What Are Temporary Anchorage Devices?
In orthodontics, moving teeth requires something stable to push or pull against. Traditionally, the anchor (called anchorage) comes from other teeth, headgear, or the palate. The problem is that when you use one group of teeth to move another, the anchor teeth can move too, sometimes in undesirable directions.
Temporary anchorage devices solve this problem by providing an anchor point that is completely independent of the teeth. A TAD is a small titanium screw, typically 6 to 12 mm long and about 1.2 to 2 mm in diameter, that is placed directly into the jawbone through the gum tissue. Elastics, springs, or wires are then attached from the TAD to the braces to deliver targeted forces.
Because the screw is fixed in bone, it does not move when force is applied. This gives the orthodontist precise control over which teeth move and in which direction. TADs have significantly expanded what orthodontists can accomplish without jaw surgery.
How TADs Work and When They Are Used
TADs provide what orthodontists call absolute anchorage. This means the anchor point stays completely stationary while force is applied to move the target teeth.
Common Clinical Uses for TADs
TADs are used in a variety of orthodontic situations where conventional mechanics fall short.
- Intrusion of over-erupted teeth: When a tooth has drifted too far out of the bone (often a molar that lost its opposing tooth), a TAD can pull it back into proper position
- Open bite correction: TADs placed near the back teeth can intrude the molars, allowing the jaw to close more and the front teeth to meet
- Protraction or retraction of teeth: Moving front teeth back (such as after extractions) without the back teeth shifting forward
- Uprighting tilted molars: A TAD can provide leverage to straighten a molar that has tipped into an extraction site or gap
- Asymmetric tooth movement: Moving teeth on one side without affecting the other side
- Avoiding jaw surgery: In some borderline cases, TADs provide enough mechanical advantage to correct the bite without surgical intervention
Types of TADs
Most TADs used in orthodontics are mini screws (also called micro-implants or orthodontic mini-implants). These are the smallest and most common type. They differ from dental implants in that they are temporary, smaller, and are not designed to support a crown or prosthetic tooth.
Another type is the mini plate, which is a small titanium plate anchored by two or more screws, typically placed by an oral surgeon. Mini plates are used less frequently but provide even stronger anchorage for more demanding tooth movements.
TADs vs. Dental Implants
It is important to understand that orthodontic TADs are not the same as dental implants. Dental implants are permanent titanium posts that integrate with the bone over months and serve as artificial tooth roots. TADs are temporary, do not integrate with the bone (they are retained by mechanical friction), and are removed once they have served their purpose. TAD placement and removal are both much simpler procedures than dental implant surgery.
What to Expect: Before, During, and After TAD Placement
TAD placement is a straightforward procedure that is usually performed in the orthodontist's office.
Before Placement
The orthodontist uses X-rays or a CBCT (cone beam CT) scan to identify the optimal placement site. The goal is to find an area with adequate bone density between tooth roots where the screw will not interfere with roots, nerves, or blood vessels. The placement site is planned as part of your overall treatment plan.
The Placement Procedure
TAD placement typically takes 10 to 15 minutes. The orthodontist numbs the gum tissue with a topical anesthetic followed by a small amount of local anesthetic (similar to what you receive for a filling). In many cases, the topical alone is sufficient because the bone where TADs are placed has relatively few nerve endings.
The orthodontist then uses a specialized driver (similar to a tiny screwdriver) to thread the mini screw through the gum tissue and into the bone. You may feel pressure during insertion, but significant pain is uncommon. No incision is made and no stitches are needed. The screw head protrudes slightly through the gum, providing an attachment point for orthodontic hardware.
Immediately After Placement
You can return to your normal routine right after the appointment. Mild tenderness at the placement site is common for 1 to 3 days. Over-the-counter pain medication (such as acetaminophen) is usually sufficient. Avoid touching or pressing on the TAD with your tongue or fingers.
The orthodontist may begin applying force to the TAD at the same appointment or may wait a few weeks, depending on the treatment plan.
Recovery and Care for TADs
TADs require minimal special care, but keeping the area clean is essential for success.
Daily Cleaning
Gently brush around the TAD site twice daily with a soft toothbrush or an interdental brush. The area where the screw passes through the gum tissue can collect plaque and food debris, which can cause gum inflammation (peri-implant mucositis) and potentially lead to TAD loosening.
An antimicrobial mouthwash (such as chlorhexidine) may be recommended for the first 1 to 2 weeks after placement. After that, regular brushing around the site is usually sufficient.
Signs of Problems
Contact your orthodontist if you notice the TAD feels loose or wobbly, the gum around the TAD is persistently red, swollen, or bleeding, you experience increasing pain at the site after the first few days, or the TAD falls out. A loose TAD typically needs to be removed and, if still needed for treatment, replaced in a nearby location.
TAD Removal
Removal is even simpler than placement. The orthodontist unscrews the TAD, which takes less than a minute. Most patients do not need any anesthesia for removal because the bone around the screw does not contain nerve endings that register pain from unscrewing. The small hole in the gum and bone heals on its own within a few days to a week, and the bone fills in completely over the following weeks.
TAD Success Rates
Published studies report TAD success rates of approximately 85% to 90%. The most common reason for failure is loosening, which can occur due to inflammation from poor oral hygiene, placement in an area with thin or low-quality bone, or excessive force applied too early. If a TAD fails, it can usually be replaced at a nearby site with no lasting consequences.
TAD Costs and Insurance Coverage
TADs add a separate charge to your orthodontic treatment fee. Costs vary by location and provider.
Typical Cost Ranges
The cost of TADs depends on how many are needed and whether they are placed by the orthodontist or referred to an oral surgeon.
- TAD placement (per screw): $300 to $600, including the device and placement procedure
- Number of TADs per case: Most cases require 1 to 4 TADs
- Total additional TAD cost: $300 to $2,400 on top of the base orthodontic fee
- TAD removal: Usually included in the original placement fee
- Replacement TAD (if one fails): May or may not incur an additional fee depending on the practice
Insurance and Payment
Some dental insurance plans with orthodontic benefits include TADs as part of the covered orthodontic treatment. Others may classify them as a separate procedure with a separate fee. Check with your insurance provider for specifics.
If TADs are placed by an oral surgeon on referral, that surgeon's fee may be billed separately and may be partially covered under the surgical benefit of your medical or dental plan. HSA and FSA funds can typically be used for TAD costs.
When to See an Orthodontist About TADs
TADs are not something patients typically request on their own. Rather, your orthodontist may recommend them as part of your treatment plan if your case involves certain challenging movements. You may be a candidate for TADs if you have an open bite that needs molar intrusion to close, your treatment plan involves moving teeth without affecting adjacent teeth, you are trying to avoid or minimize the need for jaw surgery, you have a missing tooth and the surrounding teeth have shifted and need to be uprighted, or previous orthodontic treatment was unable to achieve certain movements using braces alone.
If your orthodontist recommends TADs, ask about the expected benefits for your specific case, the placement site, how long they will remain, and any associated costs.
Find an Orthodontist Near You
If you have a complex bite issue or have been told you may need TADs as part of your orthodontic treatment, finding an experienced orthodontist is important. Use the MySpecialtyDentist.com directory to search for board-certified orthodontists in your area, review their credentials, and schedule a consultation.
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