| Summary: | This study aimed to evaluate and compare the dentoalveolar effects of the myofunctional trainer T4K<sup>TM</sup> versus twin block in children with class II division I malocclusion. Two parallel arm randomized comparative clinical trial was conducted, including twenty healthy children, 9–12 years old, showing Angle’s class II division I malocclusion due to mandibular retrusion. Children were randomly assigned into two groups according to the appliance used; Group 1: T4k, and Group II: twin block. Follow-up was done every 4 weeks for 9 months. Postoperative cephalometric X ray, study casts and photographs were taken for measurements and comparison. T4K showed a statistically significant reduction in the overjet (−2.50 ± 1.00 mm) (<i>p</i> < 0.0001), and a significant increase in the lower arch perimeter (LAP) (1.19 ± 0.96 mm) (<i>p</i> = 0.01). The twin block showed a statistically significant reduction in the overjet (−3.75 ± 1.10 mm) (<i>p</i> < 0.0001), a significant reduction in the overbite (−16.22 ± 17.02 %) (<i>p</i> = 0.03), and a significant increase in the LAP (1.69 ± 0.70 mm) (<i>p</i> < 0.0001). The overjet showed a higher significant decrease in the twin block group than in T4K (<i>p</i> = 0.03). The mean values of the overbite were significantly decreased in twin block than in T4k (<i>p</i> < 0.0001). Both groups showed significant dentoalveolar improvements toward class I occlusion; however, the twin block showed significantly better results than T4K appliance.
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