Скачать или смотреть TADs is success in science or practice?

Is torque a factor in TAD success?
Torque study – compression during insertion Motoyoshi 2006
• High torque – 60%
• Low torque = 72%
• Medium torque – 92%
Understanding
• Low torque = low compression, low primary stability - early failure as not engagement with screw
• High torque = high compression, early success, but greater resorption after insertion, remodelling results in a resorption process
• Medium = best of both = sufficient compression for primary stability, not high enough to cause resorption remodelling
Ideal
• Ideal torque range – 10 Ncm Shantavasinkal 2016
o Study of buccal tads
• Sebastian’s empirical experience between 10-25Ncm depending on site

Rules:
• Aim for medium torque
• Target 10Ncm
• Exceed 10Ncm on palate acceptable

What is the best site for TAD insertion?

Keratinised gingiva
• Evidence - states no difference Lim 2009, Chen 2008, Park 2006, Cheng 2004
• Non Keratlised – depends on mobile or non mobile, with non-mobile higher success rate Viwattanatipa 2009
• 2mm apical to muco-gingival junction
o zone of opportunity

Target zones and site
o No roots
o Consistent cortical bone
o More tolerant to higher torque
o Attached gingiva with low mobile mucosa


Is there ideal bone?
• = if ideal torque = ideal cortical plate thickness
 1-1.5mm cortical plate thickness
• CBCT can be overkill, using research sites for average sites


Ideal site:
– 1st premolar region (transverse) Sebastian 2009
– 2 mm away from mid-palatal suture
o = creates ideal zone ‘Mx1’

Evidence of site selection success
• 98% Vs buccal 71% Houfar 2017
• 84% Trainee success Sebastian 2020
• Success of Sebastian anterior palate 100%, maxillary buccal lowest 85%

Does root proximity influence TAD success?
• Not just contact with roots, but proximity to root also causes failure Kuroda 2007, Asschericks 2008, Chen 2008

Understanding
o Increase root and PDL proximity = bone stress increases = increase bone turnover = increase failure of TAD
• 4mm interradicular distance needed (depending on size of tad) to achieve 1 mm clearance from roots
• Most buccal sites have less than 4mm (resolve through diverging roots, or sites with no roots)

What happens if TADs fail and we try again?
– Secondary insertion success
o 58% (reduced by 33%) Park 2006
o 44.2% (reduced by 36%) Uesugi 2017
o 58.1% buccal (reduced by 21%), 88.9% palatal (increased by 4%) Uesugi 2018
 Uesugi 2018 showed buccal failure increases for secondary insertion, but palatal insertion increases success

For more education see Sebastian’s TAD course:
https://tadchallenge.com/tad-certific...

I have no financial interest