VERSION 2

Includes more
case pictures
& indications!

pin designed by Prof. Dr. Bumann

TAD Clinical Reference Guide
Keys for Successful TAD Placement & Efficient Biomechanics

Author: Sebastian Baumgaertel, D.M.D., M.S.D., FRCD(C)

Special thanks to:
Prof. Dr. Axel Bumann
Dr. Joseph Petrey
intro to authors
Sebastian Baumgaertel, DMD, MSD, FRCD(C) received his Orthodontic
education at Case Western Reserve University where he now holds
the position of Assistant Clinical Professor and is the Director of the
Subspecialty Clinic for Skeletal Anchorage.
In addition, Dr. Baumgaertel maintains an active private practice
in the Cleveland area. He is a Diplomate of the American Board of
Orthodontics, a Fellow of the Royal College of Dentists of Canada, and
a certified orthodontic specialist in Germany.
Dr. Sebastian Baumgaertel
overview of anchorage
Different Anchorage Concepts
Anchorage is generally defined as resistance to undesired tooth movement. TADs can be used to prevent this side effect
of orthodontic force application in two different ways:
Direct anchorage - Applying force directly from the TAD to the teeth that require movement (target teeth)
Indirect anchorage - Using the TAD indirectly to stabilize a tooth or group of teeth where tooth movement should
not take place, thus creating an implanto-dental anchorage (IDA) unit
Direct anchorage is generally perceived as being easier to use. This simplicity however comes with a substantial trade
off: when a force is applied from the TAD directly to the target teeth, pulling mechanics typically result. As the target
teeth are moved towards the TAD, the type of tooth movement dictates where the implant needs to be placed. Mesial
movement therefore requires placement of the TAD mesially to the target teeth, distal movement requires placement
distal to the target teeth, etc. (Fig 1). This may require placement of a TAD in a less favorable position within a patients
jaw and thus could increase failure rates.

Dr. Bumann has lectured nationally and
internationally at over 800 courses on
mini implants, Cone Beam Computed
Tomography, and TMJ disorders. He also
maintains an active practice in Berlin,
Germany.
Prof. Dr. Axel Bumann
Dr. Petrey received his masters in
public health, D.M.D.,and orthodontic
training at the University of Kentucky
and maintains multiple active practices
in Somerset, KY and across southern
Kentucky.
Dr. Joseph Petrey
In contrast, indirect anchorage is very similar to our traditional orthodontic thought
process: the area with high anchorage requirements will be stabilized by a TAD, thus
preventing anchorage loss. In this scenario target teeth are moved against the IDA unit
with the advantage that implant site selection can occur almost independently of the
desired tooth movement (Fig 2). Thereby, insertion can take place at the anatomically
most favorable site and thus possibly reduce failure rates. (Fig. 1) Direct anchorage
resulting in pulling mechanics
Clinically the greatest difference however may lie in the hidden force vectors that
are associated with the direct approach, which may come as a surprise to the untrained
practitioner. The indirect approach allows for the use of traditional orthodontic mechanics
with the difference that the teeth in the IDA unit are locked in and will not move as
a result of orthodontic force application.

index page
overview of anchorage............................................................................................. 3 example, the head can be a limiting factor when it comes to the selection of the anchorage
chairside protocol............................................................................................ .......... 4 approach and thus may indirectly influence where the TAD will be inserted (see above). From a clinical viewpoint, a TAD
placement protocol.................................................................................................. 5
overview of starter kit...................................................... ........................................ 6
overview of auxiliaries ............................................................................................ 7
case 1: anterior en-masse retraction / direct........................................................... 8 ligature wires. The second category are the so-called bracket-head designs which are equipped with either a single slot
case 2: anterior en-masse retraction / indirect................ ........................................ 9
case 3: molar protraction / indirect (maxilla only).......... ........................................ 10
case 4: molar protraction / direct..................................... ........................................ 11
case 5: molar protraction / indirect.......................................................................... 12
case 6: molar distalization / indirect (maxilla)......................................................... 13
case 7: molar distalization / indirect (mandible)..................................................... 14
case 8: impacted canine............................................................................................ 15
case 9: molar uprighting........................................................................................... 16
case 10: single molar intrusion................................................................................. 18
case 11: posterior intrusion...................................................................................... 19
case 12: incisor intrusion / indirect........................................................................... 20
case 13: incisor intrusion / direct ............................................................................. 21
case 14: temporary implants ................................................................................... 22
Coupling the TAD to the teeth
The head of the mini-implant is the coupling site through which the implant is connected (Fig. 2) Indirect anchorage
to the dentition. Clearly, it can influence the resulting biomechancis substantially. For allowing versatile tooth movement
head with maximum biomechanical versatility appears to be the most favorable design as it gives the clinicians multiple
options for orthodontic force application. Mini-implant heads today can be grouped into two major groups with several
subgroups each.
The first category consists of the so-called anchor-head designs. These allow only the attachment of elastic modules or
or a cross slot. In addition to the attachment of elastic modules or ligatures, these also allow the ligation of rectangular
wires. Building rectangular steel wires into the anchorage set-up can greatly increase the stability of the IDA unit.
Two options exist for attaching the wire to the bracket head implant: ligature ligation and ligature-free ligation using
composite. Ligature ligation requires either an eyelet or tie wings which can result in a higher profile TAD head and thus
cause irritation to the patients. Ligature-free ligation using composite requires neither and thus results in a smaller, lower
profile, and less contoured head, where hygiene is easier maintained and the chances for mucosal irritation are reduced.
In addition, the composite connection provides the most dependable indirect anchorage as it is very rigid and fail-safe.
To date, only the tomas system is specifically designed for ligature-free ligation.
Implant site selection
In theory, a TAD can be inserted anywhere there is bone, but only three general sites have stood the test of time for routine
TAD insertion: the buccal alveolus of the maxilla and mandible, the lingual alveolus of the maxilla, and the palate. It is
strongly recommended that clinicians focus on these sites when planning a TAD placement to ensure maximum success.
In other words, the goal should be to insert TADs in anatomically favorable areas of the jaws to achieve maximum clinical
success rates. After that the proper anchorage approach (direct/indirect) is easily chosen, based on the placement site and
the intended tooth movement. This freedom of choice only exists however with a bracket head TAD.
Sebastian Baumgaertel, D.M.D., M.S.D., FRCD(C)

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 chairside protocol placement protocol
An orthodontic mini-implant can be inserted using multiple different protocols depending on your
TYPICAL TRAY SETUP individual preference and the anatomical relationships at the given insertion site. The following
Cotton rolls Sterile cotton swabs 2 x 2 Gauze
recommendations are general guidelines to keep TAD insertion simple and successful.
Cotton forceps Curved forceps 0.12% Chlorhexidine gluconate (optional)
Mirror Topical anesthetic tomas tissue punch (optional) To view TAD placement videos, visit www.tomasforum.com
tomas pins tomas auxiliaries tomas tray w/contents

ANESTHESIA Step 1Implant Site Location

Any form of anesthesia that provides predictable numbing of the soft tissues can be used: Patient x-rays, models, and tomas X-Marker can all
Topical anesthesia with a potent formulation (for example TAC Alternate 20% which includes Lidocaine 20%, be used to help identify the proper TAD insertion site.
Tetracaine 4%, Phenylephrine 2% and can be ordered from a compounding laboratory) The ideal insertion sites should be in the buccal alveolus,
Infiltration anesthesia with a traditional syringe or a needle-free injection system the lingual alveolus of the maxilla or the palate.
Dentaurum makes no representation regarding the type or dosage of anesthetic to use when placing tomas miniscrews.
Step 2Anesthesia
STEP 1 DISCUSS TAD PLACEMENT STEPS WITH PATIENT Use a topical anesthetic with a potent formulation,
Inform and show patient exactly where the TAD(s) will be placed. followed optionally by local infiltration anesthesia
Discuss the placement procedure and explain the risks, benefits, and alternatives of the insertion and the depending on the thickness of the soft tissue.
use of TADs during treatment. (Dentaurum makes no representation regarding the type or dosage
Answer any questions or concerns that the patient may have - leave ample consideration time (min. 24 hr). of anesthetic to use when placing tomas miniscrews.)

Patient or Parent should sign an Informed Consent (TADs are included in the form available from the AAO)
Step 3Tissue Punch (optional)
STEP 2 SET UP TRAY It is recommended to note the tissue depth with a
Clean and disinfect all clinical contact surfaces, including treatment tray or cart. probe. The tissue punch step is optional in attached
Clean hands thoroughly and don surgical gloves. gingiva and recommended in mucosa. It provides for
Keep all containers, instruments, and supplies free from contamination until patient is ready for the clean tissue borders without compression trauma to
procedure. Do not remove sterile TAD(s) from container(s).
the peri-implant soft tissues.
STEP 3 PREPARE INSERTION SITE
Don surgical gloves, gown, face mask, and protective eye wear. Step 4CB Perforation (optional)
Have patient rinse for 30 seconds with 0.12% chlorhexidine gluconate (optional). Pre-drilling is not required when placing a self-drilling
Dry gingival tissue. TAD, but it can be beneficial in some cases (especially
Using a sterile cotton swab, apply topical anesthetic per pharmacy instructions. in the mandible). Center drilling the bone can help
Apply topical anesthetic no longer than 3 minutes and then rinse off. (Do not wipe) the threads to engage easier and reduce slippage. In
areas of increased cortical bone thickness, pre-drilling
STEP 4 PLACE MINISCREW
is advisable to reduce excessive bone compression.
Follow protocol on opposite page.
Have patient rinse again for 30 seconds with 0.12% chlorhexidine gluconate after TAD insertion (optional).

STEP 5 - LOAD MINISCREW AFTER INSERTION Step 5Initial Insertion

See enclosed case indications for examples on how to load tomas auxiliaries. Initial insertion takes place with the acrylic applicator in
which the tomas pin is delivered. This ensures that
STEP 6 PROVIDE HOME-CARE INSTRUCTIONS the sterile state of the TAD is not compromised.
Instruct patient to rinse with 0.12% chlorhexidine gluconate daily for the first seven days (optional).
Direct patient to brush lightly around the miniscrew during the first week. Patient may brush
normally after the first week.
Advise patient to contact the office if he/she experiences any swelling, persistent pain, or other discomfort. Step 6Final Insertion
Final insertion can be completed with other instruments
STEP 7 CLEAN UP AREA in the tomas system, such as the screwdriver, the
Transport contaminated instruments and supplies in a closed container to the sterilization area. wheel & applicator, or the torque ratchet & applicator,
Dispose of consumable products and follow appropriate cleaning and sterilization instructions
depending on your preference.
for each instrument.

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 overview of starter kit overview of auxiliaries
tomas-auxiliary kit
Includes all items shown and more
REF 400-600-00 (18 Slot)
REF 400-601-00 (22 Slot)

tomas-coil springs tomas-double tubes tomas-Nikodem springs

Light, Medium, or Heavy tension Std. Edgewise DB buccal tube 7mm, 11mm, or 14mm lengths
Custom-designed NiTi spring with Direct bond tube with auxiliary slot Superelastic NiTi spring designed by
a larger eyelet to fit the tomas-pin. for doctors who normally use single tubes. Dr. Nikodem. Custom-designed to
10 pieces, REF 302-012-(00/10/20) Available for the 18 and 22 technique. easily fit over the tomas-pin head.
10 pcs, REF 724-018-51 / REF 724-019-51 10 pieces, REF 302-016-(07/11/14)
tomas-screwdriver tomas-torque ratchet
REF 302-004-10 REF 302-004-40
tomas-starter kit
REF 302-150-20
Includes all items shown

tomas-cross tube tomas-uprighting spring

Cross tube for connecting the tomas -pin

Provides 3-D tooth control for
to the archwire. Ideal for indirect anchorage. simultaneous intrusion or extrusion
Available for the 18 and 22 technique. while uprighting molars.
tomas-pin (6mm) tomas-pin (8mm) tomas-pin (10mm) 10 pieces each, REF 302-014-18 / REF 302-014-22 10 pieces, REF 302-009-00
REF 302-106-00 REF 302-108-00 REF 302-110-00

tomas-power arms tomas-monkey hook

square or round available Additional option for securing
Crimpable square power arm that easily connects elastic components to the
tomas-tray tomas-wheel tomas-applicator tomas-X-marker the tomas-pin to the existing arch. head of the tomas-pin.
REF 302-155-00 REF 302-004-30 REF 302-004-20 REF 302-004-19 Crimpable round power arm for custom bending 10 pieces, REF 302-009-10
hooks at desired vector level.
10 pieces, REF 302-015-00 / 302-019-00

tomas-T-wire
tomas-crimp hook 3L/3R 21 x 25 SS T-wire used for anchoring seg-
Crimpable tube with 4 steps for attaching
ments of teeth to a palatal TAD.
springs and elastics at various vector points.
1 piece, REF 302-024-00
Compatible with 18 or 22 slot.
tomas-SD drill bit tomas-round bur tomas-tissue punch tomas-mechanical driver 10 pieces each, left side: REF 400-600-03 /
REF 302-103-00 REF 302-003-00 REF 302-001-00 REF 302-004-50 right side: REF 400-600-07

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CASE
1 anterior en-masse retraction / direct
CASE
2 anterior en-masse retraction / indirect
Indication Indication
To close bilateral bicuspid extraction spaces by retracting the anterior To close bilateral bicuspid extraction spaces by retracting the anterior canine-to-canine segment en-masse
canine-to-canine segment en-masse

Benefits of Using TADS Benefits of Using TADS

Space closure without mesialization (loss of anchorage) of the posterior Space closure without mesialization (loss of anchorage) of the posterior molar/bicuspid segment
molar/bicuspid segment Reduced treatment time vs. traditional space closure with canine retraction followed by anterior retraction
Reduced treatment time vs. traditional space closure with canine Indirect approach uses only one palatal pin
retraction followed by anterior retraction

Steps for TAD Implementation Steps for TAD Implementation

Preparation Preparation
Complete leveling and alignment Photo courtesy of Dr. Santiago Isaza Penco Complete leveling and alignment
Adequate root parallelism Adequate root parallelism
Continuous stainless steel arch wire
Continuous stainless steel arch wire
TAD Placement TAD Placement
Buccal, between 1st molar and 2nd bicuspid In the palate at the level of the 2nd bicuspids slightly off center (paramedian)
Loading Loading
Crimp tomas Power Arms mesial or distal to canines and adjust Customize TPA by welding a heavy SS wire to the center of TPA
length to obtain a force application near parallel to the arch wire
Attach TPA to tomas Pin and bond to lingual of maxillary molars
Attach tomas Closed Coil Springs to tomas pin head and Power Arms
On the buccal, install a full arch tomas Power Chain for retraction

Step 1 Step 2
Step 1 Step 2

Required Auxiliaries
Required Auxiliaries
two crimpable length adjustable tomas Power Arms
two tomas Closed Coil Springsforce level: light (for initial loading) Custom bent transpalatal arch (TPA)
tomas Power Chain

Dr. Baumgaertels Clinical Pearls: Dr. Baumgaertels Clinical Pearls:

E Initial position of the Power Arms can be distal to the canines to avoid soft tissue irritation. E With palatal placement of the TAD, one always stays clear of the roots.
E As spaces close the Power Arm position can be moved mesial to the canines. E When placing the TAD make sure to account for the retraction of the incisors (leave enough distance).

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CASE
3 molar protraction / indirect (maxilla only)
CASE
4 molar protraction / direct
Indication Indication
To close a posterior uni- or bilateral space by protraction of molars To close a posterior unilateral space by protraction of molars

Benefits of Using TADS Benefits of Using TADS

Space closure without retraction (loss of anchorage) of the incisors and Space closure without retraction (loss of anchorage) of the incisors
impact on overjet and impact on overjet
Avoids shift of midline due to anchorage loss Avoids shift of midline due to anchorage loss
Allows for Unilateral space closure with segmental mechanics (if desired)
Steps for TAD Implementation Force may be applied directly through the Center of Resistance, reducing
Preparation friction and alleviating tipping moment on the tooth.
Complete leveling and alignment
Steps for TAD Implementation
Adequate root parallelism
Preparation
Continuous stainless steel arch wire Photo courtesy of Dr. Sebastian Baumgaertel Photo courtesy of Dr. Joseph S. Petrey
Complete leveling and alignment
TAD Placement
Adequate root parallelism
Palatal placement at level of 1st or 2nd bicuspids (paramedian) Continuous stainless steel arch wire
Loading
TAD Placement
Adapt tomas T-Wire to lingual contour of incisors
If 1st molar is missing: between 1st and 2nd bicuspid
Secure T-Wire in tomas head and bond to lingual surface of incisors
If 2nd bicuspid is missing: between canine and 1st bicuspid
using lingual retainer composite
On the buccal, install full arch tomas Power Chain for protraction Loading
Create protraction power arm with heavy gauge SS wire (as shown)
and insert in auxiliary tube
Install tomas Closed Coil Spring on TAD and protraction power arm
Step 1 Step 2

Step 1 Step 2

Required Auxiliaries
Required Auxiliaries
tomas Closed Coil Spring
tomas T-Wire tomas Double Buccal Tube
tomas Power Chain (alternatively) Customized Protraction Power Arm

Dr. Baumgaertels Clinical Pearls: Dr. Petreys Clinical Pearls:

E If the bite is excessively deep, you can use occlusal bite elevators to generate the required clearance.
E A strongly interdigitated occlusion can hinder tooth movement. If little progress is evident, unlock occlusion
with occlusal bite elevators.
E This biomechanical solution is extremely helpful with agenesis of maxillary lateral incisors.
Indirect molar protraction can also be achieved segmentally, so a full arch bonding may not be necessary.
When not using a double buccal tube, protraction may be achieved by attaching the tomas closed coil spring directly
to the molar hook, however this may cause an excessive vertical force component, tipping of the molar,
increased friction and clinical treatment time.

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CASE
5 molar protraction / indirect
CASE
6 molar distalization / indirect (maxilla)
Indication Indication
To close a posterior unilateral space by protraction of molars To distalize maxillary molars to correct molar relationship and create space

Benefits of Using TADS Benefits of Using TADS

Space closure without retraction (loss of anchorage) of the incisors and Distalization of maxillary molars without the common side effects of
impact on overjet traditional distalizing solutions such as tipping molars and flaring of
Avoids shift of midline due to anchorage loss incisors

Steps for TAD Implementation Steps for TAD Implementation

Preparation Preparation
Complete leveling and alignment Complete leveling and alignment
Adequate root parallelism Adequate root parallelism
Continuous stainless steel arch wire Photo courtesy of Dr. Jon Silcox Continuous stainless steel arch wire
TAD Placement TAD Placement Photo courtesy of Dr. Sebastian Baumgaertel
If 1st molar is missing: between 1st and 2nd bicuspid Palatal placement at 1st / 2nd bicuspid level (paramedian)
If 2nd bicuspid is missing: distal to 1st bicuspid Loading
Loading Attach tomas T-Wire to lingual contour of incisors
Crimp tomas Square Power Arm onto arch wire, flush to the distal Secure T-Wire in tomas head and bond to lingual surface of incisors
edge of the 1st bicuspid bracket. using lingual retainer composite
(Alternatively, you can also bond a SS wire directly to the tooth as shown above) Place tomas Open Coil Springs on arch wire immediately mesial of the
Then bond other end of wire to tomas head group of teeth that requires distalization (for example between maxillary
Use either tomas Closed Coil Springs or tomas Power Chain for the lateral incisors and canines, as shown above)
protraction
Step 1 Step 2
Step 1 Step 2

Required Auxiliaries
Required Auxiliaries

tomas Closed Coil Spring

tomas T-Wire
tomas Square Power Arm
tomas Open Coil Spring
tomas Power Chain (alternatively)

Dr. Baumgaertels Clinical Pearls: Dr. Baumgaertels Clinical Pearls:

E Indirect molar protraction can also be done segmentally, so a full arch bonding is not necessary if the only treatment E If anterior retraction is planned after the distalization, the TAD position should be further distal (2nd bicuspid level).
objective is the unilateral space closure. E In cases with a deep bite or strong cusp embrasure, it can be beneficial to unlock the occlusion with occlusal bite elevators.
E Bonding lingual buttons on the 1st bicuspid and the molar and attaching a Power Chain can reduce the rotational moment E The larger the tooth segment that should be distalized, the more difficult it becomes. Here it may make sense to subdivide the
and reduce friction. segment. For example distalizing 1st and 2nd molars first, then distalizing bicuspids and canines.

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CASE
7 molar distalization / indirect (mandible)
CASE
8 impacted canine
Indication Indication
To distalize maxillary molars to correct molar relationship and create To assist in the eruption of Impacted Maxillary Canines
space Benefits of Using TADS
Benefits of Using TADS NiTi accessory wires may be utilized for forced eruption without the risk of
Distalization of mandibular molars without flaring of mandibular intrusion of adjacent teeth.

incisors Canine exposures may be completed earlier in treatment, as a need for a heavy
base wire is alleviated by the absolute anchorage of adjacent teeth.
Steps for TAD Implementation Steps for TAD Implementation
Preparation Preparation
Leveling and alignment (partial or complete) Create adequate space for erupting Canine utilizing traditional mechanics.
Adequate root parallelism Complete leveling and alignment for adequate root parallelism of adjacent teeth
Stainless steel arch wire (continuous or segmental) If space and adjacent teeth root position are not an issue, then Canine may be
TAD Placement erupted segmentally without the need for full arch treatment.
Buccal, between 1st and 2nd bicuspid Photo courtesy of Dr. Dwight Frey TAD Placement
Loading Palatal placement at 90 to cortical plate
Crimp tomas Square Power Arm to arch wire and position flush Care should be taken to avoid the impacted tooth & its eruption path.
against mesial of 2nd premolar bracket Loading Photos courtesy of Dr. Joseph S. Petrey
Bond other end of tomas Square Power Arm into TAD Adapt tomas T-Wire to lingual contour of the adjacent lateral incisor and premolar

Place tomas Open Coil Springs on arch wire between 2nd premolar The tomas T-Wire may be contoured to adapt to the curvature of the patients palate
and 1st molar Secure T-Wire in tomas head and bond to lingual surface of incisor & premolar
using lingual retainer composite

Step 1 Step 2
Buccal View Palatal View

Required Auxiliaries
Required Auxiliaries

tomas Square Power Arm tomas T-Wire

tomas Open Coil Spring tomas Power Chain (alternatively)

Dr. Baumgaertels Clinical Pearls: Dr. Petreys Clinical Pearls:

E If anterior retraction is planned, the TAD will interfere with tooth movement. It will need to be removed and re-positioned.
E Another option is to overcorrect distalization and thus account for anchorage loss during the retraction phase without TAD.
E This set-up can be used segmentally (treating one single quadrant) or on a continuous arch wire.
Canine eruption can also be done segmentally, where a full arch bonding may not be necessary in early stages
while the Canine is erupting, reducing the total time in full appliances.
Any preferred methods for eruption may be employed, using NiTi wires as shown above, or using powerchain
or powerthread, as long as the adjacent teeth are secured to the Implant.
This same technique is not restricted to impacted Canines, and may be utilized with other impacted teeth.

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CASE
9 molar uprighting
CASE
9 molar uprighting /
Keys for use of tomas uprighting spring
Indication
To upright a mesially-inclined molar due to ectopic eruption of the molar or
premature tooth loss of an adjacent tooth Option 1 - Uprighting with Extrusion
Benefits of Using TADS Place TAD approximately 10 mm from occlusal plane
Uprights molar without any undesired reciprocal movements (i.e.,
Insert uprighting spring into slot of TAD & buccal tube
extrusion and/or mesialization) of the adjacent teeth
Molar uprighting can occur without bonding of the entire dental arch Extend NiTi wire out to achieve more uprighting force
Secure uprighting spring into TAD with LC composite
Steps for TAD Implementation
Place a crimp in center of crimping tube w/ heavy wire cutter
Preparation
Cut off excess SS wire to the mesial of the TAD 0 Bend in SS Wire
None required
TAD Placement
If 2nd molar is to be uprighted: between 1st and 2nd bicuspid Photo courtesy of Dr. Axel Bumann
If 1st molar is to be uprighted: between canine and 1st bicuspid
Loading
See opposite page for loading instructions
Option 2 - Uprighting with no vertical effect
Place TAD approximately 10 mm from occlusal plane
Before After
Insert a 30 intrusion bend into SS wire on distal side of TAD
Insert uprighting spring into slot of TAD & buccal tube
Extend NiTi wire out to achieve more uprighting force
Secure uprighting spring into TAD with LC composite
Place a crimp in center of crimping tube w/ heavy wire cutter
To avoid rotation forces, place a 90 bend in SS wire at mesial 30 Bend in SS Wire
side of TAD & bond wire to tooth w/ lingual retainer composite

Photo courtesy of Dr. Axel Bumann Photo courtesy of Dr. Axel Bumann

Option 3 - Uprighting with Intrusion

Option 1 - with distal tipping of crown
(See Dr. Bumanns Clinical Pearl below)
Option 2 - with mesial tipping of root
(See Dr. Bumanns Clinical Pearl below)
Place TAD approximately 10 mm from occlusal plane
Insert a 45 intrusion bend into SS wire on distal side of TAD
Insert uprighting spring into slot of TAD & buccal tube
Extend NiTi wire out to achieve more uprighting force
Secure uprighting spring into TAD with LC composite
Place a crimp in center of crimping tube w/ heavy wire cutter
To avoid rotation forces, place a 90 bend in SS wire at mesial 45 Bend in SS Wire
side of TAD & bond wire to tooth w/ lingual retainer composite

Required Auxiliaries
Dr. Bumanns Clinical Pearls:
tomas Uprighting Spring
E If uprighting through distal tipping of the crown is desired, the set-up does not need to be modified.
E If uprighting through mesial tipping of the root is desired, the arch length must be fixed. This can be achieved by ligating a Steel Ligature Wire (optional)
stainless steel ligature wire from the TAD to the molar hook, or by annealing and cinching the end of the NiTi-segment.

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CASE
10single molar intrusion CASE
11 posterior intrusion
Indication Indication
To intrude a single over-erupted maxillary molar To close an open bite in cases with vertical maxillary excess through
posterior intrusion
Benefits of Using TADS
Intrusion of a single over-erupted molar to allow for restoration Benefits of Using TADS
of an extraction space in the opposing arch Compliance-free intrusion of posterior segments

Steps for TAD Implementation Steps for TAD Implementation

Preparation Preparation
None required Complete leveling and alignment
TAD Placement Adequate root parallelism
Buccal, between 1st and 2nd molar Continuous stainless steel arch wire
Palatal, between 2nd bicuspid and 1st molars TAD Placement
Loading Photo courtesy of Dr. Jon Silcox
Bilaterally between 2nd bicuspid and 1st molar or between 1st and
Suspend tomas Nikodem Spring between both TADs and 2nd molars
pass it over the occlusal of the over-erupted molar Loading
Place a small amount of composite on occlusal tooth surface to Suspend tomas Power Chain from tomas head, pass it around
keep the tomas Nikodem Spring in place (Optional) arch wire and attach other end back to tomas head.
Photos courtesy of Dr. Steven Nikodem This can be done alternatively with the tomas Nikodem Spring


Step 1 Step 2
Option 1 - Power Chain Option 2 - Nikodem Spring

Required Auxiliaries Required Auxiliaries

tomas Nikodem Spring tomas Power Chain

tomas Nikodem Spring (alternatively)

Dr. Baumgaertels Clinical Pearls: Dr. Baumgaertels Clinical Pearls:

E To prevent buccal flaring of the molars as a side effect, install a transpalatal arch. It should have sufficient clearance to the E To prevent buccal flaring of the molars as a side effect, install a transpalatal arch. It should have sufficient clearance to the
palate to not interfere with the intrusion. palate to not interfere with the intrusion.

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CASE
12 incisor intrusion / indirect
CASE
13incisor intrusion / direct

Indication Indication
To correct a deep bite by intruding incisors To correct a deep bite by intruding incisors

Benefits of Using TADS Benefits of Using TADS

Intrusion of incisors without the potentially detrimental effect of Intrusion of incisors without the potentially detrimental effect of
reciprocal molar extrusion reciprocal molar extrusion

Steps for TAD Implementation Steps for TAD Implementation

Preparation Preparation
Adequate root parallelism Complete leveling and alignment
TAD Placement Adequate root parallelism
Bilaterally, buccal, between 2nd bicuspid and 1st molar Continuous stainless steel arch wire
Loading TAD Placement
Photo courtesy of Dr. S. Jay Bowman Bilaterally, buccal, between lateral and central incisor Photo courtesy of Dr. S. Jay Bowman
Attach wire segment to tomas head and insert it into
auxiliary molar tube Loading
If no auxiliary tube is present, bond wire segment directly Suspend tomas Power Chain from tomas head, pass it around
to buccal molar surface arch wire and attach other end back to tomas head
Insert utility arch into main molar tube and load incisors This can be done alternatively with the tomas Nikodem Spring or
Alternatively, the utility arch may be bonded directly into the with a wire (as shown above)
tomas head, however this may apply rotation forces to the TAD

Step 1 Step 2 Step 1 Step 2

Required Auxiliaries Required Auxiliaries

Utility Arch tomas Power Chain

017 x 025 stainless steel wire segments tomas Nikodem Spring (alternatively)

Dr. Baumgaertels Clinical Pearls: Dr. Baumgaertels Clinical Pearls:

E This is the only intrusion approach that can truly prevent incisor flaring. E Often times root proximity exists at this site in the mandible so that the indirect approach should be chosen.
E Cinch utility arch back to prevent incisor flaring. E Intruding incisors using this method will result in flaring of incisors.

20 www.dentaurum.com www.tomasforum.com 800.523.3946 www.dentaurum.com www.tomasforum.com 800.523.3946 21

CASE
14 temporary implants CASE
14 temporary implants
Indication Loading instructions for pontics
To temporarily restore missing teeth in adolescents post orthodontic Ensure there is no mobility with the TAD.
treatment prior to skeletal maturation and permanent restorations. If primary stability is achieved, test fit the premade pontic directly on the TAD.
(Pontic should be pre-formed custom to the patient and hollowed or with a window to the palatal side for placement on TAD)
Benefits of Using TADS Once test fit is complete, fill the pontic with resin or acrylic material and place on the TAD.
As permanent restorative implants may not be placed until completion of
(It may be necessary to add additional resin material to the palatal side of the restoration for stability, below the line of occlusion.)
growth, placement of TADs with pontics allow for:
Remove excess flash material and finish restoration in place.
Esthetic temporary restoration prior to complete bone Bond a fixed lingual retainer to adjacent teeth but do not bond to the pontics.
development and Maturation
No need for Maryland Bridges bonded to teeth, or removable
flipper retainers with pontic teeth on them that cannot be worn Before After
while eating, and break easily.

Steps for TAD Implementation Photo courtesy of Dr. Joseph S. Petrey

Preparation
Complete all active tooth movement in the location of the missing
tooth. Preparation should be identical to the set-up for traditional
endosseus permanent restorative implants.
TAD Placement
TADs should be placed on the center of the ridge palatal enough
to ensure full bone contact and seated to the soft tissue collar.
No less than the 10 mm tomas pin should be used.
Loading
See instructions on opposite page

Buccal View Palatal View

Required Auxiliaries
automix bisacrylic resin temporary pontic (recommended)
powder-liquid acrylic temporary pontic (alternatively)

Dr. Petreys Clinical Pearls:

E  e sure to place the implant in the thick bone of the ridge, but palatal enough so the implant does not show
B
through the front of the restoration.
All photos above courtesy of Dr. Joseph S. Petrey
E Place a bonded lingual retainer on adjacent teeth to the temporary restorations and lay it against the pontics. This allows
for support of the temporary restorations without fixing the adjacent teeth to the TADs, restricting their eruption.

22 www.dentaurum.com www.tomasforum.com 800.523.3946 www.dentaurum.com www.tomasforum.com 800.523.3946 23

1st Annual
TAD User Forum
November 6-7, 2009 Henderson, Nevada
University of Southern Nevada
College of Dental Medicine CE Certified

Stack the Deck in your Favor with TADs...

Keynote Speakers
General Session Lectures with Simultaneous Workshops
Evidence-Based Protocols for Increasing TAD Success Rates
Live TAD Placements on Patients in State of the Art Clinic
Hands-On Segment with TAD Simulation Model
Q&A Session with Panel of TAD Experts
Clinical Training & Workshops for Staff Members
Prof. Dr. Bumann Dr. Baumgaertel
Also Featuring: Dr. Frank Celenza, Dr. Joseph Petrey,
Dr. Neil Warshawsky, Dr. William Gierie & Andrea Cook

Register your practice today at

tomasforum.com
800.523.3946

Market-Leading TAD. Market-Leading Support.