Temporary anchorage devices

(TADS)

KOMAL RAWAL
PG 2ND YEAR
GUIDED BY: Dr. Srikanth
 CONTENTS
 Introduction
 History
 Classification
 Placement sites
 Armamentarium and procedure
 Biological aspects of orthodontic implants
 Clinical Applications
 Advantages and disadvantages
 Risks and complications
 Conclusion
 References
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 It is defined as the nature and degree of Resistance to

displacement offered by an anatomic unit when used for the

purpose of effecting tooth movement.

Graber

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 ORTHODONTIC ANCHORAGE
• 1923, Louis Ottofy defined it as
“the base against which orthodontic force or
reaction of orthodontic force is applied.”

• Daskalogiannakis defined anchorage as “resistance to unwanted tooth

movement.”

 Anchorage is defined as the prevention of unwanted tooth movement

(Proffit 2000)

Temporary Anchorage Devices in Orthodontics: A Paradigm Shift; Jason B. Cope;Semin Orthod

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11:3-9 ; 2005
 Patient
Compliance

Tooth borne anchorage

Conventional sliding mechanics- molar moves 3.6- 3.8mm after

5 1st premolar extraction
 It is a device that is temporarily fixed to the bone for the purpose

of enhancing orthodontic anchorage

either by supporting the teeth of the reactive unit or by obviating the

need for the reactive unit altogether,

and which is subsequently removed after use

INFINITE ANCHORAGE: defined in terms of implants as

showing no movement (zero anchorage loss) as a
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consequence of reaction forces
Miniscrews – Why so Popular

Produce good
treatment result
Convenient Save time
with no need for
patient cooperation
 History
 Gainsforth and Higley (1945) first suggested the use of metallic screws as

anchors

 Using a 2.4-mm pilot hole,

 a 3.4-mm-diameter

 13-mm-long vitallium screw

 140 and 200 g of force

VITALLIUM screw in
ascending ramus of 6 dogs.
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 1964, Branemark et al observed a fixed anchorage of titanium to
bone with no adverse tissue response.

 In 1969, Linkow used a blade implant in the mandibular 1st molar

region as a partial abutment for a bridge that was restored before
orthodontics.

 Creekmore and Eklund (1983) inserted a similar device below the nasal
cavity in 1983- to treat deep bite .

• The mid-palatal implant as an anchorage device - first described in

9 1992 by Triaca and colleagues
  Kanomi (1997) first described a miniscrew, specifically designed
for orthodontic use.

 Costa et al. (1998) described a screw with a special bracket-like

head that could be used for either direct or indirect anchorage.

 Roberts et al - the first to publish studies about successful closure

of first molar extraction sites, utilizing mini-implants in the
retromolar region as anchorage.

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1. Simple to Use

2. Inexpensive

3. Immediately Loadable

4. Small Dimensions

5. Must have Primary Stability and be able to withstand Orthodontic Forces

6. Immobile

7. Biocompatible

8. Provides clinically equivalent or superior results when compared with

traditional anchorage systems.
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Classification- JB Cope
 Labanauskaite et al classified Orthodontic implants

I. According to the shape and size:

1. Conical (cylindrical)
- Micro implants
- Palatal implants
- Prosthodontic implants

2. Miniplate implants
3. Disc implants (onplants);

II. According to the implant bone contact:

- Osseointegrated.
- Nonosseointegrated.

III. According to the application:

 Used only for orthodontic purposes (orthodontic implants)
 14Used for prosthodontic and orthodontic purposes (prosthodontic implants).
 Based on LOCATION

Endosteal Transosseous
Sub-periosteal

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 Based on composition:
 Gold alloys
 Stainless steel
 Cobalt-Chromium-Molybdenum (Co-Cr-Mo)
 Titanium
 Ceramic Implants
 Miscellaneous such as Vitreous carbon and composites

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 Morphology

BLADE OR
SCREW TYPE DISC TYPE
PLATE TYPE

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 (1995)

 Designed by - Michael S. Block & David R. Hoffman

 Made of Titanium Alloy (A6V14)

10 mm Diameter

2 mm Height

Hydroxyappetite Coated Surface (Against Bone)

75 µm thick layer – for Biointergration

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 Miniplates
 Based on SURFACE STRUCTURE:

a) Threaded & Non-Threaded –.

b) Porous & Non-porous.

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Based on INTEGRITY TO THE BONE:

Osseointegrating – the term osseointegration implies an intimate

structural contact between the implant surface & the adjacent vital
bone, devoid of any intervening fibrous tissue.

Eg: Onplants, Orthosystem

Partially osseintegration/ Non osseointegrating

The stability of the implant is by mechanical retention aided by the threads

present in the body of the screw.
Eg:- Miniscrews.

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 Based on insertion method

 Self Drilling / Drill Free

 Self Tapping – Pilot Drill Required

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 PARTS OF A MINISCREW

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Temporary anchorage devices – Ravindra nanda; Mosby
 Based upon movement desired & accessories necessary for the movement

 Button–Top:
Use for NiTi coil springs, Energy Chain elastics

 Cross-Top:
Use for Archwires, Wire Ligatures

 Bracket-Top:
Use for archwires, Energy chain, NiTi coil springs, elastics

 Cross-Top with Collar:

25 Use for Archwires, Energy Chain, elastics

 C- IMPLANT
C-implant is unique titanium that provides anchorage mainly from
osseointegration. It has 2 components
1. A screw with 1.8mm diameter and 8.5mm, 9.5mm or 10.5mm in
length. The entire surface except for the upper 2mm is sand blasted,
large grit and acid etched for optimal osseointegration.

2. A head with 2.5mm diameter and 5.35mm, 6.35mm or 7.35mm in

height with a 0.8mm diameter hole located 1mm, 2mm or 3mm
from the top of the screw
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 The 2 component system keeps:
 The Neck Area from fracturing during removal and
 Long Span between the head and screw prevents gingival irritation during
orthodontic traction.

Hole for wire

Groove for
Elastic

Screw

Self Tap

C- Implant Components and Screwdriver

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 ADVANTAGES
The C-implant can be loaded immediately.

 Threaded design allow better mechanical retention which minimizes

micro motion and improves initial stability

 Trisi and colleagues associated that roughened screw surface have a

significant increase in bone implant contact

 Small size, two part design, efficiency and low cost of C-implant make

it applicable in various types of situations

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 Based on length

Regular type
• 5- 7 mm
• Cylindrical neck- 1 mm
• Buccal area of maxilla and
mandible

Long type
• 5-6 mm
• For movable tissues
• Cylindrical neck – 2- 4mm

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 Based on diameter
Minitype
• Used in anterior alveolus
• 1.4 mm

Regular type
• Used in areas where
bone quality is good
• 1.6 mm

Wide type
• Inadequate bone quality
• 1.8 mm
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 for Implant Placement

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 Dense Cortical Thick Porous Thin Porous Fine Trabecular
Bone Cortical Bone Cortical Bone Bone

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 (Kravitz and Kusnoto 2007).

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Miniscrews for orthodontic anchorage: a review of available systems; Journal of Orthodontics2018
Based on Soft tissue considerations
 “Safe zones”: a guide for miniscrew positioning in the maxillary and mandibular arch

 Poggio, Incorvati et al provided an anatomical map (“safe

zones”) to assist the clinician in miniscrew placement in the
interradicular regions of the posterior teeth by using CT Scanner, for
each interradicular space, the mesiodistal and the buccolingual
distances were measured at 2, 5, 8, and 11mm from the alveolar crest.

“ Safe zones”: a guide for miniscrew positioning in the maxillary and mandibular arch , Paolo Maria
Poggio,Cristina Incorvati,StefanoVelo, Aldo Carano. Angle Orthodontist 2006,Volume 76, Number 2,191-197
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 The order of safer sites, available in the
inter-radicular spaces in maxilla

Miniscrews for orthodontic anchorage: a review of available systems; Journal of Orthodontics2018

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 The order of safer sites, available in the
inter-radicular spaces in mandible

Miniscrews for orthodontic anchorage: a review of available systems; Journal of Orthodontics2018

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Miniscrews for orthodontic anchorage: a review of available systems; Journal of Orthodontics2018
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 Region Diameter Length Purpose
 Retraction of the whole jaw or the anterior
1.3 & 1.4mm 5 - 6 mm
Infrazygomatic Crest Area / dentition
Retromolar Area  Intrusion of the molars.
1.3-1.6mm 6 - 10mm
 Uprighting of the molars

Region Diameter Length Purpose

Between The Maxillary 1st Molar & 2nd Molars 7 - 8 mm
1.2 & 1.3mm
Buccally /  Retraction of the anterior teeth.
Between The Mandibular 1st Molar & 2nd Molars  Intrusion of molars
1.2 - 1.4mm
Buccally 5 - 7 mm

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 Region Diameter Length Purpose
Between Maxillary Canine & Premolar Buccally / 1.2 & 1.3mm, 7 - 8 mm  Distal & Mesial movement molars
Between The Mandibular Canine & Premolar  Intrusion of buccal teeth.
Buccally 1.2 & 1.3mm 5 - 7mm  Protraction of molars.

Region Diameter Length Purpose

Between Maxillary Incisors Facially 1.3 - 1.6mm 6 - 7 mm

 Intrusion & torque control of incisors.
Mandibular Symphysis Facially 1.2 & 1.3mm 4 - 6mm

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 Region Diameter Length Purpose
 Retraction of the maxillary anterior teeth
Between Maxillary 2nd Premolar, 1st Molar & 2nd
1.3 -1.6mm, 10-12 mm (Lingual ortho. Tx.)
Molars Palatally
 Intrusion of maxillary molars.

Region Diameter Length Purpose

Mid Palatal Area
1.5 & 1.6mm, 6-7 mm  Molar movement with Transpalatal arch

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The T-Zone: Median vs. Paramedian Insertion of
Palatal Mini Implants
 ARMAMENTARIUM

CONTRA
ANGLED
SCREW
DRIVER
HANDLE
STRAIGHT
SCREW
DRIVER
HANDLE
MANUA
DRIVER TIP L GUIDE
DRILL

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Temporary anchorage devices – Ravindra nanda; Mosby
 Mini screw supplied in steralized capsules
 INSERTION PROCEDURE

 Assessment of insertion area

 Local anesthesia

 Determination of insertion sites

 Point where miniscrew tip starts penetrating into soft tissue

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 Horizontal position of interdental insertion

 Alignment of roots-Buccal cusp tip

 Root configuration-Palpation of root

contours

 Linear indentation with Periodontal

probe

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 Vertical positioning

 Coronal placement – on the attached gingiva-Possibility of root

damage
 Subapical – soft tissues impingment
 Largely - Muco-gingival Junction

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 2.
Palm Grip

Finger Grip -
Finishing
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49
50
 Soft tissue penetration
 Incision not required – insertion on firm tissue such as
attached gingiva
 Minimal incision of 2-3 mm - movable tissue – visualize
underlying bone

Incorrect insertion angulation of

maxillary screw can lead to root
damage

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 Infiltration anesthesia
 Indentation on interdental
depressed area
 Marking of vertical level of
insertion point
 Insertion point marked on
gingiva
 Initiation of insertion
 Maintenance of insertion
path – interproximal area
from occ view as reference
 Manipulation of
surrounding gingival soft
tissue
 POSITIONING- STENTS

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 A SIMPILIFIED STUNT FOR THE ANTERIOR
MINSCREW PLACEMENT

Kravitz and Kusnoto

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 JIFFY JIG

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57
 BUCCAL

OCCLUSAL

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59
 • Mark site for micro implant placement

• Place the Micro - implant

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 Biological aspects of orthodontic
implants

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 POST IMPLANT OSSEOINTEGRATE MECHANICALLY
PERIOD D RETAINED
BIOLOGICAL
IMMEDIATE RESPONSE
Biofilm , formation of - TAD’s
blood clot

1 DAY Red blood cells and Attachment of

inflammatory cells osteoblasts to
titanium surfaces
3-7 DAYS Appearance of -
osteoblasts
Decrease in
inflammatory cells

After 1-4 WEEKS Bone remodelling Bone remodelling

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Temporary anchorage devices – Ravindra nanda; Mosby
63
Various clinical applications of TADs
include
 Retraction cases needing maximum anchorage
 Molar protraction
 Molar uprighting
 Molar intrusion
 Molar distalization
 Intrusion of teeth
 Maxillary expansion
 Forced eruption of teeth
 Skeletal malocclusions
 Anchorage for the periodontally compromised patients and
 Treatment of occlusal canting.
Extended range of treatment
 Usual changes during anterior teeth retraction with sliding
mechanics- Anterior and posterior segment rotates around
center of rotation of each segment (red dots); These changes
can easily be prevented with precurved archwires
 For bodily retraction – lever arms extended from main arch
 Line of force – becomes closer to center of resistance
 Labial space is limited in the vestibule, and labial lever arms
may cause discomfort and an unesthetic appearance.
 Space is abundant in the palatal area, so palatal lever arms can
be applied in the desired directions
Appliance construction for bodily movement in lingual
orthodontics
 Miniscrew on
palatal slope
 Extending the lever
arm from main arch
Correction of midline
Occlusal cant
 beginning of upper arch intrusion and stabilization of the
upper arch in the miniimplant and extrusion of the lower
arch with intermaxillary elastics
Intrusion

 Upper and lower incisor intrusion when it is desirable to

have these teeth tip buccally.
 Upper and lower incisor intrusion when it is desirable to
maintain teeth’s axial tipping
Intrusion of posterior teeth
 Different forms of intrusion of a group of posterior teeth
with some of the segments attached to brackets on the buccal
and palatal regions.
 Palatal miniscrew and modified TPA placed for maxillary
molar intrusion.
Molar distalization
 Impant supported pendulum appliance
 The distalizing mechanics created with an implant and a
transpalatal arch are simple and efficient in the case of a
shallow palatal vault, which is a common characteristic of
growing patients.
en masse distalization using tuberosity implants
Molar protraction
 Proper force system for protraction of molars
 A mini-implant is used as anchorage for protraction, while a
lever arm provides axis control and vertical control of the
molar
 Protraction without balancing lingual force can quickly swing
posterior dentition into unilateral crossbite.
 Lingual elastic thread tied to archwire to provide balancing
lingual force without sacrificing anterior dental anchorage.
First and second molars must be ligated to prevent rotation
of anterior teeth.
 Sliding band with lingual arch for protraction of alone molar.
Expansion
 MARPE
Molar uprighting
 For tooth movement like that shown in Fig force is sufficient.
If enough space is available distal to the last molar, the molar
can be uprighted effortlessly by placing an implant in the
retromolar area and applying a single force.
CORRECTION OF SCISSOR BITE
Interdisciplinary treatment approach
 . Distalization of the maxillary teeth with TADs. Two hooks
were attached to the TADs for differential vectors.
 Complications
 1)COMPLICATIONS DURING INSERTION
 Trauma to the periodontal ligament or the dental root
 Miniscrew slippage
 Nerve involvement
 Air subcutaneous emphysema
 Nasal and maxillary sinus perforation
 Miniscrew bending, fracture, and torsional stress

 2)COMPLICATIONS UNDER ORTHODONTIC LOADING

 Stationary anchorage failure
 Miniscrew migration

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 3)SOFT-TISSUE COMPLICATIONS
 Aphthous ulceration
 Soft-tissue coverage of the miniscrew head and Auxiliary
 Soft tissue inflammation, infection, and peri implantitis

4)COMPLICATIONS DURING REMOVAL

 Miniscrew fracture
 Partial osseointegration

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  Risk factors can be controlled to increase the success rate.
Predictive factors for infection:
(a) An increased distance to the attached gingiva,
(b) An increased probing depth around the miniplate, and
(c) A decrease in oral hygiene frequency. Furthermore, increased age
also contributes albeit slightly to raising the infection rate.

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 Conclusion
Implants for the purpose of conserving anchorage are welcome
additions to the armamentarium of a clinical Orthodontist. They help
the Orthodontist to overcome the challenge of unwanted reciprocal
tooth movement.

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 REFERENCES
 Miniscrews for orthodontic anchorage: a review of available
systems; Journal of Orthodontics2018

 Temporary Anchorage Devices in Orthodontics: A Paradigm

Shift; Jason B. Cope;Semin Orthod 11:3-9 ; 2005

 A study of orthodontic anchorage possibilities in basal bone;

Gainsforth;AJODO 1964

 Miniscrew Implants:IMTEC Mini Ortho Implants;Robert

Herman; Semin Orthod 11:32-39 © 2005

 Schenelle, A radiographic evaluation of the Availability of bone

for placement of Miniscrew Angle Orthod 2004;74:832-7

97
 • Temporary anchorage devices – Ravindra nanda; Mosby

• Palatal Implants:The Straumann Orthosystem;;Adriano Giacomo Crismani;

Semin Orthod 11:16-23;2005

• Intraoral Hard and Soft Tissue Depths for Temporary Anchorage Devices
Antonio Costa, Semin Orthod 11:10-15 ;2005

• “JIFFY JIG” A QUICK CHAIR SIDE MICRO IMPLANT GUIDE, Journal of the
Asian Pacific Orthodontic Society,dec 2011.

• Assessment of available sites for palatal orthodontic mini-implants through

cone-beam computed tomography. Angle Orthod. 2020 Mar

98
 Tray-Grid Guide for Accurate Mini-implant Insertion, The Journal
of Indian Orthodontic Society · April 2012.

 J Gaurav . Miniscrew implants as temporary anchorage devices in

orthodondics: A comprehensive review.J contemp Dent Pract
2013.

 Michael K. McGuire,E. Todd Scheyer, and Ronald L.

GalleranoTemporary Anchorage Devices for Tooth Movement: A
Review and Case Reports. J Periodontol • October 2006

 TADs: An Evolutionary Road to Success, Dent Update 2014; 41:

242–249

 Temporary anchorage devices (TADs) in orthodontics: review of

the factors that influences the clinical success rate of the mini-
implants. Clin Ter 2016; 167 (3):e70-77
Thank you