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The Twin Bite - Dr Jacques NUSSBAUMER

As a fan of the Herbst appliance, especially in its removable version described by Amoric, I was elated when Orthoplus contacted me for testing the TWIN BITE.

• As a matter of fact, Herbst appliances can not be viewed as an universal solution and often must be associated to an additional multiband. In fact, the TWIN-BITE is affixed to a multiband appliance and combines the benefits of both systems.

• It is advisable to distally insert the TWINBITE into the headgear tubes of both maxillary first molars. This procedure will make the construction sturdier and will horizontalize the protraction guide. The anterior part was screwed down between lower cuspids and first bicuspids. This position ensures the best orientation of the protractor without any interference with masticatory movements. I chose to treat a Class II, Division 2 case with an anterior overbite. Anterior overbite and torque of the upper incisors are always difficult to correct with removable Herbst appliances, unless a very strict wear is ascertained.

• Early March, both arches were bonded and Nitinol archwires were inserted. Early May, .016x.022 stainless steel archwires were inserted and TWIN-BITEs were affixed to both upper and lower archwires. These appliances were rapidly replaced by integrated devices inserted into the headgear tubes of both maxillary first molars. The lower fixation was secured by an 8-shaped 0.3 mm ligature wire. After this adaptation no more breakage occurred. The child came again in July and was allowed to travel for a 6 weeks vacation time.

• From the beginning, the appliance was very well accepted by the child. The protraction was tuned in an end-to-end position of the incisors and the inside spring allowed the child to eat in the MIP (Maximum Intercuspidation Position).


After 3 months of wear, an intra-oral check of the occlusion shows that the overbite and the Class II are corrected; the arches coordination is still to be done.

Cephalometry shows a Witt's going from + 2 mm to + 1 mm, a SNB going from 80° to 81°, an i/MP from 96° to 98° and i-Apo from -1 mm to 0 mm, the first molar distalization is 2 mm.



The TWIN-BITE offers interesting possibilities to orthodontists who are using the protractors' capabilities and willing to combine them with the benefits of multiband appliances. This should reduce both the cost of products and chairtime.



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