Data Collection Form 2: At time of mini screw / TAD removal or failure (with instructions)

British Orthodontic Society

National Audit of Mini Screws / Temporary Anchorage Devices (TADs)

Data Collection Form 2: At time of mini screw / TAD removal or failure

This form should only be completed when all TADs in the patient have failed or been removed.

Please complete the data collection form below for online submission or to download the form as a PDF document for postal submission to BOS click here.

For instructions and help to complete the data collection form, please point cursor to ? and * denotes mandatory field.

TAD #1
?	TAD audit registration number *
?	Patient date of birth *
?	Number of mini screws / TADs inserted (Please complete two audit sheets if more than 4) *
?	Unique patient identifier i.e. hospital / practice number *
?	Is orthodontic treatment completed at date of form submission? *	Yes No
?	Have mini screws / TADs provided desired anchorage? *	Yes No
	Which jaw? *	Maxilla Mandible
	Location *	Lingual Labial
?	Adjacent teeth (FDI notation) *
?	Removal or failure? *	Removal Failure
	Date of removal / failure *
?	Reason for failure	Infection Gingival inflammation Excess mobility
?	Any adverse effects recorded? *	Gingival inflammation Excess mobility Damage to tooth root No
?	Screw replaced following loss or removal? *	Yes No
TAD #2
	Which jaw?	Maxilla Mandible
	Location	Lingual Labial
	Adjacent teeth (FDI notation)
	Removal or failure?	Removal Failure
	Date of removal
	Reason for failure	Infection Gingial inflammation Excess mobility
	Any adverse effects recorded?	Infection Gingival inflammation Excess mobility Damage to tooth root No
	Screw replaced following loss or removal?	Yes No
TAD #3
	Which jaw?	Maxilla Mandible
	Location	Lingual Labial
	Adjacent teeth (FDI notation)
	Removal or failure?	Removal Failure
	Date of removal / failure
	Reason for failure	Infection Gingival inflammation Excess mobility
	Any adverse effects recoded?	Infection Gingival inflammation Excess mobility Damage to tooth root No
	Screw replaced following loss or removal?	Yes No
TAD #4
	Which jaw?	Maxilla Mandible
	Location	Lingual Labial
	Adjacent teeth (FDI notation)
	Removal or failure?	Removal Failure
	Date of removal / failure
	Reason for failure	Infection Gingival inflammation Excess mobility
	Any adverse effects recorded?	Infection Gingival inflammation Excess mobility Damage to tooth root No
	Screw replaced following loss or removal?	Yes No
?	Additional comments
	Email address *