Attachments

Aligners are personalized orthodontic devices designed to perfectly fit each person. The majority of treatment plans will involve incorporating special attachments as additional force may be necessary to attain complex movements. These small components are bonded to the teeth throughout the treatment process and play a crucial role in achieving the desired results. Thanks to the use of composite attachments, tooth movement can be better controlled and actively guided, increasing the contact area and locating the point of force application closer to the center of resistance, thus allowing bodily tooth movement[1].

 

What are attachments for orthodontic aligners?

Attachments are tiny shapes made of composite material that are bonded to the teeth surfaces as a part of the clear aligner’s orthodontic treatment to assist the teeth by providing an extra grasp or force for complex cases and to ensure the aligners' stability. They are strategically positioned to ensure optimal control over the teeth' movements. Attachments mostly increase the effectiveness of orthodontic treatment with clear aligners and serve to increase posterior anchorage[2]. 

Attachments are tooth-colored bumps placed on specific teeth during the clear aligner treatment. They are strategically placed to work as anchors, helping the aligners exert precise forces on the teeth for controlled movement. Other than that, attachments help achieve strong movements that require more support.

For example, when addressing a lateral incisor that requires controlled rotation, a precision attachment may be placed in a specific way to guide the tooth's movement accurately.

 

Are attachments necessary and are they placed on all of the teeth?

Attachments are used to increase the retention of aligners, support and predict complicated movements[3]; their use allows the exertion of desired force on the teeth, which is crucial for the success of Clear Aligner Therapy[4]. All of the studies indicate better control and a higher range of tooth movement in aligner treatment with attachments than without attachments, even if a given tooth is not to be moved but provides anchorage for movement[5].

Based on the teeth' dimensions and their long axis, the attachments are carefully positioned. Upon sending the treatment plan, a presentation will be received outlining the recommended position, shape, size, and number of attachments. That number will differ based on each patient’s specific case; the doctors will therefore have the authority to make the final decision regarding the recommended number, shape and timing of the attachments to be placed.

 

How are attachments adhered to the teeth?

1. To prepare the area for the attachment, an etching gel is carefully applied on the tooth surface and then rinsed off after a duration of 30 seconds to remove the acid. The etched surface is then dried, this procedure results in a minuscule roughness on the enamel surface resulting in a visibly matte, frosty white appearance ensuring that proper etching has been done. Avoiding salivary contamination is highly crucial. If the tooth surface gets contaminated with saliva, it will be necessary to repeat the etching procedure.
2. Using a micro-brush apply a bonding agent on the previously etched surface and cure it.
3. Following this, a flow composite material is used to fill the attachment voids in the flexible aligner template and then pressed onto the teeth.
4. After the composite material is properly positioned on the tooth surface, a light cure is used to solidify it.
5. Finally, the template aligner is removed and any composite excess is cleaned.

 

Are composite attachments visible?

The main advantage of clear aligners is that they are almost transparent and hardly noticeable. Therefore when patients learn that composite attachments may be involved in their treatment, concerns arise regarding their visibility. Fortunately, these attachments are usually crafted to blend in with the natural color of the teeth ensuring that they remain inconspicuous to others. However, staining of attachments can occur when exposed to dark-stain liquids like coffee. To prevent this, it is essential to maintain a high level of oral hygiene and take necessary precautions.

What are the different types of attachments that can be used?

 

Vertical rectangular attachment
Horizontal rectangular attachment
Root control attachment
Inclination
Extrusion/Intrusion
Rotation

 

What is the difference between conventional attachments and optimized attachments?

1. Conventional attachments are attachments that have a standard shape/size and that are part of a standardized library of attachments that can be used on any tooth surface[6] .To increase the effectiveness of the aligner in moving teeth conventional attachments are added to enhance the engagement between the aligner and the tooth. There are three types of conventional attachments: ellipsoid attachments, rectangular attachments, and beveled attachments. Conventional attachments are beneficial both for tooth movement and for anchorage[7].
2. Optimized attachments are specifically designed to address or correct a specific type of dental malocclusion.[8] The usage of optimized attachments is necessary to achieve the desired tooth movement and enables effective control over root movement for managing tipping and 'en masse' translation. Optimized attachments have been specifically designed to facilitate the accomplishment of multiple complex movements simultaneously.

 

Do attachments cause any pain?

Similar to other aspects of the treatment, it is common for individuals to require some time to adjust to the attachments. In the beginning, it may feel uncomfortable to have a foreign material attached to your teeth, however, this feeling shortly fades away as the oral cavity adapts to their presence. Additionally, certain patients may encounter challenges when inserting or removing their aligners, however, it is important to note that this tightness is often temporary and diminishes over time as the tray is worn for the proper duration.

When can the attachments be removed and how is it done?

Once the treatment is completed and the patients are content with the outcome, the dentist can proceed with the attachment removal. The removal process is painless and safe as the attachments are delicately smoothed using finishing and polishing burs. Additionally, a retainer will be provided to maintain the teeth in their position.

[1] Jedliński et al., “Attachments for the Orthodontic Aligner Treatment—State of the Art—A Comprehensive Systematic Review.”

[2] Nucera et al., “Effects of Composite Attachments on Orthodontic Clear Aligners Therapy.”

[3] Dalaie and Ghaffari, “Importance of Attachments in Treatment with Clear Aligners.”

[4] AlMogbel, “Clear Aligner Therapy.”

[5] Jedliński et al., “Attachments for the Orthodontic Aligner Treatment—State of the Art—A Comprehensive Systematic Review.”

[6] Burashed and Sebai, “Quantifying the Efficacy of Overbite Reduction in Patients Treated with Clear Aligners Using Optimized versus Conventional Attachments.”

[7] Jedliński et al., “Attachments for the Orthodontic Aligner Treatment—State of the Art—A Comprehensive Systematic Review.”

[8] Burashed and Sebai, “Quantifying the Efficacy of Overbite Reduction in Patients Treated with Clear Aligners Using Optimized versus Conventional Attachments.”