{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T17:13:06Z","timestamp":1790097186886,"version":"4.0.1"},"reference-count":28,"publisher":"The Angle Orthodontist (EH Angle Education & Research Foundation)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec id=\"st1\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To compare patients' experiences with the Invisalign Teen with Mandibular Advancement\u00ae (ITMA) and Twin Block (TB) appliances, both initially and after several months of wear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st2\">\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>Sixty-eight patients completed an anonymous survey after at least 2 months of wearing ITMA or TB. Forty-five patients treated with ITMA (18 boys, 27 girls, mean age 13.6 years, SD \u00b1 1.54) and 23 patients treated with TB (13 boys, 10 girls, mean age 10.60 years, SD \u00b1 1.92) were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st3\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>More patients using the TB found their appliance to be visually intimidating as compared with patients using the ITMA (21.7% vs 8.9%). TB was more noticeable than the ITMA (69.6% vs 25%). Appliance insertion was more difficult for TB patients (21.8% vs 4.44% for ITMA). After several months, there were more reports of tooth soreness and lip\/cheek soreness in the ITMA group. TB patients were more embarrassed even after several months (14.3% vs 0% for ITMA). More TB patients required extra appointments for breakage (50% vs 22.2% for ITMA). Speech, drooling, and jaw and lip\/cheek soreness worsened initially for both groups but improved over time. There were no differences between the groups regarding visible facial changes, satisfaction with treatment experience, or time to acclimatize to the appliance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st4\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>TB and ITMA patients shared similar experiences for most of the parameters measured, but there were significant differences between the groups regarding appliance wear and management, discomfort, and function.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2319\/050520-393.1","type":"journal-article","created":{"date-parts":[[2021,3,22]],"date-time":"2021-03-22T10:49:26Z","timestamp":1616410166000},"page":"490-495","source":"Crossref","is-referenced-by-count":33,"title":["Investigation and comparison of patient experiences with removable functional appliances:"],"prefix":"10.2319","volume":"91","author":[{"given":"Tyrone","family":"Zybutz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Drummond","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milos","family":"Lekic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meredith","family":"Brownlee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1164","reference":[{"key":"i0003-3219-91-4-490-b01","series-title":"Am J Orthod Dentofac Orthop","first-page":"24","article-title":"Effectiveness of orthodontic treatment with functional appliances on mandibular growth in the short term","volume":"139","author":"Marsico","year":"2011","unstructured":"Marsico\n              E,\n            \n            \n              Gatto\n              E,\n            \n            \n              Burrascano\n              M,\n            \n            \n              Matarese\n              G,\n            \n            \n              Cordasco\n              G.\n            \n          \n          Effectiveness of orthodontic treatment with functional appliances on mandibular growth in the short term.\n\t\t\t\t\tAm J Orthod Dentofac Orthop.\n\t\t\t\t\t2011;\n\t\t\t\t\t139:\n\t\t\t\t\t24\u2013\n\t\t\t\t\t36."},{"key":"i0003-3219-91-4-490-b02","series-title":"Am J Orthod Dentofac Orthop","first-page":"599","article-title":"Mandibular changes produced by functional appliances in Class II malocclusion: a systematic review","volume":"129","author":"Cozza","year":"2006","unstructured":"Cozza\n              P,\n            \n            \n              Baccetti\n              T,\n            \n            \n              Franchi\n              L,\n            \n            \n              De Toffol\n              L,\n            \n            \n              McNamara\n              JA.\n            \n          \n          Mandibular changes produced by functional appliances in Class II malocclusion: a systematic review.\n\t\t\t\t\tAm J Orthod Dentofac Orthop.\n\t\t\t\t\t2006;\n\t\t\t\t\t129:\n\t\t\t\t\t599."},{"key":"i0003-3219-91-4-490-b03","article-title":"New teen solution with introduction of Invisalign Teen with Mandibular Advancement. Align Technology Invisalign treatment with mandibular advancement will be available commercially in the United States on November 19, 2018","author":"Pascaud","year":"2017","unstructured":"Pascaud\n              R.\n            \n          \n          New teen solution with introduction of Invisalign Teen with Mandibular Advancement. Align Technology Invisalign treatment with mandibular advancement will be available commercially in the United States on November 19, 2018.\n\t\t\t\t\tPublished2017.\n\t\t\t\t\tAvailable at: http:\/\/investor.aligntech.com\/releasedetail.cfm?ReleaseID=1016092. Accessed April 19, 2018."},{"key":"i0003-3219-91-4-490-b04","series-title":"Eur J Orthod","first-page":"517","article-title":"A comparative assessment of acceptance of different types of functional appliances","volume":"20","author":"Sergl","year":"1998","unstructured":"Sergl\n              HG,\n            \n            \n              Zentner\n              A.\n            \n          \n          A comparative assessment of acceptance of different types of functional appliances.\n\t\t\t\t\tEur J Orthod.\n\t\t\t\t\t1998;\n\t\t\t\t\t20:\n\t\t\t\t\t517\u2013\n\t\t\t\t\t524."},{"key":"i0003-3219-91-4-490-b05","series-title":"Angle Orthod","first-page":"437","article-title":"Patient experiences with the Forsus fatigue resistant device","volume":"83","author":"Bowman","year":"2013","unstructured":"Bowman\n              AC,\n            \n            \n              Saltaji\n              H,\n            \n            \n              Flores-Mir\n              C,\n            \n            \n              Preston\n              B,\n            \n            \n              Tabbaa\n              S.\n            \n          \n          Patient experiences with the Forsus fatigue resistant device.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t2013;\n\t\t\t\t\t83:\n\t\t\t\t\t437\u2013\n\t\t\t\t\t446."},{"key":"i0003-3219-91-4-490-b06","series-title":"Am J Orthod Dentofac Orthop","first-page":"173","article-title":"Colonio Salazar FB, Sharma PK, Fleming PS. Understanding factors influencing compliance with removable functional appliances: a qualitative study","volume":"155","author":"El-Huni","year":"2019","unstructured":"El-Huni\n              A,\n            \n          \n          Colonio Salazar FB, Sharma PK, Fleming PS. Understanding factors influencing compliance with removable functional appliances: a qualitative study.\n\t\t\t\t\tAm J Orthod Dentofac Orthop.\n\t\t\t\t\t2019;\n\t\t\t\t\t155:\n\t\t\t\t\t173\u2013\n\t\t\t\t\t181."},{"key":"i0003-3219-91-4-490-b07","series-title":"Am J Orthod Dentofac Orthop","first-page":"698","article-title":"Orthodontic appliance preferences of children and adolescents","volume":"138","author":"Walton","year":"2010","unstructured":"Walton\n              DK,\n            \n            \n              Fields\n              HW,\n            \n            \n              Johnston\n              WM,\n            \n            et al.\n          \n          Orthodontic appliance preferences of children and adolescents.\n\t\t\t\t\tAm J Orthod Dentofac Orthop.\n\t\t\t\t\t2010;\n\t\t\t\t\t138:\n\t\t\t\t\t698\u2013\n\t\t\t\t\t710."},{"key":"i0003-3219-91-4-490-b08","series-title":"J Orthod","first-page":"209","article-title":"and management of Twin Blocks: reflections after 30 years of clinical use","volume":"37","author":"Design","year":"2010","unstructured":"Design\n              Clark W.\n            \n          \n          and management of Twin Blocks: reflections after 30 years of clinical use.\n\t\t\t\t\tJ Orthod.\n\t\t\t\t\t2010;\n\t\t\t\t\t37:\n\t\t\t\t\t209\u2013\n\t\t\t\t\t216."},{"key":"i0003-3219-91-4-490-b09","series-title":"Korean J Orthod","first-page":"326","article-title":"Pain perception among patients treated with passive self-ligating fixed appliances and Invisalign\u00ae aligners during the first week of orthodontic treatment","volume":"48","author":"Almasoud","year":"2018","unstructured":"Almasoud\n              NN.\n            \n          \n          Pain perception among patients treated with passive self-ligating fixed appliances and Invisalign\u00ae aligners during the first week of orthodontic treatment.\n\t\t\t\t\tKorean J Orthod.\n\t\t\t\t\t2018;\n\t\t\t\t\t48:\n\t\t\t\t\t326\u2013\n\t\t\t\t\t332."},{"key":"i0003-3219-91-4-490-b10","series-title":"Angle Orthod","first-page":"801","article-title":"Discomfort associated with Invisalign and traditional brackets: a randomized, prospective trial","volume":"87","author":"White","year":"2017","unstructured":"White\n              DW,\n            \n            \n              Julien\n              KC,\n            \n            \n              Jacob\n              H,\n            \n            \n              Campbell\n              PM,\n            \n            \n              Buschang\n              PH.\n            \n          \n          Discomfort associated with Invisalign and traditional brackets: a randomized, prospective trial.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t2017;\n\t\t\t\t\t87:\n\t\t\t\t\t801\u2013\n\t\t\t\t\t808."},{"key":"i0003-3219-91-4-490-b11","series-title":"Prog Orthod","first-page":"64","article-title":"Analysis of pain level in cases treated with Invisalign aligner: comparison with fixed edgewise appliance therapy","volume":"15","author":"Fujiyama","year":"2014","unstructured":"Fujiyama\n              K,\n            \n            \n              Honjo\n              T,\n            \n            \n              Suzuki\n              M,\n            \n            \n              Matsuoka\n              S,\n            \n            \n              Deguchi\n              T.\n            \n          \n          Analysis of pain level in cases treated with Invisalign aligner: comparison with fixed edgewise appliance therapy.\n\t\t\t\t\tProg Orthod.\n\t\t\t\t\t2014;\n\t\t\t\t\t15:\n\t\t\t\t\t64."},{"key":"i0003-3219-91-4-490-b12","series-title":"Orthod Pract.","article-title":"Patient perceptions of speech, discomfort, and salivary flow while wearing Invisalign\u00ae aligners\u2014research\u2014orthodontic practice US","author":"Sweeney","year":"2016","unstructured":"Sweeney\n              W\n              Jr,\n            \n            \n              Rinchuse\n              D,\n            \n            \n              Rinchuse\n              D,\n            \n            \n              Zullo\n              T,\n            \n            \n              King\n              B.\n            \n          \n          Patient perceptions of speech, discomfort, and salivary flow while wearing Invisalign\u00ae aligners\u2014research\u2014orthodontic practice US.\n\t\t\t\t\tOrthod Pract.Published2016.\n\t\t\t\t\tAvailable at: https:\/\/www.orthopracticeus.com\/research\/patient-perceptions-speech-discomfort-salivary-flow-wearing-invisalign-aligners. Accessed February 5, 2020."},{"key":"i0003-3219-91-4-490-b13","series-title":"Br J Orthod","first-page":"179","article-title":"Attitudes to orthodontic treatment","volume":"12","author":"Oliver","year":"1985","unstructured":"Oliver\n              RG,\n            \n            \n              Knapman\n              YM.\n            \n          \n          Attitudes to orthodontic treatment.\n\t\t\t\t\tBr J Orthod.\n\t\t\t\t\t1985;\n\t\t\t\t\t12:\n\t\t\t\t\t179\u2013\n\t\t\t\t\t188."},{"key":"i0003-3219-91-4-490-b14","series-title":"Am J Orthod Dentofac Orthop","first-page":"159","article-title":"Treatment timing for Twin-Block therapy","volume":"118","author":"Baccetti","year":"2000","unstructured":"Baccetti\n              T,\n            \n            \n              Franchi\n              L,\n            \n            \n              Toth\n              R.\n            \n          \n          Treatment timing for Twin-Block therapy.\n\t\t\t\t\tAm J Orthod Dentofac Orthop.\n\t\t\t\t\t2000;\n\t\t\t\t\t118:\n\t\t\t\t\t159\u2013\n\t\t\t\t\t170."},{"key":"i0003-3219-91-4-490-b01","series-title":"Am J Orthod Dentofac Orthop","first-page":"24","article-title":"Effectiveness of orthodontic treatment with functional appliances on mandibular growth in the short term","volume":"139","author":"Marsico","year":"2011","unstructured":"Marsico\n              E,\n            \n            \n              Gatto\n              E,\n            \n            \n              Burrascano\n              M,\n            \n            \n              Matarese\n              G,\n            \n            \n              Cordasco\n              G.\n            \n          \n          Effectiveness of orthodontic treatment with functional appliances on mandibular growth in the short term.\n\t\t\t\t\tAm J Orthod Dentofac Orthop.\n\t\t\t\t\t2011;\n\t\t\t\t\t139:\n\t\t\t\t\t24\u2013\n\t\t\t\t\t36."},{"key":"i0003-3219-91-4-490-b02","series-title":"Am J Orthod Dentofac Orthop","first-page":"599","article-title":"Mandibular changes produced by functional appliances in Class II malocclusion: a systematic review","volume":"129","author":"Cozza","year":"2006","unstructured":"Cozza\n              P,\n            \n            \n              Baccetti\n              T,\n            \n            \n              Franchi\n              L,\n            \n            \n              De Toffol\n              L,\n            \n            \n              McNamara\n              JA.\n            \n          \n          Mandibular changes produced by functional appliances in Class II malocclusion: a systematic review.\n\t\t\t\t\tAm J Orthod Dentofac Orthop.\n\t\t\t\t\t2006;\n\t\t\t\t\t129:\n\t\t\t\t\t599."},{"key":"i0003-3219-91-4-490-b03","article-title":"New teen solution with introduction of Invisalign Teen with Mandibular Advancement. Align Technology Invisalign treatment with mandibular advancement will be available commercially in the United States on November 19, 2018","author":"Pascaud","year":"2017","unstructured":"Pascaud\n              R.\n            \n          \n          New teen solution with introduction of Invisalign Teen with Mandibular Advancement. Align Technology Invisalign treatment with mandibular advancement will be available commercially in the United States on November 19, 2018.\n\t\t\t\t\tPublished2017.\n\t\t\t\t\tAvailable at: http:\/\/investor.aligntech.com\/releasedetail.cfm?ReleaseID=1016092. Accessed April 19, 2018."},{"key":"i0003-3219-91-4-490-b04","series-title":"Eur J Orthod","first-page":"517","article-title":"A comparative assessment of acceptance of different types of functional appliances","volume":"20","author":"Sergl","year":"1998","unstructured":"Sergl\n              HG,\n            \n            \n              Zentner\n              A.\n            \n          \n          A comparative assessment of acceptance of different types of functional appliances.\n\t\t\t\t\tEur J Orthod.\n\t\t\t\t\t1998;\n\t\t\t\t\t20:\n\t\t\t\t\t517\u2013\n\t\t\t\t\t524."},{"key":"i0003-3219-91-4-490-b05","series-title":"Angle Orthod","first-page":"437","article-title":"Patient experiences with the Forsus fatigue resistant device","volume":"83","author":"Bowman","year":"2013","unstructured":"Bowman\n              AC,\n            \n            \n              Saltaji\n              H,\n            \n            \n              Flores-Mir\n              C,\n            \n            \n              Preston\n              B,\n            \n            \n              Tabbaa\n              S.\n            \n          \n          Patient experiences with the Forsus fatigue resistant device.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t2013;\n\t\t\t\t\t83:\n\t\t\t\t\t437\u2013\n\t\t\t\t\t446."},{"key":"i0003-3219-91-4-490-b06","series-title":"Am J Orthod Dentofac Orthop","first-page":"173","article-title":"Colonio Salazar FB, Sharma PK, Fleming PS. Understanding factors influencing compliance with removable functional appliances: a qualitative study","volume":"155","author":"El-Huni","year":"2019","unstructured":"El-Huni\n              A,\n            \n          \n          Colonio Salazar FB, Sharma PK, Fleming PS. Understanding factors influencing compliance with removable functional appliances: a qualitative study.\n\t\t\t\t\tAm J Orthod Dentofac Orthop.\n\t\t\t\t\t2019;\n\t\t\t\t\t155:\n\t\t\t\t\t173\u2013\n\t\t\t\t\t181."},{"key":"i0003-3219-91-4-490-b07","series-title":"Am J Orthod Dentofac Orthop","first-page":"698","article-title":"Orthodontic appliance preferences of children and adolescents","volume":"138","author":"Walton","year":"2010","unstructured":"Walton\n              DK,\n            \n            \n              Fields\n              HW,\n            \n            \n              Johnston\n              WM,\n            \n            et al.\n          \n          Orthodontic appliance preferences of children and adolescents.\n\t\t\t\t\tAm J Orthod Dentofac Orthop.\n\t\t\t\t\t2010;\n\t\t\t\t\t138:\n\t\t\t\t\t698\u2013\n\t\t\t\t\t710."},{"key":"i0003-3219-91-4-490-b08","series-title":"J Orthod","first-page":"209","article-title":"and management of Twin Blocks: reflections after 30 years of clinical use","volume":"37","author":"Design","year":"2010","unstructured":"Design\n              Clark W.\n            \n          \n          and management of Twin Blocks: reflections after 30 years of clinical use.\n\t\t\t\t\tJ Orthod.\n\t\t\t\t\t2010;\n\t\t\t\t\t37:\n\t\t\t\t\t209\u2013\n\t\t\t\t\t216."},{"key":"i0003-3219-91-4-490-b09","series-title":"Korean J Orthod","first-page":"326","article-title":"Pain perception among patients treated with passive self-ligating fixed appliances and Invisalign\u00ae aligners during the first week of orthodontic treatment","volume":"48","author":"Almasoud","year":"2018","unstructured":"Almasoud\n              NN.\n            \n          \n          Pain perception among patients treated with passive self-ligating fixed appliances and Invisalign\u00ae aligners during the first week of orthodontic treatment.\n\t\t\t\t\tKorean J Orthod.\n\t\t\t\t\t2018;\n\t\t\t\t\t48:\n\t\t\t\t\t326\u2013\n\t\t\t\t\t332."},{"key":"i0003-3219-91-4-490-b10","series-title":"Angle Orthod","first-page":"801","article-title":"Discomfort associated with Invisalign and traditional brackets: a randomized, prospective trial","volume":"87","author":"White","year":"2017","unstructured":"White\n              DW,\n            \n            \n              Julien\n              KC,\n            \n            \n              Jacob\n              H,\n            \n            \n              Campbell\n              PM,\n            \n            \n              Buschang\n              PH.\n            \n          \n          Discomfort associated with Invisalign and traditional brackets: a randomized, prospective trial.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t2017;\n\t\t\t\t\t87:\n\t\t\t\t\t801\u2013\n\t\t\t\t\t808."},{"key":"i0003-3219-91-4-490-b11","series-title":"Prog Orthod","first-page":"64","article-title":"Analysis of pain level in cases treated with Invisalign aligner: comparison with fixed edgewise appliance therapy","volume":"15","author":"Fujiyama","year":"2014","unstructured":"Fujiyama\n              K,\n            \n            \n              Honjo\n              T,\n            \n            \n              Suzuki\n              M,\n            \n            \n              Matsuoka\n              S,\n            \n            \n              Deguchi\n              T.\n            \n          \n          Analysis of pain level in cases treated with Invisalign aligner: comparison with fixed edgewise appliance therapy.\n\t\t\t\t\tProg Orthod.\n\t\t\t\t\t2014;\n\t\t\t\t\t15:\n\t\t\t\t\t64."},{"key":"i0003-3219-91-4-490-b12","series-title":"Orthod Pract.","article-title":"Patient perceptions of speech, discomfort, and salivary flow while wearing Invisalign\u00ae aligners\u2014research\u2014orthodontic practice US","author":"Sweeney","year":"2016","unstructured":"Sweeney\n              W\n              Jr,\n            \n            \n              Rinchuse\n              D,\n            \n            \n              Rinchuse\n              D,\n            \n            \n              Zullo\n              T,\n            \n            \n              King\n              B.\n            \n          \n          Patient perceptions of speech, discomfort, and salivary flow while wearing Invisalign\u00ae aligners\u2014research\u2014orthodontic practice US.\n\t\t\t\t\tOrthod Pract.Published2016.\n\t\t\t\t\tAvailable at: https:\/\/www.orthopracticeus.com\/research\/patient-perceptions-speech-discomfort-salivary-flow-wearing-invisalign-aligners. Accessed February 5, 2020."},{"key":"i0003-3219-91-4-490-b13","series-title":"Br J Orthod","first-page":"179","article-title":"Attitudes to orthodontic treatment","volume":"12","author":"Oliver","year":"1985","unstructured":"Oliver\n              RG,\n            \n            \n              Knapman\n              YM.\n            \n          \n          Attitudes to orthodontic treatment.\n\t\t\t\t\tBr J Orthod.\n\t\t\t\t\t1985;\n\t\t\t\t\t12:\n\t\t\t\t\t179\u2013\n\t\t\t\t\t188."},{"key":"i0003-3219-91-4-490-b14","series-title":"Am J Orthod Dentofac Orthop","first-page":"159","article-title":"Treatment timing for Twin-Block therapy","volume":"118","author":"Baccetti","year":"2000","unstructured":"Baccetti\n              T,\n            \n            \n              Franchi\n              L,\n            \n            \n              Toth\n              R.\n            \n          \n          Treatment timing for Twin-Block therapy.\n\t\t\t\t\tAm J Orthod Dentofac Orthop.\n\t\t\t\t\t2000;\n\t\t\t\t\t118:\n\t\t\t\t\t159\u2013\n\t\t\t\t\t170."}],"container-title":["The Angle Orthodontist"],"original-title":[],"link":[{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/view\/journals\/angl\/91\/4\/article-p490.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/meridian.allenpress.com\/angle-orthodontist\/article-pdf\/91\/4\/490\/2854452\/i0003-3219-91-4-490.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/downloadpdf\/journals\/angl\/91\/4\/article-p490.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/downloadpdf\/journals\/angl\/91\/4\/article-p490.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T13:22:24Z","timestamp":1780060944000},"score":1,"resource":{"primary":{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/view\/journals\/angl\/91\/4\/article-p490.xml"}},"subtitle":["Invisalign Teen with Mandibular Advancement versus Twin Block"],"short-title":[],"issued":{"date-parts":[[2021,7]]},"references-count":28,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.2319\/050520-393.1","relation":{},"ISSN":["0003-3219"],"issn-type":[{"value":"0003-3219","type":"print"}],"subject":[],"published":{"date-parts":[[2021,7]]}}}