What Are TADs?
TADs — Temporary Anchorage Devices, also called orthodontic mini-screws, mini-implants, or micro-implants — are small titanium screws temporarily placed in the jawbone to create a stable anchor point for tooth movement. They stay in for a few months, do their job, and come out when the movement is complete.
TADs solve one of the oldest problems in orthodontics: moving one tooth without moving the teeth next to it. Before TADs were available, the only way to anchor an orthodontic force was against other teeth — which meant those teeth would drift in the opposite direction (an effect orthodontists call reactive movement). TADs eliminate reactive movement because they are anchored directly in bone, not in teeth. Whatever force the wire or elastic pulls, the mini-screw holds fast.
Why Bold Bite Orthodontics Plans TADs Digitally First
Dr. Greenberg and Dr. Cao plan every TAD case from the Vatech Green CT scan taken at the complimentary new-patient visit. The 3D scan shows bone thickness, root positions, sinus floors, and nerve paths in every direction — information a flat panoramic X-ray cannot provide. That detail lets the treatment plan specify the exact mini-screw length, diameter, angle, and site before the patient ever sees the surgical partner. The placement appointment itself is short because the decisions have already been made.
When TADs Are the Right Tool
TADs are not used for every orthodontic case. They are the right tool when the required tooth movement cannot be achieved predictably with braces or clear aligners alone. Common indications Dr. Greenberg and Dr. Cao evaluate for at Bold Bite Orthodontics:
Molar Intrusion for Open Bite
Pushing the upper back teeth up into the bone lets the lower jaw rotate forward and closes an anterior open bite. This movement is extremely difficult without TADs — conventional methods usually require jaw surgery. TADs often turn a surgical case into a non-surgical correction. See Open Bite Treatment.
MARPE (Adult Palatal Expansion)
Miniscrew-Assisted Rapid Palatal Expansion uses TADs placed directly in the palatal bone so the expander pushes on the suture rather than on the teeth. Without TADs, expansion in an adult with a fused suture usually requires jaw surgery (SARPE). Dr. Cao places MARPE TADs in-office as part of the MARPE workflow — see the Palatal Expander page for the full protocol.
Impacted Canine Traction
Buried canines often need steady traction force over 6–18 months. A TAD gives that pull a stable anchor in bone, so the traction does not drag the neighboring teeth out of position while the canine is coaxed down. See Impacted Canine Treatment.
Asymmetric Space Closure
Closing a gap on one side of the arch without pulling the teeth on the other side across the midline. A TAD on the closing side absorbs the reactive force, so only the intended teeth move.
Severe Crowding — Distalization
Pushing the back molars further back to create arch length for crowded front teeth without extracting premolars. TADs anchor the distalizing force directly to bone so the front teeth stay put while the back teeth slide rearward.
Gummy Smile Correction
Intruding the upper front teeth into the bone to reduce the amount of gum tissue that shows at a full smile. Without TAD anchorage this movement is unpredictable — the back teeth usually extrude as the front teeth refuse to move up.
How TAD Placement Works at Bold Bite Orthodontics
Complimentary 3D CBCT Evaluation
Every new-patient consult at Bold Bite includes a Vatech Green CT scan at no charge. Dr. Greenberg and Dr. Cao use it to measure cortical bone thickness, locate tooth roots, and map nerve canals and sinuses before any appliance or mini-screw is planned. The exact TAD position, angle, and size are chosen on the scan — not guessed chairside.
Surgical-Partner Coordination
Bold Bite Orthodontics coordinates TAD placement with Dr. Doug Stortch at Modern Perio in Jacksonville. Dr. Greenberg and Dr. Cao send the full 3D plan — CBCT, intraoral scan, and the target force system — so Dr. Stortch places the mini-screw to the exact specification the orthodontic mechanics require. One team, one plan, two offices with complementary expertise.
Short In-Office Placement Visit
Placement itself takes roughly 10 minutes per mini-screw. A small amount of local anesthetic numbs the gum, similar to a filling. Most patients describe the sensation as pressure, not pain. There is no cutting of gum tissue and no drilling of tooth structure — the self-drilling screw threads directly through the tissue into the bone.
Immediate Loading and Active Orthodontics
Unlike dental implants (which need 3–6 months to integrate), TADs can usually be loaded the same day or within a week. Dr. Greenberg or Dr. Cao attaches the spring, elastic chain, or wire at the next Bold Bite visit and tooth movement begins right away. Follow-up checks happen at every regular orthodontic appointment.
Removal
Once the tooth movement is finished, the TAD is removed in a short appointment — usually without anesthetic, usually in under five minutes. The soft tissue heals within a few days and the bone remodels to fill the channel within weeks. There is no visible scar.
Coordinated Care: How TAD Cases Are Handled at Bold Bite Orthodontics
Some orthodontic offices place every TAD themselves; others refer every TAD out. Bold Bite Orthodontics takes a coordinated approach built around the specific anatomy of each case.
MARPE cases — the palatal-expansion mini-screws that go into the roof of the mouth — are placed in-office by Dr. Cao as part of the MARPE appointment. That workflow is described in detail on the palatal expander page.
Standalone anchorage TADs — the mini-screws used for molar intrusion, asymmetric space closure, impacted canine traction, distalization, and gummy-smile correction — are placed by Dr. Doug Stortch at Modern Perio in Jacksonville. Dr. Stortch is Bold Bite's trusted surgical partner for all non-MARPE anchorage cases. The reason is technical: many anchorage TADs sit between dental roots or in regions with complex bone anatomy where a periodontist's surgical training and flap-handling skills deliver a more predictable result than an orthodontist placing the same screw chairside.
One Treatment Plan, Two Specialists
Dr. Greenberg and Dr. Cao design the full orthodontic mechanics from the Vatech Green CT and intraoral scan before the surgical appointment is scheduled. Dr. Stortch receives the complete digital plan — 3D imaging, exact target site, angle, and length — so the mini-screw is placed to the ortho specification, not guessed at chairside.
Local, Same-Week Scheduling
Modern Perio is a Jacksonville practice, not a cross-town referral. Most TAD placements are scheduled within a week of the treatment-planning appointment at Bold Bite, and follow-up checks happen at the regular orthodontic visits without another surgical trip.
Periodontal Expertise for Soft-Tissue Sites
Most TAD failures are soft-tissue events, not bone events. A periodontist trained to manage inflamed or thin tissue around the screw head has a real advantage on the sites where TADs most often loosen. Bold Bite concentrates on the mechanics; Dr. Stortch concentrates on the biology.
Honest About the Trade-Off
A few Jacksonville orthodontic offices advertise in-office TAD placement. Bold Bite could do the same, but has chosen the coordinated-care model because the outcomes are more predictable when the right specialist handles each part of the case. The goal is the movement, not the marketing badge.
If a TAD Loosens Mid-Treatment
Published clinical data put TAD failure rates at roughly 2–5%. If a mini-screw loosens, Bold Bite coordinates a same-week re-placement visit with Modern Perio at no additional orthodontic charge when the TAD is part of the comprehensive treatment plan. The orthodontic timeline is protected and the family is not left negotiating between two offices.
What Does It Feel Like?
The most common question parents and adult patients ask about TADs is whether they hurt. The honest answer: the placement itself is uncomfortable for a few seconds (similar to the first 3–5 seconds of a dental injection), then shifts to pressure rather than pain. Once the anesthetic wears off, most patients report:
- Day 1–2: Mild soreness at the mini-screw site. Acetaminophen (Tylenol) handles it when needed — not ibuprofen, which can slow orthodontic tooth movement by blunting the bone-remodeling process.
- Day 3–7: Minor tenderness when the area is touched directly. Normal eating, speaking, and brushing are comfortable.
- Week 2 and beyond: Most patients forget the TAD is there. The tissue around the screw head adapts and stays healthy with routine brushing and flossing.
- Daily cleaning: Brush the mini-screw head like a tooth. A small interdental brush helps clean under the head. Good hygiene is the single most important factor in preventing the soft-tissue inflammation that drives most TAD loosenings.
Pain Management Note — Acetaminophen, Not Ibuprofen
Dr. Greenberg and Dr. Cao specifically recommend acetaminophen (Tylenol) rather than ibuprofen or naproxen for any soreness after TAD placement or routine orthodontic adjustments. Anti-inflammatory medications (NSAIDs) can slow orthodontic tooth movement by interfering with the bone remodeling that moves teeth. This guidance applies to the whole course of active orthodontic treatment, not just the TAD visit.
How Much Do TADs Cost?
When TADs are clinically indicated as part of a comprehensive orthodontic plan at Bold Bite Orthodontics, the orthodontic portion of the case — treatment planning, digital workup, follow-up checks, and TAD coordination — is included in the overall comprehensive fee. There is no separate anchorage surcharge from Bold Bite.
The surgical placement fee for standalone anchorage TADs is billed directly by Modern Perio. That fee varies with the number of mini-screws and the complexity of the site, and is quoted transparently to the family before placement is scheduled. Most PPO dental and orthodontic benefits apply a portion of the cost, and HSA / FSA funds are eligible for both the orthodontic and surgical charges.
MARPE TADs — which are placed in-office by Dr. Cao — are included inside the MARPE appliance fee ($1,500–$3,500 total), with no separate surgical bill. See the expander page for the full MARPE cost breakdown.
For a precise quote with insurance applied, use the braces cost calculator or Invisalign cost calculator, or book the complimentary consultation.
Financing
- In-House 0% APR: 0% interest, no credit check, from $500 down.
- Cherry: $189 down, no hard credit check.
- CareCredit: $0 down for approved credit.
- Pay-in-Full Discount: 5% off total treatment cost.
Frequently Asked Questions About TADs
Are TADs the same thing as dental implants?
No. Dental implants are permanent prosthetic tooth replacements that need 3–6 months of bone integration before a crown can be loaded onto them. TADs are temporary orthodontic anchors — smaller (1.4–2.0 mm diameter versus 4+ mm), shallower (6–12 mm versus 10–15 mm), designed to be removed after 4–8 months of use, and loaded within days rather than months. Both are titanium, but that is where the similarity ends.
Will anyone see the TAD when I smile?
Usually not. Anchorage TADs are placed on the inside (palatal) or side (buccal) of the jaw, typically in attached gum tissue. Only a small head about the size of a pencil tip is visible, and it is often covered by a rubber ring or attached directly to a wire. Most family members and coworkers do not notice unless the patient opens wide and points.
Why does Bold Bite coordinate TAD placement with a periodontist instead of placing them in-office?
Bold Bite Orthodontics places MARPE mini-screws in-office — those sit in the hard palate, and Dr. Cao's CAGS training covers that placement directly. Anchorage TADs for other uses (molar intrusion, distalization, impacted-canine traction) sit in sites where a periodontist's soft-tissue and flap-management training delivers a more predictable result. Coordinating those cases with Dr. Doug Stortch at Modern Perio is a clinical choice, not a scheduling convenience. Dr. Greenberg and Dr. Cao design the mechanics; Dr. Stortch places the anchor to that specification.
What happens if a TAD loosens or falls out?
TAD loosening is uncommon — about 2–5% in published clinical studies — and is almost always caused by soft-tissue inflammation around the screw head. If a TAD loosens during treatment, the family calls or texts Bold Bite at (904) 595-6869 the same day. Bold Bite coordinates a re-placement visit at Modern Perio within the same week. There is no additional orthodontic charge when the TAD is part of the comprehensive treatment plan.
Can a different treatment plan avoid TADs altogether?
Sometimes yes, sometimes no. For some cases, braces or clear aligners alone can achieve the same finish — it may just take longer, or produce slightly less precise control over the final tooth positions. For other cases — molar intrusion to close an open bite, adult palatal expansion, severe asymmetry — TADs or jaw surgery are the only non-compromise options. Dr. Greenberg and Dr. Cao discuss every alternative at the complimentary consultation and only recommend TADs when conventional mechanics cannot deliver the same result.
Are TADs safe for teenagers?
TADs are routinely used in adolescents from roughly age 12 and up, once the jawbone has enough cortical density to hold the mini-screw. They are not generally used in younger children because the bone is still soft and the roots of developing permanent teeth occupy more of the jaw. Every Bold Bite new-patient Vatech Green CT lets Dr. Greenberg and Dr. Cao measure bone density directly and confirm the patient is a safe candidate before a TAD is part of the plan.
What material are TADs made of, and is the metal safe long term?
TADs are medical-grade titanium alloy — the same material used in dental implants, joint replacements, and surgical bone screws. Titanium is biocompatible (the body does not reject it), corrosion-resistant, and has been used in medicine for more than 50 years. The FDA classifies orthodontic TADs as Class II medical devices with an excellent long-term safety profile. The mini-screws at Bold Bite Orthodontics are removed at the end of treatment, so the material is not in the body long term at all.
Conditions Where TADs Are Used
- Impacted canines -- TADs control eruption anchorage when guiding the canine into position.
- Open bite -- TADs intrude posterior molars to close the bite without surgery in skeletal cases.
- Crowding -- TADs assist anchorage when the case demands precise control over which teeth move and which stay still.