How to Place Aligner Attachments

Attachments are composite handlebars that are bonded to the buccal surface of the teeth. They
allow the aligners to grip the teeth and exert force to facilitate movement. They can come in many
shapes, sizes, and orientations relative to the tooth's surface.

In the video and outline below, we will review the equipment and steps needed to place aligner attachments. 

Required Tools & Supplies

To place attachments, you'll need the following:

  • Cheek 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

Template Try-In

  • Seat the Attachment Template on the patient to confirm the fit.
    • Rinse thoroughly once complete

Clean & Isolate the Teeth

  • Place the retractor in the patient's mouth one side at a time
  • Lock the tongue piece into position.
  • Turn on the suction to remove moisture from the back of the mouth

Acid Etch the Teeth

  • Review the attachment template and place the acid etch on the teeth receiving attachments.
  • Repeat the process 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
  • Once the etch is placed, wait about 20 seconds to set fully
  • Wash and thoroughly dry in the same direction and speed that the etch was placed
  • Confirm that each tooth receiving an attachment is chalking white

Bond & Cure the First Arch

  • Place the bonding agent on each tooth receiving the attachment
    • Note: Dandy recommends working on one arch at a time to maintain isolation
  • 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 & Seat Attachment Template 

  • Take the attachment template and double-check that the wells are slightly overfilled with composite.
    • Remove any excess composite from the wells.
  • 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 seat the template tray fully.
  • Using your finger, press down on the template where the attachment is placed to ensure complete adaptation.

Light Cure the Attachment Sites

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

Once the first arch is complete, take your air-water syringe and make sure the second arch is dry and free from moisture.

Bond & Cure the Second Arch

  • Place the bonding agent on each tooth on the second arch that will be receiving an attachment.
  • 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 & Seat Attachment Template 

  • Take the attachment template and double-check that the wells are slightly overfilled with composite.
    • Remove any excess composite from the wells.
  • 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 seat the template tray fully.
  • Using your finger, press down on the template where the attachment is placed to ensure complete adaptation.

Light Cure the Attachment Sites

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

Remove Attachment Templates

  • Take a scaler and begin where the attachments are to get separation between the attachment template and the tooth.
  • 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

  • If any attachment comes off with the tray:
    • Remove the composite
    • Refill the attachment well with composite
    • Place the attachment template back in the patient's mouth
  • If any voids are present:
    • Take some composite and place it directly on the attachment.
    • Place the template back in the patient's mouth
  • Light cure where the new composite was placed.

Final Review

  1. Double-check to ensure all attachments are placed and voids are 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 can deliver your first set of aligners.

 

 

 

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