TADs, or temporary anchorage devices, are tiny screws placed into the jawbone during orthodontic treatment to serve as fixed anchor points. They give your orthodontist a stable base to push or pull teeth without relying on other teeth to absorb the force. Most are between 1.2 and 2 mm wide and 5 to 12 mm long, roughly the size of a small earring post. Unlike dental implants, TADs are designed to be removed once treatment is complete.
Why Orthodontists Use TADs
Every time braces apply force to move a tooth, an equal force pushes back in the opposite direction. In traditional orthodontics, other teeth act as the anchor absorbing that reactive force, which means those anchor teeth can shift in ways you don’t want. Orthodontists have long used headgear, elastics, and strategic bracket placement to manage this problem, but all of those methods have limits and often depend on the patient wearing appliances consistently.
TADs bypass the issue entirely. Because they’re screwed directly into bone, they transfer the reactive force to the skeleton rather than to other teeth. This “skeletal anchorage” lets orthodontists attempt movements that would be difficult or impossible with braces alone: pulling back front teeth without the molars drifting forward, pushing molars straight down into the bone without neighboring teeth popping up, or shifting an entire arch of teeth in one direction. The screw stays put while everything around it moves on command.
Common Reasons You Might Need One
TADs are most often recommended when your treatment plan calls for tooth movements that require heavy or precise force control. Some of the most common uses include:
- Retracting front teeth after extractions, where the orthodontist needs all the closure space to come from the front teeth moving backward rather than the back teeth drifting forward.
- Intruding teeth that have over-erupted, pushing them back into the bone without causing other teeth to shift.
- Distalizing molars, or moving them toward the back of the mouth to create space, which traditionally required headgear.
- Correcting an open bite by intruding back teeth so the jaw can rotate closed.
- Uprighting tilted molars or moving teeth into positions that braces alone can’t reliably achieve.
In many of these situations, TADs replace the need for headgear or other bulky appliances, simplifying treatment and reducing how much your cooperation affects the outcome.
What TADs Are Made Of
Most mini-implant style TADs are made from stainless steel, while larger bone screws and mini-plates typically use a titanium alloy containing aluminum and vanadium. Both materials are biocompatible, meaning the body tolerates them without significant reaction. The choice between the two often depends on the type of TAD and where it’s being placed. The stainless steel versions are the ones most patients encounter, since mini-implants are the most common form used in everyday orthodontic treatment.
How Placement Works
Getting a TAD placed is a short, minimally invasive procedure done right in the orthodontist’s chair. You’ll receive a local anesthetic, the same numbing injection used for a filling, at the insertion site. Once the area is numb, the orthodontist may use a small tissue punch to clear the gum at the entry point. Some screws are self-drilling and go directly into bone. Others require a small pilot hole drilled about 2 to 3 mm deep before the screw is threaded in with a handheld driver. A surgical guide or template is often used to ensure the screw lands at the right angle and avoids nearby tooth roots.
Most patients describe the experience as less uncomfortable than getting a tooth extracted. In studies measuring pain levels, interradicular mini-implants (the type placed between tooth roots, which is the most common placement) scored an average pain rating of about 9 out of 70, well into the mild range. TADs placed in the palate or other bony areas of the jaw scored higher, averaging in the 30 to 36 range, but these locations are less frequently used. Peak discomfort tends to hit within the first one to six hours after placement and fades quickly.
Success Rates and What Affects Them
TADs work reliably. Roughly half of all clinical studies report success rates of 90% or higher, and most failures involve loosening rather than anything more serious. Mini-plates tend to perform slightly better than mini-implants, with average success rates around 95% compared to about 87% for mini-implants. When a TAD does loosen, your orthodontist can usually place a new one nearby.
Several factors influence whether a TAD stays stable. Placement in dense cortical bone improves the odds. If the screw overlaps with a tooth root on imaging, success rates drop significantly, from roughly 75 to 80% down to about 35%. Good oral hygiene around the site also matters, since inflammation of the surrounding soft tissue is one of the more common reasons TADs fail.
Risks and Complications
The most frequently reported complication is contact with a nearby tooth root during insertion. One study found that about 20% of mini-implants touched an adjacent root, though most of these contacts are minor and heal without lasting damage once the screw is repositioned. More significant root injury is rarer. If a screw penetrates more than 50% of its diameter into a root, there’s a risk of the tooth losing vitality. Damage covering more than 4 mm or 20% of the root surface can, in rare cases, cause the root to fuse to surrounding bone.
Soft tissue irritation and inflammation around the screw head are common but usually manageable with proper cleaning. Repeated or poorly placed insertions can lead to persistent gum inflammation and, in severe cases, infection requiring additional treatment. Your orthodontist uses imaging and careful planning to minimize these risks.
Caring for Your TAD
Keeping the area around your TAD clean is the single most important thing you can do to prevent complications. Brush gently around the screw with a soft toothbrush at least twice a day. An interproximal brush or cotton swab dipped in mouthwash works well for getting into the tight space around the screw head. For the first week after placement, rinsing with salt water for about 60 seconds twice a day helps keep the site clean, and using a non-alcohol antimicrobial mouth rinse adds an extra layer of protection.
Some minor swelling in the first week is normal. Contact your orthodontist if you notice persistent or worsening pain, swelling with pus, or if the TAD feels loose or falls out.
What Removal and Healing Look Like
Removal is typically even simpler than placement. The screw is unscrewed from the bone, often with little or no anesthesia needed since the bone around the TAD doesn’t integrate the way a permanent dental implant does. The whole process takes seconds.
After removal, the small hole in the bone heals on its own. New bone begins filling the site within the first two to six weeks, and bone volume reaches levels comparable to surrounding bone by about seven weeks. The bone that fills in initially is a less mature type, and full quality restoration of the bone tissue takes longer, with studies showing the site is still remodeling even at 13 weeks. For most patients, though, the gum tissue closes over quickly and the area is unremarkable within a few weeks.