TADs and Mini-Screws in Orthodontics: The UK Patient Guide

What are TADs and why are they used?

A temporary anchorage device (TAD) is a small titanium or titanium alloy screw, typically 6 to 12mm long and 1.2 to 2mm in diameter, that is inserted into the bone of the jaw to act as a fixed anchor point for orthodontic mechanics. Conventional orthodontic anchorage relies on teeth — when you push on one tooth to move it, there is an equal and opposite force on the teeth being used as anchors, which can cause unwanted movement. TADs bypass this entirely because the screw is anchored in bone and does not move. This allows the orthodontist to move teeth in ways that would otherwise be mechanically impossible — such as intruding (pushing up) upper or lower teeth to close an open bite, retracting all upper front teeth without affecting molar position, or correcting a centreline discrepancy without patient cooperation. TADs have dramatically expanded what fixed orthodontic treatment can achieve without surgery in many patients.

Placement procedure — what to expect

TAD placement is a brief in-office procedure. Local anaesthetic is injected into the gum at the planned insertion site — most patients describe this as the most uncomfortable part, similar to a routine dental injection. Once numb, the gum tissue is prepared and the mini-screw is inserted, typically taking under two minutes. Most patients feel pressure but no pain during insertion. The overlying gum does not usually need suturing. Patients are advised to take over-the-counter pain relief such as paracetamol or ibuprofen for the first 24 to 48 hours. Most patients return to normal eating and function the same day. A brief period of mild soreness at the insertion site for two to three days is typical; significant ongoing pain is unusual and should be reported.

Placement positions — palate and alveolar bone

TADs can be placed in several locations depending on the planned tooth movement. Alveolar bone TADs are placed between the roots of teeth in the jaw bone — common sites include between upper first and second molars, or between lower premolars. Palatal TADs (placed in the midpalatal suture or paramedian palate) offer very stable anchorage for more demanding mechanics and are associated with higher success rates because the palatal bone is denser and there are no tooth roots to avoid. Buccal shelf TADs placed in the external oblique ridge of the lower jaw are used for certain lower arch mechanics. The placement site is selected based on a combination of CBCT or periapical radiograph assessment to confirm safe root clearance, and the specific biomechanical demands of the treatment plan.

Loading, force application, and treatment mechanics

After placement, the TAD is typically loaded (connected to the teeth to apply force) either immediately or after a short healing period of two to four weeks, depending on the clinical preference and the bone quality. Forces are applied via elastic chains, springs, or steel ligatures connecting the TAD to the teeth or archwire. The mechanics are customised to the planned movement — for example, elastic traction from a palatal TAD to upper incisors provides intrusive and palatal force, which is used in deep bite correction; power chain from a buccal TAD to an archwire segment can retract an anterior segment. The orthodontist will adjust these connections at regular review appointments in the same way as other aspects of treatment.

Removal and success rates

Removal is even simpler than placement. The area is numbed with topical anaesthetic or a brief local injection, the screw is unscrewed with a small driver in under a minute, and the site heals rapidly without suturing. Most patients report minimal discomfort. Success rates — defined as the TAD remaining stable throughout the planned treatment period without requiring replacement — are approximately 85 to 90% in published literature. Failure involves the TAD becoming loose or falling out, usually because of infection around the head of the screw (peri-screwitis) or excessive loading. If a TAD fails, it can generally be replaced in a nearby site. Smoking, poor oral hygiene, and insertion in keratinised tissue are associated with higher failure rates.

Cost and NHS versus private

TADs are used in both NHS and private orthodontic treatment. In NHS treatment, where TADs form part of a clinically necessary treatment plan, they are included within the NHS course of treatment at band 3 cost (currently £332.10 in England, 2026/27). In private treatment, TADs may be included in the overall treatment fee or charged separately — typical additional costs range from £100 to £300 per TAD in private practice, though this varies. Your orthodontist should explain exactly what is included in your treatment fee and whether TADs are anticipated before treatment begins.

Useful related pages

This guide is for general information only. It is not a diagnosis, treatment plan, or substitute for advice from a registered dentist or orthodontist.