Treatment of Class II div 1 malocclusion with quadri block-a modified fixed twin block appliance

In growing patients. Class II malocclusion can be corrected by various modalities. Among all methods, functional appliances bring about better facial esthetics and functional harmony. Twin block is a most common among all functional appliances used to the correct skeletal discrepancy in growing individuals.1−4 A crowded dental arches necessities an additional prefunctional orthodontics to align the dental arches for improvement of arch forms and to achieve a stable occlusion. Hence treatment of patients presenting with combination of crowding in arches and skeletal discrepancy requires increased treatment time; which further increases need for compliance from patients. In recent years, large number of fixed attachments has been developed to integrate functional mandibular advancement with fixed appliance therapy with each attachment having their own advantages and disadvantages.5−8 Hence this article is an attempt to introduce a new modified fixed twin block design, which can be used in adjunct with fixed appliance. This modified fixed twin block helps us to correct the skeletal discrepancy optimally; as the functional phase is preceded by prefunctional fixed orthodontic appliance therapy to overcome the problem of pathologic construction bite in cases with crowded dental arches and with reduced over jet due to dental compensations. Hence, this design reduces treatment time and utilizes residual growth of patient efficiently to correct skeletal discrepancy.