Advantages of aligners
- Aesthetic Thai 2020
- Less white spot lesions Peter 2019
- Efficacy:
- Good for distalising 1.5-2.2mm Simon Ravera
- Poor expansion, mainly tipping Houle 2017
- Poor space closure Papadimitriou 2019
Challenges with aligners
- Bodily movement
- Distalise 2mm+
- Mesialise
- Expansion
Can resolve challenges with aligners by incorporating TADs
TAD insertion
- Location success Houfar 2015 / 2017
- 98% success anterior palate
- 71% success buccal
- Anterior palate
- ‘T’ zone – behind 3rd palatal rugae Wilmes 2016
- Paramedian – more stable then mid palatal suture – Nienkemper 2013
2 stage protocol
- TAD slider mechanics initially
- Followed by aligner treatment for completion
- Easier than 1 stage as synchronisation of aligner movement not required
1 stage protocol
- Scan for aligners
- Once inserted aligner, place distalisation slider
- Requires synchronisation of distalisation with aligner movement
Distalisation
Clinical tips
- Speed of distalisation
- 6mm / months using slider – incorporate into aligner sequence
- Bands with aligners do not fit well:
- Use bonded tubes – wire with composite
- Aligner scanned after insertion, or cut out of aligner
- To deactivate appliance, ligature placed from slider to bonded tube
Mesialisation
Mesial slider Wilmes 2019
- Clinical tips
- Posterior attachment with bonded tubes and well as mid arch – premolar region
Expansion
- 2 Screws anterior palate
- BMX expander – pre-fabricated – no lab requirement, 6,8,10mm between holes and adaptable chairside (pre activation)
- Slow expansion: as no risk of teeth tipping
Insertion of beni-slider
- Laboratory fabrication or
- Digitial design
- Insertion guide
- CADCAM design – insert TADs and RPE at the same time
