Dr. Greg Jorgensen
(505) 891-9440
1401 Barbara Loop SE
Rio Rancho, NM 87124

The Jorgensen Orthodontics Blog

What are Temporary Anchorage Devices (TAD’s)?

Posted by Dr. Jorgensen on June 12th, 2013

TAD2Sir Isaac Newton’s third law of motion states that for every action there is an equal and opposite reaction. Imagine two teams having a tug-of-war. Even though one group may be bigger or stronger, the minute there is force placed on the rope to pull one group over the line, there is an equal and opposite force acting upon the group doing the pulling. Although this can be fun at a church picnic, this third law of motion creates some challenges during orthodontic treatment.

When a patient has an overbite for example, it is common to remove some teeth and scoot the front teeth back into the space created. If the force needed to move the front teeth back is attached to the back teeth alone, there is an undesirable consequence that the back teeth will also move forward (following Newton’s law). In the past, orthodontists would ask patients to wear headgear to secure or anchor the back teeth so that they can’t move. As you know, full-time headgear wear is not a popular solution in today’s modern world.

In 2005, the FDA approved the use of Temporary Anchorage Devices (TAD’s) in the United States. These devices were not new as German and Asian orthodontists had already been using them for almost a decade. The professional journals were full of articles and case studies showing the remarkable results produced by these foreign doctors using TAD’s and those of us here in the states couldn’t wait to get our hands on them. In 2005, only one manufacturer offered a TAD at the annual product show. By the next year, the list of suppliers had grown to 19 demonstrating how quickly these devices were implemented into modern orthodontic practice.

Temporary anchorage devices are known my many names among which are mini-screws, mini-implants, and micro-implants. They are about the size of a small wood screw (6 to 10 mm long) and look like an earring resting on the gums when they are in place. Although they resemble a screw, they are made out of biologically inert materials that will not corrode in the mouth or be rejected by the body. They are designed to hold fast in bone and be compatible with the soft tissue through which they pass.

The placement process is very simple. In my practice I place topical and a very small dose of anesthetic into the area of soft tissue overlying where the TAD will be placed. The soft tissue is the only part of the mouth that can feel anything as bone itself feels no pain. If your gums are numb, the procedure will be completely painless. Insertion takes less than a minute and I can’t tell you how many of my patients respond exactly the same way when I’m done. “That’s it? I didn’t feel a thing.”

After a TAD is in place, it provides an immovable object that can be used to push, pull, lift, or intrude teeth that are being straightened. The only maintenance required is that patients keep the tissues around them clean and healthy. In addition to routine brushing, I prescribe a chorhexidine mouthwash for my patients. As long as the gums are kept healthy, there are very few complications with these devices.

The removal of a TAD is even easier than its insertion. Because the implant is being removed, there is already a breach of the soft tissue and there will be no pain associated with just unscrewing it. If the tissues are swollen or sore in the area beforehand, I may place some topical just for comfort.

Since TAD’s don’t move, orthodontists can use them to move teeth in directions and amounts that previously were not possible. Although they cannot eliminate the need for jaw surgery or pulling teeth in all patients, many times they may change a surgery case into an extraction case or and extraction case into a non-extraction case. Ask your orthodontist if temporary anchorage devices might be appropriate for your treatment.

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Because he has over 25,000 readers each month, it is impossible for him respond to all questions. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.

62 comments so far in response to “What are Temporary Anchorage Devices (TAD’s)?”

  1. Melody says:

    Dr. Jorgensen,

    Thank you for your very helpful article. I may need to have a mini-screw implanted to pull my teeth together. However, I work with nuclear magnetic resonance (NMR) spectrometers, so I was just wondering if you could tell me if it is okay to get near a giant magnet with a mini-screw in my mouth. And what are some possible complications of this procedure? How long does it usually take a patient to recover/eat/talk normally?


    • I have never heard of this being an issue. Very few TADS are made of stainless steel. Most are made of titanium which would not be a problem for sure. Ask you orthodontist to verify what yours will be made of and have him contact the manufacturer if there is any question.

  2. AC says:

    Hi , Dr. Jorgensen!
    I have had my TAD plates in for almost 2 years and am to get them out soon. One is in each upper jaw (each plate has 3 screws). Should I have an X-ray just before getting them out? Or would there be too much reflection from the plates to get a good Xray. Or maybe an X-ray is not necessary. I’m a little nervous that a tooth root could have moved close to the plate (probably just being paranoid..ha!)
    I bruised terribly after they went in, really unusual according to the oral surgeon. Bruises from under the eyes to all the way down my neck. But maybe this won’t happen when I get them taken off~
    Thanks so much!
    You are so great to write these blogs!

    • It is my practice to take an x-ray about 6 months into treatment and at least once a year thereafter to make sure all is well. You don’t really need an x-ray prior to TAD removal, but you may need one for other reasons.

  3. Lisa says:

    Dr.Jorgensen, I have been advised to use TAD to close the 5-6mm premolar gaps I have on either side. These gaps would be closed by bringing the 2nd premolar and the molars towards canine. Would this create any adverse effect on the bite or the roots of the teeth. My concern is stability. Thank You Sir. You help to the public through this blog is immense.

    • There have been extensive studies on the effects of TADS on the adjacent teeth. Surprisingly they hardly ever cause a problem, even if placed too closely to the adjacent roots. TADS are an amazing addition to an orthodontist’s toolbox.

  4. Louisa says:

    Hi Dr. Jorgensen, I recently (5days ago) got TADS placed in my upper gums above my molars. The left side is fine, I don’t feel it at all. However the right side, I feel a numb sensation in the tooth directly below it. Is the screw touching the root of my tooth? Is this dangerous for my tooth? I have a fear of the dentist so I’m not particularly interested in going back to get it replaced! Thank you.

    • You need to communicate what you are feeling to your doctor. Although the research shows that TADS have very few side effects, you need to let your orthodontist know what you are feeling so that he can make an appropriate diagnosis.

  5. Elisabeth says:

    I have tads, I’ve had my braces on for 6 years. I have a space that won’t close right under the placement of the tad. I’m wondering if the tad placement is not letting my space close.

  6. Stephanie says:

    Hi Doc,

    I’ve had my braces in for about 2 months and had 4 second premolars removed as part of my treatment. My orthodontist thought she’d move my front teeth back 1-3 mm (uneven overjet) and move the molars forward 5mm. I think my front teeth have pretty much moved back the 1-3 mm, so I would expect that the back molars should close the rest of the gap. I know that this will probably take a year or longer.

    I have been wearing my elastics (just over the gaps atm) consistently and have noticed a little movement in mainly the molars in my lower jaw. However, the molars in the upper jaw seem to be moving very little or not at all. This wouldn’t concern me, because it’ll take a long time for the gaps to close, but now I have a 1-2 mm gap between my canine and incisors on the left, and a gap is starting on the right.

    I’m now wondering if it is even possible to pull those back teeth forward without pulling the front teeth back. I don’t want my teeth to move back further because of profile and speech.

    You explained that TADs are used to keep the molars from moving, but should they be used to stop the front teeth from moving? I’ve not heard my orthodontist mention them, so they may not be using them.

    • Stephanie says:

      *I did read that gaps can open up between teeth that already seem straight and that people worry about them. The answer tends to be that space needs to be created to move the teeth correctly and that these spaces will be closed later on. I just worry that in closing those gaps my teeth will be moved back a further 2-3 mm or so.

      As a layman(?) I have no real understanding of the forces that are/can be applied in orthodontics other than what I read (and I’ve limited myself to your blog, because you explain things clearly and frankly and I don’t end up being scared to death). I probably shouldn’t worry so much, but because the braces are, quite literally, in my face I keep being reminded of ‘issues’.

      Are there any basic principles you could explain perhaps? The ‘every action has an equal and opposite reaction’ sounds to me as if the 1-3 mm vs 5mm isn’t possible.

    • TADS are one option. You will need something or your front teeth will continue to move… even with elastics as they will pull the front teeth back if they are attached to them.

      • Stephanie says:

        Oh my. I had hoped it was all in my head. You explained that TADS are one option. What might another option be? Should I stop wearing my elastics for now? The practice is closed for another week still during the holidays, although I will phone the locum tomorrow to see what they have to say. Genuinely worried now. Though thank you for your swift reply.

  7. Gov says:

    Hello Doctor,
    I’ve had tads for a few weeks now, but they have gotten wiggly even though I haven’t done anything wrong. What might be the problem, and how might it be resolved?


  8. Sheree says:

    Hello Doctor,
    We really need your help. My daughter has had braces for 30 months now to close 4 mm gaps on either side of her incisors at the top. There is still 1- 2 mm gap on each side and several gaps between her other teeth. Her doctor is trying to pull all teeth forward. She is getting very frustrated with the look and the gaps. Can we kindly ask you the following:
    1. Can she at least remove the braces on the lower arch as there is nothing wrong with the lower arch?
    2. Her doctor says that she will need pins on her upper arch to move the braces but I am worried about gum problem later on.
    3. Can she have the braces on the front teeth removed and only have braces on the premolars and molars which will then be pulled froward with the aid of the pin?
    4. she is only 17. Will the growth of wisdom teeth in future help to move the teeth forward a bit naturally and close the gaps?
    5. Her doctor suggested a hybrid solution of Invisalign for the front 6 teeth and braces with pin ( screw) for molar and premolars on either side. Would this work ? Have you seen this done before?

    Thank you much you are a saviour

    • I can’t diagnose your daughter on a blog, but here are some tips. Leave all of the braces on until the end of treatment. They are all part of as system and removing some of them early will jeopardize the outcome. The “pins” are probably TADS and will cause not gum problems later on if done right. Wisdom teeth will NOT move the molars forward. I would never try to move molars or premolars this far with Invisalign.

  9. JB says:

    Dear Dr. Jorgensen,

    I will get a TAD in my palate soon. My understanding is that it will look exactly like the picture in your article with the title “What are Temporary Anchorage Devices (TAD’s)?”.

    I perform a sales function at my work where I have to speak to clients on a daily basis and is concerned that my speech will be severely impacted. I appreciate that is difficult to gauge the exact impact on a patient’s speech but can you maybe give us some sort of indication of the possible speech side effects? If there is an impact on speech, will it only be temporary?

    Thank you.

    • There may be some effect, but it is not usually “severe.” The key to TADS is that they usually allow the braces to do alone what would normally require jaw surgery. A slight change in speech (whether temporary or permanent) may be a small price to pay for the benefit you’ll receive.

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