1 TADs: Keeping it simple while being successful Sebastian Baumgaertel
· Insertion torque
o Ideal 5-10Ncm Baumgaertel 2010
o Ideal thickness cortical bone 0.5-1.5mm
o Success
§ Avoid areas of very thin area
§ Pre-drill in thick bony area
· Insertion where site not ideal:
o Tissue punch – for mobile mucosa
o Cortical bone perforation 1.5-2.5mm
o Cortical bone pilot hole 2.5mm+ (pre-drill)
Simplification TAD placement
1. Target sites – no implant insertion preparation
· Ideal bone 1.5mm cortical bone
· Ideal root clearance
· Maxilla buccal
o 6mm from crestal bone
o Located at mucogingival junction 1-2 mm apical from junction
1. Palatal
o Parasagittal around 4-5 area: Baumgaertel 2009, same site Wilmes 2016 using 3rd palatal rugae
Avoiding roots
2. Minimal interradicular distance
o Size of TAD + 2 x SD – (0.5mm Lioni’s study)
o =1.6mm + 1mm = 2.6mm
Hierarchy sites
1. Sites lacking roots – buccal shelf / anterior palate
2. Site naturally diverging roots – Palatal alveolus
3. Site requiring diverging roots – orthodontic divergence of roots
Cases
· AOB
o TAD palatal between 6-7 with powerchain from palatal TAD to molars
o TPA – 5mm clearance from palate
o Biomechanic effects
§ Centre of rotation of maxilla between 3-4, therefore rotation of maxillary plane = posterior intrusion and anterior clockwise rotation
· MARPE
o Sebastian’s own design
· AOB – failure
o Palatal TADs between 6-7
o Thick mucosa, overgrew
· Intrusion of 1 tooth when over-erupted U6
o Sectional appliances buccal
o Palatal TADs x 2 rigid fixation to U7, U5
§ = Intrusion of U6 without buccal rolling of tooth – published AJODO
Resources
Temporary Anchorage Devices textbook Jae Hyan Park
