Objective To analyze the effect of modified Twin-block appliance combined with micro-implant anchorage on treatment efficiency in patients with Angle Class Ⅱ division 1 malocclusion. Methods A total of 66 patients with Angle Class Ⅱ division 1 malocclusion admitted to Lianping Xujiaren Dental Clinic from July 2021 to August 2024 were selected, and they were divided into group A and group B by the random number table method, with 33 patients in each group. Group A was treated with modified Twin-block appliance, and group B was treated with modified Twin-block appliance combined with micro-implant anchorage. The treatment efficiency, hard-tissue cephalometric indicators and soft-tissue cephalometric indicators were compared between the two groups. Results The correction time, occlusion opening time and alignment time in group B were shorter than those in group A (P <0.05). After treatment, the ANB, U1-SN, ULP and LLP in group B were smaller than those in group A, and the L1-MP and Z angle were larger than those in group A (P <0.05). Conclusion Modified Twin-block appliance combined with micro-implant anchorage for Angle Class Ⅱ division 1 malocclusion can effectively improve orthodontic treatment efficiency, correct sagittal maxillomandibular discrepancy, and enhance overall dentofacial aesthetic profile.