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.

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

  1. CICI says:

    Thank you for your article! Actually I am looking for orthodontist who has the experience to lift the upper jaw by TAD to reduce the gummy smile. I found one in the AZ but I am living in NJ. Could you recommend some orthodontists in NJ and NY? I visited some orthodontists who use TADs, but they don’t have the experience to lift the whole jaw up. I am in the middle of my treatment BTW. Thank you so much again!

    • Lifting the entire jaw with tiny TADS is probably unrealistic. You may be able to intrude the front or the back a millimeter or two, but a true maxillary vertical excess requires surgery to correct. Two sources for finding orthodontists are the websites of the American Association of Orthodontists and the American Board of Orthodontists. These resources cannot tell you which doctors have experience with TADS.

  2. VAB says:

    I want to know whether TAD overall speed up the process and I had trauma and got my central incisor intrusion and I had root canal done and started orthodontic treatment started with my orthodontist had me TAD applied.What are chances of my intruded teeth getting in normal position because of TAD?

    • TADS allow orthodontists to make movements that otherwise would be difficult or impossible (since they are wonderful anchors). They do NOT speed up treatment. In fact, they may slow down space closure since all of the movement will then be one-way rather than bi-directional.

  3. Anita says:

    Thank you for your article. I am currently using TADs for the treatment of my open bite (I sucked my thumb as a child) and somewhat overbite. In your article you mention that patients should typically not feel any pain during insertion of the screws. I suppose its placement dependent. With that said, my experience with insertion of the two TADs in my upper pallet was excruciating!!! My orthodontist who practices in Santa Fe (NM) tried several attempts with both topical and a pressurized system or gun, for lack of a better word, to numb me. It did not work. After 4 hours of sitting in the orthodontists chair, and several tears (from a grown 32 year old woman), I walked out of the office exhausted with two screws at the top of my mouth alongside a TP bar. No sooner to find out the TAD length was not long enough for one screw, it fell out and had to be re-inserted two other times, of which the last time the screw was too long. And now I have a screw sticking out of my pallet such like a nail that hasn’t been hammered flush onto a 2×4. It should be noted that, a few months later a TAD was placed on my gums, of which I felt no pain… success there. So nearly one and a half years later (after being told I would have them for 6-9 months) I will be removing them in a couple of weeks, after I told the Dr. that I couldn’t handle having this system in mouth any longer. It should also be noted that yes, we were successful in the treatment, but not without a lot of trauma and continual discomfort in my mouth. Therefore, I have some questions. 1) Should I be concerned that I experienced so much pain during TAD insertion, i.e. were nerves, tissue etc. damaged? 2) Given the TADs have been in so long, do I have to worry about my bone fusing to the screw? I am concerned that I will feel more of the same pain or cause damage to my mouth when I get them removed in a couple weeks. 3) I noticed that the procedure has essentially caused my molars to “disappear”, that is they have intruded into my gums. What will this do for the overall health of my teeth and mouth? 4) Is what I experienced a red flag for a doctor that doesn’t know what he/she are doing with this type of treatment? Thank you for your feedback.

    • Hi Anita. I’m sorry that your experience has not been good with TADS. They are and amazing technology and have allowed orthodontists to provide treatment options that used to be impossible. Here are my responses to your questions: 1) My patients do not experience pain when I insert TADS because I numb them up completely with “Novocain.” I would not want to only have a topical in my mouth for this procedure so I don’t do that to my patients. 2) Orthodontic TADS do not fuse the the bone like regular implants. They are designed to be temporary (hence the name Temporary Anchorage Device). Removal may be slightly uncomfortable due to the pressure, but nothing like putting them in. 3) There is going to be some relapse when the TADS are removed, so your molars will erupt again. And 4) Nothing you described makes me think the doctor did anything wrong. In fact the description of your molars “disappearing” sounds like they worked well. Some doctors have more experience than others, but I didn’t hear anything in your description that set off an alarm in my mind. Good luck!

  4. Catherine Gass says:

    Hello Dr. Jorgensen,

    I have TADS to move my teeth up. The goal is 5 mm. The bands were placed above my front teeth, at the sides of my outer teeth and recently a couple on the roof of my mouth. The back teeth appeared to have moved 1-1.5 mm. The front teeth, especially the two front appear to not have moved at all since January. I have measured from the midpoint of my eye to the center of my tooth many times. The doctor removed the side bands since the back teeth had already moved. Do you know why it is taking so long to move the front teeth up? What do you think it that estimated amount of time to move teeth up 5 mm? Your input would be greatly appreciated. Thank you.



    • Only your local orthodontist can accurately evaluate your progress (or lack there of). In my experience with TADs, I have not been able to intrude teeth 5mm. I’m not saying it is impossible, I’m just saying that I haven’t seen it.

  5. Milenia says:

    I had orthodontic work done a few years ago with four premolars extractions and as you imagine, I ended up with dished in profile. Now I’m seeing a new orthodontist. He is going to use headgear and TADs to push the jaw forward and do some expansion at the same time. I would like to know if the headgear and TADs works on Adults?

    • As you can tell from the hundreds of comments I’ve made on this topic, I disagree with the premise that removing bicuspids dishes in the profile. I have removed teeth from thousands of patients WHO NEEDED extractions and I have not seen this. TADs do work on adults for many applications. I have no idea how headgear could ever fix a dished in profile unless it pulls the teeth forward.

  6. Gabriella says:

    I have a failed root canal on my first molar. And they said I should extract it, and I don’t want to get implants. Can I use TADs to close the gap even if I don’t have my wisdom tooth yet?

    • Closing the space where a molar has been removed is very difficult. It requires a long treatment time and can cause problems with the bite and the adjacent teeth. While it is possible, I wouldn’t try it with my patients. Implants are very successful and would be cheaper than braces if that is your only problem.

  7. Phan Mai says:

    Hi Dr Jorgensen
    You helped me before in this blog by explaining some points that I was still vague about my daughter’s case. I really appreciate what you have done so far here to help people like me. Thank you very much indeed.
    Now I have another concern. Let me explain again about my daughter’s case. She is 11 years old nearly puberty. She has 2 jaws of similar size, good bite. She has deep bite in the front and the upper front teeth protruded. One orthondotist wants to expand two jaws. Another wants to use TAD (screw) to move the upper molars inwards to create space. Which do you think is better? more stable? safer? less risky? My wish is to put in order of priority as: 1. less risky (lowest ratio of future problems to health ); 2. stable; 3. good-looking ( I just would be satisfactory with 50% improvement for her protruded front teeth). I’m very confused now. I learn from you that expanding the lower jaw may have some risks and not stable. What about the other option, TAD to move molars? Pls help me. Thank you.

    • I honestly cannot diagnose your daughter’s case on the Internet. In general, I would say that expanders are a lot less risky. I use 100 expanders for every TAD I use. That should give you some idea of how I might treat her in my office.

  8. Emma says:

    I know that it is difficult to comment on whether the cost of procedure is reasonable or not, as it can vary for many factors including geography. However, is there a range that you would expect to see for the charge to place a TAD? I have just been quoted $2,250 per TAD, excluding sedation, making for a total of over $5,000 to place two TADs in the upper jaw. That seems extremely expensive to me; the FairHealth consumer site suggests $600 per TAD placement (excluding sedation) is the estimated charge in my area. Do you have any thoughts? Thank you!

  9. Areli Contreras says:

    Dr. Jorgensen,

    Hi doctor I am 20 years old and about a month ago I started seeing an orthodontist here in Woodbridge VA…I have a very bad crossbite my canines are really up high my mouth. Doctor suggestest she was going to put a TAD expander in my mouth…when the day came in to put the screws in….the expander didn’t go where she wanted because my palate is very narrow… she said that she didn’t want to put in longs screws because it would be discomfort. So she’s didn’t put the TADS in…she said that she would cement it in without the TADS and turn it once a day for 14 days….so when I go to my appointment which is in Nov 20 she said she will see if she would but the TADS in IF my upper jaw expands ……my question is how many mm will my mouth expand? I heard each turn is 1/4mm….will this work? I’m really stressed and praying this will work. She did say at some point I would need 4 teeth extracted.

    • I can’t answer these questions about your mouth specifically. 1/4mm is about right, but every manufacturer makes their device differently. I am concerned about you having an expander at age 20. I’d be shocked if your palatal suture could still spread at this age without surgery. Beware of the expander moving your TEETH and not your JAW. I your teeth start to move out of the bone, you can lose bone and have recession on the roots of the side teeth. Most 20-year-old patients need to have a surgical procedure along with their expander so that the jaw moves instead of the teeth.

  10. James says:

    First I’d like to say thank you for taking the time to answer so many questions. Not many people in your position would offer to do this.
    I lost both molars in my lower left jaw, and, because of a very severe illness,wasn’t able to wear my retainers for about 10 months. And as you can guess, my teeth have moved and the retainers no longer fit. This happened a few years ago and my teeth continue to move.
    Because of this I’d like to go through treatment again. What I was wondering was if the TAD’s can be used to compensate for the missing molars.

    • TADS allow orthodontists to move teeth in ways and directions that used to be difficult or impossible. They are used for anchorage and stability. They do not replace teeth. You should discuss whether or not dental implants are an option for you.

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