Overview: This guide provides step-by-step instructions for the clinical application of clear aligner composite attachments using a template tray.
Prerequisites
To apply clear aligner attachments, clinicians must have the following tools and supplies:
Cheek Retractor: Nola Dry Field System is recommended.
Instruments: Scaler, mirror, and explorer.
Chemicals: Acid etch, bonding agent, and attachment composite.
Accessories: Cotton rolls, microbrushes, and a curing light.
Clinical Assets: Attachment aligner templates.
Preparation and Isolation
Attachment Template Fitting
Before beginning the bonding process, seat the attachment template on the patient to confirm the fit. Rinse the template thoroughly once the fit is confirmed.
Teeth Cleaning and Isolation
Place the cheek retractor in the patient's mouth one side at a time. Lock the tongue piece into position and turn on suction to remove moisture from the back of the mouth. Ensure the teeth are clean and free of debris.
Bonding Procedure
Etching the Teeth
Review the attachment template to identify which teeth require attachments. Apply acid etch only to the specific teeth receiving attachments. Clinicians should etch a slightly larger area than the attachment footprint to ensure total coverage. Wait 20 seconds for the etch to set fully, then wash and dry the teeth. Confirm that each tooth receiving an attachment appears chalky white.
Applying Bonding Agent
Apply the bonding agent to each etched tooth on the first arch. Clinicians should work on one arch at a time to maintain isolation. Thoroughly light-cure the bonding agent. It is critical to dry and cure the bonding agent completely to prevent the attachment template from adhering to the teeth.
Attachment Placement
Filling the Attachment Template
While the clinician cures the bonding agent, an assistant should fill the attachment template wells with composite. Ensure the composite slightly overfills the wells. Remove any excess composite from the template before seating.
Seating and Curing the Template
Place the filled template on the teeth. If the patient has multiple posterior attachments, have the patient bite down on two cotton rolls to fully seat the template tray. Press down on the template at each attachment site with a finger to ensure complete adaptation. Light cure each attachment site thoroughly while the patient maintains pressure on the template. Repeat the bonding and placement process for the second arch.
Finishing and Quality Review
Template Removal and Void Check
Use a scaler to create separation between the attachment template and the tooth. Pull up on the template from the lingual side and work around the arch until the template is removed. Inspect the attachments for debonding or voids.
If an attachment remains in the tray, remove the composite, refill the well, and repeat the placement and curing steps. If voids are present, place composite directly on the attachment, re-seat the template, and light cure again.
Flash Removal
Perform a final review to ensure all attachments are present and free of voids. Remove the lip and cheek retractor. Inspect the area around the attachments for excess composite (flash). Use a high-speed handpiece with a polish bur to remove flash, taking care not to polish or damage the attachments themselves.
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