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Posted on 04.18.2023 12:18 AM By oscar maldonado In Implants
TAD GRAFTING: Temporary Anchorage Devices (TADS) have gained popularity in orthodontics and have been very helpful providing maximum anchorage not available before. The anatomy of the oral cavity and the quality of the soft tissue can prevent the insertion of temporary anchorage devices. Mini implants inserted in keratinized gingiva present less tissue related complications. TAD grafting technique gives the clinician the opportunity to insert TADS beyond the mucogingival junction, avoid the proximity of roots, and be able to deliver vectors of force closer to the center of resistance.
Maurice Salama says on 04.18.2023 03:24 PM
Can you explain better? Is this an FGG around the TAD at time of insertion? What are you grafting around the TAD?
Thanks Dr. Salama
oscar maldonado says on 04.19.2023 02:49 PM
Yes, FGG (Free Gingival Graft). The purpose is to insert the mini-implants beyond the muco-gingival junction to avoid the roots of neighboring teeth. TADS placed in oral mucosa present chronic inflammation and patients complain of irritation and discomfort. Grafting with keratinized gingiva gives more comfort to the patient. Also, the vectors of force can be directed to the center of resistance by modifying the gingival anatomy. Expanding the anatomy driven approach at TAD insertion. TADS in keratinized gingiva present fewer complications.
TAD GRAFTING Technique
Palatal donor site: Clean with chlorhexidine. Infiltrate lidocaine with vasoconstrictor. Cut with a 6mm biopsy tissue punch, in circular motion 1 to 2mm deep. Apply pressure with gauze or cellulose based hemostat (A).
With the pilot drill attached to the screwdriver make a hole at the center of the graft, insert the tad trough the graft with the screwdriver all the way to the neck of the TAD(B).
Buccal recipient site: Clean with chlorhexidine, infiltrate anesthetic, stretch the mucosa, mark the insertion point with the pilot drill, de-epithelized the tissue around the selected area with a round diamond bur. Insert the tad until the graft is in contact with the recipient bed. Do not overpressure the graft(C).
Graft integration was observed after twenty-one days of healing (D). Tad grafting allows to insert the mini screws high in the oral mucosa to avoid the roots of neighboring teeth (E). Wait six weeks of healing before loading.
oscar maldonado says on 04.25.2023 04:41 PM
10 weeks after TAD grafting, no signs of gingival inflammation. Patient reports no pain or discomfort.
Approx. 6 weeks of loading. This will help the doctors and patients to correct “gummy smiles” with incisor intrusion.
Also for lower incisor intrusion to correct severe deep bites. Any where in the buccal segment where you need to apply a tad in the absence of attached gingiva. molar protraction and total intrusion arch.
In a study from Taiwan involving 129 consecutive patients with 266 TADS. Drs Chen and Lai, found that tads placed in keratinized gingiva had a survival rate of 96.2% vs 66.7% for tads placed in oral mucosa.