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Temporary Anchorage Devices (TAD's)
Temporary anchorage devices, or TAD's, and skeletal fixation plates are innovative, small, titanium anchors used in orthodontics to help achieve tooth movement which cannot sometimes be achieved with conventional braces. These devices allow for tooth movement to occur more efficiently and comfortably in cases where there is the need to apply greater forces or when the direction of force required is very different than that which can be provided by the teeth and/or braces alone. In the past, patients requiring greater anchorage had to rely solely on unattractive headgear or maintainers. These devices are used as an alternative to headgear use. The use of either TAD's of fixation plates is generally determined by the amount of force required and direction (vector) desired to achieve the expected outcome.
TAD's are small screw-like devices that are placed between the roots of teeth and directly into the bone which can be placed with small amount of local anesthesia and with limited surgical intervention. This simple device provides a much-needed “fixed point” to accomplish effective tooth movements. These can be placed either on the lip side of the upper and lower jaw as well as in the palate. As the name describes the device, these are only placed temporarily until the movement desired is obtained and these can be removed. Some of their advantages include:
- 1) TAD's placement is customized to the patient’s needs. Placing a TAD is not a one-size-fits-all procedure. Rather, we will place the TAD in a location optimized for your medical/dental needs and cosmetic goals.
- 2) TAD's offer an attractive alternative to headgear. Headgear can not only be uncomfortable, but many patients find it embarrassing and unattractive. One of the best parts of choosing a temporary anchorage device is that it works “behind the scenes.” People won’t even know you have it.
- 3) TAD's are low-maintenance. Beyond normal brushing, TAD's usually do not require any special care on the part of the patient.
- 4) TAD's achieve predictable results, even in difficult cases. Temporary anchorage devices have been shown to work effectively and predictably, even when it comes to the most serious of orthodontic cases.
While TAD's alone may be enough for certain patients, others require an extra boost to support tooth movement; that is, they need enhanced anchorage which the TAD might not be able to provide. For these cases, titanium skeletal fixation plates are then used. These can be prefabricated plates used specifically for dentofacial orthpaedics (i.e. Bollard Plates), or custom molded plates that can be adapted to any part of the facial skeleton depending on the need. These are generally however placed under general anesthesia. These plates are generally used for:
- 1) Intrusion of molars for correction of open bites. Placing fixation plates will allow the intrusion of molars to acheive a greater amount of mandibular closure when presentation of complete jaw closure is not possible significantly reducing the need for potential orthognathic (corrective jaw surgery) procedures.
- 2) Stimulation and/or reduction of jaw growth. With the use of Bollard skeletal fixation plates for prognathic or retrusive facial profiles the use of traction elastics can help stimulate and guide the growth of the maxilla forward or retard and prevent mandibular growth forward just as a headgear does.
- 3) Movement of multiple posterior teeth and/or quadrant orthodontics in any direction. Since the device is firmly fixated to bone, the possibility to avoid unwanted tooth movement is bypassed with quicker and more predictable results in any quadrant movements like correction of significant dental midline discrepancies.
Removal of a TAD or plates is much easier than their placement and it usually takes just a few minutes. Tylenol® or ibuprofen is recommended to help relieve your pain after TAD or plate removal. TAD's or plates can be cleaned by brushing them while one brushes their teeth and sometimes the use of an antimicrobial mouthwash are needed.