Skeletal Anchorage and Temporary Anchorage Devices (TADs) for Adults

Conventional orthodontic treatment relies on teeth as anchors — meaning that when a force is applied to move one tooth, the tooth used as the anchor point is also subject to an opposing force. In many cases, this is manageable. In more complex cases, however, the tooth movements required simply cannot be achieved reliably using teeth as anchors alone: the anchorage demand exceeds what the natural dentition can provide.

Skeletal anchorage using temporary anchorage devices (TADs) changes this. By anchoring forces directly to bone — using small titanium mini-screws placed in the jaw — it becomes possible to apply precise, controlled forces to move teeth in ways that would otherwise be impossible, unreliable, or achievable only through surgery.

At Lusk Orthodontics, TADs are used routinely as part of complex adult orthodontic treatment, significantly expanding the range of cases that can be managed non-surgically and allowing more predictable outcomes in challenging tooth movements.

What Are Temporary Anchorage Devices?

TADs — also referred to as mini-screws, mini-implants, or orthodontic bone anchors — are small titanium screws, typically 6–12mm in length, that are placed directly into the jawbone to serve as a fixed, stable point from which orthodontic forces can be applied.

Unlike dental implants, TADs are placed for the duration of orthodontic treatment only and are removed once they are no longer needed. Placement is a simple, minimally invasive procedure carried out under local anaesthetic in the orthodontic clinic, with no incisions required. Most patients report minimal discomfort during and after placement.

Once in position, the TAD provides a point of anchorage that does not move — regardless of the forces applied — allowing the orthodontist to direct tooth movement with a level of precision and control not possible with conventional brace mechanics alone.

What Can TADs Achieve?

Closing Extraction Spaces

Where teeth have been removed — either as part of the treatment plan or following loss of teeth — closing the resulting space requires moving adjacent teeth over a significant distance. Without skeletal anchorage, this movement can cause unwanted reciprocal movement of the anchor teeth. TADs allow the space to be closed efficiently and predictably, with full control over the direction and extent of tooth movement, and without compromising the position of surrounding teeth.

Moving Teeth Over Long Distances

Some tooth movements — particularly the movement of impacted, displaced, or significantly out-of-position teeth — require sustained forces applied over a long distance. TADs provide the stable platform needed to generate and maintain these forces throughout treatment, making it possible to guide teeth into correct alignment that would otherwise be unachievable.

Correcting Severe Bite Problems Without Surgery

Severe underbite (skeletal class III). Where the lower jaw protrudes relative to the upper, creating a reverse bite, surgical correction is conventionally the most reliable option for significant discrepancies. However, where a patient declines surgery or is not a surgical candidate, TAD-supported mechanics — combined with fixed braces or clear aligners — can be used to compensate for the skeletal discrepancy through carefully planned tooth movements, achieving a functional and aesthetic improvement within the limits of dental rather than skeletal correction.

Large overjet (skeletal class II). Where there is a significant horizontal discrepancy between the upper and lower teeth — with the upper front teeth sitting prominently in front of the lower — TAD-anchored mechanics can be used to retract the upper front teeth or advance the lower teeth with a degree of control and efficiency not achievable with conventional brace mechanics alone. This is particularly valuable in adult cases where growth modification is no longer possible and surgical correction is not desired.

Correcting Gummy Smiles

A gummy smile — where an excessive amount of gum tissue is visible above the upper front teeth when smiling — can have a significant impact on a patient’s confidence and smile aesthetics. In cases where the gumminess is caused by over-eruption of the upper front teeth rather than by excess gum tissue or a skeletal vertical excess, TAD-supported intrusion offers a highly effective non-surgical solution.

By anchoring intrusive forces directly to bone, TADs allow the upper anterior teeth to be moved upward (intruded) precisely and predictably — reducing the amount of tooth and gum displayed on smiling. This is a tooth movement that is extremely difficult to achieve reliably with conventional brace mechanics, as standard braces tend to produce unwanted reciprocal effects. With skeletal anchorage, the intrusion can be controlled and directed with a level of accuracy that produces a genuinely aesthetic and stable result.

For patients with a gummy smile who want to avoid surgical correction, TAD-supported intrusion is one of the most impactful treatments available.

Closing Anterior Open Bites Without Surgery

An anterior open bite — where the front teeth do not meet when the back teeth are together — can be one of the most challenging problems to correct orthodontically, and has a significant tendency to relapse if not managed appropriately. Surgical impaction of the upper jaw is the most stable long-term solution in severe cases, but for patients who do not wish to pursue surgery, TAD-supported intrusion of the back teeth offers an effective non-surgical alternative.

By using TADs to intrude (move upward) the posterior teeth, the bite naturally closes at the front as the jaw autorotates. This mimics the effect of surgical impaction through controlled tooth movement rather than jaw surgery, and can produce significant and lasting improvement in carefully selected cases.

TADs as Part of a Broader Treatment Plan

Skeletal anchorage is rarely used in isolation — it is almost always part of a broader treatment plan involving fixed braces or clear aligners. The TAD provides the anchorage; the braces or aligners deliver the tooth movements. The combination allows cases to be treated to a level of precision and completeness that neither could achieve alone.

Where TADs are indicated as part of your treatment, their placement, position, and role in the overall plan will be explained clearly before treatment begins.

Book a Consultation

If you have been told that your case is complex, that surgery may be required, or that certain movements are difficult to achieve — TAD-supported mechanics may offer an alternative or a more effective treatment approach. Book a consultation at Lusk Orthodontics for a full assessment and discussion of your options.