When selecting a TAD system, you should consider various factors, including the quality of the hand-driver, the quality and versatility of the TAD and associated auxiliaries, affordability, and your relationship with the sales representative, among others. 9Īlthough I have never experienced complications with the use of compound topical anesthetics, due to the lack of federal regulation, I now only infiltrate with 4% Septocaine (1:100,000 epinephrine), with a 30-gauge short needle. they may contain high concentrations of ester anesthetics, which can lead to para-aminobenzoic acid (PABA) anaphylaxis.prolonged application may cause tissue sloughing and.they may be improperly mixed, measured, or labeled.they have a low therapeutic index (a narrow difference between optimal dose and toxic dose).the maximum recommended dosage is unknown.They are not-regulated by the Federal Food Drug and Cosmetic Act.The risks regarding use of compound topical anesthetics are the following: 7,8 Significant concern exists, however, regarding the safety of these anesthetics. Popular compound topical anesthetics, such as TAC 20% Alternate (20% lidocaine, 4% tetracaine, 2% phenylephrine) and Profound PET (10% lidocaine, 10% prilocaine, 4% tetracaine, 2% phenylephrine) are widely used by orthodontists for soft-tissue laser surgery and placement of TADs. The Debate Over Compound Topical AnestheticsĬompound topical anesthetics are nonregulated, custom-made, strong topical formulations, often containing high concentrations of both amide (lidocaine and prilocaine) and ester (tetracaine) anesthetics.įigure 1: Notable features of the Dual-Top button-top orthodontic TAD include a button-top head, which provides a built-in low-profile healing abutment and allows for “snap-on” attachment of auxiliaries, a gingival collar to reduce soft-tissue overgrowth, a body with reverse-buttress threading to ensure maximum retention, and a grooved sharp tip for easy insertion and reduced risk of slippage. 3 In the buccal posterior regions where the mucogingival junction is shorter (often less than 5 mm), the clinician may choose to diverge roots or place the TAD in alveolar mucosa in favor of achieving adequate bone stock. 6 As the body of the TAD approximates the root surface, stationary anchorage reduces significantly. Under a heavy force load, a TAD will tip and extrude 0.5 mm toward the direction of the pull. 5Īpproximately 1.5 to 2 mm of bone stock is recommended between the root and the body of the TAD. Rising up the palatal slope, the attached tissue thickens, as does the layer of submucosal fat reaching a combined soft tissue thickness of 3 to 5 mm. In the paramedian region, the attached tissue has a uniform thickness of 1 mm with little submucosal fat. Thin, attached tissue is located in dentoalveolus incisal to the mucogingival junction or in the palatal paramedian region. In the posterior dentoalveolus, the greatest amount of interradicular bone is located between the second premolar and first molar, approximately 5 to 11 mm from the alveolar crest. Regions with a bone density in the category of D2 (850 to 1250 Hounsfield Units, or HU) or D3 (350 to 850 HU) bone, such as the dentoalveolus, palatal paramedian region, palatal slope (mesial to the second molar), and zygoma are ideal for TAD insertion. 2,3 Ideally, TADs should be inserted into a region with high bone density and thin keratinized tissue, with 4 to 5 mm of interradicular bone stock.Ĭortical bone influences primary mechanical stability. The primary determinants of stationary anchorage success are cortical bone thickness, soft-tissue health, and adequate bone stock. TADs maintain relative anchorage via a combination of mechanical grip, fibrous connection, and partial osseointegration. This article will provide a simplified insertion protocol for placement of orthodontic TADs. 1Īs an adjunctive procedure, the use of TADs have allowed the orthodontist to overcome anchorage limitations and perform difficult tooth movements predictably and with minimal patient compliance. A temporary anchorage device (TAD) is a titanium-alloy miniscrew, ranging from 6 to 12 millimeters in length and 1.2 to 2 millimeters in diameter, that is fixed to bone temporarily to enhance orthodontic anchorage.
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