A wide variety of functional/orthopaedic appliances are available for the correction of Class II skeletal and occlusal disharmonies. Twin block is a functional appliance described by Clark (1982) in United Kingdom. It is effective in correcting Class II malocclusion with a combination of skeletal (mainly restriction of maxillary growth) and dento-alveolar modifications which effectively modify occlusal inclined plane and induce favourably directed occlusal force by causing a mandibular displacement. The main objective of therapy with functional appliances such as Twin Block is to induce supplementary lengthening of the mandible by stimulating increased growth at the condylar cartilage. The use of functional appliances mainly depends on their cooperation. Once in a while cases with multiple problems do come which calls for change in the conventional design. Here is a case of a 14 year old girl with class 2 division 1 malocclusion with congenitally missing lower central incisor treated with modification of twin block appliance.
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