TAD Supported Space Closure in Agenesis Cases Bjorn Ludwig. AAO June 2021. Episode 117

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Farooq Ahmed

TAD Supported Space Closure in Agenesis Cases Bjorn Ludwig


Space open Vs space closure


Space opening


Space opening with implants – challenges

·      Continued growth Zachrisson

o   Relative infra-occlusion

o   Solution – replace crown but pink aesthetics not addressed

·      Vertical growth continues around adjacent teeth

o   Age 30-40 upper dentition move backwards and downwards Bjork 1983

o   Dental implants intra-occlude in adulthood until age of 60  Thilander 2001, Bernard 2004, Ghizlanzoni 2017 & Cocchetto 2019

·      Orthodontic space opening = loss of bone, bony region has labio-lingual defect Uribe 2013

o   Blue discolouring through for unilateral implants 57% Dueled 2009

o   Root uprighiting is a biomechanical challenge


Space opening with bridges

·      TAD bourne canteliver bridge

o   Easy to change crown


Autotransplant teeth

·      Rarely done in clinical practice



Patient centered approach to decision making

·      Dental professionals shouldn’t not impose their view of aesthetics on the patient in agenesis cases Schneider 2019

·      Phycology of spacing and bullying Iyad 2014



Space closure missing lateral incisors

·      Implant site development

o   Moving a tooth into the site of agenesis – develops bone

·      Guided eruption

o   Timing of extraction of peimary teeth

·      TADs

o   Push from labial side

o   Pull from palatal side

§  To overcome friction / binding in system

o   Iatrogenic risks 3rd palatal rugae

§  0.18 risk of root damage if free-hand insertion

§  Non-parallel TAD placement

·      Solution – TAD guide for insertion

o   Slider TAD supported palatal mecahnics

§  Like final archwire – transverse and vertical effects

·      Drawback round – no torque control

·      Solution – fully customised appliances


o   Aesthetics following space closure

§  Canine substitution = canine gingiva high Marco Rosa

·      Extrude canines, intrude premolars

·      Torque – using torquing auxillaries Warren or Goodman springs

·      Aligners for finishing – best use of appliances

§  4 in 3 position occlusal issues

·      No TMD Rosa 2016



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