Cephalometric facial soft tissue changes with the twin block appliance in Class II division 1 malocclusion patients. A systematic review
To evaluate facial soft tissue changes after the use of the twin block appliance in Class II division 1 malocclusion patients. Several electronic databases (PubMed, MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cochrane databases, EMBASE, Web of Science, and LILACS) were searched with the help of a senior health-sciences librarian. Abstracts that appeared to fulfill the initial selection criteria were selected by consensus, and the original articles were retrieved. The article references were hand-searched for possible missing articles. Clinical trials that assessed facial soft tissue changes with the use of the twin block appliance without any surgical intervention or syndromic characteristics were considered. A comparable untreated control group was required to factor out normal growth changes. Two articles fulfilled the selection criteria and quantified facial soft tissue changes. Although some statistically significant changes in the soft tissue profile were found, the magnitude of the changes may not be perceived as clinically significant. Changes produced in the upper lip seem to be controversial, although the study with sounder methodological quality did not report significant changes. No change in the anteroposterior position of the lower lip and the soft tissue menton or improvement of the facial convexity was found. Three-dimensional quantification of the soft tissue changes is required to overcome current limitations in our understanding of the soft tissue changes obtained after the use of the twin block appliance in Class II division 1 malocclusion patients.