Is this mid-palatal TSAD going to hurt?
Temporary Skeletal Anchorage Devices (TSAD) are now a well-established method for reinforcing anchorage. Placing TSADs in the mid-palate may offer advantages over other locations. The thick cortical bone and increased bone depth provide excellent stability.
Recently, this method is gaining popularity, but research on patient experiences with it is limited. This study explores looks at this question.
A Dublin, Ireland, Homburg and Mainz, Germany team did this research. Progress in Orthodontics published the paper.
Patient experiences and discomfort associated with mid-palatal temporary skeletal anchorage devices
Aoife P. Barry, Vanessa Knode, Padhraig S. Fleming and Björn Ludwig
Progress in Orthodontics: Advance access. https://doi.org/10.1186/s40510-024-00549-9
I have a massive conflict to declare as I know the members of this team well.
What did they ask?
They did this study to find out.
“What are the patient experiences, including pain, functional and social impacts associated with mid-palatal temporary anchorage devices”?
What did they do?
The team conducted a cross-sectional survey of a group of patients who they treated with TSADs.
They created a customized questionnaire with 27 items designed to gather information on operative experience and post-operative recovery following the placement of TSADs. Most responses were collected using visual analogue scales and binary response options.
They identified 550 participants who received TSADs as part of their treatment. A single operator placed all the TSADs.
The participants needed to be between 10 and 21 years old and had no prior experience of orthodontics.
What did they find?
They received responses from 152 participants (aresponse rate of 28%). They provided a large amount of data. I thought that the most important results were:
- 87.5% described the experience of TSAD insertion “as expected or better”.
- When they reported pain at the operation, 62.5% reported this as mild.
- Over the next three days, 21% reported that the post-operative pain was moderate, requiring painkillers for 33.6% of patients.
- 62.5% felt that they needed to spend more time on oral hygiene.
- In terms of functional impairment, 63.2% felt that the TSAD caused some difficulty with speech, and 67% reported eating problems.
- When they looked at the overall experience, participants were very likely to recommend this treatment to others (65.1%).
The team’s conclusions were;
“Appreciable levels of pain, discomfort and functional impairment were found with mid palatal TSADs. However, any unpleasant experiences were mild”.
What did I think?
This paper is unusual for orthodontics because it focuses on outcomes that are relevant to patients. I found it particularly interesting. In the past, I have discussed the importance of research that examines outcomes beyond just cephalometric measurements and similar outcomes.
Furthermore, the authors reported on a relatively new technique, making the paper timely and valuable.
The findings are encouraging and provide reassurance for patients considering a relatively invasive and potentially uncomfortable treatment. The authors also noted that orthodontists may take comfort in these results. This suggests that we are not causing our patients excessive discomfort.
As with all research, there are issues that we need to consider. The first is the response rate of 28%. Some may consider this low. However, it is similar to other studies and is about as good as possible. Nevertheless, we should note that they did not report on the characteristics of the non-responders, as this is helpful information in any survey-based research.
It is also worth pointing out that one highly experienced operator placed all the TSADs. This means that the study may lack generality.
A final “good point” about this research was that it was conducted in a specialist practice. This makes it far more “real-world” than studies conducted in University Clinics.
Final comments
This was a nice study that asked a simple, focused question about a clinical treatment provided in a real-world clinical setting. We need more of these.
Emeritus Professor of Orthodontics, University of Manchester, UK.
Looking in reverse: why did 72% not respond. What can we rightly or wrongly assume from that lack of feedback? Hopefully that we are performing satisfactorily – or……
The 72% of non responders may have thought…”no thanks, i’d never have that done again!!”.
📢 Understanding the Low Response Rate: Evidence-Based Perspective
We received 152 responses out of 550 sent questionnaires, giving us a 28% response rate. While this might seem low, it actually aligns with typical response rates for similar studies in orthodontics.
🔹 Response Rates in Orthodontic Studies: Research shows that response rates in patient-reported outcome studies typically range from 20-40%. Factors contributing to lower response rates include survey fatigue, lack of urgency, and the perception that participation is not essential.
🔹 Survey Methodology Considerations:
✅ The study allowed 3 months for responses and sent a reminder, which aligns with best practices in survey-based research.
✅ The age range (10-21 years) may have influenced participation, as younger patients often do not prioritize survey engagement.
✅ The study focused on patient-reported experiences, which, compared to clinical outcome studies, tend to yield lower response rates due to perceived subjectivity.
📍 Personal Note: A Unique Challenge in Our Practice
Thanks for your insights! Our practice is located in a small village along a German river, and many of our patients move away as they reach a certain age. Nobody moves to our village! This significantly impacts our ability to recall patients for follow-ups, making it even harder to achieve higher response rates over time.