Analysis of the efficacy of AngelAligner A6 mandibular advancer and Twin Block in the treatment of class II malocclusion in growing patients: a prospective clinical study

Although the twin block is the most commonly used appliance for the treatment of Class II malocclusion, the clear aligner industry has developed systems with integrated mandibular advancement. The purpose of this study was to evaluate and compare the effects of Twin block appliances, standard AngelAligner clear aligners and AngelAligner A6 mandibular advancement clear aligners as early orthodontic interventions for patients who develop Class II division 1 malocclusion. The study sample comprised 60 patients with a mean age of 12.4 ± 1.3 years, who were divided into three homogeneous groups of 20 patients each and received different treatments: Twin Block (GTB), AngelAligner aligners (GAA) and AngelAligner A6 for mandibular advancement (GA6). Clinical and radiographic assessments were performed at baseline (T0), immediately prior to appliance placement, and repeated after the completion of treatment objectives (T1). Class II malocclusion was corrected with all three appliances. The GA6 and GTB groups showed similar mandibular advancement, with an increase in the SNB angle of 2.1° and 2.3° respectively, and correction to Class I in 85–90% of cases, outperforming the GAA group, which showed an increase in the SNB angle of 1.2° and correction to Class I in 70% of cases. The duration of treatment was shorter in the GA6 group (15.2 months). These findings suggest that the AngelAligner A6 MA and Twin Block are superior for skeletal correction, whereas the standard AngelAligner is effective for milder cases with aesthetic priorities. ClinicalTrials.gov, NCT07591025. Registered 6 May 2026. Retrospectively registered.