From Enthusiasm, to frustration or back to the future TADs in the digital age

TADS were one of the most discussed topics of the last decade. It started in the 90th and experienced in the last 15 years an extreme hype. Practitioners were enthusiastic about the possibility to counteract newton’s third law. Now, more than a decade later quite a lot of clinicians are frustrated about high loss rates and non-working biomechanics. Currently, the alveolar process still is the most preferred insertion site. However, due to the varying bone quality and the risk of root contact, the survival rate of implants inserted in the alveolar ridge, especially interradicular, still needs improvement. Other regions, such as the anterior palate for miniscrews and implants or the mental region for miniplates, provide much better conditions for mini-implant insertion, since the amount and quality of the available bone is far superior. Implants with several types of abutments and connectors allow the construction of versatile and cost-efficient appliances for a large variety of orthodontic applications. Utilizing TAD´s in the anterior palate and the mental region eliminates the risk of root injury and takes the implants out of the path of tooth movement. This lecture will show an overview of the up to date literature, current developments of appliance designs, main indications, placement techniques, and risk factors during placement and orthodontic treatment. It will especially focus on the virtual TAD placement from intraoral scanning up to a ONE-VISIT protocol of simultaneous TAD insertion and appliance placement. Many different biomechanics of the connected orthodontic appliance will be presented. The lecture will show scientific and clinical perspectives on how mini-screws can become a safe and reliable standard device.