Objective: This study was undertaken to determine contemporary trends in the use of the Twin Block appliance among UK orthodontists, including the wear time currently prescribed. In addition, the study explored if there had been any change in wear time prescribed, considering recent research evidence proposing part-time wear. Design: Cross-sectional, online survey. Participants: Members of the British Orthodontic Society (BOS). Methods: The questionnaire was emailed to all BOS members in November 2021 and hosted on the QualtricsXM platform. The questionnaire was piloted for content validity and tested for reliability. Results: A response rate of 19% was attained. Nearly all (n = 244, 99%) participants used the Twin Block, and 90% (n = 218) prescribed full-time wear including/excluding eating. Although the majority (n = 168, 69%) had not made changes to their wear time prescriptions, nearly one-third (n = 75, 31%) had. Those who reported a change in their prescriptions currently prescribe less wear time than before, and commonly quoted ‘research evidence’ as the reason. A wide range in success rates (41%–100%) was reported, with patient compliance as the main reason for treatment discontinuation. Conclusion: The Twin Block is a popular functional appliance among orthodontists in the UK, originally designed by Clark to be worn full time to maximise functional forces applied to the dentition. However, this wear regime may place considerable strain on patient compliance. Most participants prescribed full-time Twin Block wear excluding eating. Approximately one-third of orthodontists made changes to their wear time prescriptions during their practising career, and currently instruct less wear time than before.
This case report discusses the characteristics, sequelae and management of the supernumerary tooth in a developing dentition, particularly the mesiodens. The case describes when an eruption of a mesiodens was misdiagnosed as a microdont maxillary central incisor, leading to ectopic and late eruption of the permanent maxillary incisor. This case highlights the importance of clinical and radiographic investigation where tooth size asymmetry is observed in the upper anterior region. CPD/Clinical Relevance: The incidence of a single microdont maxillary central incisor is rare and is not known to be documented in the literature. If a small tooth erupts in the midline it should be considered a supernumerary tooth until proven otherwise. Further clinical and radiographic investigation should be performed to determine the presence and location of the maxillary central incisor(s).
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