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.

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

  1. sarah says:

    Hi, this morning our orthodontist told us that my daughter will need a TAD at her next appt to correct her mid-line that hasn’t corrected very well. Your site has been helpful in explaining what to expect from this procedure and that it is relatively routine these days in ortho. I am wondering if the site in the bone will heal once it has been removed. Thank you!

  2. Geetika says:

    Hi Dr. Jorgensen,

    I am 32 years old and have been wearing bracers since Dec 2015.
    I had 4 premolars (2 on top and 2 on the bottom) removed before start of th treatment. I am using self ligating ceramic bracers and my teeth have made good progress so far. My ortho says it will take approximately another 6 moths to finish the treatment.
    I am moving to a different country within 3 months and while checking for a way to fasten the treatment, my ortho suggested using TAD. I have arounf 2 mm space between the molars on the top. I got 2 TAD’s implanted today.
    Can you let me know how effective the TADs would be to fasten the process and can those 2 mm gaps close in 2 months time.

    • This is a huge misconception about TADS. TADS only provide anchorage and allow us to move teeth in directions and amounts not possible without them. They DO NOT make teeth move faster. You need to discuss your treatment plan and timing with your orthodontist.

  3. Alex says:

    Hello Dr. Jorgensen. are tads the only treatment for extruded molars w/ tpa? or are there cheaper options? thanks

    • Intruding molars is very difficult, even with TADS. Two other options include shaving down the tooth and crowning it (but this may also require a root canal if it is shaved down too much) as well as pulling it and replacing it with a bridge or implant (not a great option in my mind). Good luck!

  4. carol says:

    do tads move the jaw back? i have a 10 mm over bite and openbite,iam 34years old.i had this propblem from 4 years since i was pregnant and by time it got worse.ps: i didnt have any problem with my teeth before pregnancy.they used to be perfect.

  5. Sheela says:

    I saw online that TADS can also be used for gummy smile, is that correct? I’ ll be using TADS for my molars that became a little longer when molar bands and TPA were placed. After pulling the molars with TADS, can i use that same TADS for my gummy smile? I have an overbite and on elastic powerchain now. Can gummy smile be treated by an orthopedic doctor while I have braces? Thank you for answering questions here.

    • TADS can be used to treat many condition. The key is where they are placed and the direction of forces that are attached to them. The placement of your TADS in the back will not be helpful for improving your gummy smile in front. You’ll need additional TADS placed closer to the desired movements

  6. suraj dewan says:

    Hello sir my orthodontist places one mini screw above my front two upper tooth and asked me to vist after 2 weeks. As i visited him after 2 weeks he tried to place a wire or something in the TAD, he stopped as it was quite painful. He told me that the screw has loosened and one more screw may be required. Sir can you explain me what happened

    • I can’t tell you what happened exactly because I’m not there, but about 20% of mini screws just get loose. This is not unheard of. Hopefully he’ll find another location that will be more stable and your treatment can proceed as planned. Good luck!

  7. Karen says:

    Dear Dr. Jorgensen,
    Im so glad to find your site.
    I have previously done damon braces without TADs and my teeth align but was not pulled in. I still have protruding teeth and that the braces was done almost ten years ago.
    After many years, I thought of doing braces again but I have already taken two top molar teeth and an Orthondontics who did my braces before didn’t recommend any teeth removal.
    Today I saw an orthondontists who told me that I can use damon braces with TADs and not having to remove teeth, and yet still can pull in up to 8mm.
    I thought of redoing again but just didn’t want to waste the money again if it doesn’t really a lot of my front teeth protrusion. I do hope with TADs, it can achieve my ideal result and yet no teeth removal required. Do you think so?

    • TADS are temporary anchors that give orthodontists something to hold onto so they can move the teeth. In the olden days we would use headgear for this reason. TADS may be one option for you. Do not be persuaded by the orthodontist using Damon brackets. Any bracket can do what it can do. It is just a self-ligating bracket that has a lot of good marketing behind it. It is not magical.

  8. Sage says:

    Bones do have nerves. Therefore bones feel pain. Please revisit that section of the article.

    • Bone itself has no feeling Sage. There are nerves that run in the bone that sense pain and pressure. Think about it like electrical wires in a wall. The framing inside the walls are not electrified unless you hit a wire. I assure you that the bone itself does not feel pain.

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