Two-phase treatment of skeletal Class II malocclusion with the combination of the Twin-block appliance and high-pull headgear

The patient was a boy with a Class II skeletal and dental relationship, a large overjet, an impinging overbite, and a steep mandibular plane angle. Treatment started with the Twin-block appliance combined with high-pull headgear to promote growth of the mandible, restrain the maxilla in the anteroposterior and vertical planes, and improve his profile. This was followed by extraction of the maxillary second premolars and the mandibular first premolars. Then fixed appliances were used to align and level the dentition. Pretreatment and posttreatment records are shown, and the treatment results are stable 2 years after debonding.