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Purpose The objective of this study was to investigate how daily wear time (DWT) influences class II malocclusion treatment efficiency. Materials and methods The study group consisted of 55 patients (mean age 10.4 years) diagnosed with a class II/1 malocclusion. Twin block appliances, with built-in Theramon® microsensors (MC Technology, Hargelsberg, Austria) to monitor patients’ cooperation (daily wear time assessment), were used for treatment. Cephalograms were taken and the following initial and final measurements were compared: Co-Gn, Co-Go, Co-Olp, Pg-Olp, WITS, SNA, SNB, ANB, Co-Go-Me, overjet, molar and canine relationships. The Shapiro–Wilk test, Wilcoxon signed-rank test, Student’s t-test, Levene’s test, Mann–Whitney U test, Kruskal–Wallis test, χ 2  test, and Spearman’s rank correlation coefficient with  p  &lt; 0.05 set as the statistical significance level were used to determine the correlation of the outcomes with DWT; a ROC (receiver operating characteristic) curve was calculated to illustrate diagnostic ability of the binary classifier system. Results DWT was very highly positively correlated with change of the Pg-Olp parameter and highly with an improvement in the ANB, SNA, and SNB angles, an increase in the WITS parameter and an increase in Co-Gn distance. DWTs   7.5 h did not significantly correlate with the improvement of the overjet and most of the linear parameters in the mandible. The ROC curve and its AUC (area under curve) allowed the determination of a DWT of 7 h and 48 min to be capable of establishing a class I relationship with 83% probability. Conclusions Class II treatment efficiency was influenced by DWT; an 8 h threshold value had an 83% probability of establishing a class I relationship.

Does daily wear time of Twin Block reliably predict its efficiency of class II treatment?