For every action there is an equal and opposite reaction. Sound familiar? Envision Newton’s third law of motion as a tug-of-war. One group may be bigger and stronger, but the instant the force strikes that rope that pulls one group over the line, there is an equal and opposite force acting on the winning group. This is all fun and laughs at a family reunion, but this law of motion can irritate orthodontic treatment.
For example, in the case of a patient’s overbite, we can commonly remove some teeth and shift the front teeth into that new available space. If the force needed to migrate the front teeth back is applied to the back teeth alone, those back teeth will also move forward, which is where Newton’s law is evident. Of course, we want to avoid that scenario. Headgear has been used in the past to anchor the back teeth in place, but full-time headgear wear is undesirable these days for many reasons.
The FDA approved in 2005 the use of Temporary Anchorage Devices (TAD’s) in the United States. German and Asian orthodontists had been using these for close to ten years. Orthodontists and other dental experts were perusing professional journals full of case studies and articles outlining the success of TADs, and the idea was gaining momentum in the U.S. Only one manufacturer offered a TAD at the annual product show in 2005, but in only one year, that number had grown to 19 suppliers. The TAD took the U.S. market by storm, being implemented very quickly into modern orthodontic practice.
TADs are also known as mini-screws, min-implants, and micro-implants. They are small, approximately 6-10 millimeters long, and look like an earring resting on the gums when in place. They are composed of biologically inert materials that have no effect on the body. They are non-corrosive, and will not be rejected. They are specially designed to be compatible with bone, as well as soft tissue.
Placement of the TAD is very easy, and typically a topical and small dose of anesthetic is placed on the soft tissue. The bone feels not pain, so once the soft tissue is numbed, the procedure is completely painless and insertion takes less than a minute.
The TAD provides a secured object used to push, pull, lift, or intrude teeth that need to be straightened. TAD care is low maintenance, including routine brushing and sometimes a chlorhexidine mouthwash is prescribed. Very few complications are reported if gums are kept healthy.
TAD removal is easier than implementation. Since there is already a breach of the soft tissue and no pain associated with simply unscrewing it, it is a very simple procedure. A topical may be applied beforehand if there is any swelling or soreness.
Since TADs are immobile, they can be used to move teeth in directions and to certain degrees previously unattainable. They may not completely avoid a prognosis for jaw surgery or extractions for all patients, but in many cases they can diminish treatment significantly.