How to Place Attachments

How to Place Attachment Instructions

Tools

To place attachments, you'll need the following tools:

• Retractor (Dandy recommends using the Nola Dry Field System)
• Scaler
• Mirror and Explorer
• Acid Etch
• Cotton Rolls
• Bonding Agent
• Microbrushes
• Attachment Composite
• Attachment Aligners
• Curing Light

First Arch

Clean and Isolate the Teeth

To place attachments:

1. Place the retractor in the patient's mouth one side at a time.
2. Position both sides of the lips into the cheek retractor.
3. Place the tongue piece and ask the patient to open really wide
4. Lock the tongue piece into position.
5. Turn on the suction to remove moisture from the back of the mouth

Acid Etch the Teeth

1. Grab the acid etch and the template
2. Look at the attachment template
3. Place the acid etch on the teeth receiving attachments on one arch
4. Place the acid etch on the teeth receiving attachments on the other arch
   • Note: It is always better to etch a little bit more than you think you'll need
5. Once the etch is placed, wait about 20 seconds to fully set
6. Grab the high-speed such and the air water syringe
7. Wash in the same direction and speed that the etch was placed
8. Once the teeth are etched, use the air water syringe to thoroughly dry the teeth
   • Note: It is helpful to make sure the lip and cheek retractors are free from any moisture
9. Confirm that each tooth receiving an attachment is chalking white

Bond the First Arch

1. Place the bonding agent on each tooth receiving the attachment
   • Note: Dandy recommends working on one arch at a time to maintain isolation

Light Cure the Bonding Site

1. Thoroughly light cure the bonding agent while your assistant places the composite inside of the attachment template wells
   • Note: It is crucial that you thoroughly dry and cure the bonding agent so that the attachment template does not stick to the teeth.

Fill the Attachment Voids

1. Take the attachment template and double-check that there is excess composite inside of the wells
2. Seat the First Attachment Template
3. Ask the patient to open slowly
4. Place the template on the teeth

Ensure Attachment Adhesion

1. Using your finger, press down on the template where the attachment is placed to ensure complete adaptation.

Light Cure the Attachment Sites

1. Take your curing light and thoroughly cure the attachment
2. Move to the Second Arch and Clean the Teeth
3. Once the first arch is complete, take your air-water syringe and make sure the second arch is dry and free from moisture.

Second Arch

Bond the Second Arch

1. Place the bonding agent on each tooth on the second arch that will be receiving an attachment.

Light Cure the Attachment Sites

1. Thoroughly light cure the bonding agent while your assistant places the composite inside of the attachment template wells
   • Note: It is crucial that you thoroughly dry and cure the bonding agent so that the attachment template does not stick to the teeth.

Fill the Attachment Voids

1. Take the attachment template and double-check that there is composite inside of the wells and is slightly overfilled.
2. Remove any excess composite from the wells.

Seat the Second Attachment Template

1. Ask the patient to open slowly
2. Place the template on the teeth
   • Note: If multiple posterior attachments are present, it is helpful to take two cotton rolls and ask the patient to bite down to fully seat the template tray.

Ensure Attachment Adhesion

1. Using your finger, press down on the template where the attachment is placed to ensure complete adaptation.

Light Cure the Attachment Sites

1. While the patient is biting down, thoroughly light cure each attachment 

Remove Attachment Templates

To remove the attachment template:

1. Take a scaler and begin where the attachments are to get separation between the attachment template and the tooth
2. Starting from the lingual side, pull up on the attachment template using the scaler and work around until the template is off the teeth.

Check for Debonding Attachments and Voids

1. Ensure that there are no voids on the attachments.
2. Proceed with removing the template from the opposite arch
3. Ensure there are no attachments left inside the template tray
4. If any attachment comes off with the tray, remove the composite
5. Refill the attachment well with composite
6. Place the attachment template back in the patient's mouth

Light cure the attachment

1. Double-check for any voids on the attachments
2. If any voids are present, take some composite and place it directly on the attachment.
3. Place the template back in the patient's mouth and light cure where the new composite was placed.

Remove the attachment template 

1. Double-check to ensure the void is no longer present
2. Once you are certain that all attachments have been placed and are free of voids, remove the lip and cheek retractor
3. Double-check for any flash around the attachments
4. If any flash is detected, take a high-speed handpiece with a polish bur and remove any excess flash
   • Note: Be careful not to polish any of the attachments

Congratulate Your Patient and Begin Treatment

Once all excess flash has been removed, you're ready to deliver your first set of aligners.