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
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