Temporary Anchorage Devices in Orthodontics (034)

Number: 034
(Updated)

Subject: Temporary anchorage devices in orthodontics

Date: October 29, 2012

Important Note

This Clinical Policy Bulletin expresses our determination of whether certain services or supplies are medically necessary. We reached these conclusions based on a review of currently available clinical information including:

  • Clinical outcome studies in the peer-reviewed published medical and dental literature
  • Regulatory status of the technology
  • Evidence-based guidelines of public health and health research agencies
  • Evidence-based guidelines and positions of leading national health professional organizations
  • Views of physicians and dentists practicing in relevant clinical areas
  • Other relevant factors

We expressly reserve the right to revise these conclusions as clinical information changes, and welcome further relevant information.

Each benefits plan defines which services are covered, excluded and subject to dollar caps or other limits. Members and their dentists will need to consult the member's benefits plan to determine if any exclusions or other benefits limitations apply to this service or supply. The conclusion that a particular service or supply is medically necessary does not guarantee that this service or supply is covered (that is, will be paid for by Aetna) for a particular member. The member's benefits plan determines coverage. Some plans exclude coverage for services or supplies that we consider medically necessary. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. In addition, coverage may be mandated by applicable legal requirements of a state, the federal government or CMS for Medicare and Medicaid members.

Policy

Aetna considers a temporary anchorage device (TAD) to be a device that is temporarily fixed to bone for the purpose of enhancing orthodontic anchorage. The procedure includes the device removal.

Background

A temporary anchorage device (TAD) is a biocompatible device that is fixed to bone to enhance orthodontic anchorage and/or overcome anchorage limitations. It is used during procedures to move teeth by either supporting the teeth of the reactive unit or by preventing the need for the reactive unit altogether. The TAD is removed after treatment and the removal is considered part of the overall TAD procedure. TADs may be located transosteally, subperiosteally or endosteally and may be fixed to bone either mechanically (cortically stabilized) or biochemically (osseointegrated).

TADs are generally manufactured with a smooth endosseous surface and/or additional surface treatments to actively discourage osseointegration and simplify their removal.

Osseointegrated dental implants, either conventional or mini-implants (D60101), placed for the ultimate purpose of supporting a prosthesis, regardless of the fact that they may be used for orthodontic anchorage, are not considered temporary anchorage devices since they are not removed and discarded after orthodontic treatment.

Codes1

D7292 -- Surgical placement: temporary anchorage device [screw retained plate] requiring surgical flap. Insertion of a temporary skeletal anchorage device that is attached to the bone by screws and requires a surgical flap. Includes device removal.
D7293 -- Surgical placement: temporary anchorage device requiring surgical flap. Insertion of a device for temporary skeletal anchorage when a surgical flap is required. Includes device removal.
D7294 -- Surgical placement: temporary anchorage device without surgical flap. Insertion of a device for temporary skeletal anchorage when a surgical flap is not required. Includes device removal.

Revision Dates

Original policy: August 24, 2009
Updated: October 4, 2010; September 26, 2011; October 29, 2012
Revised:

The above policy is based on the following references:

1 American Dental Association. Current dental terminology, CDT 2011-2012: 47, 59.*

2 Current products and practice, bond anchorage devices in orthodontics. Jagadish Prabhu and Richard Cousley, Journal of Orthodontics, Vol. 33, No. 4, 288-307, December 2006 doi:10.1179/146531205225021807© 2006 British Orthodontic Society.

3 Lecture summary: temporary anchorage devices in orthodontics: clinical experimentation or evidence-based? Dr. Jason Cope, Summary by Dr. Rodney D. Hyduk, July 19, 2006.

4 Temporary anchorage devices for tooth movement: a review and case reports. McGuire, MK, Scheyer ET, Gallerano RL, J Periodontal, 2006 Oct;77(10):1613-24.

*Copyright 2010 American Dental Association. All rights reserved.

Property of Aetna. All rights reserved. Dental Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical/dental advice. This Dental Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating health care professionals are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating health care professionals are solely responsible for medical/dental advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.

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  • Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Treating providers are solely responsible for dental advice and treatment of members. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider.
  • While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Aetna's conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna). Your benefits plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government.
  • Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change.
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