Dr. Greg Jorgensen
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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.

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

  1. Candy says:

    My daughter is 11 and they just put expanders cause her mouth is to small n she has two teeth that is not coming out how long do u think she would need this for n is there another way to bring those two teeth down? She is in a lot of pain n crys everyday.

    • The length of time is determined by the amount of expansion needed and how fast it is achieved. My patients typically have theirs in for 3 to 6 months. The only alternative to expansion is extraction (removing teeth). Hopefully your daughter will get used to her expander and all will go smoothly.

  2. Katty says:

    I have vertical maxillary excess,not too much but i have and it causes lip incompetence,can anchorage device help,
    how much time it will take to fix it as i already had braces and only maxillary excess is there.

    • While it may be possible to intrude your upper jaw some with TAD’s, the amount that is possible is no where near what can be accomplished surgically. If your lip incompetence and excessive gingival display are unacceptable, you should do it right and have the surgery. The amount that can be accomplished with TAD’s is limited, unpredictable, and extends treatment time. Surgery is predictable and immediate. Too bad it is also expensive.

  3. Roumiana Davidson says:

    Dr. Jorgensen, I am so grateful for your blog which answered so many of my questions and helped me move forward with the decision to get braces. My reason for needing them is functional and not so much esthetic. I am 36 and had an upper wisdom tooth removed which had erupted and had no problems. My dentist was putting a crown on the tooth next to my wisdom tooth and re-doing a crown on the bottom tooth which is right across from the new crown. He suggested we take the wisdom tooth out since I was numbed for the rest of the procedures. Afterwards I couldn’t chew even though I went for adjustments weekly for 3 months. Every time, we needed to adjust different teeth all over my mouth. We discovered my teeth were moving in different directions. The back upper teeth next to the wisdom tooth had spread apart by a whole millimeter and one of my front teeth was starting to get crowded. I also couldn’t relax my jaw, as it was trying to find a resting place but it couldn’t, so it was fatigued in the morning. I went to an orthodontist who suggested surgery or removing 2 upper teeth, but since I was horrified about the idea of a surgery, I went to another orthodontist for a 2nd opinion and he said we could fix my bite with braces with forsus but the correction will not be optimal at about 80%. I then had to go to a different orthodontist because of my insurance and she said she “wasn’t a fan of teeth extractions” and we could correct my bite close to 100% by using braces and a TAD. My teeth on top are straight and the 2nd orthodontist with the 80% projection didn’t think a TAD would be useful in my case. His diagnosis was: “progressive crowding of the upper and lower anterior teeth which has occured in the last several years
    • There is a discrepancy between the relaxed biting position (CR) and the habitual biting position (CO)
    • There are rotations of teeth in both upper and lower arches
    • The lower jaw is behind the upper jaw
    • Lower front teeth are too far behind upper front teeth
    • Overbite is excessive, giving a deep bite
    • The back teeth are in an overbite biting relationship with the upper molars
    forward of the lower molars
    • Health of gums and supporting tissues is good
    • TMJ screening exam suggest less than ideal TMJ function”
    After reading your articles, I am open to whatever treatment will give me the best results even if it is surgery, but do I go to a new orthodontist since the current one is “not a fan of extractions” and her opinion about a TAD is conflicting with the other orthodontist? I am so confused.

    • Beware of any orthodontist that rules out extractions. There are times when extraction are necessary. Your self-description sounds like you have a significant jaw-size discrepancy. That usually means that you either need to move the top teeth back (extraction of two upper teeth) or surgery to lengthen the lower jaw. Forsus springs are not a very good option if you have a really small lower jaw since they push the lower teeth forward (and you don’t have much bone down there). I would guess that upper extractions (with or without a TAD) or lower jaw advancement are your two best options. “Not a fan of extractions” is a sales pitch.

  4. Jake Mcmillian says:

    When I had my braces, my orthodontist wanted me to have a TAD put in at the very back of my upper right gums, behind all of my teeth. The first one actually fell out while I was eating less than a week later. I had to go back to the oral surgeon and have another one put in. The put it about half a centimeter behind the location of the first. This one took about a month to come out. This time my oral surgeon was very surprised because the TAD they used the second time was much longer and the hole it was in completely closed up a day later they recommended a plate. A cross shaped device that attached to the bone with 4 screws under my gums and a hole in the center where a new TAD could be placed. Within a month, 3 of the 4 plate screws and most of the plate were exposed, the TAD fell out, and my oral surgeon removed the device free of charge and apologized for the many inconveniences. Has this ever happened before?

    • Hi Jake. I am sorry you are having so many problems with your TADs. I have used hundreds of them in my practice since 2006 and can count on one hand the number that have come loose. It is not unheard of, but it is very rare.

  5. Gaurav says:

    A couple of months ago, i went to the orthodontist for getting braces on my teeth and, i was told that i have four extra teeth in my mouth. so, i have to get them extracted first.when they extracted my upper premolars, for few days i had my gums paining.and then as per the recommendation i had Ibuprofen and paracetamol Tablets(pain killers) for few days and then the pain disappeared. And i don’t feel pain now .

    But when they extracted my lower Premolars, i am having severe pain in my gums and its quite painful and it starts paining badly as soon as the painkillers finishes its effect. so i wanted to know is it normal or ???
    what should i do in this case?

  6. Jongky says:

    Hi, my son started his orthodontic treatment when he was 11. Now he is 13 and his orthontist told me that he needs TAD for his class 3 lower jaw. My question: can TAD stays in his jaw until he finish his growth (around 18 years old)?
    If TAD cant stay that long. What is going to happen when he grows again after the treatment finish?

    • There is no way that a TAD alone can stop your son’s Class III growth. I think you need to discuss the purpose of the TAD and how long it will be in place with your orthodontist. In my experience, Class III growth is genetically determined and only mild cases can be corrected non-surgicially.

  7. Amber says:

    My daughter has a tad in the upper right and there is extra tissue around it, quite puffy but no purulent fluid and NO pain. We are out of the country and can’t get to the Dr right away. How concerned should I be?

    • The puffiness is called hyperplasia (extra tissue) and the best thing she can do is keep everything as clean as possible. I have my patients use chlorhexidine rinse to keep this to a minimum. Ask your doctor about it when you return.

  8. Laurie Busch says:

    My daughter almost 11 has a very gummy smile, we went to the orthodontist for the first time and he said she was tough tied(we had no idea) and needed tissue removed at the top of her gums best to do before braces-we did both procedures with a perodontist-painful but glad it was done.He also talked about doing TAds to help move the teeth up at the same time she has her braces. Just curious on your input on best way to improve a gummy smile.
    Thanks,

    • There are several ways to improve a gummy smile. A gingivectomy like your daughter already had is one. TADS can be used for intruding the upper incisors in some patients, but in others surgery to shorten the upper jaw is more appropriate. One other option is to have the upper lip “lengthened” if it is too short. This can be done with another periodontal procedure that releases some of the muscles that are pulling up on the lip. I’ve also heard some claims that Botox can temporarily lengthen the lip. Last of all, with time our facial tonicity relaxes and our faces “sag.” The result is that smiles look less gummy.

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