Temporary Anchorage Devices (TADs)
Surgical placement of Temporary Anchorage Devices (TADs) in conjunction with orthodontic treatment is a widely accepted solution for some patients with malocclusions. TADs provide a fixed point from which your orthodontist may apply force to move teeth.
Because TADs can be placed in many different sites in the mouth, they can contribute to predictable orthodontic results, shorter orthodontic treatment time, and in some cases, be a less invasive alternative to jaw bone surgery (orthognathic surgery).
What are TADs?
TADs are titanium alloy mini-screws, which are fixed to bone to temporarily enhance orthodontic anchorage. Titanium alloys have been used for joint replacements and dental implants for many years because they are seldom rejected by the body. TADs can be placed alone, or with titanium alloy bone plates. The placement of bone plates can allow for greater stability of the TADs during tooth movement.
How are TADs placed?
Placement of TADs is customized for each patient, a treatment plan which is determined through consultation between the patient’s orthodontist, Dr. Bolourian and oral and radiographic evaluation in our office. Through coordination of care, the doctors will determine whether TADs can be placed alone, or with bone plates.
The procedure will be performed in the office under the appropriate anesthesia to maximize patient comfort. If bone plates are used, an incision will be made in the gum tissue, and the bone plate will be attached to the jaw bone underneath. The incision will be closed allowing the TAD to extend through the gums. Regardless of the type of bone plates placed during the procedure, only the top of the TAD is visible above the gum tissue, to which the patient’s orthodontist can attach the necessary devices for tooth movement. The patient is typically seen by Dr. Bolourian a week or so after the procedure for follow up, then referred back to their orthodontist for continued care.
Removal of TADs
When a patient’s orthodontic treatment plan dictates, the patient will be directed by their orthodontist to return to our office for removal of the TADs or bone plates if applicable. The procedure for removal of the TADs is similar to the original placement procedure in that it will be done in the office under the appropriate anesthesia to maximize patient comfort.
After Placement of Temporary Anchorage Devices (TADs)
Do not disturb the wound. Avoid rinsing, spitting, or touching the wound on the day of surgery. There will be a metal piece protruding through the gum tissue.
A certain amount of bleeding is to be expected for a day or two (2) following surgery. Slight bleeding, oozing, or redness in the saliva is not uncommon. Excessive bleeding may be controlled by first rinsing with cold water and wiping any old clots from your mouth, then placing a gauze pad over the area and pressing firmly for thirty (30) to sixty (60) minutes. Repeat if necessary. If bleeding continues, bite on a moistened tea bag for thirty (30) to sixty (60) minutes. The tannic acid in the tea bag helps to form a clot by contracting bleeding vessels. To minimize further bleeding, do not become excited, sit upright, and avoid exercise. If bleeding does not subside, call for further instructions.
Swelling is a normal occurrence after surgery. To minimize swelling, apply an ice bag or a plastic bag filled with ice, then wrapped with a towel, to the face in the area(s) of surgery. For the first twenty-four (24) hours, ice packs should be utilized every 20 minutes (20 minutes on, 20 minutes off) while you are awake.
Drink plenty of fluids. Avoid hot liquids or foods. Soft food and liquids should be eaten on the day of surgery. Return to a normal diet as soon as possible unless otherwise directed. Avoid chewing food in the area in which the TAD was placed until after seeing Dr. Bolourian for follow up (approximately one week after surgery).
Unfortunately, most oral surgery is accompanied by some degree of discomfort. You will usually have a prescription for pain medication. If you take the first dose before the anesthesia has worn off, you will be able to manage any discomfort better. Effects of pain medicines vary widely among individuals. For moderate discomfort, one (1) or two (2) Tylenol or one (1) Extra Strength Tylenol may be taken every four (4) hours. Ibuprofen (Advil or Motrin) may be taken instead of Tylenol, unless you are on Coumadin/warfarin. Ibuprofen bought over the counter comes in 200mg tablets. Two (2) to three (3) 200 mg tablets (400 – 600mg total) of Ibuprofen may be taken every four (4) hours as needed for discomfort.
For severe pain, take the tablets prescribed as directed. The prescribed pain medicine will make you groggy and slow down your reflexes. Do not drive an automobile or work around machinery. Avoid alcoholic beverages. If you do not achieve adequate relief from your prescription, you may supplement your prescription with two (2) to three (3) 200 mg tablets of Ibuprofen every four (4) hours, if you are NOT on Coumadin/warfarin. Some people may even require two (2) of the prescription tablets at a time during the early stages, but that may add to the risk of upset stomach. The more severe discomfort is usually experienced within the first three (3) days after the surgery. Pain or discomfort following surgery usually subsides more and more each day after that, and your need for medicine should lessen as well. Sometimes, the pain increases as the swelling increases over the next two (2) to three (3) days. If significant pain persists for more than three days, it may require attention and you should call the office. Do not take any of the above medication if you are allergic, or have been instructed by your doctor not to take it.
Mouth cleanliness is essential to good healing. No vigorous rinsing should be performed the day of surgery. You may brush your teeth the night of surgery, but rinse gently. Avoid brushing the gums in the area of surgery for one (1) week. The day after surgery, you should begin gently rinsing after meals and additionally, for a total of four (4) to six (6) times a day, with an 8oz. glass of warm water mixed with one-half teaspoon of salt. Continue this procedure for two (2) weeks.
In some cases, discoloration of the skin follows swelling. The development of black, blue, green or yellow discoloration is due to blood spreading beneath the tissues. This is a normal post-operative occurrence, which may occur two (2) to three (3) days post-operatively. Moist heat applied to the area may speed up the removal of the discoloration.
Antibiotics may be given to help prevent or treat an infection. If you have been placed on antibiotics, take the tablets or liquid as directed. Discontinue antibiotic use in the event of a rash or other unfavorable reaction. Antibiotics make birth control pills ineffective. Women who take birth control pills should use another form of contraception for one complete cycle after the course of antibiotics has been used. Call the office if you have any questions.
Nausea & Vomiting
Nausea may occur after surgery, and is sometimes caused by stronger pain medications. Nausea may be reduced by preceding each tablet with a small amount of food, then taking the tablet with a large volume of water. In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour, including the prescribed medicine. You should then sip on tea or ginger ale (after stirring out carbonation). You should sip slowly over a 15-minute period. If you are not on Coumadin/warfarin, you may also try Alka-Seltzer or Pepto Bismol. When the nausea subsides, you can begin taking solid foods and the prescribed medicine. If nausea persists for more than four hours, call the office.
Sutures may be placed in the area of surgery to minimize post-operative bleeding and to help healing. Sometimes they become dislodged. This is no cause for alarm. Just remove the suture from your mouth and discard it. In most cases, sutures will dissolve unnoticed within a week. Occasionally, sutures require removal after one week. The removal of sutures is a quick procedure that requires no anesthesia or needles and is usually associated with minimal to no discomfort.
Keep physical activities to a minimum following surgery. If you exercise, throbbing or bleeding may occur. If this occurs, you should discontinue exercising. Keep in mind that you are probably not taking normal nourishment. This may weaken you and further limit your ability to exercise.
Make sure that you follow up with your orthodontist as directed to ensure the success of the TADs and your overall orthodontic treatment plan.