An occasionally irregular blog about orthodontics

Two years of this orthodontic blog: Temporary Anchorage Devices revisited.

Two years of the blog! Temporary Anchorage Devices revisited

This week the blog is two years old. I am very surprised to find that from being read by about 100 people in the first week, it was hit 20,000 in September and this was a new record.  It has now become a major part of my work and I am continuously surprised to see how many people read the posts.  However, I am having to slow down on postings as I have a neck problem that is stopping me working on computers for lengthy periods of time.  As a result, over the next few weeks I am going to confine future posts to themed collections of  the most popular blog posts.  This is the first and is on Temporary Anchorage Devices. Just click on the post titles.

Distal movement of molars: A case of swings and roundabouts?

This was concerned with the results of a Cochrane systematic review that we carried out. In effect, we showed that while it was possible to move molars distally with various intra oral devices. There was inevitable anchorage loss and what was gained was lost!  This was one of my first blog posts and was not read widely and leads into the subsequent post on temporary anchorage devices.  See what you think about the evidence that we currently have in these three posts.

October 2013, update on Temporary Anchorage Devices

This paper was one of the first trials of TADS and compared them to a form of mechanics that was intended to increase posterior anchorage. I felt that this was a good an interesting paper that certainly began to add to the evidence that they were effective.

A systematic review that shows TADS are effective

This systematic review was carried out by a Manchester based team led by Safa Jambi and was a Cochrane review.  This means that the review was of high quality, because of the Cochrane requirements.  We reviewed all the relevant literature and reported in detail on several good RCTs of TADS.  Overall, we concluded that TADS were effective and provided a good alternative to other forms of anchorage reinforcement.  This review is relevant to all practising clinicians.

TADS are effective the results of a trial

This was a review of a paper of a trial that was run by my friend and colleague Professor Jonathan Sandler, who is currently doing a great job of Chairing the WFO 2015 congress!  This also won the Turpin Award of the AAO in 2014.  In this trial, we compared headgear, palatal arches and TADS. The results again showed that TADS were a good alternative to more traditional methods of anchorage reinforcement. This paper was not included in the systematic review, as it was not published. However, it would have strengthened the findings of the study.

What do I think?

I think that it is clear from these papers and the systematic review that TADS do work as a good alternative to other methods of anchorage reinforcement. I hope that this summary is useful.

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  1. I read your blog with interest on several levels. Agreeing with your findings that TADs can be an effective, or improved, methodology for anchorage reinforcement, what is your opinion on relapses of open bites that were closed via TADS, but reopened after orthodontic treatment is complete? My understanding is that Hawley retainers were never intended to do other than keep the front six teeth in alignment. Do you have any insight about retainers that are designed to keep the closed-bite in that position? I have read of one that is a removable retainer that connects to permanent molar bands in some fashion; I’ve only heard about it, not seen one in action. My daughter, after six years of treatment, achieved a beautiful closure of her open bite, only to have it reopen within three months. I am interested in treatment options that could take on this challenge without resorting to orthognathic surgery: possibly a second round of TADs (which were very effective in retracting large molars that inhibited bite closure) but then somehow making the results last. Thank you for your sharing your expertise.

    • Kevin O'Brien says:

      Hi Pamela, thanks for the comments. I try not to comment on individual cases. However, in general terms the closure of an anterior open bite is one of the most difficult movements in orthodontics. It is particularly prone to relapse and sometimes no amount of retention can solve the problem. There has been no research on the comparative effectiveness of intrusion with TADS or surgery. So I would go with the advice of your orthodontist.

      I had a look at your website. It looks great. I will try and link my blog to it!

  2. andy pearson says:

    Great Blog, of course. I was never really convinced by the efficacy of headgear, palatal arches etc. so stopped using them years ago and it seemed to make no difference. Many of these devices, it struck me , are used because of an assumption that they will be necessary before you even start. The occlusion strikes me as more important at preventing unwanted tooth movement and I seem to remember a paper on this by an eminent ortho a year or so ago (who was that? was it Birte Melsen?). For example when taking upper 4s out in a full unit class 2 molar case and retracting the anteriors I very rarely see the molars moving forwards past class 2 since they are “locked in” with the lowers.
    Then TADs came along. I’m a bit worried that they are being used just because it is assumed they will be necessary. Eg. space closing in a missing laterals case when you can space close with class 3 elastics, or at least try it before reaching for the screwdriver.
    So my main question here is : should research into anchorage efficacy have a control group that has NO anchorage reinforcement, as well as any other groups you want to add such as headgear?

    • Kevin O'Brien says:

      Hi Andy, you have made great points and I too have wondered about a control of no anchorage. I may suggest this the next time that we are thinking about a study

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