BIOMECHANICS OF

TADs

Guided by, DEEPAK SINGH

Prof. TP Chaturvedi Sir JR-II
Prof. Ajit V Parihar Sir ORTHODONTICS, FDS, BHU.
Temporary anchorage device (TAD) ???

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 (indirect anchorage) or by obviating
the need for the reactive unit altogether (direct anchorage).

Cope JS. Temporary anchorage devices in orthodontics: a paradigm shift. Semin Orthod 2005;11:3–9.
 HISTORICAL PERSPECTIVE

• GAINFORTH AND HIGLEY(1945) first published the use of subperiosteal

vitallium implant to retract maxillary canines in dogs.

• LINKOW (1969) described endosseous blade implants.

• KAWAHARA( 1975) developed Bioglass coated ceramic implant.

• CREEKMORE(1983) inserted surgical vitallium bone-screw just below
the anterior nasal spine for deep bite correction.

• ROBERTS(1984) used implant in the retromolar region for closing first

molar extraction site in the mandible .
• Weherbein and colleagues (1990) developed palatal implants called
“Straumann orthosystem” which was specially designed for
orthodontics anchorage.

(Palatal implants: The Straumann Orthosystem Adriano Giacomo Crismani Thomas Bernhart Hans-Peter Bantleon Jason
B. Cope)

• Kanomi (1997) implanted mini bone screw for intrusion of mandibular

incisors.

3.3 mm

4-6 mm
• Melsen and colleagues (1999) developed a 6-mm titanium
implant for early loading called the ‘‘Aarhus implant’’, designed
to be placed in multiple locations.

(Melsen B, Lang NP. Biological reactions of alveolar bone to orthodontic loading of oral
implants. Clin Oral Implants Res 2001;12(2):144–52.)

6 mm

1.2 mm
 “Mini” or “Micro” ????

• Mini - Miniature
• Micro - Microscope

(Jason B. Cope, Temporary anchorage devices in orthodontics: A paradigm shift, Seminars in Orthodontics, Volume 11, Issue 1,
2005, Pages 3-9. ISSN 1073-8746)
 “Screw” or “Implant” ???

• Screw - more length less diameter and threaded

• Implant – lesser length and more diameter and threaded

Miniscrew implant
TYPES OF TADs
Minimum patient
cooperation Easy to use

MAJOR
ADVANTAGES
OF TAD

Shorter treatment Good control on tooth

time movement
 • Simple to use.
• Inexpensive.
• Immediately loadable.
• Biocompatible.

Ideal temporary • Withstand various orthodontic forces.

anchorage device • Immobile throughout treatment.
• Provides clinically equivalent or
superior results when compared with
traditional anchorage.
ORLUS SYSTEM OF MINISCREW IMPLANT

• Designed for enhanced stability and clinical efficiency.

• Easy to use and has wide variety of uses.
• Pre-drilling and making a flap is not necessary.
• Immediate loading.
• Selection on the basis of hard and soft tissue condition.
ANATOMY OF ORLUS MINISCREW IMPLANT
 IMMEDIATE AND DELAYED LOADING

• Biochemical – osteointegration.
• Mechanical – cortical stabilization.

• Creekmore TD, Eklund MK: The possibility of skeletal anchorage. J Clin Orthod 17:266-269, 1983
• Costa A, Raffaini M, Melsen B: Miniscrews as orthodontic anchorage: a preliminary report. Int J Adult Orthod Orthognath Surg 13:201-209, 1998
BIOMECHANICS FOR ANTERIOR RETRACTION

• Miniscrew implants are usually placed between 2nd premolar

and 1st molar.
• Reinforcement of anchorage is primarily required in the upper
arch

WHY ???
Temporary anchorage devices in orthodontics, Ravindra nanda, mosby 2009
1- ROOT SURFACE AREA -
2- BONE SUPPORT AND TRANSLATION MOVEMENT

• UPPER ANTERIOR SEGMENT – More bone support –

Translation movement – High anchorage

• LOWER ANTERIOR SEGMENT – Thin alveolar housing

– Tipping movement – Low anchorage
 3- TRABECULAE BONE STRUCTURE

• UPPER POSTERIOR SEGMENT – LESS DENSE BONE –

MORE ANCHORAGE MOVEMENT

• LOWER POST. SEGMENT – MORE DENSE BONE – LESS

ANCHORAGE MOVEMENT
 TADs ASSISTED ORTHODONTICS:
SLIDING MECHANICS vs LOOP MECHANICS

• In TADs assisted ortho., sliding mechanics is biomechanically

advantageous.
• Arch integrity is maintained throughout the retraction.
• Movement is determined by centre of resistance (Cres) of arch and
line of force with TADs.
• Sliding mechanics:
No wire bending
Predictable force system
Minimum discomfort
• Loop mechanics:
More wire bending
Less practicable force system
More discomfort
 IS COMPENSATING/REVERSE CURVE OF SPEE NECESSARY ??
(occlusal plane rotation – lateral view)

• In conventional mechanics, RCS – reinforce posterior

anchorage and counteract the mesial tipping of molars.

• In TADs assisted ortho, RCS not required – distal tipping of

posteriors – posterior open bite
ROTATION OF OCCLUSAL PLANE/CANTING – frontal view

• Asymmetrical vertical position of miniscrew implants

TYPE OF TOOTH MOVEMENT IN ANTERIOR RETRACTION

• CONTROLLED TIPPING
• ROOT MOVEMENT
• TRANSLATION

- Can be achieved by adjusting line of force with respect to centre

of resistance.
• Limitation of lever arm and site of insertion......!!!

• LEVER ARM
• TAD PLACEMENT
HEIGHT
LIMITATION
LIMITATION
 CONTROLLED TIPPING

• Short hooks are attached on archwire

• Iine of force is below the Cres.
• Retraction force- 150-250 gm/side.
 ROOT MOVEMENT

• Small hooks on anterior region below the level of Cres

• Labial crown torque in anterior segment.
• Force magnitude is reduced to less than 100 gm/side.
 TRANSLATION / BODILY MOVEMENT

• Large lever arm hooks are attached to the archwire.

• Line of force is closure to the Cres.
• Sometimes additional torque is given in anterior segment to mainatain
proper M/F ratio.
BODILY MOVEMENT IN LINGUAL ORTHODONTICS

• Extended lever arm from the main arch.

• TADs placed on the palatal slope to establish line of force
 INTRUSION AND ROOT MOVEMENT

• Small hooks on anterior region below the level of Cres

• Labial crown torque in anterior segment, Force magnitude is less than
100 gm/side.
• Additional TAD placed in anterior segment.
 Onplant as orthodontic anchorage

• Block and Hoffman (1989).

• Thin titanium alloy disk.
• Textured and coated with hydroxyapatite,
• Threaded hole on opposite side.

3 mm

8-10 mm
Onplant®, Nobel Biocare
• Other anchorage devices (miniscrews and palatal implants) caused a
greater interest in utilizing these devices.
• Simplicity in placement and removal as compared to onplant.
• Onplant®, Nobel Biocare™ have stopped providing/selling the
product.
Onplant Use for Orthodontic Anchorage Reinforcement; Aslam Alkadhimi and John Ahn; JUNE 2020
 INSERTION AND REMOVAL TORQUE VALUES

• For self-drilling (MIT), 13.6-15.3 Ncm

• For pre-drilling, 8.6-9.9 Ncm

• For self-drilling (MRT), 16.8-18.4 Ncm

• For pre-drilling, 22-23.3 Ncm
Suzuki EY, Suzuki B. Placement and removal torque values of orthodontic miniscrew implants. Am J Orthod Dentofacial Orthop. 2011 May;139(5):669-78.
doi: 10.1016/j.ajodo.2010.11.017. PMID: 21536211.
 BIOMECHANICS FOR MOLAR INTRUSION

• Cres of molar is expected to be at the centre of occlusal

surface along axis, close to the palatal root.
• Line of force should pass through the Cres.
• Insertion site of miniscrew
-Buccal surface, mesial interdental area
-Palatally, distal interdental area, or vice versa.
• Additional miniscrew can be placed on either side of the
alveolar slope to enhance the adjustability of force direction.
• 3 or 4 TAD can be placed to correct severely extruded and
tipped molars
Intrusion of molars and adjacent tooth

• Cres located below the interproximal contact close to the

molar.
• Site of insertion, interproximal buccal and palatal slope of
alveolus.
 Intrusion of molars on both side
• Symmetrical intrusion, intrusive force delivered by trans-palatal
bar connecting both the molars.
• Site of TAD placement, mid-palatal region along line connecting
central fossa of molars.
• Trans-palatal bar needs to be slightly expanded to
prevent the molars from tipping palatally.
• If the buccolingual position cannot be controlled during
intrusion, additional miniscrew implant on buccal side
may be necessary.
 BIOMECHANICS FOR MOLAR DISTALIZATION

• TAD assisted molar distalization is advantageous over headgear or other

distalization appliances.
- Doesn’t need patient compliance
- No undesired action in anterior segment.
• To achieve distal translation movement of molars, line of force need to be
established along vertical axis of Cres of molar.
 Molar distalization in mixed dentition stage

• To establish class I molar relationship

• To regain space for non-extraction treatment

• Couldn’t place TAD on buccal or palatal slope – developing tooth germ

• Midpalatal suture not closed at this age
• Parasaggital area and anterior rugae area – optimum site.
• Miniscrew-reinforced Nance holding arch
• Bone born pendulum appliance
• These appliances initially induce distal tipping of the molars,
subsequent root movement of the molars is required.
• Bracket positioning and alignment with archwire need to be
followed.
 Molar distalization in permanent dentition

• Line of force should be established at the Cres of molar.

• Insertion site – palatal alveolar slope and mid palatal region.
• Mid palatal miniscrew combined with transpalatal lever arm
and horse-shoe type transpalatal bar
• Transpalatal arch in combination with miniscrew on
palatal slope
• Molar distalization using buccal miniscrew

• Insertion site – buccal aspect between 2nd pm and molar

• Open coil spring engaged between 2nd premolar and 1st molar
• Canine / Premolars tied with ligature wire to TAD, prevent anterior
movement.
 BIOMECHANICS FOR MOLAR UPRIGHTING

• Frequently indicated for

mesially tipped 2nd molars

• TAD insertion site – mesial or

distal side of the target molar
depending on the severity.
• Mild to moderate mesial tipping – pushing from mesial
side

• Severe mesial tipping – pulling from distal side

• Mild mesioangulation,
• Distally directed single force with open coil spring,
provides a sufficient moment of the force for uprighting
the molar.
• Line of force passes above the Cres of 2nd molar.
• TAD insertion site – between 1st molar and 2nd premolar
• 0.016 SS wire with open coil spring (Mini-screw assisted
push spring-MAPS)
• Moderate mesial tipping, two steps -
• Initially open coil spring used to unlock the molar from
distal contour of mesial tooth
• Miniscrew assisted Molars uprighting spring (MAUS)
• Step 1 – open coil spring with 0.016 SS wire, to
unlock the molar
• Moment of force is not enough to upright the
molar completely.
• Step 2 – Miniscrew assisted molar uprighting spring of any
rectangular SS wire, is then hooked on head to deliver a tip-
back moment.
• Severe tipping,
• Impossible to attach brackets or tubes on buccal surface
• TAD insertion site (Long-collared) – Retromolar area
• 3rd molar is removed before uprighting 2nd
• A Button is bonded on the distal surface of molar
• TAD placed on retromolar area
• E-chain is placed to deliver distal single force to unlock the
tooth and tips the tooth distally.
BIOMECHANICS FOR MOLAR PROTRACTION

• Frequently required in mandibular arch in cases of missing

molars as well as residual extraction space.
• Increased bone density of mandible – Hinders natural
mesial / anterior movement.
 PROTRACTION BY PURE TRANSLATION

• INDICATION – congenitally missing premolars and

incomplete closure of extraction space.
• TAD insertion site – between 2nd premolar and space, at
the level of furcation area of molar / Cres.
• Line of force should pass through the Cres of molar
• Protraction with lever arm – prevents unwanted tipping
• Lever arm made of rigid SS wire.
• Protraction without lever arm – mesial tipping of molar and
bowing of arch wire in premolar region
 PROTRACTION BY ROOT MOVEMENT

• INDICATION – Mesially tipped molar because of missing, impacted

or ankylosed teeth.
• TAD insertion site – one miniscrew Mesial interdental space.
• Two force system,
- Tip back force = For uprighting of molar
- Mesio-gingival force = To counteract extrusion and distal
crown movement
• For tip back force – MAUS is used
• To prevent extrusion and distal crown tipping – passive
elastic tie

- Blue arrow, extrusive and tip back

movement of MAUS
- Red arrow, mesiogingival force to
counteract extrusion and distal
crown movement

Net result – Pure root movement

PROTRACTION BY ROOT MOVEMENT PLUS TRANSLATION

• INDICATION – Mesially tipped second molar into mutilated

1st molar space.
• TAD insertion site, 1st screw mesial interdental area and 2nd
screw more mesially and supports long range of action of
spring.
• Force system,
- Tip back moment and intrusive force
generated by MARS
- Mesial force given by light elastic chain
• Blue arrow, tip back and intrusive force generated by
MARS because of presence of 2nd screw.
• Red arrow, additional mesial force by E chain

Net result – root movement(uprighting) + mesial translation

 CONCLUSION

• Miniscrews can reduce treatment time and simplify the

appliance while increasing the predictability of the treatment
outcome.
• Many surgical and extraction cases are now treated through
nonsurgical and nonextraction modalities using miniscrews.
• These are powerful tools reestablishing conventional
orthodontic concepts and might become
indispensable in future orthodontics practice.
• Next seminar………………………!!!
• Case reports and articles by Chris chang, benedict
wilmes and Papadopoulos.