Special Section: Class III Correction Let's Talk About That Patrick Turley Interviews Dr. Karen Guinn Regarding the Correction of Class III Malocclusion with Buccal Shelf TSADs Dr. Karen Guinn is a graduate of Howard University College of Dentistry. She is a Diplomate of the American Board of Orthodontics. Dr. Guinn is a progressive orthodontist who has traveled extensively throughout the world and in Taiwan to train with Dr. Chris Chang on the use of temporary skeletal anchorage devices (TSADs). Dr. Patrick Turley PCSO Bulletin Section Editor This article is a summary of how to place TSADs in the buccal shelf areas of the mandible using stainless steel miniscrews. The delivery of buccal shelf TSADs in the mandible can give the orthodontist a greater opportunity to correct malocclusions, such as Class IIIs, vertical mandibular excess, and anterior open bites. These techniques enable orthodontists to expand their capabilities and to correct skeletal deformities that would normally require orthognathic surgery. Dr. Karen Guinn Pasadena, CA Patrick Turley (PT): What type of TSADs do you use? Karen Guinn (KG): Stainless steel miniscrews. PT: Why not titanium TSADs? KG: I have found titanium TSADs break much more easily than stainless steel. Stainless steel is much more reliable for placement in the buccal shelf and infrazygomatic crest. Especially due to the bone density of these areas, stainless steel TSADs experience little to no breakage when placing the TSADs. PT: When do you use TSADs for Class III correction? KG: As long as you are within a molar's length, less than or equal to 10 mm from the mesial buccal groove of the maxillary first molar to the mesial buccal groove of the mandibular first molar, the mandibular arch can be retracted with TSADs placed in the buccal shelf. You can retract even with wisdom teeth in, especially in younger patients. PT: Why do you prefer to place TSADs in the mandibular buccal shelf? KG: I like placement of TSADs in the buccal shelf for Class III correction and vertical control of the arch. The main reason I use this area is because you will not hit any roots (Figures 1 and 2). PT: I understand you take a pretreatment posteroanterior (PA) ceph on patients who will be receiving buccal shelf TSADs. What are you looking for in the pretreatment PA ceph? KG: You take a frontal PA cephalometric radiograph prior to placement of the TSADs (Figure 3) and follow up with a frontal PA to verify placement of the TSADs relative to the long axis of the molars (Figure 4). Our goal is to place Figure 1. TSAD in the buccal shelf Figure 2. Area of the buccal shelf 50 PCSO Bulletin Summer 2021