The Management of Occlusal Plane with Extra-Alveolar Miniscrews. Marcio Almeida. AAO June 2021. Episode 116

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Farooq Ahmed

The Management of Occlusal Plane with Extra-Alveolar Miniscrews. Marcio Almeida


Extra-alveolar TADs

·      Introduced by Chris Chang 2008

·      Marcio Almeida Textbook on extra-alveolar miniscrews 2018



Total arch distalisation – Biomechanics using TADs Almeida 2019

·      2 key factors for total arch distalisation

o   Height of hook (attachment to the archwire such as power arm)

o   Height of the TAD

§  Can change incisal torque and occlusal plane rotation


What difference does the height make Kawamura 2021

·      Changes to angle of force

o   All angles clockwise rotation of occlusal plane

§  Intrusion of posterior teeth

§  Extrusion of anterior teeth

§  Loss of anterior torque

§  Clockwise rotation of maxilla of up to 11 degrees


Biomechanics of extra-oral Miniscrews


·      Can distalise entire arch as segment

·      Buccal shelf TADs distalisation (class 3)

§  Rotation counterclockwise  Roberts 2015

·      Can alter the rotation depending on the line of action direction in the mandible

o   Above CR = counter clockwise rotation

o   Below CR = clockwise rotationChae 2019


Example of biomechanics and line of action Class 3 with AOB

·      IZC TAD:  level with the arch = below CR = clockwise rotation of maxilla – aid AOB closure

·      BS TAD 2 options

o   Counterclockwise rotation desired = coil from TAD to archwire in 2-3 region

o   Clockwise rotation desired = coil from TAD to long hook to archwire in 2-3 region


TADs Vs elastics in class 3 case

·      No significant difference AP

·      However biomechanically better vertical control due to counterclockwise control Nakamura 2017




Temporary Anchorage Devices in clinical orthodontics Jae Park


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