Closing extraction spaces:TADs or not?

[anniev2]

iBraces, Applied Jan 23, 2008 :: Removal Jan 2010 (2 yr treatment)
Extractions: 4 total, premolars at top and bottom

The reason for my post is that I need to get some input from other lingual patients to be sure I'm covering all bases with my ortho and choosing a conventional treatment plan. I'm nervous about experimental treatments.

Smiles concerns prior to braces:
overbite - upper :: caused "bucked teeth" smile, mouth poked out, somewhat difficult to close
crowding - lower :: made bottom tooth look discolored

I've posted before about second guessing extractions. That was such a huge step for me that I actually cried in the surgeons office during the extraction. However, I remembered what I'm working toward and I relaxed.

Ortho is now suggesting TADs...to close extractions (of course) and prevent back teeth from moving forward. He showed me a patient file where he used TADs and it looked weird. Bunched up gums (ortho said that's normal while teeth are moving and the gum eventually move back into normal position). My issue is that now he is suggesting I use TADs but saying that it will cost and additional $800. WTH?!!? He should have told me this before I signed the $8000 contract and had the teeth taken out. Ultimately, I know its my fault but I'm pissed and confused about what to do.

Has anyone had ortho suggests TADs but decide not to do them? What was your experience? What did your ortho tell u about back teeth moving fwd?

How often do you have adjustments for linguals?

What questions should I ask about my bite?

Got a lower power chain at last adjustment, caused some jaw stiffness. Is this normal?

What other questions should I ask?


Please help, I will clarify if necessary as it is 1am and I'm trying to put together sensible thoughts.

[lionfish]

Hi Anniev2,

I didn't have TADs. Have a look at Lisa65's story, don't know if the anchorage devices are the same as what your ortho plans for you, but I believe she has similar issues.

My linguals adjustments (I had uppers only) ranged from 4-8 weeks.

Powerchains can cause a bit of discomfort initially, but this should ease after a day or two.

[Lisa65]

Hi Anniev2

As Lionfish says, I have TADS. Initially they were to move my molars back which were too far forward, and now I have them to keep my molars in place while the front teeth are pulled back.

Without some kind of anchorage, it's possible that trying to pull your front teeth back will cause your molars to move forward. Think of a tug of war. The stronger team will always pull the weaker team forward to some extent, but if one end of the rope is tied round a tree, those people can pull as hard as they like, and that tree won't move.

I have had mixed experiences with TADS. Once in and settled, they work really well, but I have had trouble with some of them getting inflamed and loosening (I've had 6 in total two of which were unusable and one of the remaining four was only usable for a short time before falling out). Insertion is not difficult, although if you have linguals I guess your ortho would place the TADs on the lingual side of your gum so they are not visible? I will say that the two I had placed on that side were the two which were too inflamed and painful to ever use. The ones I had on the outside have been fine.

The bunched up gums you mentioned during gap closure, is not because of the TADs. The "extra" gum in the extraction gap has to go somewhere and it gets kind of squinched up for a while, but eventually smooths back out.

Regarding the cost of TAD - sometimes it's included in treatment pricing, but I guess if your ortho has only just decided he needs to use them on you, he might not have budgeted for it initially.

I can't help you with your other questions as I do not have linguals, but if you are considering going down the TAD route and your ortho is charging you for them, I'd strongly suggest you ask him what will happen if one should reject and loosen. You don't want to be saddled with another $800 bill because one's dropped out and he needs to put another one in.

[shan*rock]

I don't have lingual, but I do have TADs with my ceramic traditional braces. They've been in a few weeks, and were only sensitive (slightly painful) for two or three days. They seem pretty strong and don't feel loose at all. My ortho agreed to give me the two TADs at no extra charge because he strongly feels they will give me the best results. And it makes sense to me. I don't want the back teeth moving forward. I have two on my top gum above my teeth on the side closest to my cheeks. I'm happy with them so far, but I completely understand you being disappointed at the extra cost. Maybe you could negotiate the price. I dunno, good luck!

[anniev2]

Thank you for your insight. I don't like the thought of the TADs falling out...it seems like they should be pretty reliable espc given what they are for. If they wiggle out, I wonder how much progress is lost as a result of them being ineffective anchors up until the point they are loosening and fall out.

[Lisa65]

If they are just a little bit wobbly, they can still be used and will still be effective. Sometimes they can be tightened back up successfully. Think of a nail in the wall that you hang a picture on. If the nail isn't firmly into the wall and you pulled it, then you could pull it straight out. But you could probably still hang a lightweight picture on it because the weight of the picture is pulling the nail to the side rather than straight out of the wall.

If they become very wobbly then usually they have to be removed and re-sited. The gum tissue round them gets inflamed and sore. Failure is not uncommon and usually happens either because the implant is not loaded immediately, or because the ortho has gone off true slightly during insertion, so the hole is a bit too big. Another reason is contact with a tooth root either during insertion or later on if teeth move.

I admit that it's not a pleasant feeling when they start to wiggle, but removal takes a matter of seconds, and the little hole soon heals over.