Orthodontic Anchorage: Is There a TAD In Your Future?

Efforts that allow our patients to be able to accept the treatment they want and need is ever on our minds, whether we are restorative dentists or specialists.

Orthodontics can claim the distinction for the most patients declining treatment. This can sometimes lead to accepting a compromised treatment plan for the patient and restorative dentist when the teeth are not in the right place to restore.

Innovations keep erupting (no pun intended) in the orthodontic world, being applied to help achieve, speed up or direct tooth movements. Being educated on the benefits of orthodontic treatment and the innovations now available for improving the orthodontic experience can help patients get beyond their “old school” beliefs about orthodontic treatment.

One of those innovations is a TAD, which stands for a “temporary anchorage device.” Mini plates and mini screws are also names used for a similar appliance and orthodontic mechanic technique.

The decision to place a TAD surfaces during the development of the overall treatment plan. As we know, an isolated orthodontic treatment plan can miss possible positioning and alignment considerations that the interdisciplinary team can help identify.

Even in cases where either the restorative dentist or the orthodontist individually think this is a “straight forward “case, if we treatment plan alone, we only see what we know. Whenever possible, it is beneficial to expand our treatment planning to be inclusive of specialty and restorative perspectives. The collaboration and communication between restorative and orthodontic treatment planning is ideal to make sure the patient is well-informed of their treatment options.

TADs were developed in the early 1980s from its precursor, the fully-integrated implant for tooth replacement.  As orthodontists became interested in using osseointegrated implants for treatment, early studies showed that a temporary mini implant could be placed and later removed. This was a valuable asset for orthodontic treatment. A TAD provides several different qualities that allow it to be an accessible adjunct to achieving the correct tooth positions.

1. TADs, by name and definition, are temporary. They require a short-term mechanical stability in the bone to provide the absolute anchorage needed during the appropriate time in the orthodontic treatment. As with most of our procedures, there can be reasons the TAD can become “loose” and need to be removed. Compared to a long-term “fully integrated” implant, this is a consequence without a significantly negative sequela. Part of the informed consent to treatment is a discussion that the TAD may loosen and will be removed and replaced in a new area or that time will need to be allowed for the bone to stabilize (followed by TAD replacement). I describe it as similar to a “brace” or “attachment” coming loose from the tooth. We simply repair it and move on with treatment.
2.  A TAD is easy to place. TAD placement does not require surgical intervention. With a profound topical anesthesia, a TAD can be placed with minimal patient discomfort. Most patients report that there is a sense of pressure as the TAD is being positioned. A TAD can be placed by any trained practitioner, including the orthodontist, the restorative dentist and the surgeon. Even with differences in practice management, schedule flow and comfort levels of practitioners, there is no reason a TAD placement could not be integrated into an interdisciplinary treatment plan. Placement is timed by the treating team together.
3. TADs are small and can be placed in multiple areas of the mouth (usually out of the smile line when placed in the buccal or labial). Placement on the palatal can be of benefit where bone strength is an advantage. Because of the potential irritation to surrounding soft tissue, placement must be carefully considered. Inflammation of the area around the TAD can be managed with good oral hygiene. A small brush like a micro-brush applicator makes a convenient oral hygiene adjunct.
4. TADs are versatile in the application of orthodontic mechanics. They can be placed where they will be engaged in an indirect support of the teeth needing anchorage while moving other teeth into place. This has the advantage of allowing standard orthodontic mechanics with wires or clear aligners. TADs can also be used to directly move teeth to take advantage of intrusion or extrusion movements required in the treatment plan.
5. A TAD can be loaded with a constant force immediately after placement. Since there is no need for a wait time for integration, TADs can be engaged to support the treatment mechanics at any appropriate time in the treatment progress.

Inclusion of new innovations like TADs that develop in our industry will provide our patients essential benefits so they can more often achieve the results they desire.

(If you enjoyed this article, click here for more by Dr. Donna Stenberg.)

Donna J. Stenberg D.D.S., M.S., P.A. Spear Visiting Faculty and Contributing Author. www.stenbergorthodontics.com

References

1. J Contemp Dent Pract. 2013 Sep 1;14(5):993-9. Miniscrew implants as temporary anchorage devices in orthodontics: a comprehensive review. Jasoria G1, Shamim W2, Rathore S2, Kalra A3, Manchanda M4, Jaggi N5.

2. Am J Orthod Dentofacial Orthop. 2007 Apr;131(4 Suppl):S52-8. Systematic review of the experimental use of temporary skeletal anchorage devices in orthodontics. Cornelis MA1, Scheffler NR, De Clerck HJ, Tulloch JF, Behets CN.

3. Natl J Maxillofac Surg. 2010 Jan-Jun; 1(1): 30–34. PMCID: PMC3304189 doi: 10.4103/0975-5950.69160 Temporary anchorage devices – Mini-implants. Kamlesh Singh, Deepak Kumar,1 Raj Kumar Jaiswal, and Amol Bansal​.