Pacific Coast Society of Orthodontists Bulletin Summer 2014 - (Page 17)

pcso program taLk TADs by dR. alySSa levin Dr. Levin I t is a very exciting time to be part of the orthodontic profession. Perhaps for the first time since modern advances in adhesive technology and the introduction of nickel titanium wires in the 1970s, we are seeing a major paradigm shift in orthodontic diagnosis and treatment planning. This column is a new feature for the PCSO Bulletin. It is fashioned after John Graham's "The Hot Seat" in the Journal of Clinical Orthodontics. Unlike "The Hot Seat," however, this column's purpose will be to explore how the 12 orthodontic residency programs within the PCSO constituency are teaching and integrating emerging appliances and softwaredriven technologies. Some trends are controversial (CBCT imaging), and some come with hefty price tags (SureSmile, iTero scanners); through the dissemination of information, it is my hope that we can stimulate some discussion and learn something in the process. In honor of the upcoming PCSO Annual Session Joint Meeting with the World Implant Orthodontic Conference, SUMMER 2014 * PCSO BULLETIN this inaugural column will focus on the use of temporary anchorage devices (TADs). Not 10 years ago it seemed like TADs, at the time an orthodontic adaptation of overdenture miniabutments, were being used in almost every clinical situation imaginable. By now the dust has had time to settle - or has it? As you read through the programs' responses (N=11), you will note many similarities and definite trends. Most programs cite absolute molar intrusion for open bite closure and en-masse retraction/protraction as top indications for the use of TADs (n=10), and many (n=7) identify emerging orthopedic protocols (such as that of DeClerk1) as promising applications. Anesthetic protocols are typically, but not always, topical plus local infiltration (n=7). All programs cite the hard palate as the most reliable placement site, and factors related to surgical technique as the most common reasons for TAD failures. Most programs (n=9) use CBCT imaging as part of a presurgical work-up, and prefer immediate loading whenever possible. There was also no preference (n=8) for indirect vs. direct biomechanics. In other areas, answers were surprisingly more varied. There was no one proprietary TAD clearly preferred, although all TADs had similar design characteristics (interestingly reminiscent of our bracket choices). Estimated failure rates varied between 10% to 40%, with the majority at 15% to 25%. There were no special, recurring themes to any post-op instructions.* A universal driver with improved driver features was the most frequently desired design improvement (n=5). Skeletal anchorage in orthodontics is not a new concept. The first published use of implants as orthodontic anchors occurred more than 70 years ago; Gainsforth and Higley placed vitallium screws in dog mandibles to effect tooth movement.2 If you do a PubMed search for "temporary anchorage devices orthodontics OR mini-implants orthodontics," you will find hundreds of case reports and studies on TAD design and success rates. Noticeably lacking are randomized controlled trials and meta-analyses on treatment outcomes or long-term stability, relative to conventionally treated controls. I urge any resident looking for a research topic to consider adding to our body of evidence-based literature in this area. As a practicing clinician, you too have the opportunity to get involved by participating in your regional dental practicebased research network. TADs have revolutionized orthodontics and expanded our abilities to effect orthodontic tooth movement. Although the dust has not yet settled, it is clear that TADs are here to stay. * Answers to this question were not included in the table. References 1. De Clerck HJ, Cornelis MA, Cevidanes LH, Heymann GC, Tulloch CJ. Orthopedic traction of the maxilla with miniplates: a new perspective for treatment of midface deficiency. J Oral Maxillofac Surg 2009;67:2123-2129. 2. Gainsforth BL, Higley LB. A study of orthodontic anchorage possibilities in basal bone. Am J Orthod Oral Surg 1945;31:406-417. S 17

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Summer 2014

The Big Easy: Not Always So Easy
About the PCSO Mission Statement
AAO Trustee Report
PCSO Business
AAO Council on Scientific Affairs (COSA) Report
Component Reports
PCSO at a Glance
AAOF Report
Decrease Stress and Increase Volume
Resident Spotlight: Loma Linda School of Dentistry Postgraduate Orthodontic Program
Younger Member Spotlight: Dr. Melissa Bailey
Third Molar Protocols
Editorial: Special Section
PCSO Program Talk: Orthodontic Residency Programs and the Use of TADs
Case Report: Pre-Treatment
Faculty Files: TADs in Orthodontics: A Review
Seasoned Practitioner's Corner: Dr. Terry McDonald Interviews Dr. Michael Chaffee on TADs
Case Report: Post-Treatment
Pearls of the Pacific: Instant Edentulous Anchorage
Portrait of a Professional: Dr. Earl S. Johnson
Sweet Farewell: Retainers and Retention
In Memory: Dr. Burton Littleton Fletcher

Pacific Coast Society of Orthodontists Bulletin Summer 2014