case_images: PMC5952230_01
case_images: Pretreatment photos showing space loss of upper left central incisor
case_images: JOS-7-8-g001.jpg
case_images: PMC5952230_01_JOS-7-8-g001.jpg
case_images: F1
case_images: Class II on the right and a one-half unit Class II on the left [Figure 1]. Canines were Class II on both sides.
case_images: Orthopantograph confirms the presence of all permanent teeth except the upper left central
case_images: JOS-7-8-g002.jpg
case_images: PMC5952230_01_JOS-7-8-g002.jpg
case_images: F2
case_images: The upper left central incisor was confirmed as missing [Figure 2].
case_images: PMC5952230_02
case_images: Pretreatment cephalometric radiograph and its tracing
case_images: JOS-7-8-g003.jpg
case_images: PMC5952230_02_JOS-7-8-g003.jpg
case_images: F3
case_images: The cephalometric radiograph and analysis [Figure 3] showed ANB value of 6 , which suggests that the patient had a Class II skeletal pattern.
case_images: PMC5952230_03
case_images: PMC5952230_04
case_images: Twin Block appliance design
case_images: JOS-7-8-g005.jpg
case_images: PMC5952230_04_JOS-7-8-g005.jpg
case_images: F4
case_images: The design of the appliance was modified by adding two C-clasps; one was mesial to the upper left lateral, and the other was mesial to the upper right central, where each clasp was attached to a different acrylic plate to create space for the missing incisor during expansion [Figure 4]. The design composed of 0.9 mm stainless steel Adam clasps on first molars and premolars, in addition to ball-ended clasps on lower incisors.
case_images: PMC5952230_05
case_images: PMC5952230_06
case_images: End of Phase I
case_images: JOS-7-8-g006.jpg
case_images: PMC5952230_06_JOS-7-8-g006.jpg
case_images: F5
case_images: Canines and molars were over corrected to Class III, and space for the missing upper incisor was increased (by 3 mm) as a result of the expansion; however, the overbite was maintained [Figure 5].
case_images: PMC5952230_07
case_images: Phase II of treatment. Prosthetic tooth (riding pontic) replacing missing central incisor is seen in frontal picture
case_images: JOS-7-8-g007.jpg
case_images: PMC5952230_07_JOS-7-8-g007.jpg
case_images: F6
case_images: An acrylic tooth with a bonded bracket and extended acrylic phalanges helped to maintain the space and improve patient esthetics [Figure 6].
case_images: End of treatment photos showing full incisor space, optimum overjet, and overbite
case_images: JOS-7-8-g008.jpg
case_images: PMC5952230_07_JOS-7-8-g008.jpg
case_images: F7
case_images: The end of treatment photos demonstrates the space created for the missing central incisor [Figure 7].
case_images: Finishing stage OPG and PA
case_images: JOS-7-8-g010.jpg
case_images: PMC5952230_07_JOS-7-8-g010.jpg
case_images: F8
case_images: No other pathology or abnormal anatomy were noted [Figure 8].
case_images: Posttreatment cephalometric radiograph and tracing
case_images: JOS-7-8-g011.jpg
case_images: PMC5952230_07_JOS-7-8-g011.jpg
case_images: F9
case_images: The posttreatment cephalometric tracing [Figure 9] and analysis [Table 1] showed that ANB value has reduced from 6  to 4 .