Association between Clark twin block appliance treatment and social and emotional wellness in children with malocclusion – a cohort study

INTRODUCTION: Class II malocclusion is common among adolescents and can negatively affect aesthetics, self-esteem, and social interactions. Myofunctional appliances like the Clark twin block aid in correcting jaw discrepancies during growth. Traditional clinical assessments often overlook psychosocial outcomes, which can be captured through patient-reported outcome measures (PROMs) such as the Child Perception Questionnaire (CPQ). This study evaluates the association between Clark twin block appliance therapy and social and emotional wellness in children, addressing a gap in patient-centered orthodontic care in Pakistan. METHODS: This cohort study, approved by the Ethical Review Committee (ERC) and adhering to STROBE guidelines, involved 56 children treated with Clark’s Twin Block appliance at Aga Khan University Hospital. Patients aged 13–17 years at Cervical Vertebral Maturation (CVM) stages 3 or 4, compliant with the appliance, were included; those with anomalies or communication issues were excluded. Pre- and post-treatment social and emotional impacts were assessed using the prevalidated CPQ, administered after the completion of Clark Twin Block appliance treatment. Data analysis via SPSS employed paired t-tests/Wilcoxon tests, with p < 0.05 considered significant. RESULTS: The study included 56 participants: 27 males (48.2%) and 29 females (51.8%), with median ages of 13 (IQR: 13–14) and 14 years (IQR: 13–15), respectively. A positive association was found between the intervention and improved emotional and social wellness. Emotional wellness scores decreased from a median of 7.5 to 3 (p < 0.001), and social wellness scores from 1.5 to 0 (p < 0.001). Gender-based comparisons showed no significant differences, indicating equal effectiveness for both genders. CONCLUSIONS: Interceptive orthodontic treatment with Clark’s Twin Block is positively associated with social and emotional wellness in children with malocclusion. It reduces distress, frustration, and shyness while boosting confidence in social interactions and school activities. The study emphasizes using PROMs to assess clinical and psychosocial outcomes, promoting patient-centered orthodontic care.