Crozat, 1920)
provides a useful alternative with minimum palatal
and lingual coverage.
• An upper transpalatal arch or lower Jackson design
may be used as an alternative to screws for arch
development.

• The palate-free Twin Block is an excellent alternative

for added comfort and to improve speech.
SAGITTAL DEVELOPMENT
• The Twin Block sagittal appliance is designed primarily for
antero-posterior arch development by positioning two screws which
are aligned antero-posteriorly in the palate.
• Some oblique movement is also possible by offsetting the angulation
of the screws.

• If the cut is positioned distal to the canines or premolars the

distalization of posterior teeth increases in proportion to
the number of teeth included as anchorage in the anterior
segment.
TRANSVERSE AND SAGITTAL
DEVELOPMENT
• Many cases require a combination of transverse
and sagittal development. A three-way screw
incorporates two screws in a single housing and
allows independent activation for transverse and
sagittal expansion.