Pacific Coast Society of Orthodontists Bulletin Summer 2014 - (Page 44)

TADs Pearls of the Pacific By Aaron Rouleau, DDS, MC and Justin Cooper, DDS, MSD Mountain View, California INSTANT EDENTULOUS ANCHORAGE A t our practice, we are accustomed to using pre-prosthetic implants for anchorage. Often, we need some anchorage before the surgeon places the dental implant and allows it to osseo-integrate. A temporary crown is fabricated so that, finally, we have something to which a tube can be bonded. If we need anchorage before all of this transpires, we can place our own anchor using temporary anchorage devices (TADs). We recently saw a patient with a bimaxillary protrusion produced by a protrusive complete maxillary denture and protrusive mandibular anterior teeth. There were no molars in the left mandibular quadrant (Figure 1). The patient's chief request was to reduce the amount her teeth and lips protruded. The treatment plan was to retract the mandibular dentition, and then remake the maxillary denture with the incisors in a more acceptable and retrusive position. We placed a vertical TAD in the center of the mandibular left alveolar ridge. The TAD head was first covered with flowable composite and then built up with standard composite so that a standard orthodontic button could be bonded on the buccal of the "composite crown." A Vector TAD (ORMCO) was used because its triangular implant head offered good mechanical retention. This technique allows the orthodontist to create a provisional custom crown anywhere in the edentulous region, and bond a bracket or tube of his/her choice (Figure 2). Extending the retraction arch wire to the TAD crown's bracket allows one to utilize all the benefits of the edgewise appliance with the additional advantage of the TAD's absolute skeletal anchorage. Minor rotation caused by off-center bracket placement is not usually an issue (Figure 3). The TAD allowed us to retract the lower anterior dentition with good vertical control. The bimaxillary protrusion was reduced significantly (Figure 4). Figure 1. Pre-treatment. Edentulous left posterior quadrant. Figure 2. TAD with composite crown. Button is bonded on buccal surface, allowing retraction with no intrusive force. Figure 3. AlastiKā„¢ retraction chain to TAD. A B C S Figure 4. A: Initial bimaxillary protrusion. B: Existing overjet after mandibular anterior retraction. C: Revised overjet after fabrication of new maxillary complete denture. 44 PCSO BULLETIN * SUMMER 2014

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Summer 2014

The Big Easy: Not Always So Easy
About the PCSO Mission Statement
AAO Trustee Report
PCSO Business
AAO Council on Scientific Affairs (COSA) Report
Component Reports
PCSO at a Glance
AAOF Report
Decrease Stress and Increase Volume
Resident Spotlight: Loma Linda School of Dentistry Postgraduate Orthodontic Program
Younger Member Spotlight: Dr. Melissa Bailey
Third Molar Protocols
Editorial: Special Section
PCSO Program Talk: Orthodontic Residency Programs and the Use of TADs
Case Report: Pre-Treatment
Faculty Files: TADs in Orthodontics: A Review
Seasoned Practitioner's Corner: Dr. Terry McDonald Interviews Dr. Michael Chaffee on TADs
Case Report: Post-Treatment
Pearls of the Pacific: Instant Edentulous Anchorage
Portrait of a Professional: Dr. Earl S. Johnson
Sweet Farewell: Retainers and Retention
In Memory: Dr. Burton Littleton Fletcher

Pacific Coast Society of Orthodontists Bulletin Summer 2014