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tself-esteem. Those who had early treatment had more attendances, received treatment for longer times, and incurred more costs than the adolescent treatment group. They also had significantly poorer final dental oc-clusion.Conclusions: Twin-block treatment when a child is 8 to 9 years old has no advantages over treatment started at an average age of 12.4 years. However, the cost of early treatment to the patient in terms of atten-dances and length of appliance wear is increased. (Am J Orthod Dentofacial Orthop 2009;135:573-9) W e report the results of a 10-year randomized controlled trial examining the effectiveness of early orthodontic treatment with the Twin-block appliance. Over the past few years, there has been considerable debate on the merits of early ortho-dontic treatment for Class II Division 1 malocclusions. When a young child with a severe Class II malocclusion comes for assessment just after the eruption of the perma-nent incisors, orthodontists have a dilemma. This wa