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The future of skeletal anchorage Options · View
Dr. Robert L. Boyd
Posted: Monday, February 28, 2005 12:15:00 PM
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In the January 2005 JCO Editor's Corner, Dr. Robert Keim outlines the issues surrounding the orthodontic use of miniscrews or "temporary anchorage devices" (TADs). The JCO article by Drs. James Mah and Fredrik Bergstrand (Temporary Anchorage Devices: A Status Report, March 2005) provides another important contribution by consolidating and summarizing the various currently used methods, techniques, and designs. This report was the result of a panel discussion sponsored by 3M Unitek at last year’s AAO meeting in Orlando.
What are your experiences with TADs? With so many different miniscrews available on the market worldwide and so many techniques described in the literature, how do clinicians select the best one(s)? What successes and failures are associated with the following factors?

--Length and diameter
--Screw material
--Conical vs. cylindrical design
--Sharpness of the end placed into bone
--Self-tapping screws vs. pilot drilling
--Insertion techniques
--Patient selection (for example, maxillary miniscrews are usually considered ineffective in 12-to-14-year-old patients)

How do you ensure that the screws are set securely in the cortical plate? How do you avoid spongy marrow in the area selected? Do you place your own TADs or refer them out to an oral surgeon or other dentist?

JCO's articles on skeletal anchorage are all currently available at no charge in the Online Archive. Post your reply to this topic and join the discussion.

Drs. Robert L. Boyd
and Heon Jae Cho

[ February 28, 2005: Message edited by: Dr. Robert L. Boyd ]

[ April 05, 2005: Message edited by: JCO Staff ]

Dr. Robert L. Boyd
University of the Pacific
School of Dentistry
Department of Orthodontics
2155 Webster Street
San Francisco, CA 94115
Birte Melsen
Posted: Thursday, March 17, 2005 2:09:00 AM
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The use of skeletal anchorage started in Aarhus already in the early '90s, when we inserted ligatures in the infrazygomatic ridge in order to retract and intrude incisors in patients with insufficient posterior teeth. This was published in JCO in 1998. Later we started using screws in the same region but also in other areas. We have performed biomechanical tests, analyzing the influence of the dimension and design. The conclusion has been that the self-tapping screw that is slightly conical and has a diameter of 1.5-2mm is preferred. The length of the threaded part varies according to the bone quality. In the case of a thick cortex (>1mm), a short screw is preferred, whereas a longer screw is needed if the stability has to depend on the trabecular bone. Primary stability is crucial. The self-tapping screw is preferable as no pilot drilling is needed.
Patients, in our regimen, are patients with insufficient teeth for conventional anchorage, patients with the need for tooth displacements that would generate an adverse effect on the anchorage unit, and patients with atrophia of the alveolar process, where the skeletal anchorage can be used for the rebuilding of bone by displacement of teeth into atrophic alveolar processes. Skeletal anchorage can, in my opinion, be used also in young patients in areas with low remodeling. We have done extensive histological studies on monkeys and analyzed the tissue reaction to immediate loading. A survey is published in the book from the 2004 Moyers Symposium.
Robert L. Boyd DDS
Posted: Thursday, March 17, 2005 8:17:00 AM
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Thank you, Dr. Melsen, for your reply and your very long-term interest, research, and publications in this area. I did not realize you were the earliest user. I would be curious to see who was the first author to publish on the current types of miniscrews we are using today. I agree completely with your comments, as do our other faculty who are experts, Drs. Heon Jae Cho and Cheol Ho Paik. One question I had was, where are the areas of choice for placement of the miniscrews in younger patients? Also, can they be done sucessfully in the middle mixed dentition? There was just a symposium held at this year's IADR meeting in Baltimore on miniscrews, which will be published in the next six months and should add even more knowledge to our understanding.
Joanne Castillo
Posted: Thursday, May 5, 2005 5:52:00 PM
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I read the TAD Status Report Dr. Boyd referenced below. It was noted that TADs seem to be more successful in the maxilla than in the mandible. What is the success rate with TAD placement in the mandible? Also, what, if any, are the advantages/disadvantages for utilizing a TAD in the mandible for upper and lower midline correction?
Martina Poldrugac, DDS
Posted: Wednesday, January 25, 2006 4:33:00 PM
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I am a graduate student in the Department of Orthodontics at the University of Zagreb, Croatia. I have no chance to see miniscrew use and I would like to know where in Europe could I go to see and learn about that kind of anchorage.
Thanks, Dr. Martina Poldrugac

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