TADs or Forsus Anchorage for Space Closure

Congenitally missing premolars present complications to standard orthodontic treatment. A lack of premolars may sometimes be the sole impetus for orthodontic treatment. Dentists may misunderstand the prevalence rate, the prognosis and the treatment options for congenitally missing premolars. In fact, there may be a misunderstanding of the best options for treatment, such as the choice between extraction and preservation of the primary molar. Treatment options include leaving the primary molar in situ as a long term solution, extracting the primary molar and preserving the space for an implant, extracting with passive space closure, slicing or bifurcating the primary molar during space closure, or closing the space orthodontically.

Historically, orthodontic closure of the spaces produced by extraction of the primary molar was complicated by the lack of anchorage. In cases where anterior teeth retraction was undesirable, inter-arch elastics may have been one of the only options to assist in molar protraction.

More recently, the introduction of temporary anchorage devices or TADs (Rocky Mountain Orthodontics) and Class II correction appliances such as the Forsus appliance (3M) provide opportunities to increase anchorage and minimize unwanted retraction and/or teeth movement. The following six cases involve congenitally missing mandibular premolars. In most of the cases, TADs were placed in order to provide indirect anchorage. In the first and sixth cases, Forsus appliances were used to provide anchorage during molar protraction.

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Gary Schulman

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