‫بسم هللا الرحمن الرحيم‬

Temporary Anchorage Device

(TAD) or Mini (screw ,implant)
By: Dr. Khaled Mohamed Wafaie
• Mini-implants have become a routine anchorage
method in orthodontic practice given their high
predictability and scientifically proven benefits. The
small size of miniscrew implants allows them to be
placed into bone between the teeth, thus
expanding their clinical applications. With more
patients treated with screw implants as
((anchorage)), their stability is gathering attention.
Despite their tremendous success in facilitating
treatment outcomes, the implant failure rates are
widely variable and could be as high as ( 10-30%))
 Success in mini-implant orthodontics
is defined as a mini-screw with
minimal mobility and inflammation
and the ability to obtain full functional
correction either through direct or
indirect anchorage.
• Various factors affecting
success;
• I. Implant dependent
• II. Operator dependent
• III. Patient dependent
 I .Implant dependent factors

• A)Shape:
• 1) conical : torque measurements suggest that a
conical screw design will provide greater primary
stability
• 2)cylindrical :superiority was evident in the pullout
tests.
• # All the miniscrews’ primary stability rose after drill-
free insertion.
B)Dimension:
1)Length :
a) long = more forces = breakage .
B) longer than 10 mm could result in
greater risk of iatrogenic
perforation .
2. Diameter and Trans-gingival Collar:
#increase diameter = increase success but
increase proximity of the root so use diameters of 1.2,
1.5, and 2.3 mm .
II- Operator related factors :

1. Selection of implant site: 0.5-

1 mm to nearest vital structure .
# For proper position : 5 mm from CEJ and x-ray
.
2. Bone density: D1, D2, D3 are optimal for self-
drilling miniscrews D4 not preferred.
3. Soft tissue considerations
4. Placement technique: small
amount of local anesthetic is
sufficient .
1.Surgical technique: Ideally a pilot
drill should be 0.2 to 0.5 mm less
than the implant diameter, and the
depth should be less to obtain
proper initial mechanical stability.
• 2. Self drilling method: The self-drilling
Implant has high placement torque and high
bone-implant contact values. This procedure is
contraindicated in the posterior and inferior
aspects of the mandible since they have been
reported to have a high breakage rate.

• Used in maxilla
3. Direction of placement and Insertion angle: Angulation
of the bone surface needs to be moderate, a 45 degree angulation relative to
the occlusal plane is considered acceptable
oblique insertion is advantageous to avoid possible root damage .

Excessive angulation may weaken the cortical bone structure and

part of the threaded portion may be exposed on buccal side.
• 4. Implant placement
torque: Motoyoshi et al
recommended an implant
placement torque range of 5 to
10Ncm. Very high insertion torques
leads to higher failure rates due to
excessive bone compression.
• 5. Loading protocol: involves
immediate loading or a waiting
period of 2 weeks to apply
orthodontic forces.14 Most mini-
implants can withstand 100 to 200 g
of horizontal immediate loading
successfully.
• 6. Minimizing soft tissue over growth:
This can be done by placing of a healing
abutment cap, a wax pellet, or an elastic
separator.

• #Using Chlorhexidine mouthwash

slows down epithelialisation.
• 7. Using mini-plates: The connection of two
mini-implants with mini- plate provides a
stable anchorage system and improves the
versatility of the device.1
• 8. Sterilization and asepsis are mandatory
throughout the procedure.

• 9. Clinician experience and skill do contribute to

the success of mini implants.
 III -Patient dependent factor-
• Along with regular tooth-brushing,
Chlorhexidine (0.12%, 10 ml) mouthwash is
recommended. Patient should be explained
about the importance of oral hygiene and
motivated at every visit.
Removing miniscrews
 Conclusion;
• Orthodontic mini-implants are a powerful aid for
the orthodontic practitioner in resolving
challenging malocclusions but, Implant failure
might delay treatment time. A good knowledge of
factors affecting miniscrew success will help us to
increase their success rate, thereby achieving
desired treatment results and save chair-side
time.
 Uses of miniscrews
• 1) intrusion of molars to treat open bite
•2)retraction or firing of
teeth
• 3)Extrusion of posteriors in
opposing arch to treat deep bite.
• Extrusion of anteriors in the same
arch to treat open bite.
• 4) up righting tilted teeth
• 5) lingual orthodontics , substitute to
(Transpalatal arch or nance appliance)
•Researches
 Failure rates and associated risk factors of
orthodontic miniscrew implants: a meta-
analysis.
Department of Oral Technology, School of Dentistry, University of
Bonn, Bonn, Germany.
• Fifty-two studies were included for the overall
miniscrew implant failure rate and 30 studies for the
investigation of risk factors. From the 4987
miniscrew implants used in 2281 patients, the overall
failure rate was 13.5% (95% confidence interval,
11.5-15.8).
 manual vs. motor-driven mini-screw
insertion:
• Methods
• We retrospectively reviewed 429 orthodontic
mini-screw placements in 286 patients (102 in
men and 327 in women) between 2005 and 2010
at private practice. Age, gender, mini-screw
length, and insertion site were cross-tabulated
against the insertion methods. The Cochran-
Mantel-Haenszel test was performed to compare
the success rates of the 2 insertion methods.
• Results
• The motor-driven method was used for 228 mini-
screws and the manual method for the remaining 201
mini-screws. The success rates were similar in both
men and women irrespective of the insertion method
used. With respect to mini-screw length, no difference
in success rates was found between motor and hand
drivers for the 6-mm-long mini-screws (68.1% and
69.5% with the engine driver and hand driver,
respectively). However, the 8-mm-long mini-screws
exhibited significantly higher success rates (90.4%, p <
0.01) than did the 6-mm-long mini-screws when placed
with the engine driver. The overall success rate was
also significantly higher in the maxilla (p < 0.05) when
the engine driver was used. Success rates were similar
among all age groups regardless of the insertion
method used.