Ravelling Of Skeletal, Dental and Soft Tissue Changes between Twin Block and HERBST Appliances in Growing Children with Class II Malocclusion: A Systematic Review
Year: 2025
Type: review
Study design: Systematic Review
Abstract: Objective - Our systemic review aimed to evaluate the efficacy of applying Herbst and Twin Block appliances in the treatment of Class II malocclusion among children. Materials and Methods - A systematic review following PRISMA guidelines was conducted to compare Twin Block and Herbst appliances in treating Class II malocclusion in growing children (12–18 years). Studies were identified through PubMed, ScienceDirect, Google Scholar, and Cochrane Library (2000–2024) using the terms: Twin Block OR Herbst Appliance AND Skeletal, Dental, Soft Tissue changes. Eligible studies included RCTs, CCTs, and cohort studies in English. Primary outcome assessed was skeletal changes; secondary outcomes included dental and soft tissue effects. Study quality was scored (0–9) based on design, sample details, error analysis, and statistics, and categorized as high, medium, or low quality. Results - Eighteen studies met the inclusion criteria from an initial yield of 4306 records across four databases. The selected studies evaluated skeletal, dental, and soft tissue changes in growing patients treated with Twin Block or Herbst appliances for Class II malocclusion. Twin Block therapy predominantly demonstrated mandibular advancement and correction of molar relationship, with variable improvements in facial aesthetics. Herbst appliance use was associated with increased mandibular ramal height and similar skeletal corrections. However, direct comparisons were limited due to heterogeneity in study designs and outcome measures. Quality assessment classified nine studies as high quality and nine as medium. Although all studies had adequate sample sizes, only eight were randomized controlled trials, and comprehensive error analysis was reported in a minority. Statistical methods were adequate in most studies, though several relied solely on descriptive analysis. Conclusion - Both Twin Block and Herbst appliances are effective in correcting Class II malocclusion through favourable skeletal, dental, and soft tissue modifications. While Herbst offers greater mandibular advancement due to its fixed design and superior compliance, Twin Block is associated with enhanced skeletal changes and improved facial aesthetics. Overjet reduction is comparable, though incisor proclination is more pronounced with the Herbst. Despite faster initial correction with the Herbst, overall treatment durations are similar. Longterm stability, gender-specific responses, and retention protocols warrant further investigation
Authors: Dr. Lay Rakeshkumar Doshi, Dr. Narayan Kulkarni, Dr. Ipsit Trivedi, Dr. Nirali Shah, Dr. Bhumi Shah
Language: English
Subfield: Orthodontics
Field: Dentistry
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4410178006