Objective: A twin block appliance used for correction of skeletal Class II malocclusion suffers from undesirable dental effects andbulkiness. To overcome these limitations and the need for more esthetic appearance of this appliance, an esthetic twin block wasdesigned and used in patients. This study aimed to compare dentoskeletal changes and esthetic and functional efficacy in patientstreated with conventional and newly designed esthetic twin block (CTB and ETB) appliances using cephalometric measurements anda questionnaire.Methods: A pilot study with a 2-arm parallel-randomized double-blind clinical trial was conducted on 24 patients (20 males, 4 females) in the age group of 11-13 years. Subjects were treated with CTB (group 1 [G1]: n=12; mean age=11.67±0.49 years) and ETB(group 2 [G2]: n=12; mean age=11.75±0.62 years) appliances. A modified Pancherz analysis was performed to evaluate skeletal anddental changes. The esthetic and functional efficacy was evaluated by a questionnaire using Likert scale. Wilcoxon and Mann-WhitneyU tests were employed for intra and intergroup comparisons respectively (p<0.05).Results: In G1, a significant increase in lower incisor inclination was observed (p<0.05) whereas it was insignificant in G2. The changeswere predominantly skeletal in G2 whereas they were both skeletal and dental in G1. ETB was found to be esthetically and functionallyacceptable in all the patients while CTB patients were esthetically conscious, lacked confidence and had discomfort and difficulty ineating, chewing and speaking.Conclusion: ETB had greater skeletal effects with a reduced tendency of lower incisor proclination, was esthetically acceptable, andfunctionally more comfortable than the CTB.