Pacific Coast Society of Orthodontists Bulletin Summer 2021 - 53

Let's Talk About That
and/or right above or below the mucogingival
junction (Figure 8).
PT: How do you angulate the driver to place the
TSAD into the buccal shelf?
KG: Take the TSAD with the driver and go between
the mandibular first and second molar at the
Figure 8. Buccal shelf TSAD placement at the
mucogingival line
mucogingival junction. Initially, start the insertion
perpendicular to the alveolar bone at the mucogingival
margin. Drive the TSAD in one-third of
its length, 2 to 3 mm, perpendicular to the molars,
then change the direction of your insertion to be
vertical (11-12 o'clock; Figure 1) to the molars and
complete the insertion straight down (Figure 9).
PT: Do you unscrew the TSAD and reinsert it into
the insertion site more vertically?
KG: No, it is all one motion to insert the TSAD. Be
sure to leave some of the smooth part of the TSAD
exposed, right below the head. Take a frontal PA to
verify whether insertion is acceptable (Figure 10a).
PT: Does the TSAD in the buccal shelf go between
the apices of the mandibular first and second
molar roots?
Figure 9. TSAD insertion in the buccal shelf from
a computed tomography scan; note the vertical
placement
it necessary to place the TSAD in nonattached
gingiva, a longer TSAD should be used.
PT: How far down do you place the TSAD in the
buccal shelf?
KG: I screw the TSAD vertically down until the
smooth part of the TSAD is still showing right below
the neck. Do not screw the TSAD all the way
down to the gingiva; it is a good plaque collector,
and the patient is more prone to gingival irritation.
Avoid placing TSADs in the loose alveolar
mucosa. You want to be in the attached gingiva
KG: No, the TSAD is in the buccal shelf, not
between the roots. If viewed from a panorex, it
may appear to be between the roots or over a
root. Just taking a panorex will not show you the
position of the TSADs in relationship to the roots
(Figure 10b).
PT: What do you use to activate the buccal shelf
TSADs?
KG: E-chains or NiTi coil springs.
PT: How are the chains or coil springs attached to
the teeth or arch wire?
KG: I use a vertical hook that slides on the archwire,
and it is crimpable to secure it. The length of
the hook can vary based on the vector you want
Summer 2021 PCSO Bulletin
53

Pacific Coast Society of Orthodontists Bulletin Summer 2021

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