A TAD is a Temporary Anchorage Device that provides stability so that teeth can be moved more effectively and efficiently. The placement of TAD’s is a relatively simply procedure and is typically painless. The reason for this that bone tissue has no pain receptors. If adequate topical anesthetic (gooey ointment) is applied to the mucosa (the thin pink tissue that covers the bone tissue), there is no perception of pain by the patient, because the thin gum tissue is the only tissue that contains nerve fibers the placement of TAD’s is not painful. The patient does feel pressure as the orthodontist or other dental professional who places the TAD needs to push the sharp point of the TAD against the bone so that the TAD can start to enter the bone. Bone is really like wood, although it is harder than wood, it is just a dense substance into which the TAD can be threaded. As the threads engage, the turning of the TAD makes it go inward just as a screw goes into wood—again, bone is just like wood, in that it does not have any nerve supply at all.
The placement of a TAD is not painful and is far less traumatic than the extraction of even a simple single-rooted tooth. The pulling of a tooth is traumatic in that the tooth is actually separated from the bone by a considerable force, and, all around the entire root of the tooth, there are nerve fibers in the ligament. This ligament is known as the periodontal ligament and it is loaded with nerve fibers. Also, with the extraction of a tooth there is considerable bleeding and some definite pain to one degree or another. The cavern of bone that is left after the tooth is extracted has to all fill in with bone as it heals. By contrast the placement of a TAD is a mere insertion of a finely polished slender holding device with threads on it that is inserted without really having bleeding or discomfort.
It is true that if a TAD is placed very close to a root of a tooth the insertion of the TAD can push the bone sideward to a slight degree and that side pressure can result in some pressure being exerted to the adjacent tooth (the periodontal ligament of the tooth, mentioned above), thus causing some discomfort. However, the orthodontist customarily does everything possible to avoid putting the TAD extremely close to a tooth.
The orthodontist or other professional who places a TAD can select from a variety of designs. Some are a little thicker than others or longer that others but that typically has nothing to do with causing discomfort to the patient. Sometimes the little head of the TAD that protrudes can be a little bit on the “rough” side but that can be taken care of by the placer of the TAD doing a little smoothing of the small head that protrudes.
Interestingly, the removal of TAD’s is even easier than their placement, as all they have to be is turned b in a counterclockwise direction and they simply just come out. No numbing at all needs to be used in doing this— again, bone tissue has no nerve fibers in it!
TAD’s are a truly wonderful innovations in the orthodontic treatment of patients and should not be feared. The placement of TAD’s is not painful and as more people understand them they will receive far more acceptance by patients.