Molar intrusion with TADs: correcting open bites and over-erupted molars

Key facts

• TADs provide a fixed anchor to move molars into the bone
• Can help close selected skeletal open bites without surgery
• Recovers space for a crown or implant opposite an over-erupted tooth
• Planned with CBCT imaging; placed under local anaesthetic
• Slow, light forces over several months protect roots and gums

What molar intrusion means

Intrusion is the orthodontic movement of a tooth along its long axis, deeper into the supporting bone. For front teeth it is relatively common, but intruding molars is difficult with braces alone, because molars have large, multiple roots and there is nothing stronger in the mouth to pull against; the other teeth would simply be extruded instead. Temporary anchorage devices solve this. These small titanium mini-implants, typically about 1.5 to 2 millimetres in diameter, are placed through the gum into the bone and provide a stable point. Light, continuous forces from elastic chains or springs attached to the TADs then move the molars upwards (or downwards in the lower jaw) slowly and in a controlled way.

Closing an anterior open bite

In a skeletal open bite, the back teeth meet but the front teeth do not, often because the molars and upper jaw have grown too far vertically. Traditionally, severe cases were treated with jaw surgery. Intruding the upper, and sometimes lower, molars with TADs allows the lower jaw to rotate upwards and forwards, which can help bring the front teeth together and may reduce face height slightly. This approach can be an alternative to surgery for selected adults with mild to moderate skeletal open bites. Habits such as tongue thrust or mouth breathing that contribute to open bites are also assessed, because myofunctional therapy and retention are important for stability.

Making space for an implant or crown opposite

When a lower molar is lost and not replaced, the upper molar above it often over-erupts into the gap over time, and vice versa. This leaves too little vertical space to place a crown or implant restoration and can create an uneven bite plane and interferences when chewing. Intruding the over-erupted tooth with one or two mini-implants can restore the space, often avoiding the need to shorten the tooth heavily or to perform root canal treatment for that purpose. Dr. Pacha plans this together with the clinic’s implant and restorative team, so that the orthodontic movement creates exactly the room needed for the final restoration on the opposite side.

Treatment steps, timeline and comfort

Planning starts with a clinical examination, digital intraoral scans and CBCT 3D imaging to measure bone thickness, root positions and the amount of intrusion required. The TADs are placed under local anaesthetic in a short visit, and most people feel pressure rather than pain; mild tenderness for a day or two is common. Light forces are applied and adjusted at regular reviews. Molar intrusion is slow by design, often taking several months, because gentle forces are kinder to roots and gums. Once the target position is reached, the result is held with retainers or the restoration. The TADs are removed at the end, usually quickly and without an injection.

Risks, limits and who to see

Possible issues include temporary gum irritation around the screws, a screw loosening and needing replacement, and, rarely, small amounts of root shortening, which is monitored. Intrusion has limits: very large open bites or major jaw discrepancies may still need surgical correction, and relapse can occur if contributing habits persist. Keep the screw sites clean with a soft brush and follow the hygiene advice given. Dr. Moaiyad Pacha, a Consultant Orthodontist with a clinical PhD from Queen Mary University of London and a practice that includes TADs and complex bite correction, explains the options openly. You receive a written, itemised plan after examination; contact the clinic for his Dubai dates.

Temporary anchorage devices are small titanium screws placed temporarily in the jaw to give the orthodontist a fixed anchor point. They allow movements that would otherwise need headgear or extractions, and are removed at the end.

Prepared by the Manhal Medical Center editorial team · Updated: 2026-10-18 · Treating specialist: Dr. Moaiyad Pacha

This page is general information and does not replace a consultation. Suitability, risks and results vary between patients.