Clear Aligner Attachments: Benefits, Types & Procedure In Dentistry

Written by Dr. Febin Mary George, BDS | Medically Reviewed by Dr. Shaista Salam, BDS; Dr. Zein El Hammouz, DDS, MFD/RCSI.

Fact Checked ✓

 

Table of Contents 

1. What are dental attachments?

2. Types of attachments

3. Does your patient need clear aligner attachments?

4. How are dental attachments attached?
5. Wearing attachments and dental care: tips and guidance for patients
6. FAQs

 

Over the years, clear aligners have increased in popularity owing to the comfort and esthetics they offer when compared to traditional braces. In addition, we've seen an increase in the treatment of advanced malocclusion cases, all thanks to auxiliaries like attachments and buttons!

In my experience with clear aligner treatments, attachments enable the application of a wide variety of forces; which in turn reflects massively on our patient’s treatment outcomes,” says Reham Kilano, Clinical Affairs Manager at Eon Aligner. 

Dr. Salim Qadri, an expert aligner user also reports, “The acceptance rate of attachments by patients is relatively high. A lot of them mention how surprised they are whenever a family member or a friend does not notice they have attachments placed."

Indeed, attachments have proved invaluable in handling complex aligner cases with ease. Let us walk you through everything you need to know about clear aligner attachments in this article. 

What are dental attachments?

Dental attachments are small geometries made of tooth-colored material attached to the teeth. They facilitate tooth movement in clear aligner treatments.1 Attachments serve as a handle on which the aligners apply force to bring about the desired teeth movements. 

Image
Mouth with Eon Aligner's attachments

What are they made from?

Dental attachments are made from composite resin, a tooth-colored material that can be bonded to the tooth. They are usually attached to the middle part of the facial surface of the tooth and come in various shapes and sizes.

Why do we use them?

Attachments provide an active surface on which the aligners can exert force to bring about complex tooth movements like rotations. Thus, these tiny tooth handles enhance the efficiency of aligners and increase the predictability of teeth movement.

Types of attachments

  Used On  Function 
1. Horizontal Rectangular Bevelled (HRB) Back Teeth
  • Aid in retention of the aligners
2. Vertical Rectangular Bevelled (VRB) Both front and back teeth 
  • Bodily movements of front and back teeth 
3. Extrusion Attachment Upper or lower front teeth 
  • Extrusion
4. Rotational Attachment Rounded teeth (canines & premolars)
  • Rotation of cone shaped teeth (canines & premolars)
5. Biplane Rotational Attachment Upper or lower front teeth 
  • Rotation of upper or lower front teeth
6. Root Control Attachments Upper front teeth 
  • Midline correction
  • Diastema closure

 

 

Image
3D Image of Eon Aligner's attachments for a clear aligner therapy

 

Image
3D Image of Eon Aligner's attachments (horizontal, vertica and rotational)

 

Does your patient need clear aligner attachments?

 

Conventional Attachments vs. Optimized Attachments

 

Conventional attachments or passive attachments are passive in nature and meant to enhance the aligners' engagement to the tooth surface.2 They act as a handle for the aligners and help bring about successful teeth movements. 

Optimized attachments or active attachments are a little bit different from conventional attachments as they are:2 

  • Uniquely designed for each tooth through proprietary software to bring about more predictable tooth movements.
  • Specifically customized to suit the dimensions, contour and long axis of each tooth.
  • Positioned accurately to apply the right forces and eliminate any interference.

When the individual wears the aligners, the optimized attachments fit into pre-formed pockets within the aligner. 

How are dental attachments attached?

Aligner attachments are attached in a few quick steps:

  1. An etching gel is applied to the area where the attachment has to be placed and washed off after 30 seconds (or as per the manufacturer’s instructions). This process creates a microscopic roughness on the tooth surface and when properly dried, the tooth surface appears chalky to the naked eye. Proper etching ensures the attachment's tight bonding.
  2. Next, a bonding agent is applied and cured (hardened) to ensure the attachments are firmly secured on the teeth.
  3. Afterward, a flowable composite material is loaded onto a template aligner and placed over the teeth. The composite material is gently pressed onto the teeth so that it adheres to the tooth surface. Doctors can use any type of composite but a flowable composite is preferred. 
  4. Finally, a curing light is used to harden the composite material in its place, after which the template aligner is removed.

Reasons aligner attachments could fall

Attachment placement is a technique-sensitive process and must be carried out keeping the following things in mind:

  • Proper isolation of the teeth
  • Use of good quality materials 
  • Planning for the presence of restorations like crowns and bridges which might affect the bonding. (In this case, etching with Hydrofluoric acid and using a silane coupling agent will help in developing a strong bond). 

If the attachments are not appropriately bonded to the tooth surface, they may fall off (3).  Bonding failure could be the result of multiple factors like:

  • Improper curing of the composite material or
  • Excess saliva in the mouth during attachment placement.

Remember, attachments may occasionally fall off but they can easily be fixed back! If they fall off due to any reason, patients can schedule an appointment with their doctor at the earliest.

How are attachments removed?

 

When do you remove attachments?

 

Attachments can be removed once the teeth have moved to their ideal positions and the patient finishes his treatment. Finishing and polishing burs can be used to aid in the removal of aligner attachments.

Wearing clear aligner attachments 

 

1. Roughness 

When you initially get your dental attachments placed, you may feel some discomfort or roughness on the inner surface of your lips and cheeks. But the feeling goes away within a few days, as your mouth adjusts to the attachments. 

2. Staining and plaque buildup

Like plaque buildup on teeth, sometimes clear aligner attachments can also get covered with plaque. To keep a check on it, one needs to maintain optimum oral hygiene through regular brushing and flossing.

Exposure to dark-stain liquids like coffee or red wine can also cause staining of aligner attachments. So proper oral hygiene is needed to prevent staining of the attachments. 

Dental care: tips and guidance for patients

Clear aligners must be worn for a minimum of 22 hours daily.  Listed below are a few guidelines that can help you take care of your dental precision or button attachments:

  1. Regular brushing: Brush your teeth preferably after every meal or at least twice daily to remove food debris stuck between the teeth. While brushing, work gently around your dental attachments
  2. Flossing routinely: Though you may find flossing tiring after a long day, never skip it! Flossing removes the food particles trapped between the teeth in the areas your toothbrush cannot access. 
  3. Stick to your dentist’s guidelines: Your dentist will provide guidelines on how to wear your aligners, take them off, and clean them. Follow the instructions diligently to ensure a high success rate with your clear aligners.
  4. Avoid beverages that can stain: To prevent staining of the clear aligner attachments, avoid having colored drinks like dark coffee or red wine. If you have had them, rinse your mouth soon after! 
  5. Drink only water with your aligners on: Do not consume food when you have your aligners in. You may drink water, though. Drinking other liquids like soft drinks is not recommended as some liquid may flow into the gaps between the teeth and the aligners, causing tooth decay or staining.

 

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FAQs

For Patients:

Q1. Can I refuse attachments?

Attachments help to bring about complex tooth movements, which may be difficult to achieve through aligners alone. Hence, refusing attachments is not advisable as it can impede the progress of your treatment through clear aligners.

Q2. How many attachments do people usually have?

The number of attachments totally depends on the complexity of an individual case and varies from one person to another.

Q3. Are attachments noticeable?

Dental attachments are made of composite resin, which is a tooth-colored material. Their appearance merges with the teeth; hence, they are almost difficult to notice.

Q4. Do attachments stain?

Yes. They may get stained if you are not careful with what you consume. Dark liquids like red wine or coffee can stain the dental attachments. 

Q5. Do attachments damage teeth?

No. Attachments won’t damage your teeth if you properly take care of your oral hygiene. Bacterial action due to the accumulation of food debris on the teeth can lead to demineralization or cavities.

Q6. Does getting attachments off hurt?

No. It doesn’t hurt at all. You may feel a mild vibration as the attachments are chipped off from your teeth.

Q7. What happens if a button falls off?

Buttons or attachments provide an extra surface onto which the aligners can apply optimum orthodontic force and bring about the desired tooth movement. If a button falls off, your treatment can get delayed as the tooth won’t move as planned by your dentist.

Q8. What is the best way to remove aligners with attachments?

The best way to remove aligners with attachments is by using gentle force so that you do not detach the attachments from the tooth surface. Alternatively, an aligner hook can lift the aligners away from the attachments and help you remove the aligners with ease.

Q9. What happens after the attachments are removed?

Once the treatment is complete, attachments are removed and the teeth are polished to give a smooth surface. Patients are advised to wear retainers to prevent any relapse. 

For Doctors:

Q1. What are attachments in aligners?

Attachments in aligners are tiny tooth geometries made of composite resin. They act as a handle for the aligners to bring about the necessary tooth movements.

Q2. Why do aligners need attachments?

It is with the help of attachments that aligners exert the right orthodontic force three-dimensionally on the teeth and carry out the necessary movements. 

Q3. How often do you change attachments?

There is no need to change attachments after they are placed until the treatment ends.