Raise your hand if you re a fan of treating malocclusions and difficult tooth movements in a predictable fashion, or even of moving specific teeth while minimizing the movement of others. Then you ve got to love temporary anchorage devices (aka, TADs), right? These tiny, simple screws have revolutionized modern orthodontics and have steadily become a staple in orthodontic practice and residency programs. Orthotown Magazine reached out to several leading manufacturers of TADs to get a snapshot on the current state of TAD usage in the orthodontic profession. From your perspective, have you seen an increase or decrease in TAD usage over the last year? Jamie Morness, global product manager, 3M Unitek: Over the last year, market data shows the use of TADs has declined slightly. However, this trend is somewhat regional, with the Asia region continuing to show growth. Dan Lopez, mini-implants product manager, American Orthodontics: American Orthodontics is seeing some growth in regard to TADs. In the coming years, there might be a gradual increase as a result of younger orthodontists who become increasingly familiar with TAD placement during residency. Craig Beach, general manager, Dentaurum USA: We have experienced high growth rates over the past seven years, however, we have seen this growth level off in the past 12-18 months. Some of this slow-down effect is due to the struggling economy and the pressure to provide lower treatment fees. TADs obviously add cost for the patient, so this can be a more difficult sell-through during a consultation with a patient in this economy. The economy is one reason, but we feel the main reason for the decrease in TAD usage is that many companies are selling starter kits without any guidelines for success or without hands-on training, and this has resulted in many doctors experiencing high failure rates. Obviously, when TADs fail it is very frustrating for the doctor and also for the patient, so these high failure rates have caused many doctors to become less enthusiastic about using TADs on their next patient. Karri Denny, marketing coordinator, Forestadent USA: We have seen an increase in the usage of TADs in the residency programs, so the residents 44
by Benjamin Lund, Editor, Orthotown Magazine are getting in-depth instruction and hands-on practical experience while they are in school, and when they graduate they are very comfortable incorporating TADs into their treatment. As a result, we predict that TAD usage will increase drastically in 2014 and beyond. Joe Panara, AbsoAnchor product manager, Great Lakes Orthodontics, Ltd.: An increasing number of doctors, and specifically orthodontists, have become trained and more comfortable placing micro implants. The market is continuing to grow. Ortho Organizers: There has been a decrease in the use of TADs especially domestically and in Europe over the past year. The first half of 2012 has also shown a decrease over the first half of 2011 in this market segment. Jobe Dubbs, director of marketing, Ormco: Over the past year, we ve seen consistent usage of our VectorTAS product in North America, while experiencing greater adaptation in Asia. Do you think doctors are becoming more comfortable with the idea of placing TADs? Morness: When looking at the lecture schedules of many of the industry events, TADs continue to have a strong interest and attendance. I think 3M Unitek The uniqueness of the Unitek Temporary Anchorage Device (TAD) System is in its simplicity: a one-head design, with one-size diameter and three different lengths, thus making it simple to understand and use. The selfdrilling and self-tapping design allows for an installation procedure that can be done in one appointment with no pilot hole and can be loaded with an attachment immediately. Visit solutions.3m.com/wps/portal/3m/en_us/ orthodontics/unitek for more information. American Orthodontics The American Orthodontics Aarhus System offers a user-friendly mini-implant screw that delivers safe and consistent treatment and a complete line of accessories. The high quality TAD system delivers the perfect balance of strength and working diameter, with premium high strength titanium alloy noted for its biocompatibility and resistance to corrosion. Visit www.americanortho.com for more information. orthotown.com \\ NOVEMBER 2012 continued on page 46 45
continued from page 45 Dentaurum USA The tomas TAD offers a patented cross-slot and undercut head design for easy, versatile and efficient treatment of all TAD cases with one universal head design. Whether you prefer using TAD mechanics with elastics, coil springs or SS stabilization wires, the tomas pin provides many different treatment alternatives for each case. Dentaurum is also the only supplier that offers a complete TAD Auxiliary Kit & Clinical Reference Guide. Visit www.tomasforum.com for more information. Dentsply GAC The Infinitas Mini Implant System is a versatile TAD. Its unique multi-purpose head design accommodates direct attachment of many forms of traction. The body has a full-length cutting thread and is tapered, designed for increased stability. The angled transmucosal neck is designed for insertion at any angle. Infinitas uses a self-drilling insertion technique, to ease insertion and maximize stability. Available system kits: Introductory Clinical Kit (sterile/ non-sterile); Complete Clinical Kit (sterile/non-sterile); Guidance Kit. Visit www.gacintl.com for more information. Forestadent USA From the innovative screw design, inspired by some of the leading TAD experts, to the high quality material make-up, the OrthoEasy Mini Screw effectively delivers excellent outcomes in a variety of clinical treatments. Features include an innovative octangular head, three color-coded lengths and shark-like cuts. Visit www.forestadent.com for more information. because orthodontic manufacturers have continued to offer TAD training courses, and as more residents are learning about TADs during their residency, the awareness of TAD systems and doctors comfort level with placement is increasing. Lopez: Yes. In addition to orthodontists becoming more comfortable with TAD placement due to research confirming them as a proven technology, the younger generation of orthodontists is embracing them, as residents are now often exposed to placing TADs during their residency. Beach: Yes, we have seen a huge shift in this area over the past five years. I would estimate that approximately 80 percent of orthodontists are now placing their own TADs, and about 20 percent are still referring them out. This is compared to about five years ago, when only approximately 15 percent of orthodontists were placing their own TADs. Orthodontists have found that referring out TAD placements can result in disadvantages from poor communication on TAD location or angle of insertion, higher cost to the patient and lower patient acceptance rates. Dentsply GAC: Yes. Especially orthodontists who now routinely have access to TADs during the course of their schooling, and the prevalence of hands-on TAD courses. Denny: Since it is still a relatively new treatment, there is still a little hesitation for doctors across the country, but in my experience, most of them are looking to find ways to expand their treatment offerings and make their treatments more efficient. So they are taking the time to become informed, and attending courses to become more proficient and comfortable in TAD placement in order to incorporate this treatment into their practice. Panara: Yes, doctors are becoming more comfortable placing micro implants. In addition, many university residents are now learning and training with TADs, and beginning their practices using micro implants in their treatments. Ortho Organizers: Yes, as companies have provided more courses on TADs, they have also provided hands-on workshops whereby the doctors are able to place TADs on one another. This has helped specialists overcome their hesitancies in placing TADs. Dubbs: Yes. According to Dr. Scheffler, today many leading orthodontists use TADs as part of routine orthodontic treatment. What typical treatment plans are you aware of that TADs make easier for the clinician? Morness: Indications for TADs have a wide range. They are useful for space closure, tooth uprighting, open bite correction, molar distalization and a number of other applications. Lopez: The treatment plans that come to mind are molar mesialization and distalization, molar uprighting, intrusion, indirect anchorage, en masse retraction and molar protraction. Beach: [In addition to the top indications for TADs] recently we have even seen a big increase in doctors using TADs as temporary implants versus forcing patients to wear a flipper or some other device that needs to be removed while eating. These cases mentioned above are all cases that provide challenges to the orthodontists, and without the help of a TAD, the patient will endure longer treatment times and less comfortable alternatives like surgery, Class II correctors, headgear and other appliances that depend on patient compliance. If TADs are placed with good success, then 46
the majority of patients will jump at the chance to choose a TAD versus these alternatives. Dentsply GAC: Many routine cases can be made easier with the use of TADs due to additional anchorage control and more predictable outcomes. However, the types of cases where we see TADs making the greatest contribution to treatment are: adult cases, especially those which require substantial tooth movements; limited anchorage: hypodontia premature tooth loss/reduced root support; molar intrusion for anterior open bite cases; molar protraction and distalisation; centerline corrections; and single tooth intrusions. Denny: TADs provide excellent anchorage mechanics, which offer the clinician a variety of treatment options. Implementing TADs can help with the following treatments: space closure, mesialization, distalization, intrusion and vertical displacement. Panara: There are several reasons why micro-implant treatment, in many cases, could be considered better, easier and faster than traditional treatment for both the patient and the doctor. Prominent examples include: molar intrusion, tilted molar uprighting and retraction of maxillary/mandibular anterior dentitions. Ortho Organizers: TADs are wonderful in conjunction with the Carriere Distalizer Appliance as it is an easy source of anchorage for distalizing the canine to first molar segment. Dubbs: TADs have been shown to be particularly useful for cases requiring anchorage, anterior open bite correction, gummy smile correction, edentulous space closure, segmental intrusion/extrusion, occlusal cant correction and molar uprighting. In your opinion, why should more doctors start placing TADs? Morness: TADs offer a fixed anchorage option to assist the efficiency of orthodontic treatment and can be used in a number of cases. There are even some cases where patients are unable or unwilling to undergo surgical treatment; in these situations, TADs could be an alternative. Lopez: Adult treatment has presented some very difficult situations that require alternative methods of establishing proper anchorage. TADs have made it possible for orthodontists to coordinate treatment without the associated concerns of tooth-to-tooth anchorage. Beach: In all honesty, our goal is not to get more doctors to place more TADs our goal is to get our existing users to place their TADs more successfully! I think if we are able to achieve this goal, then the number of TADs sold should be an afterthought. There is no disagreement among orthodontists about the vast level of clinical advantages that TADs offer, but in order to see those advantages, the TADs must work successfully on a consistent basis. Dentsply GAC: TADs offer the following advantages: minimal requirement for patient compliance, flexible timing, greater predictability and outcomes, reduced treatment times, 3D anchorage and they are ideal for adults. Denny: If there are ways to help improve productivity, efficiency and the overall satisfaction outcome of their service, then that idea should be explored. TAD treatment can affect all three of these areas of a clinician s practice by simply allowing treatment to progress faster and more efficiently. Panara: Using orthodontic micro implants gives doctors a technological advantage using directional force mechanics to improve dentition, dental Ormco VectorTAS designed for treating anterior open bites, occlusal cant and molar intrusion provides clinicians with a fast, effective means to treat a full range of orthodontic cases without compensating for the inadvertent reciprocal movement of adjacent teeth. Designed by orthodontists specifically for orthodontic use, VectorTAS is a coordinated system of mini screws, attachments and instruments that provide clinicians with all the benefits of temporary anchorage. Visit www.ormco.com for more information. Ortho Organizers The Orlus Mini Screw features a unique design that is easy to use and is designed for enhanced stability and clinical efficiency. Additionally, it is not technique-dependent, not site-dependent and minimizes the influence of bone-dependent conditions. Visit www.orthoorganizers.com for more information. Ortho Technology The Spider Screw Temporary Anchorage Device screw head has an easy open, easy close design with a slot for wires up to.018 x.022, and an under-tie-wing for additional anchorage. The patented design offers a conical thread, allowing the Spider Screw to be self-drilling and self-tapping, eliminating drilling in most applications. Visit www.orthotechnology.com/tads for more information. orthotown.com \\ NOVEMBER 2012 continued on page 48 47
continued from page 47 function and dental appearance. Micro implants, in many cases, can make treatment better, easier and faster for both the patient and doctor. Ortho Organizers: It s easy, it can all happen in one short appointment with precise placement, exactly where you want it, and with immediately loading. What else can you ask for? Why refer it out to your oral surgeon when you can do it yourself? Dubbs: TADs offer professionals the ability to treat difficult cases with non-surgical or non-extraction treatment plans. Working with TADs removes unwanted reciprocal forces, allowing simple cases to be treated more quickly, and puts compliance in the hands of the orthodontist, rather than the patient. What kind of training does your company offer when it comes to TAD placement Morness: We have a number of training opportunities for doctors to familiarize themselves with the Unitek Temporary Anchorage Device System. The most hands-on training approach is Dr. Jason Cope s in-office courses. He leads two separate courses for both beginner and advanced users. We also have a Webinar, presented by Dr. Mohammad Razavi, on the use of the Unitek TAD for palatal anchorage to control vertical dimension and correction of anterior open bites. CE is also offered at our various user meetings and at other lectures by Drs. Cope and Razavi. Lopez: American Orthodontics offers multiple training opportunities for the Aarhus System, ranging from full course lectures by system founder and premier researcher Professor Birte Melsen, to in-office, hands-on training featuring an effective demonstration kit. Beach: We offer several different TAD Clinical Reference Guides, which provide step-by-step instructions on how to place and use TADs with all the challenging indications that an orthodontist faces. Also, we are the only company offering a full tomas auxiliary kit that provides time-saving, customized TAD auxiliaries for easier and more efficient treatment. Regarding education, we offer seminars at our AAO booth, a one-day seminar series throughout the country and also our TAD User Forum which is always held in Vegas and is now in its fourth year with more than 300 doctors attending this year! Dentsply GAC: Hands-on training, accredited TAD courses and supplemental educational materials. Denny: We offer various training programs in the U.S. and abroad, featuring some of the leading experts on TAD treatment. The training sessions range from lectures featuring treatment planning using TADs and mechanics to practical hands-on placement of TADs in a clinical setting. All of which are extremely beneficial for a doctor looking to start a TAD regimen in their practice or for the seasoned expert looking for new ideas in TAD treatment. Panara: Great Lakes sponsors a full-day seminar once a year just prior to the annual AAO in May. This year s conference was the seventh Annual World Micro Implant Anchorage [WMIA] Congress. This seminar features many of the doctors responsible for designing the AbsoAnchor System, as well as the pioneers and experienced users of micro-implant anchorage around the world. We also sponsor micro-implant courses for study clubs and dental/orthodontic organizations. Dubbs: Ormco offers live seminars with hands-on placement training and Webinars for ongoing VectorTAS educational support. In addition, many of the classes offered are accompanied by a comprehensive how to workbook for orthodontists to reference. Dr. Nicole Scheffler, co-creator of VectorTAS, commented that support for the appliance is multi-faceted, with full-day course trainings available, including instruction for proper TADs placement on patients, as well as Webinars and access to leading orthodontists who can answer specific treatment questions. Ad Index Our advertisers make it possible for us to bring Orthotown to you free of charge. Almost all of the advertisers provide telephone numbers in their advertisements for your convenience and fast response. Our advertisers want to hear from you. PAGE # ADVERTISER 011 DDS Lab IFC Dentaurum 017 Forestadent, Inc. 013 Imaging Sciences 014 Metal Mouth Media 009 Ortho Classic 003 Ortho2 Edge 023 Ortho2 Orchestrate PAGE # ADVERTISER IBC OrthoAccel Technologies, Inc. 005 Ortho Organizers Twin Force 037 Ortho Organizers Carriere 015 OrthoSelect, Inc. BC Planmeca, Inc. 007 PROPEL Orthodontics 032 Risk Management Consultants, LLC 48