What This Guide Covers
This guide explains temporary anchorage devices (TADs), the small titanium mini screws orthodontists use to create fixed anchor points in the jaw. You will learn how they work, what placement feels like, and when they are recommended.
TADs have become a widely adopted tool in orthodontic practice. A cross-cultural survey of orthodontists in Australia and the UK found that the majority of practitioners now use TADs in clinical treatment, reflecting their growing role in modern orthodontics. [1] Earlier surveys of U.S. orthodontic residency programs and private practices confirmed a similar trend toward routine TAD use. [7]
This guide is for anyone who has been told they may need TADs as part of braces or aligner treatment. It is also useful for parents of teens facing complex orthodontic corrections. If you are exploring orthodontic options more broadly, visit the orthodontics page for a wider overview of treatment types.
How TADs Work in Orthodontic Treatment
TADs provide a fixed point in the bone so orthodontic forces can move specific teeth without shifting other teeth. Think of them as tiny anchors that hold steady while braces do the pulling.
In traditional orthodontics, moving one tooth means another tooth absorbs the reaction force and may drift in an unwanted direction. This is called reciprocal anchorage. TADs eliminate that problem by anchoring forces directly to bone rather than to other teeth. [4] The result is more predictable, controlled movement with fewer side effects on surrounding teeth.
What a TAD Looks Like
A TAD is a small screw made of biocompatible titanium alloy. Most TADs measure 6 to 12 mm in length and 1.2 to 2 mm in diameter. [4] That is roughly the width of a pencil lead. The screw has a smooth head that sits at the gum surface and a threaded body that grips the bone.
Unlike dental implants, TADs are not designed to fuse permanently with the bone. They rely on mechanical retention, meaning the threads hold the screw in place without biological bonding. This is what makes them easy to remove once treatment is complete. [4]
Common Reasons Orthodontists Recommend TADs
TADs solve several problems that are difficult to address with braces or aligners alone. Their most frequent uses include tooth intrusion (pushing a tooth deeper into the bone), space closure after an extraction, and correction of open bites or deep bites. [4]
A systematic review found that TAD-supported intrusion of molars produced clinically significant results, with measurable reduction in open bites when molars were pushed into the bone. [6] A clinical study on miniscrew-assisted molar intrusion confirmed that TADs achieved effective intrusion of overerupted molars, helping restore a level bite plane. [2]
TADs are also used for total arch distalization, which means moving all the upper teeth backward to correct a Class II malocclusion (where the upper jaw sits too far forward relative to the lower jaw). A systematic review and meta-analysis found that TAD-assisted distalization was effective at moving upper molars backward by a clinically meaningful amount, often reducing or eliminating the need for jaw surgery or tooth extractions. [5]
- Molar intrusion: pushing overerupted or extruded molars back into proper position [2] [6]
- Open bite correction: closing a gap between the upper and lower front teeth by intruding back teeth [6]
- Space closure: pulling teeth together after extractions without unwanted movement of anchor teeth [4]
- Arch distalization: moving the entire upper arch backward to correct bite misalignment [5]
- Midline correction: shifting teeth to center the midline of the upper and lower arches [4]
- Canine retraction: pulling canine teeth back into alignment after premolar extraction [4]
Success Rates and What Affects Them
TADs have a reported success rate of approximately 85% to 90% in most clinical studies. [4] "Success" means the screw stays stable and functional for the full duration it is needed. If a TAD loosens before treatment is complete, the orthodontist can typically remove it and place a new one at a nearby site during the same visit.
Several factors influence whether a TAD stays stable. These include the thickness and density of the bone at the placement site, oral hygiene around the screw, and whether the screw contacts a tooth root. Inflammation of the soft tissue around the TAD is the most common reason for loosening. Keeping the area clean greatly reduces this risk. [3] [4]
What You Should Know Before Getting TADs
TADs require minimal preparation and are suitable for most teens and adults who need complex tooth movement.
Age and Candidacy
TADs are most commonly placed in adolescents and adults. The patient needs enough bone density to hold the screw, so very young children whose jaws are still developing are typically not candidates. Your orthodontist will evaluate bone quality using a dental X-ray or cone beam CT scan before recommending TADs.
Certain medical conditions may affect candidacy. Patients taking bisphosphonate medications (used for osteoporosis) or those with uncontrolled diabetes should discuss risks with their orthodontist. Smoking also increases the chance of TAD failure because it slows healing and promotes inflammation around the screw. [4]
How to Prepare
There is very little preparation needed for TAD placement. Your orthodontist may ask you to rinse with an antimicrobial mouthwash before the appointment. You do not need to fast or arrange for a ride home, since the procedure uses only local anesthesia (numbing of the area).
If you take blood-thinning medications, let your orthodontist know in advance. In most cases, blood thinners do not need to be stopped, but your provider should be aware.
What Patients Report About Comfort
A systematic review of patient-reported outcome measures found that most patients experienced only mild to moderate discomfort during and after TAD placement. [3] Pain levels were generally described as less intense than the discomfort of having a tooth extracted. Some patients reported mild soreness for one to three days after placement, which typically responded well to over-the-counter pain relievers.
The same review noted that overall patient acceptance of TADs was high. Most patients said they would agree to have TADs placed again if needed for future treatment. [3] Anxiety before placement was often greater than the actual discomfort experienced.
What to Expect During TAD Placement and Removal
TAD placement is a brief, in-office procedure that typically takes 10 to 15 minutes from start to finish.
Step-by-Step Placement
First, the orthodontist applies a topical numbing gel to the gum tissue. Then a small amount of local anesthetic is injected near the placement site. You will feel pressure but should not feel sharp pain.
Once the area is numb, the orthodontist uses a handheld driver to thread the mini screw through the gum tissue and into the bone. No incision or stitches are needed in most cases. The screw is turned slowly until it reaches the planned depth. The entire insertion typically takes less than a minute. [4]
After placement, the orthodontist may take a quick X-ray to confirm the screw is in the correct position and is not contacting any tooth roots. An elastic chain, spring, or wire is then connected from the TAD to the braces to begin applying the desired force.
- Step 1: Topical numbing gel is applied to the gum.
- Step 2: Local anesthetic is injected near the placement site.
- Step 3: The mini screw is threaded into the bone using a handheld driver.
- Step 4: An X-ray confirms proper position.
- Step 5: The TAD is connected to the braces with an elastic or wire.
Aftercare and Oral Hygiene
Keeping the tissue around the TAD clean is the single most important thing you can do to prevent loosening. Use a soft-bristled toothbrush or an interdental brush to gently clean around the screw head twice a day. Your orthodontist may also recommend an antimicrobial rinse.
Avoid poking or pushing the TAD with your tongue or fingers. Eat softer foods for the first day or two if the area feels tender. Most patients return to normal eating within 24 hours. Over-the-counter acetaminophen or ibuprofen is usually sufficient for any soreness. [3]
How TADs Are Removed
Removal is even simpler than placement. In many cases, local anesthesia is not even needed. The orthodontist unscrews the TAD with a small driver. The process takes only a few seconds. Most patients describe feeling mild pressure and nothing more.
The tiny hole in the bone fills in naturally within a few weeks, leaving no permanent mark. There are no stitches and no recovery period after removal. [4]
How Long TADs Stay In
TADs remain in place for 3 to 12 months, depending on the type and amount of tooth movement needed. Some cases, such as full arch distalization, may require TADs for the longer end of that range. [5] Simpler movements, like intruding a single tooth, may need TADs for only a few months.
Your orthodontist will monitor the TAD at each adjustment visit. If a TAD loosens, it can usually be replaced at a nearby site during the same appointment with no significant delay to your treatment.
TAD Costs and Insurance Coverage
TADs typically add $300 to $600 per screw to the total cost of orthodontic treatment. Costs vary by location, provider, and case complexity.
Most treatment plans require one or two TADs, though some complex cases may need more. The total added expense for TADs is generally between $300 and $1,200 on top of the base fee for braces or aligners. Some orthodontists include the cost of TADs in their overall treatment fee, while others bill them separately. Ask your provider how TADs are priced before treatment begins.
Dental insurance plans that cover orthodontic treatment may partially cover TADs as part of the overall orthodontic benefit. However, coverage varies widely by plan. Some insurers classify TADs as an ancillary orthodontic procedure and apply a separate allowance. Contact your insurance company and ask specifically whether "temporary anchorage devices" or "orthodontic mini screws" are included under your plan.
If TADs help you avoid jaw surgery, they may represent a significant cost savings overall. Orthognathic surgery (corrective jaw surgery) typically costs many times more than TADs, so discuss all treatment alternatives with your orthodontist.
When to See an Orthodontist About TADs
An orthodontist is the right specialist to evaluate whether TADs are needed for your treatment. General dentists do not typically place TADs.
You may benefit from TADs if your orthodontist identifies any of the following situations during your treatment planning:
- An open bite caused by overerupted back teeth that need to be pushed into the bone [6]
- A Class II bite (upper jaw too far forward) that could be corrected by moving upper teeth backward without surgery [5]
- Missing teeth with space closure needs, where remaining teeth must be pulled together without drifting anchor teeth
- A deep bite or asymmetric midline that requires precise, controlled movement of individual teeth [4]
- Cases where headgear was traditionally recommended but you prefer a less visible alternative [4]
- Situations where avoiding jaw surgery is a priority and TADs may offer a non-surgical path to correction [5]
TADs Compared to Other Anchorage Methods
Before TADs became widely used, orthodontists relied on headgear, Nance palatal arches, and transpalatal bars to provide anchorage. These appliances work, but each has limitations. Headgear depends on patient compliance, meaning it only works if you wear it as directed. Palatal arches are fixed inside the mouth but provide less anchorage force than TADs. [4]
A systematic review comparing intrusion methods found that TAD-supported intrusion produced more consistent and predictable results than intrusion arches alone. [6] TADs also allow forces to be applied 24 hours a day without any patient compliance, since the screws are always in place. Your orthodontist can help you weigh TADs against other anchorage options based on your specific needs.
Find an Orthodontist Experienced with TADs
If you have been told you need TADs, or if you want to explore whether TADs could simplify your orthodontic treatment, an experienced orthodontist can evaluate your case. Use our directory on the orthodontics page to search for board-certified orthodontists in your area who offer temporary anchorage devices as part of their practice.
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