Cephalometric effects of Twin-block and van Beek Headgear-Activator in the correction of Class II malocclusion

The Twin-block (TB) and the van Beek Headgear-Activator (vBHGA) are indicated for patients with Class II malocclusion with a retrognathic mandible. Although the former is commonly prescribed for horizontally growing patients, the latter is often recommended for those growing vertically. This study aimed to compare the skeletal, dentoalveolar, and soft-tissue short-term effects of TB and vBHGA, taking growth patterns into account.

Immediate prefunctional (T1) and postfunctional appliance (T2) lateral cephalometric radiographs were retrospectively obtained for vBHGA (n = 46), TB (n = 45), and untreated control (n = 45) groups. The interaction of several variables at T1, T2, and T2 - T1, as well as the resultant treatment effect, were analyzed using the analysis of covariance regression models at the 5% significance level.

Except for a greater reduction in Wits measurement (3.0 mm; P <0.0001) in the TB group, no anteroposterior (AP) skeletal difference was observed between the 2 appliances (ANB, 0.530; P = 0.07) (Harvold, 0.13 mm; P = 0.81). Both improved the AP skeletal relationship (ANB and Harvold) compared with the control (P <0.05). Although this mostly occurred because of the forward positioning of the mandible with the TB (SNB, 0.960; P = 0.01), the maxillary restriction was the main mechanism with the vBHGA (SNA, 1.590; P <0.01). Dentoalveolar compensations were more pronounced with the TB (IMPA, 1.92; P = 0.02), leading to greater overbite and overjet correction. Only the inclination of the maxillary incisors showed interaction with the growth pattern, with the TB horizontal growers experiencing more retroclination (U1-NA°. 3.620; P = 0.0067).

Both appliances produced similar modest AP skeletal changes that, together with dentoalveolar compensations, were able to correct the Class II malocclusion regardless of growth pattern.