Let's Talk About That take into account what you are trying to achieve and how distal and/or vertical you need to place the TSAD in the buccal shelf so you can achieve your goals. a. If you want to retract the lower arch straight back, you would place an e-chain or NiTi coil spring in a horizontal direction from the TSAD to the hook on the canine (Figure 5). Figure 6. (a) TSAD Insertion in the ramus at a 45° angle with a nonsubstantial buccal shelf. (b) TSAD insertion in the ramus at a 45° angle with a nonsubstantial buccal shelf b. If the buccal shelf anatomy adjacent to the first and second molar is nonsubstantial, you will need to move your insertion to the retromolar pad area (Figure 6a). You cannot see this on the x-ray, but you can feel it with your fingers. See the TSAD insertion in retromolar pad area (Figure 6b). c. If a patient presents with an open bite and posterior mandibular vertical excess, placing a TSAD as low as you can go and/or at the mucogingival line will allow you to intrude the mandibular posterior vertical excess to help level a reverse curve of Spee (Figure 7a-f). PT: Do you give injection anesthesia for this procedure? KG: Yes, I do. I infiltrate only in the vestibule by the mandibular first and second molar. It will take less than half a carpule per side. I use a short needle. PT: What size TSADs do you use in the buccal shelf? Figure 7. (a) Pretreatment. (b) Molar activated to TSAD with NiTi coil spring. (c) Molar activated to the TSAD with e-chain TSAD. (d) Post-TSAD correction. (e) Post-TSAD correction with posterior vertical mandible excess and anterior open bite. (f) Correction with posterior vertical mandible excess and anterior open bite 52 KG: I use 2.0 × 10 mm or 2.0 × 12 mm depending on the amount of unattached gingiva I am dealing with. I take a periodontal probe and penetrate where the TSAD is going to go in the desired angulation. This procedure gives me a trial run of how I am going to direct and place the TSAD successfully. I have found that younger patients do not have a lot of mucosal tissue, so I can usually use 2.0 × 10 mm. You want to avoid placing a TSAD in the unattached mucosa due to high risk of failure. Placing a TSAD in the unattached mucosa presents hygiene problems and can be painful to the patient's cheek area. If you find PCSO Bulletin Summer 2021