Clear aligner versus twin block dalam perawatan maloklusi kelas II pada anak:  ulasan sistematik

Claudia Nur Rizky Jayanti; Risti Saptarini Primarti

doi:10.24198/pjdrs.v9i2.62513

Clear aligner versus twin block dalam perawatan maloklusi kelas II pada anak: ulasan sistematik

Claudia Nur Rizky Jayanti, Risti Saptarini Primarti

Abstract

ABSTRACT

Pendahuluan: Maloklusi Kelas II merupakan salah satu masalah ortodontik yang paling umum dijumpai. Dalam beberapa tahun terakhir, penggunaan aligner bening (clear aligner/CA) telah berkembang untuk menangani kasus-kasus yang lebih kompleks, termasuk maloklusi Kelas II dengan pendekatan kemajuan mandibula (CA dengan mandibular advancement/MA). Meskipun CA menawarkan alternatif modern terhadap alat fungsional tradisional, efektivitasnya dibandingkan dengan alat yang telah mapan seperti Twin Block (TB) belum diteliti secara menyeluruh. Ulasan sistematis ini bertujuan untuk membandingkan hasil perawatan dan efek dentoskeletal antara CA dengan MA dan TB dalam koreksi maloklusi Kelas II pada anak dan remaja. Metode: Kajian ini dilakukan berdasarkan pedoman Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Artikel yang diterbitkan antara tahun 2014 hingga 2024 diambil dari basis data ScienceDirect, PubMed, dan Scopus menggunakan kata kunci yang telah ditentukan sebelumnya dan kerangka kerja Population-Intervention-Comparison-Outcome (PICO). Sebanyak enam studi diikutsertakan untuk mengevaluasi efektivitas kedua modalitas perawatan dalam memperbaiki hubungan sagital rahang, kenyamanan pasien, dan dimensi jalan napas. Hasil: Hasil menunjukkan bahwa baik CA maupun TB efektif dalam meningkatkan hubungan sagital antara maksila dan mandibula. TB menunjukkan perubahan skeletal yang lebih besar, khususnya pada reposisi mandibula, sedangkan CA memberikan kenyamanan, estetika, dan tingkat kepatuhan pasien yang lebih baik. Simpulan: CA terbukti lebih efektif dalam meningkatkan dimensi jalan napas, terutama di area hipofaring. Meskipun kedua pilihan perawatan menunjukkan hasil yang menjanjikan, diperlukan uji coba terkontrol acak jangka panjang untuk mengevaluasi stabilitas dan efektivitas jangka panjangnya. Rencana perawatan sebaiknya disesuaikan dengan kebutuhan spesifik pasien, kondisi klinis, dan luaran yang diharapkan.

KATA KUNCI: Alat ortodonti, Maloklusi, Angle Kelas I

Clear aligner versus twin block in the treatment of class II malocclusion in children: a systematic review

ABSTRACT

Class II malocclusions are among the most prevalent orthodontic problems. In recent years, clear aligner (CA) therapy has expanded its scope to include more complex cases, including the clear aligner with mandibular advancement (CA with MA) for treating Class II malocclusions. While CA provides a modern alternative to traditional functional appliances, their effectiveness in comparison to well-established devices like the Twin Block (TB) has not yet been thoroughly studied. This systematic review compares the treatment outcomes and dentoskeletal effects of CA with MA and TB appliances for Class II malocclusion correction in children and adolescents. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The articles, which covered publications from 2014 to 2024, were taken from the databases of ScienceDirect, PubMed, and Scopus. The search used predefined keywords and a Population-Intervention-Comparison-Outcome (PICO) framework. Six studies were included, evaluating the effectiveness of both treatment modalities in improving sagittal jaw relationships, patient comfort, and airway dimensions. Both CA and TB appliances effectively enhanced the sagittal relationship between the maxilla and mandible. TB appliances showed greater skeletal changes, particularly in mandibular repositioning, while clear aligners offered superior patient comfort, aesthetics, and compliance. CA was also more effective in improving airway dimensions, particularly in the hypopharyngeal region. While both treatment options show promise, further long-term randomized controlled trials are needed to better assess their stability and effectiveness. The treatment plan should be tailored to the patient's specific needs, clinical condition, and desired outcomes.

KEYWORDS: Orthodontic appliances, Malocclusion, Angle Class II

Keywords

Alat ortodonti, Maloklusi, Angle Kelas I, Orthodontic appliances, Malocclusion, Angle Class II

Full Text:

PDF

References

DAFTAR PUSTAKA

Abdellatif HM, Sawan N, Alabdulmohen AM, AlKheraif G, AlKhonin H, Ali A, et al. Prevalence and risk indicators of primary dentition malocclusion in Riyadh-Saudi Arabia using a new case definition: A cross-sectional study. Saudi Dent J [Internet]. 2024 Jan;36(1):60–5. Available from: https://doi.org/10.1016/j.sdentj.2023.09.003

De Ridder, L., Aleksieva, A., Willems, G., Declerck, D., & Cadenas de Llano-Pérula, M. (2022). Prevalence of Orthodontic Malocclusions in Healthy Children and Adolescents: A Systematic Review. International Journal of Environmental Research and Public Health, 19(12), 7446. Available from: https://doi.org/10.3390/ijerph19127446

Inayah Y, Horax S, Fajriani, Marhamah, Erwansyah E. Malocclusion: prevention and treatment during growth and development. Makassar Dental Journal [Internet]. 2021 Dec 1;10(3):264–7. Available from: https://doi.org/10.35856/mdj.v10i3.462

Zhou X, Chen S, Zhou C, Jin Z, He H, Bai Y, et al. Expert consensus on early orthodontic treatment of class III malocclusion. Int J Oral Sci [Internet]. 2025 Apr 1;17(1):20. Available from: https://doi.org/10.1038/s41368-025-00357-9

Nascimento LV do, De Sousa HJL, Paiva Neto G de O, Oliveira NC da S de, Meira G de F, Santos BRM dos. Treatment of Class II division 1 Angle malocclusion with Extrabucal apparatus: a case report. Brazilian Journal of Case Reports. 2022;2(3):83–9. Available from: https://doi.org/10.52600/2763-583X.bjcr.2022.2.3.83-89

Alhammadi MS, Qasem AAA, Yamani AMS, Duhduh RDA, Alshahrani RT, Halboub E, et al. Skeletal and dentoalveolar effects of class II malocclusion treatment using bi-maxillary skeletal anchorage: a systematic review. BMC Oral Health. 2022;22(1):1–16. Available from: https://doi.org/10.1186/s12903-022-02363-3

de Araújo Brito DB, Henriques JFC, Fiedler CF, Janson G. Effects of class ii division 1 malocclusion treatment with three types of fixed functional appliances. Dental Press J Orthod. 2019;24(5):30–9. Available from: https://doi.org/10.1590/2177-6709.24.5.030-039.oar

Shinwari AR, Zia MH. Impact of malocclusion of oral health related quality of life among 13-18 years visiting dental hospital. 2023;7(June):2172–8. Available from: https://doi.org/10.53730/ijhs.v7nS1.14467

Baskaradoss JK, Geevarghese A, Alsaadi W, Alemam H, Alghaihab A. The impact of malocclusion on the oral health related quality of life of 11 – 14 - year - old children. 2022;1–6. Available from: https://doi.org/10.1186/s12887-022-03127-2

Jain N, Soni S. An overview of class II division 2 malocclusion. Int J Health Sci (Qassim). 2021;5:214–21. Available from: https://doi.org/10.53730/ijhs.v5nS2.5635

Lone IM, Zohud O, Midlej K, Proff P, Watted N, Iraqi FA. Skeletal Class II Malocclusion: From Clinical Treatment Strategies to the Roadmap in Identifying the Genetic Bases of Development in Humans with the Support of the Collaborative Cross Mouse Population. J Clin Med. 2023;12(15):5148. Available from: https://doi.org/10.3390/jcm12155148

Cardarelli F, Drago S, Rizzi L, Bazzani M, Pesce P, Menini M, et al. Effects of Removable Functional Appliances on the Dentoalveolar Unit in Growing Patients. Medicina (B Aires). 2024 Apr 30;60(5):746. Available from: https://doi.org/10.3390/medicina60050746

Batra A, Shetty V. Effect of Twin-block Appliance on Pharyngeal Airway, Sleep Patterns, and Lung Volume in Children with Class II Malocclusion. J Contemp Dent Pract. 2022;23(1):66–73. Available from: https://doi.org/10.5005/jp-journals-10024-3289

JM S, A S, JF C. Obstructive Sleep Apnea [Internet]. Treasure Island (FL): StatPearls Publishing. 2024 [cited 2025 Mar 16]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459252/

McNicholas WT, Pevernagie D. Obstructive sleep apnea: transition from pathophysiology to an integrative disease model. J Sleep Res. 2022 Aug;31(4):e13616. Available from: https://doi.org/10.1111/jsr.13616

Zreaqat MH, Hassan R, Alforaidi S. Snoring and Obstructive Sleep Apnea in Children with Class II Skeletal Malocclusion: Efficacy of Twin Block Management. In: Işik B, editor. Rijeka: IntechOpen; 2023. Available from: https://doi.org/10.5772/intechopen.113375

Stoica SN, Nimigean V, Justina M, Vîrlan R. The Pathology of the First Permanent Molar during the Mixed Dentition Stage — Review. Applied sciences. 2023;13(438). Available from: https://doi.org/10.3390/app13010483

Inchingolo AD, Dipalma G, Ferrara I, Viapiano F, Netti A, Ciocia AM, et al. Clear Aligners in the Growing Patient : A Systematic Review. 2024;1–15. Available from: https://doi.org/10.3390/children11040385

Schneider-moser UEM. Very early orthodontic treatment : when, why and how ? Vol. 27. 2022. 1–47 p. Available from: https://doi.org/10.1590/2177-6709.27.2.e22spe2

Makhbul MZM, Hassan WNW. A Clinical Audit of the Success Rate of Removable Functional Appliances Treatment. Malays Dent J. 2019;1(1):61–73.

Radwan ES, Maher A, Montasser MA. Comparative Evaluation of Twin Block Appliance and Fixed Orthodontic Appliance in Early Class II Malocclusion Treatment: A Randomized Controlled Trial. J Contemp Dent Pract. 2022;23(11):1111–21. Available from: https://doi.org/10.5005/jp-journals-10024-3426

Liu A, Zhang W, Zhang W, Shi S, Chen Z, Liu Y, et al. Efficacy of a modified twin block appliance compared with the traditional twin block appliance in children with hyperdivergent mandibular retrognathia: protocol for a single-centre, single-blind, randomised controlled trial. BMJ Open. 2023;13(11):e071959–e071959. Available from: https://doi.org/10.1136/bmjopen-2023-071959

Bie RM Van Der, Bos A, Joseph J, Bruers M, Edwin R, Jonkman G. Patient adherence in orthodontics : a scoping review. BDJ Open. 2024;(May). Available from: https://doi.org/10.1038/s41405-024-00235-2

Sabouni W, Hansa I, Al Ali SM, Adel SM, Vaid N. Invisalign treatment with mandibular advancement: A retrospective cohort cephalometric appraisal. J Clin Imaging Sci. 2022;12:42. Available from: https://doi.org/10.25259/JCIS_64_2022

Behroozian A, Kalman L. Clear Twin Block: A Step Forward in Functional Appliances. Dent Hypotheses. 2020;11(3):91. Available from: https://doi.org/10.4103/denthyp.denthyp_14_20

AlMogbel AbdulMajeed. Clear Aligner Therapy: Up to date review article. J Orthod Sci. 2023 Sep;12(1):1–9. Available from: https://doi.org/10.4103/jos.jos_30_23

Vijayalakhsmi K. Textbook of orthodontics. 1st Editio. New Delhi, India: CBS Publishers & Distributors Pvt Ltd; 2020. 419 p.

Gurgel ML, de Oliveira Ruellas AC, Bianchi J, McNamara JAJ, Tai S, Franchi L, et al. Clear aligner mandibular advancement in growing patients with Class II malocclusion. AJO-DO clinical companion. 2023 Apr;3(2):93–109. Available from: https://doi.org/10.1016/j.xaor.2023.01.003

Meade MJ, Weir T. Clinical efficacy of the Invisalign mandibular advancement appliance: A retrospective investigation. American Journal of Orthodontics and Dentofacial Orthopedics. 2024;165(5):503–12. Available from: https://doi.org/10.1016/j.ajodo.2023.11.008

D’Antò V, De Simone V, Caruso S, Bucci P, Valletta R, Rongo R, et al. Effects of clear aligners treatment in growing patients: a systematic review. Frontiers in Oral Health. 2024;5(January). Available from: https://doi.org/10.3389/froh.2024.1512838

Feng Q, Jiang F, Wang H, Shen G, Zhao Z, Jiang L, et al. Evaluation of modified clear Twin Block aligner in treating adolescents with skeletal class III malocclusion: A two‐centre cephalometric study. Orthod Craniofac Res. 2024 Aug;27(4):665–73. Available from: https://doi.org/10.1111/ocr.12783

Lombardo EC, Lione R, Franchi L, Gaffuri F, Maspero C, Cozza P, et al. Dentoskeletal effects of clear aligner vs twin block—a short-term study of functional appliances. Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie. 2024 Sep 18;85(5):317–26. Available from: https://doi.org/10.1007/s00056-022-00443-1

Zhang Y, Zheng J, Wu Q, Jiang T, Xiao H, Du Y, et al. Three-dimensional spatial analysis of temporomandibular joint in adolescent Class II division 1 malocclusion patients: comparison of Twin-Block and clear functional aligner. Head Face Med. 2024 Jan 6;20(1):4. Available from: https://doi.org/10.1186/s13005-023-00404-y

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar 29;1–9. Available from: https://doi.org/10.1136/bmj.n71

Aromataris E, Fernandez R, Godfrey CM, Holly C, Khalil H, Tungpunkom P. Summarizing systematic reviews. Int J Evid Based Healthc. 2015 Sep;13(3):132–40. Available from: https://doi.org/10.1097/XEB.0000000000000055

Sun Z, Pan Y, Lin T, Lu H, Ai H, Mai Z. Comparison of cephalometric measurements of the Twin Block and A6 appliances in the treatment of Class II malocclusion : a retrospective comparative cohort study. 2022;10(16). Available from: https://doi.org/10.21037/atm-22-3762

Caruso S, Nota A, Severino M, Gatto R, Meuli S, Mattei A, et al. Mandibular advancement with clear aligners in the treatment of skeletal Class II . A retrospective controlled study. 2021;26–30. Available from: https://doi.org/10.23804/ejpd.2021.22.01.05

Zhang Y, Zheng J, Wu Q, Jiang T, Xiao H, Du Y, et al. Three - dimensional spatial analysis of temporomandibular joint in adolescent Class II division 1 malocclusion patients : comparison of Twin - Block and clear functional aligner. Head Face Med. 2024;1–14. Available from: https://doi.org/10.1186/s13005-023-00404-y

Cretella Lombardo E, Lugli L, Cozza P, Lione R, Loberto S, Pavoni C. Comparison between twin block appliance and mandibular advancement on clear aligners in the improvement of airway dimension: incremental versus maximum bite advancement. Frontiers in Oral Health. 2024;5(September):1–9. Available from: https://doi.org/10.3389/froh.2024.1463416

Yue Z, Yi Z, Liu X, Chen M, Yin S, Liu Q, et al. Comparison of invisalign mandibular advancement and twin-block on upper airway and hyoid bone position improvements for skeletal class II children : a retrospective study. 2023;1–10. Available from: https://doi.org/10.1186/s12903-023-03295-2

He J, Hu L, Yuan Y, Wang P, Zheng F, Jiang H, et al. Comparison between clear aligners and twin-block in treating class II malocclusion in children : a retrospective study. 2024. Available from: https://doi.org/10.22514/jocpd.2023.070

Wu Y, Yu Q, Xia Y, Wang B, Chen S, Gu K, et al. Does mandibular advancement with clear aligners have the same skeletal and dentoalveolar effects as traditional functional appliances ? BMC Oral Health. 2023;1–12. Available from: https://doi.org/10.1186/s12903-023-02709-5

Zreaqat M, Hassan R, Samsudin R, Alforaidi S. Effects of twin-block appliance on upper airway parameters in OSA children with class II malocclusion and mandibular retrognathia : a CBCT study Effects of twin - block appliance on upper airway parameters in OSA children with class II malocclusion and ma. Eur J Pediatr. 2023;(September). Available from: https://doi.org/10.1007/s00431-023-05226-3

Entrenas I, González‐Chamorro E, Álvarez‐Abad C, Muriel J, Menéndez‐Díaz I, Cobo T. Evaluation of changes in the upper airway after Twin Block treatment in patients with Class II malocclusion. Clin Exp Dent Res. 2019;5(3):259–68. Available from: https://doi.org/10.1002/cre2.180

Hamid T, Triwardhani A, Wardhana LK. Benefits and Risks of Orthodontic Treatment : A Scooping Review. 2022;5(1):18–26. Available from: https://doi.org/10.20473/ijdm.v5i1.2022.18-26

Ukra A, Bennani F, Farella M. Psychological aspects of orthodontics in clinical practice. Part one: treatment-specific variables. Prog Orthod. 2011 Nov;12(2):143–8. Available from: https://doi.org/10.1016/j.pio.2011.06.007

Schäfer K, Ludwig B, Meyer-Gutknecht H, Schott TC. Quantifying patient adherence during active orthodontic treatment with removable appliances using microelectronic wear-time documentation. Eur J Orthod. 2015 Feb;37(1):73–80. Available from: https://doi.org/10.1093/ejo/cju012

Al-Moghrabi D, Salazar FC, Pandis N, Fleming PS. Compliance with removable orthodontic appliances and adjuncts: A systematic review and meta-analysis. American Journal of Orthodontics and Dentofacial Orthopedics. 2017 Jul 1;152(1):17–32. Available from: https://doi.org/10.1016/j.ajodo.2017.03.019

Alfawzan AA. Evaluation of Patient Acceptance and Compliance with Clear Aligners vs. Lingual Braces: A Randomized Trial. J Pharm Bioallied Sci. 2024 Feb;16(Suppl 1):S546–8. Available from: https://doi.org/10.4103/jpbs.jpbs_854_23

Torsello F, Amico GD, Staderini E, Marigo L, Cordaro M, Castagnola R. applied sciences Factors Influencing Appliance Wearing Time during Orthodontic Treatments : A Literature Review. 2022. Available from: https://doi.org/10.3390/app12157807

AlMogbel A. Clear Aligner Therapy: Up to date review article. J Orthod Sci. 2023;12:37. Available from: https://doi.org/10.4103/jos.jos_30_23

Al-Nadawi M, Kravitz ND, Hansa I, Makki L, Ferguson DJ, Vaid NR. Effect of clear aligner wear protocol on the efficacy of tooth movement. Angle Orthod. 2021 Mar;91(2):157–63. Available from: https://doi.org/10.2319/071520-630.1

Papadimitriou A, Mousoulea S, Gkantidis N, Kloukos D. Clinical effectiveness of Invisalign ® orthodontic treatment : a systematic review. 2018. Available from: https://doi.org/10.1186/s40510-018-0235-z

O’Brien K, Wright J, Conboy F, Sanjie YW, Mandall N, Chadwick S, et al. Effectiveness of treatment for class II malocclusion with the Herbst or Twin-block appliances: A randomized, controlled trial. American Journal of Orthodontics and Dentofacial Orthopedics. 2003;124(2):128–37. Available from: https://doi.org/10.1016/s0889-5406(03)00345-7

Khan MI, Neela PK, Unnisa N, Jaiswal AK, Ahmed N, Purkayastha A. Dentoskeletal effects of Twin Block appliance in patients with Class II malocclusion. Med Pharm Rep. 2022. Available from: https://doi.org/10.15386/mpr-1989

DOI: https://doi.org/10.24198/pjdrs.v9i2.62513