Prevention of (TAD) Temporary Anchorage Devices’ Complications and Infection Control

Write up by: Melanie Joan Yapson-Bergonio

Temporary Anchorage Devices (TAD’s) or mini/micro implants used during orthodontic treatment play a fundamental role in providing anchorage for orthodontic tooth movement. The success of these implants depends on a triage of factors: on the device, on the dentist, and on the patient.

In Orthodontics, anchorage is one of the most important factors in the outcome of a case. There have been extensive attempts to control anchorage, both intra-orally and extra-orally, but not all are effective and can control the slipping of anchorage. These traditional anchorage devices particularly the extra-oral devices only work well with patient compliance; otherwise, anchorage loss is imminent.

In recent years, there have been numerous research on the efficacy of using the osseous structures as anchorage, and the TAD’s or the temporary anchorage devices gained the most popularity and became the most widely used method to control anchorage in Orthodontics because of the ease of placement and removal and low cost.

This article gives a glimpse of some of the causes of the TAD’s failure and how to prevent these. Initially, a good knowledge of the anatomical structures of the teeth and its surrounding structures to avoid soft tissue injury, bone and sinus perforation will already give the operator a good chance of success.

Sometimes, these TAD’s break during placement and removal Mini screw fracture during placement is unusual if the diameter of the screw is thick enough and if the shape of the implant is conical or tapered. Fracture during removal of the implant is unavoidable if there is too much implant osseointegration inside the patient’s mouth over long periods of time. Bleeding and numbness can be due to trauma of an artery or a nerve. Pain arising from implant insertion can be resolved with a prescription of NSAIDs or non-steroidal anti-inflammatory drugs for a few days. The implant may fail, too, on patients with osteoporosis or diabetes.

Implant insertion infections may also arise with poor infection control. There are many ways to sterilize and disinfect patient-care items and other surfaces. These are both methods of decontamination but sterilization is aimed at killing all microorganisms that may cause infection and disinfection only reduces the amount of contaminant to a level that cannot be transmitted. Methods such as dry heat sterilization, gas sterilization, plasma sterilization, chemical sterilization and autoclaving are all intended at decreasing the incidence of infection of the operative site.

My assumption is, a big chunk of the success of mini implant placement for orthodontic use is very much dependent on rigid patient selection, proper insertion site and a careful operation with the proper infection control. After all, an ounce of prevention is always better than a pound of cure.

Dr. Robert Quiambao received his dental degree from the de Ocampo Memorial College of Dentistry and underwent his oral surgery training at the UP-PGH Dental Externship Program and in Germany. He is the current President of the Philippine College of Oral Maxillofacial Surgeons. He is the husband of APO member, Dr. Monica Luz S. Quiambao.

Infection Control in the Dental Clinic Setting

With Dr. Jean Galindez as speaker, the focus in the second lecture was to learn the real way of how we should protect ourselves, our staff and our family while we practice our dental profession. In the current dental practice especially in financially challenged countries, cost is a very critical consideration and sometimes it supersedes the importance of health and safety, unfortunately, in some cases even ignored. More often than not infection control is thought to be the least of the things practitioners invest in as we don’t really see the devastating result until it is too late. She was an animated entertaining speaker who was very knowledgeable about the topic.

There was an overview of current CDC recommendations and ISO standard for minimizing the potential for disease transmission during the delivery of dental care. As dental healthcare personnel are encouraged to review the complete guidelines. It includes a wealth of valuable background information and references that promote understanding the need for a comprehensive dental infection control program.

HER LEARNING OBJECTIVES:

1. Outline the objectives and goals in establishing an infection control program in the dental healthcare setting.
2. Differentiate between universal precautions and standard precautions.
3. Identify and describe methods of disease transmission.
4. Discuss occupational exposures to blood-borne pathogens, including prevention, postexposure
5. management, and prophylaxis.
6. Summarize how to establish and manage an infection control program.
7. Identify infectious hazards in the dental setting.

Dr. Jean V. Galindez graduated from the Centro Escolar University where she was a University Scholar grantee and obtained her continuing education certificate in Advanced Restorative Dentistry at the University of Illinois. She has been a speaker locally and internationally speaking on the art of Tooth Whitening, Multi- Layering Technique, Marketing of Dental Practice and Non or Minimal-Reduction Technique in Restoration and Basics in 3D Diagnostic Imaging. . Previously part of DentPhix, Inc., and Alphadent she is currently, Managing Partner of Dental Masters In Diagnostics and Consultant of Dental Domain Corp.