Temporary Anchorage Devices

Temporary Anchorage Indications

• Mesial or distal movement of buccal teeth
• Lingual or the labial movement of anterior teeth
• Vertical intrusive movement of buccal or anterior teeth

Read And Learn More: Anchorage In Orthodontics Notes

Tads Placement Techniques

• Patients who lost their posterior teeth
• As an anchorage for the distalization of molars
• For intrusion of maxillary teeth
• For anterior open bite and deep bite correction
• A source of anchorage for the retraction of canines as well as interiors
• For correcting the canted occlusal planes
• As an aid in the treatment of Class III malocclusion.

“Steps to explain different types of temporary anchorage devices: Mini-screws vs mini-plates: Q&A guide”

Orthodontic Mini-Implants

Types of Microimplants

• Open method: The head of the micro implant is exposed to he oral cavity. The open method is used when the implant is placed in an area where the soft tissues are not movable, e, i.e., attached to the gingiva.
• Closed method: The head of the micro implant should be embedded under the soft tissue. The closed method is used when the implant is placed in an area where the soft tissue is movable.

• Self-drilling method: In this method, an implant drills itself into the bone. It is used for larger-diameter micro-implants.

• Oblique direction: Inthissi, the insertion of the microimplant is diagonally at an angle of 30 to 60 degrees to the long axis of the tooth. This method is used in areas where interradicular bone is very narrow.
• Perpendicular: In this, the microimplant is inserted perpendicular to the bony surface. This method is used if there is sufficient interradicular bone.

“Early warning signs of issues addressed by temporary anchorage devices: Common questions”

Procedure of Placement of Temporary Anchorage Device

• The procedure is carried out by the orthodontist as an adjunct to the orthodontic treatment.
• An intraoral periapical or a panoramic radiograph of the particular region is needed to evaluate the interradicular space present. Ideally, a minimum of 2 mm interradicular bone is needed.
• Give a minimal amount of local anesthetic to the mucosa, which lies adjacent to the proposed implant placement site. Since underlying bone does not consist of innervate,d profound anesthesia of the adjacent teeth and periodontal ligaments is contraindicated.
• If the drill or implant approaches the periodontal ligament, it will lead to some pain for the patient which will alert the orthodontist to redirect the implant. This pain feedback from the patient would not be possible with profound anesthesia.

“Asymptomatic vs symptomatic effects of ignoring TAD placement needs: Q&A”

• Drill a pilot hole with a 1.2 mm twist drill at 600 rpm to just short of the implant length. Provide adequate cooling with a physiological saline solution while drilling to avoid thermal damage to the bone.
• Insert the implant by using a handpiece at 12 rpm, or it can be hand-driven with a hand driver.
• Take a post-operative radiograph to assess the proper placement of implant.
• Following insertion, the peri-implant tissues are gently rinsed with sterile saline solution before the screws are loaded.

Skeletal Anchorage Devices

Removal of the Implant

• As treatment is complete,e the temporary anchorage device can be easily removed.
• Removal of tmini-implantsnts is easily done with the same screwdriver as used for insertion.
• The whole of this procedure is carried out under the application of a local anesthetic gel.
• The removal site should be gently swabbed with 0.2% chlorhexidine.
• The wound present at the time of screw removal is minimal and usually closes within a few days. In most of the cases, healing will continue uneventfully.

Micro-Screws For Orthodontic Anchorage

“Steps to educate patients about temporary anchorage devices and their importance: Q&A format”

Possible Complications of Temporary Anchorage Device

• Contact with adjacent roots: It is possible while placing the temporary anchorage devices. It has been seen that minor root contact does not lead to any serious long-term damage. If a patient expresses discomfort at the time of placing, it is possibly because of a close approximation of the periodontal ligament. During placement, if increased resistance is felt during drilling or placing the implant, it could be due to root contact. This can be verified by a radiograph. It may be required to reposition the implant.
• Breakage of implant: It is extremely rare for the bone to give enough resistance to break an implant; if resistance is present, the orthodontist should ensure that the implant is not being directed into a root. If an implant breaks, an attempt should be made to remove it unless it is too deep.
• Damage to anatomic structures: When implants are placed in maxillary premolars and molars the maxillary sinus can be approximated. This can be avoided by placing the implants coronally in the attached gingiva.

“Role of counseling in clarifying TAD goals for patients: Questions answered”

• Soft tissue overgrowth: If there is soft tissue overgrowth over the head of the implant, this can produce difficulty in placing attachments to them and can also irritate the tissues. This is avoided by ensuring the implant enters via the attached gingiva and not the unattached alveolar mucosa.
• Loosening of implant: It is the most common complication and may occur any time following implant placement. Some of the causes of implant loosening are poor bone quality, excessive force application, and approximation to the root surface. If an implant gets loose, an initial solution may involve simply tightening the implant a few more turns. If it loosens again, remove the implant and replace it in a new position. If space is enough, a larger diameter implant can be placed inside the same hole.