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Fixed protruding appliances are interesting tools for correction of Class II dental malocclusion in adult and growing patients. The appliances most commonly used for this purpose are: Herbst, Forsus and Jasper Jumper. The present clinical case report shows an alternative called Twin Force Bite Corrector which was used for 3 months by a patient aged 10 years and 6 months associated with the Andrews prescription fixed appliance (Abzil 3M). After treatment, malocclusion was found to be adjusted to Class I dental occlusion in a single stage.

The aim of this study was to evaluate if upward or downward head inclination might interfere with determination of the growth stage, using cervical vertebrae maturation index (CVMI), in order to verify the accuracy of such diagnosis when radiographs are taken with errors. Forty-nine patients, 26 females and 23 males, aged 9 to 15 years, were submitted to 3 lateral cephalograms: normal (NHP), with 15° upward head inclination (NHP-Up), and with 15° downward head inclination (NHP-Down). Three examiners evaluated the CVMI on the 147 cephalograms. The agreement among examiners was higher in the evaluation of cephalograms taken in NHP. The weighted Kappa test revealed moderate to substantial agreement between NHP and NHP-Up and between NHP and NHP-Down. There was greater agreement between NHP-Up and NHP-Down. It may be concluded that the evaluation of the CVMI on cephalograms in NHP is different as compared with radiographs taken with inclinations. Both NHP-Up and NHP-Down exhibited greater disagreement in the interpretation among examiners, since the evaluation method was not designed for cephalograms with positioning errors.