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Who places miniscrews? Options · View
Jack.Fisher@mac.com
Posted: Thursday, July 31, 2008 9:06:39 PM

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Joined: 3/28/2007
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I have placed about 1000 TADs in my private practice and two residency programs. I have lectured nationally and internationally on the topic
of the placement and use of TADs and taught several cadaver courses on the placement of these devices and possible indications for their use.

There is no question that the patient is best served by having the orthodontist place the tads due to the following reasons:
- cost
- immediate loading of TADs
- location/positioning
- placement protocol
- many oral surgeons, periodontists, & GPs do not have the training in the mechanics being used with these devices

In my opinion the use of skeletal anchorage is the standard of care. The only question that exists now is: How many orthodontic providers are willing to seek proper education and training in order to deliver this service to our patients?

It is my recommendation that before placing TADs, one should seek the proper education and training to do so. I have noticed that in talking and working with docs all over the world that their confidence and competence is directly proportional to their education and experience.

Jack Fisher, DMD
rcousley@yahoo.com
Posted: Friday, August 1, 2008 10:35:55 AM

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Joined: 7/28/2007
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I've watched this debate with interest and have observed a similar 'generational gap' when I have run miniscrew courses and talked to colleagues here in the UK. In essence, I strongly believe that orthodontists are the best clinicians to insert TADs (with the exemption of mini-plates). I work closely with several surgeons experienced in orthognathic, trauma and implant surgery and was both surprised and disappointed to observe how they handle miniscrew insertions. Quite simply they fail to realise the delicate, relatively atraumatic and precisely controlled 3D nature of TAD insertion. This frequently resulted in suboptimal positioning and was one of the reasons I developed a 3D guidance stent. At least if they now insert TADs (alongside other surgical treatment) I can accurately prescribe the insertion positions and angles with a stent, rather than relying on their evaluation and tactile skills.

Conversely, we as orthodontists are used to working in close-up 3D detail (think how obsessed we are about bracket positions!), treating both patients and kit sensitively, and having an overview of the whole treatment and mechanics. Cost is yet another disincentive to involve surgeons. TADs techniques are evolving extremely rapidly, but if anything it appears that the common clinical scenarios are becoming more standardised - hopefully this will make it less off-putting to those orthodontists yet to integrate them into their practices.

Richard Cousley BDS, MSc, FDS, FDS(Orth)
nealkravitz@gmail.com
Posted: Monday, August 18, 2008 1:52:14 PM

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Joined: 3/30/2007
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I place all TADs mesial to the second molar. I do not place retromolar or zygomatic TADs. I have colleagues that place TADs and an equal number who refer out. I believe, in general, TAD placement is equally divided amongst orthodontists, periodontists, and oral surgeons. With this said, I believe only 5% of orthodontists are placing their own TADs; maybe 10% are using them or thinking of using them. It will be interesting to see what happens in the next five years, when orthodontic residents trained in TAD placement enter the work force. Will TADs become mainstream, or will the excitement of skeletal anchorage fade similar to distraction osteogenesis?

Neal Kravitz, DMD, MS
South Riding, VA and White Plains, MD


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