Treatment with Twin-block appliance followed by fixed appliance therapy in a growing Class II patient

•A growing girl had a Class II malocclusion, severe overjet, and retrognathic mandible.•She was treated with a Twin-block and fixed appliances.•Functional therapy was done during a period of peak growth.•CBCT images showed that joint space between condyle and glenoid fossa was normalized.

A girl, aged 11 years 4 months, with a skeletal Class II pattern and a severe overjet (10 mm) was treated with a Twin-block appliance. After 9 months of appliance therapy, the skeletal Class II was overcorrected. After 26 months of retention, when the occlusion was stable and the growth rate was diminishing, fixed orthodontic appliances using temporary skeletal anchorage devices were initiated. The total active treatment time with fixed orthodontic appliances was 30 months. Posttreatment records after 18 months demonstrated excellent stability: a functional occlusion and a pleasing facial balance. Cone-beam computed tomography was used to visualize temporomandibular joint adaptations after the functional and fixed orthodontic therapies.