Use Of Temporary Anchorage Devices Research Articles

Intrusion Mechanics in Orthodontics

Various methods for incisor intrusion and molar intrusion are discussed in detail in this review. These techniques involve applying different forces and mechanics to move teeth vertically into the jawbone.For incisor intrusion, methods such as utility arches, Connecticut intrusion arches, Burstone intrusion arches, K sir Arch, and tip back springs are utilized. Each of these methods employs unique mechanics to achieve the desired vertical movement of the incisors.On the other hand, molar intrusion techniques include the use of Temporary Anchorage Devices (TADs), headgears, biteplanes, magnets, maxillary intrusion splints, Invisalign, and active vertical correctors. These methods provide various approaches to intrude molars by applying force in different ways.The choice of intrusion method depends on factors such as the specific orthodontic case, treatment goals, and patient anatomy. Each technique has its own advantages, limitations, and indications for use in clinical practice..The aim of this overview is to provide information for approaching the ways of intrusion.

Two simple yet efficient biomechanics for correction of retroclined maxillary central incisors

Angle’s class II division 2 malocclusion is characterized by retroclined maxillary central incisors and increased overbite. The first step in the treatment of such cases involves the correction of incisor inclination and their intrusion. Conventional techniques for intrusion are taxing on the anchor teeth like molars and adjacent teeth like lateral incisors. Appropriate biomechanical use of temporary anchorage devices (TADS) will enable the clinician to avoid undesirable tooth movements. The following are two cases in which simple and efficient biomechanics have been performed with the use of TADS for the correction of incisor inclination and deep overbite. The case-specific use of single vs two mini implants as well as round vs rectangular wire for intrusion and proclination of central incisors has also been explained.

Usage of temporary anchorage devices: A cross-cultural and cross-sectional survey of orthodontists in Australia and the UK

Detailed insight regarding the use of temporary anchorage devices (TAD) in Australia and the United Kingdom (UK) is lacking. The primary aim of the present cross-sectional survey was to investigate TAD usage among UK-based and Australian-based orthodontists. The secondary objectives were to compare TAD-related preferences and protocols between orthodontists in the two countries. A pilot-tested electronic questionnaire was distributed to members of the British Orthodontic Society and the Australian Society of Orthodontists. Questions pertained to their demographic details, and current use of TADs including protocols, treatment objectives and factors influencing their use. A total of 192 responses were recorded (Australia: 122; UK: 70). One hundred and forty-two respondents (74.0%) reported using TADs as part of their orthodontic treatment, 77.0% in Australia (n=94) and 68.6% in the UK (n=48). Molar protraction was the most common procedure for which TADs were reportedly used (Australia: n=118; 87.2%, UK: n=36; 75.0%). "Loosening" was the most prevalent reported complication overall (n=124; 90.1%). "Confidence", "insufficient postgraduate education" and "availability of equipment" were the factors that most influenced the decision not to provide TADs. Most orthodontists in both countries provided TADs. TAD protocols of orthodontists in both countries were reported. Similarities and differences regarding TAD-related clinical practices and procedures, complications and factors influencing the use of TADs and reasons for not using TADs were explored. Information from the present study can provide baseline data for future related studies in each country and for comparison of TAD usage in other countries.

Mecánica de cierre de espacios mediante el uso de TAD en ortodoncia

The incorporation of temporary anchorage devices (TADs) in orthodontic treatment has revolutionized the mechanics of space closure by sliding and/or friction, since it completely improves anchorage and three-dimensional dental control. TADs have also become a widely used absolute-temporary anchorage device due to several advantages such as their low cost, ease of placement and removal, possible immediate loading, reduction of treatment time and possible placement in most areas of the alveolar bone; However, different mechanics are defined that seek to explain tooth movement, sometimes leading to a contradiction of concepts. Literature was selected through a search in the following electronic databases: Pubmed, Lilacs, Google Academic, Elsevier and Proquest. The information search was performed from January 2013 to January 2023 including all languages. After the evaluation of the search trees, 521 articles were considered, then the inclusion and exclusion criteria were applied, resulting in 14 articles that meet the parameters for this review. The available literature revealed that the use of TAD and an adequate and intelligent selection of space closure mechanics would shorten the orthodontic treatment time by approximately 6 months for the management of any malocclusion.

Rehabilitation of Dentofacial Asymmetry Secondary to Unilateral Temporomandibular Joint Ankylosis with Dual Distraction and Fixed Orthodontics - Stability at Three-year Follow-up.

Optimal rehabilitation of asymmetric dentofacial deformity secondary to unilateral temporomandibular joint (TMJ) ankylosis is often a challenge. The purpose of this case series is to present an insight into esthetic, occlusal and functional rehabilitation of two patients with varying degree of asymmetric Class II dentofacial deformities secondary to long-standing unilateral TMJ ankylosis. The patients were treated with one-stage surgical protocol employing simultaneous dual distraction technique along with interpositional arthroplasty. Dual distraction technique entailed the simultaneous use of two distractors which allowed for proper control of proximal condylar segment during the course of distraction and lowering the risk of ankylosis recurrence. Thereafter, comprehensive fixed orthodontic mechanotherapy involving the use of temporary anchorage devices was instituted to align and level the compensated dentition. Post-treatment records showed significant improvements in skeletal disharmony and functional stability with good functional occlusion. At the three-year follow-up, the morphological and functionally acceptable results were reasonably well-maintained, with no signs of relapse. Through the two cases reported here, we would like to highlight that one-stage concurrent arthroplasty and dual distraction technique is a safe, stable, and reliable approach for surgical and functional rehabilitation of an adult asymmetric dentofacial deformity secondary to unilateral TMJ ankylosis. Meticulously executed comprehensive orthodontic manipulations involving use of acrylic bite-blocks, elastic traction, and temporary skeletal anchorage device play a crucial role in enhancing the final occlusal outcomes.

Indication and Success Rates of Skeletal Anchorage System in Orthodontics

Skeletal anchorage systems, a pivotal innovation in orthodontics, involve the use of Temporary Anchorage Devices (TADs) or mini-implants, providing stable anchor points in the bone to facilitate precise tooth movements. This comprehensive review article aims to investigate the indications and success rates of skeletal anchorage systems in orthodontics. The research, initiated on November 2nd, 2023, involved an extensive examination of existing literature, utilizing databases like PubMed, Web of Science, and Cochrane. Various components, including mini-screws, mini plates, palatal, buccal shelf implants, and infrazygomatic implants, have enriched orthodontic diversity. Mini screws have displayed remarkable success rates, with most complications related to manageable soft tissue inflammation. Gingival health and smoking habits have been identified as influential factors in mini screw implant success. Mini plates offer sturdy anchorage with resistance to root damage and fracture, surpassing mini screws in overall success rate. Age, implantation site viability, and soft tissue characteristics influence their success. Palatal and buccal shelf implants provide exceptional stability, enhancing the results of fixed bracket appliances. The anterior palatal region is a preferred site for implantation. Infrazygomatic implants, while offering commendable stability, display failure rates within the range of 21-28%, with compromised oral hygiene, immediate loading, inflammation, tooth mobility, and a high mandibular plane angle as potential failure factor. These anchorage methods have expanded treatment possibilities, offering effective solutions for challenging orthodontic cases and ultimately improving patient outcomes.

Retraction of Anterior Teeth with Temporary Anchorage Devices (TADS) – A Review

One of the most important contemporary use of Temporary anchorage devices also known as TADS is anterior teeth retraction, most commonly needed in bimaxillary protrusion cases or Class II dentoalveolar cases involving extraction of premolars. This function is performed by providing absolute anchorage by using direct or indirect means depending upon the mechanism used. Various clinicians have adopted different methods and different miniscrew systems for the purpose. The aim of this article is to describe some of these methods for their effective use in enabling this function of providing a powerful anchorage so that orthodontic concern of loosing anchorage in critical cases could be addressed efficiently.

Treatment of Palatally Displaced Canines Using Miniscrews for Direct or Indirect Anchorage: A Three-Dimensional Prospective Cohort Study on Tooth Movement Speed

Palatally impacted canines are usually challenging to treat in terms of both biomechanics and possible side effects. Different therapeutic approaches have been reported with or without the use of temporary anchorage devices, including the canine-first approach. Two groups of patients with palatally impacted canines were compared, observing their canine movement measured on consecutive CBCTs after three months of treatment. In the control group, impacted canines were treated with direct anchorage on miniscrews, and in the test group with indirect anchorage using a miniscrew-supported transpalatal arch. The primary outcome was the canine movement speed; the secondary outcome was the change in the root length of adjacent teeth. The median monthly apex speed was 1.05 mm in the control group (IR [0.74, 1.64]) and 0.72 mm in the test group (IR [0.27, 1.30]). The median monthly cusp displacement was 1.89 mm in the control group (IR [1.04, 2.84]) and 1.08 mm in the test group (IR [0.81, 1.91]). Approximately 50% of teeth adjacent to an impacted canine underwent a negative root length change of less than 1 mm in the majority of cases, but no significant differences were found in root length changes between groups. No statistically significant differences in the reported speeds were found, and no miniscrew failures were observed in either group.

A Case Treated with Maxillary Molar Distalization through the Maxillary Sinus: Three-Dimensional Assessment with a Cone-Beam Computed Tomography Superimposition

In this report, we describe a successful orthodontic treatment through the maxillary sinus and show the utility of cone-beam computed tomography (CBCT) for this procedure. A 20-year-old man with Class I molar relationships and crowding of the maxillary and mandibular anterior teeth came to us to improve his malocclusion. Maxillary molar distalization was necessary to reduce the crowding of the teeth. This was achieved by the use of temporary anchorage devices (TADs) and the uprighting of the mandibular molars. However, several roots of the maxillary molars protruded into the maxillary sinus. The maxillary sinus is a known barrier to orthodontic tooth movement, leading to root resorption and/or tipping movement. We aimed to distalize the maxillary molars through the maxillary sinus by bodily movement. The findings were three-dimensionally confirmed by using the superimposition of CBCT obtained before and after the treatment.

Effectiveness of antibacterial therapy following the implantation of orthodontic temporary anchorage devices

The use of temporary anchorage devices (TADs) for the purpose of absolute anchorage in orthodontics is considered as a significant revolution in modern orthodontics. This skeletal anchorage has replaced the conventional methods of anchorage such as extraoral devices, which frequently were insufficient and resulted in unpredictable side effects. TADs provide versatility, minimal invasiveness as well as biocompatibility, thus helps the clinician to achieve optimal treatment results. The aim of the study was to evaluate the effectiveness of «Hexalyse» used for the prevention of early inflammatory complications in orthodontic patients after implantation of TADs. Objects and methods. The current study included 42 patients who required orthodontic treatment of malocclusion using titanium TADs. Two equal study groups – the main group, and the control group were assembled according to gender and patient’s age. In the post implantation period, the main group patients were prescribed the local antibacterial medicine «Hexalyse». Gingival and papillary-marginal-alveolar indices were used to assess the condition of periodontal tissues and the dynamics of the inflammatory process in both groups. Results and discussion. Antibacterial therapy including the intake of «Hexalyse» in the main group was significantly more effective (p < 0.05) and helped to facilitate the healing process of the soft tissue surrounding the titanium TADs. Conclusion. «Hexalyse» can be recommended for use during the early post-implantation period in the system of inflammatory complications prevention to facilitate the healing process of the mucous tissues surrounding TADs.

The effect of social media on patient acceptance of temporary anchorage devices.

To investigate the relationship between the use of social networking sites (SNSs) on patient perceptions, acceptance, and expectations of treatment using temporary anchorage devices (TADs) and to compare differences between patients from the United Kingdom and Brazil. Cross-sectional questionnaires were administered to 39 participants at orthodontic practices in the United Kingdom and Brazil about patients' use of SNSs, exposure to TADs on SNSs, and thoughts on extractions, jaw surgery, or TADs as treatment options. UK patients prefer for clinicians to have SNS profiles (P = .022). Most UK and Brazilian patients want to see their clinician's work online (76.7%) and use SNSs to get information about treatment options (76.6%). There was a statistically significant difference in Brazilian patients' acceptance of TADs as a treatment option compared with UK patients, particularly if it meant avoiding extractions (P = .002), avoiding jaw surgery (P = .004), or reducing treatment time (P = .010). Knowledge of TADs was greater in Brazilian patients (P < .001). Patients use SNSs to obtain information about treatments and prefer clinicians to have social media accounts. Patients exposed to TADs on SNSs are more likely to accept them as an orthodontic treatment option. UK patients have less knowledge of TADs and are therefore less sure to consider TADs as an option. Brazilian patients are more confident in considering the use of TADs. Clinicians should consider increasing their social media presence to accommodate patients' expectations and acceptance of TADs.

Knowledge of undergraduate dental students toward orthodontic skeletal temporary anchorage devices at Kuwait University

BackgroundThe introduction of skeletal Temporary Anchorage Devices (TADs) into orthodontics has provided orthodontists with reliable techniques of correcting anchorage problems. The objective of this study was to evaluate the knowledge of undergraduate dental students during their clinical years (fifth, sixth and seventh-year) at Kuwait University Faculty of Dentistry regarding the use of TADs.MethodsA printed structured questionnaire consisting of 21 questions was given to the undergraduate dental students of Kuwait University in the fifth (n = 22), sixth (n = 28) and seventh (n = 22)-years. It evaluated the level and source of information regarding orthodontic TADs.ResultsThe seventh-year dental students displayed the best degree of knowledge regarding the use of TADs and the clinical case management, compared with the sixth and fifth-year dental students. The significance of introducing the orthodontic TADs topic earlier in the orthodontic curriculum has been agreed upon by 42% of respondents. The total knowledge score showed a significant difference (χ2 = 40.3, p = 0.000), where the seventh year dental students had the best level of knowledge regarding the topic of TADs. Two-thirds (63.6%) preferred to introduce that topic during the sixth year.ConclusionsThe senior (7th year) dental students had the best knowledge about the topic of TADs. Introducing the topic of TADs earlier in the undergraduate dental program will enhance the students’ case-based learning setup. Hence, the early exposure to use of TADs will improve the students’ clinical problem-solving and decision making skills during their undergraduate clinical years.

Orthodontic Treatment Combined with Miniscrew Anchorage for an Angle Class II Division 1 Case with Severe Crowding and TMDs

The case report describes that the treatment of an Angle Class II and division 1 malocclusion in adult with excessive overjet and high mandibular angle case. The patient has also severe crowding on maxilla and mandible and temporomandibular disorders (TMD). The treatment was performed by use of 0.018×0.025-inch slot straight wire appliances with four first premolars’ extraction. The improvement of excessive overjet was achieved by the proclination of anterior teeth by use of temporary anchorage devices (TADs). After completion of orthodontic treatment, the molar relationships on both sides were almost normalized to Class I and proper overjet and overbite were acquired. Improvement of facial and occlusal problems was acquired. The symptoms of TMDs have been stable due to the continuous care through the treatment period. TADs are considered as a very useful material in terms of the anchorage of molars for the achievement of a large amount of incisor retraction and molar intrusion.

Advances in studies on distal molar movement with temporary anchorage devices

Crowding and protrusion of the dentition are often the chief complaint of orthodontic patients. For patients with severe crowding or protrusion, orthodontist often improve their profile with premolar extraction treatment. However, for patients with mild crowding and protrusion, orthodontist usually achieve treatment objective using distal molar movement with temporary anchorage devices (TAD). The present article reviewed the advances in the use of TAD in total arch distalization, including therapeutic effect measured in three-dimensions, factors that affected distal movement and the stability of curative effect.

Failure load and stress analysis of orthodontic miniscrews with different transmucosal collar diameter.

Miniscrews have been introduced in orthodontics as temporary anchorage devices (TADs), in order to move the correct teeth and avoid other elements to slide toward a wrong direction. Moreover the ease of use of TADs encouraged clinicians to use miniscrews also for non-conventional purposes, as fixation in mandibular fracture, mini-implant supported temporary pontics, miniscrew-assisted rapid palatal expanders and distalizers. These applications develop higher forces, so TAD fracture can be an unwanted complication. Some authors analyzed torsional loads but no studies measured forces required to bend the screws and ultimate flexural strength. Accordingly, in the present report, Ti-6Al-4V TADs were mechanically evaluated. Seven different diameters of screws were tested: 1.3 mm (Aarhus Screw, Medicon), 1.5 mm (Spider Screw, HDC), 1.6 mm (Aarhus Screw, Medicon), 1.7 mm (Ortho Easy, Forestadent), 1.8 mm (Ortho Implant, 3 M), 1.9 mm (Spider Screw, HDC) and 2.0 mm (Storm, Kristal). The forces to bend the titanium TADs were measured at 0.1 mm, 0.2 mm magnitude of deflections and at maximum load (as peak before screw fracture) in air with a universal testing machine. Statistical analyses were performed. Both at 0.1 mm and at 0.2 mm deflections and at maximum load, the significantly highest forces were reported with 1.7, 1.8, 1.9, and 2.0 mm TADs. The lowest values were reported with 1.6, 1.5, and 1.3 mm mini-implants. No significant differences were reported between 1.6 mm and 1.7 mm screws. It was found that load values in N versus stress in MPa were not fully comparable when screws with small and larger diameter were compared. Therefore, when placing a miniscrew for applications that need maximum shear bending resistance, these results would be considered in order to reduce risk of unwanted fracture.

An update on local anaesthesia in orthodontics

Abstract: With the increasing use of temporary anchorage devices in orthodontics the use of topical and local anaesthesia is becoming more common in everyday practice. The mode of action, types of anaesthetic and the potential local and systemic complications will be described. CPD/Clinical Relevance: A knowledge of local anaesthetics is essential for any orthodontist, particularly with the increasing popularity of the use of temporary anchorage devices.

A novel method for treatment of Class III malocclusion in growing patients

BackgroundManagement of Class III malocclusion is one of the most challenging treatments in orthodontics, and several methods have been advocated for treatment of this condition. A new treatment protocol involves the use of an alternating rapid maxillary expansion and constriction (Alt-RAMEC) protocol, in conjunction with full-time Class III elastic wear and coupled with the use of temporary anchorage devices (TADs). The aim of this study was to evaluate the dento-skeletal and profile soft tissue effects of this novel protocol in growing participants with retrognathic maxilla.MethodsFourteen growing participants (7 males and 7 females; 12.05 ± 1.09 years), who displayed Class III malocclusions with retrognathic maxilla, were recruited. Pre-treatment records were taken before commencing treatment (T1). All participants had a hybrid mini-implant-supported rapid maxillary expansion (MARME) appliance that was activated by the Alt-RAMEC protocol for 9 weeks. Full-time bone-anchored Class III elastics, delivering 400 g/side, were then used for maxillary protraction. When positive overjet was achieved, protraction was ceased and post-treatment records were taken (T2). Linear and angular cephalometric variables were blindly measured by one investigator and repeated after 1 month. An error measurement (Dahlberg’s formula) study was performed to evaluate the intra-examiner reliability. A paired-sample t test (p < 0.05) was used to compare each variable from T1 to T2.ResultsTreatment objectives were achieved in all participants within 8.5 weeks of protraction. The maxilla significantly protracted (SNA 1.87°± 1.06°; Vert.T-A 3.29± 1.54 mm p < 0.001), while the mandibular base significantly redirected posteriorly (SNB −2.03° ± 0.85°, Vert.T-B − 3.43± 4.47 mm, p < 0.001 and p < 0.05 respectively), resulting in a significant improvement in the jaw relationship (ANB 3.95°± 0.57°, p < 0.001; Wits 5.15± 1.51 mm, p < 0.001). The Y-axis angle increased significantly (1.95° ± 1.11°, p < 0.001). The upper incisors were significantly proclined (+ 2.98°± 2.71°, p < 0.01), coupled with a significant retroclination of the lower incisors (− 3.2°± 3.4°, p < 0.05). The combined skeletal and dental effects significantly improved the overjet (5.62± 1.36 mm, p < 0.001) and the soft tissue Harmony angle (2.75° ± 1.8°, p < 0.001).ConclusionsClass III elastics, combined with the Alt-RAMEC activation protocol of the MARPE appliance, is an efficient treatment method for mild/moderate Class III malocclusions. The long-term stability of these changes needs further evaluation.

Surgical-Orthodontic Management of Mandibular Hypoplasia with Severely Short-Rooted Dentition Secondary to Anti-Leukemic Treatment: A Case Report

Major advances in anti-leukemic treatment have increased a significant number of pediatric cancer survivors over the past few decades. Such treatment in children is also reported to cause abnormal dentofacial development including a significant mandibular hypoplasia, dental anomalies, and severely short-rooted dentition. These problems, despite a becoming both functional and psychosocial problems, are often neglected as many clinician’s lack experience in managing them. They are exacerbated by the fact that orthodontic treatments can potentially cause further root shortening. Therefore, a special consideration to minimize a risk of root resorption must be given when an orthodontic treatment plan is formulated for these patients. We report a unique treatment approach employed on a 14-year-old male patient with severe dentofacial abnormalities secondary to anti-leukemic treatment. Treatment goals were to correct dental malocclusion, optimize facial balance, and also prevent further root shortening. A treatment plan combining orthodontics, orthognathic surgery, and use of temporary anchorage devices, was developed so that light orthodontic forces could be used throughout the course of treatment. Consequently, the lighter force reduced the risk of potential root resorption. The final outcome demonstrates that the surgical-orthodontic approach optimizes facial and occlusal changes while minimizing further root resorption.

Temporary Anchorage Devices in Bimaxillary Protrusion

Introduction of mini implants in orthodontic treatment mechanics has caused a paradigm shift in the treatment modalities. Mini-screw type of temporary anchorage devices (TADs) are small, placed with a minor surgical procedure and have helped treat complicated as well as borderline surgical cases with relative ease. This case report highlights the use of TADs for the treatment of a 19-year-old female with severe bimaxillary dento-alveolar proclination, protrusive lips and divergent face type. Clinical examination and cephalometric parameters indicated that the case was a critical anchorage case which required extraction of all first premolars. The TADs were placed in all four quadrants between the roots of the second premolar and first molar with the aim of providing absolute anchorage. After retraction of the anterior teeth, fullness of the upper and lower lip has reduced, lip incompetency is eliminated and the severe dentoalveolar proclination is corrected providing absolute anchorage. Clinical Relevance: The treatment of severe bimaxillary dentoalveolar proclination cases with conventional orthodontics has always remained as a challenge; with a greater chance of anchorage loss and inadequate retraction of anteriors into the extraction space resulting in an unsatisfactory treatment result. Use of TADs helps us in implementation of absolute anchorage into the treatment mechanics.

Evaluation of primary stability of innovated orthodontic miniscrew system (STS): An ex-vivo study.

BackgroundStability is determined as one of the requirements in use of Temporary Anchorage Devices (TAD) in orthodontics. Miniscrew has been a widely used Bone Anchor. Compared with mini-implant that necessitates osseointegration; mechanical retention is a determining factor for primary stability of miniscrew. Studies investigated various ways to increase primary stability. The aim of this study is to introduce a new configuration of miniscrew system which is believed to obtain more primary stability.Material and MethodsFreshly ovine mandibles were cut in blocks. Twenty-seven miniscrews (diameter 1.6 × 8 mm; G2, Dual Top Anchor System, Jeil Medical, Seoul, Korea) were inserted in the blocks and divided in 2 experimental groups: single miniscrew and the innovated design “Seifi Twin Screw (STS)”. Primary stability was evaluated by Periotest “M”® device.ResultsIndependent t-test showed a significant difference between 2 experimental groups in periotest evaluation (p< 0.05). STS demonstrated higher primary stability due to its mechanical configuration and design.ConclusionsThe STS provides higher primary stability and was found to be effective in increased success rate of miniscrew systems from the standpoint of primary stability. Key words:Anchorage procedures, anchorage techniques, orthodontic anchorage procedures, miniscrews, temporary anchorage device.