If you’re exploring orthodontic treatment and wondering whether a temporary anchorage device could help solve your bite or tooth problem, you’re in the right place. TADs are tiny titanium or surgical grade stainless steel screws used during treatment to help shift teeth with more precise control than traditional methods allow. They’re common in modern orthodontic care and can reduce the need for headgear or even jaw surgery in many cases. This guide is written for patients considering braces or clear aligners who want to understand how TADs work.

I have personally placed hundreds of TADs, and I do find them to be quite helpful in improving my treatment results- making treatment more conservative, and less invasive.  Check the FAQ at the bottom for quick answers.

What Is a Temporary Anchorage Device (TAD)?

A TAD is a small, medical-grade titanium mini-screw temporarily placed in the jawbone to serve as an anchor point during orthodontic treatment. TADs are placed directly into the jawbone, which allows your orthodontist to apply force to a stable, non-moving, and predictable anchor, providing enhanced control during treatment.

• Size: Typically About 1.2–2.0 mm wide in diameter and 6–10 mm long-resembling a tiny earring stud with a small head above the gum.  The most common size is 1.6x8mm.
• “Temporary”: Used only during treatment, then easily removed
• “Anchorage”: A fixed point to pull against when moving teeth
• "Device": TADs are an FDA approved medical device for orthodontics
• Different from implants: TADs are way smaller, not intended to replace teeth, and removed once tooth movement is complete

By providing a fixed point in the mouth, TADs enable orthodontists to achieve refined and controlled movements, expanding treatment options for complex cases.

How Do TADs Work in Orthodontic Treatment?

Traditional "anchorage" uses other teeth, headgear, or elastics (rubber bands)-which can cause unwanted movement of anchor teeth. TADs work by anchoring directly in bone, offering a stable foundation.

• The TAD is gently placed in the bone
• Braces or aligners connect to the TAD with springs, elastics, or wires
• This allows movement of certain teeth while keeping others still
• TADs are used for significant tooth movement where traditional anchorage methods may be insufficient (or even impossible)

TADs are employed as a discreet alternative to bulky, extraoral devices like headgear. The use of TADs allows for more precise control over tooth movement, and they reduce reliance on patient compliance.  In my opinion, they are way more effective than most other orthodontic alternatives.

Example: Using a TAD to move molar teeth forward without bringing the front teeth backwards to close a space for a congenitally missing tooth.

Common Problems TADs Can Help Solve

TADs aren’t for every patient, but they’re powerful for specific problems that braces alone can’t fix predictably. TADs can help correct complex orthodontic issues such as severe malocclusions and complex bite problems.

• Closing gaps when teeth are missing-moving back teeth forward instead of placing implants in some cases
• Open bite correction-helping front teeth meet without orthognathic jaw surgery
• Underbites/overbites-moving whole groups of teeth without removing teeth and even avoiding jaw surgery in some cases
• Impacted canines-guiding teeth stuck in the gum or palate into the arch
• Canted smile-evening out one side that appears higher than the other
• Gummy smile- moving teeth back "into" the jaw to create less gum display on smiles
• Supraerupted teeth- this is when a tooth has gone "too far" and needs to be pushed back up into the bone to avoid extraction or more extensive dental work
• Expansion- a true anchor point for upper adult jaw expansion.  Also known as a MARPE.  This can be a great much less invasive approach compared to jaw surgery.

TADs help correct severe jaw and alignment discrepancies, potentially avoiding invasive surgery. They can also treat poor spacing of teeth, crowding, and jawbone problems. In many cases, TADs can significantly reduce treatment time by allowing more direct tooth movement.

TADs to Avoid Orthognathic Jaw Surgery

Depending on the severity of the bite problem, this may be a possibility.  Typically things such as:

• Expansion
• Open bite
• Underbite
• Gummy Smile
• Overbite
• Canted smile

Please keep in mind this will largely depend on the situation and how bad the jaw discrepancy is.  Because TADs only move teeth, large discrepancies will still require jaw surgery as the best, most predictable option.  However, everyone is different- so we would need to assess your individual situation before deciding what route is best.

What to Expect: TAD Placement, Comfort, and Removal

The placement of a TAD is a minor oral surgery procedure that typically requires a local anesthetic for numbing the area. The process generally occurs in three stages: consultation, surgery, and removal-with the surgery itself being quick and minimally invasive.  The actual placement typically takes less than a minute.

TAD placement procedure:

1. Clean and numb the area with local anesthesia
2. Gently place the tiny screw
3. Rinse and connect to orthodontic appliance

TAD Discomfort after procedure:

Most patients feel slight pressure rather than pain. After the TAD is placed, you may experience mild soreness, which typically subsides within 24-72 hours. Over-the-counter acetaminophen or ibuprofen usually helps.

Any pain and discomfort is typically way less than the first few days of new braces.  Some initial soft tissue irritation is possible, but things usually adjust quickly as with anything new in your mouth.

TADs stay in for several months to over a year, monitored at follow up appointments.

TAD Removal:

Removal is quick-often no anesthesia needed. Most patients report feeling only brief pressure and experience minimal discomfort afterward.

Caring for a Temporary Anchorage Device at Home

Maintaining good oral hygiene is crucial around TADs to prevent infections and inflammation due to their protrusion through the gums.

Proper aftercare includes:

• Brush gently around the TAD with a soft-bristled toothbrush twice daily
• Use an antimicrobial mouthwash, especially the first 1–2 weeks
• Avoid hard or sticky foods that might catch on springs or wires
• Contact our office if the TAD feels loose, painful after a few days, or shows swelling or redness

In most instances, TADs stay stable and comfortable when patients maintain good brushing habits.

Are Temporary Anchorage Devices Right for You?

Not every patient needs a TAD-the decision depends on your specific bite, tooth positions, and treatment plan. TAD placement requires extreme precision to avoid perforating adjacent anatomical structures, so careful planning is essential.

• Typical candidates: Teens and adults with complex problems-open bite, narrow maxilla, missing teeth, severe crowding
• Requirements: Healthy gums, controlled cavities, no untreated gum disease
• Planning: We use 3D digital X-rays to determine safe placement sites with adequate bone support

Failure rates for TADs generally range between 11% and 30%, influenced by factors such as poor bone density or excessive loading-which is why proper evaluation matters.  However, When a TAD comes loose, replacing it is typically no big deal.

Schedule an appointment today with me for a personalized evaluation to see if a TAD could help achieve optimal results in your treatment.

Real World Examples of TADs from Starling Orthodontics

These examples show how TADs work in everyday orthodontic care at my office:

• Adult with open bite: Struggled to chew sandwiches properly. TADs and braces intruded back teeth, closing the bite and avoiding jaw surgery recommended elsewhere.

• Underbite: TADs placed in the back of the lower jaw to pull the bottom teeth backwards behind the uppers.

• Canted smile: Used to "lift" up the lower side of a smile.  Normally, this would require corrective jaw surgery.  This patient is wearing lingual braces used with the TAD.

• Supraerupted (over-erupted) teeth: TADs carefully lifted the inside of the upper teeth, leveling the upper smile line

Outcomes depend on each person’s unique situation, but these cases demonstrate the benefits and range of what temporary anchorage can help us achieve.

Frequently Asked Questions about TADs

Will getting a TAD hurt? Local anesthesia is used to numb the area. Most patients feel pressure rather than pain, with mild soreness for a day or two.  Discomfort is significantly less than you think- and usually even less than the first week of braces.  There are no nerve receptors in bone which is key for understanding why this is so.

Are TADs safe? Made of biocompatible titanium or stainless steel and are widely used in orthodontics,. Complications are very rare when placed and cared for properly.

Will I feel the TAD all the time? It may feel strange initially, but most patients forget it’s there within days.

Can I eat and speak normally? Yes-avoid chewing directly on the TAD area at first and be cautious with hard foods.  It will have no impact on speech.

How long will my TAD stay in? Depends on your treatment plan-typically several months to over a year.

What if a TAD gets loose? It’s usually not an emergency. We’ll see you promptly and can reposition or replace it if needed.

Are TADs used with braces or aligners? Both-TADs offer additional support with metal braces, ceramic braces, lingual braces, or clear aligners.

How much does a TAD cost? Costs vary by case. Contact our practice so we can review your benefits and provide a clear estimate.

Have more questions? Call or request an appointment today to discuss whether a TAD could be the perfect solution for your orthodontic progress. As your doctor and orthodontist, I’m here to help you achieve the smile you deserve.

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