See Also: Attachments Fall Off , Are There Still Attachments?
Orthosnap clear aligners allow for far fewer attachments (sometimes called engagers or activators) than other orthodontic options. Occasionally, however, the treatment plan will call for them.
The following best practices information can make placing attachments easy and quick.
What are attachments?
Attachments, or engagers, are composite shapes applied to teeth to engage the aligner. They act like small handles that add pressure to help move teeth. This added force is sometimes needed to get a tooth to move, especially with difficult movements.
For example, extrusions or rotations of round shaped teeth require the use of attachments.
Note: Please advise us if you have preferences when submitting a case. For instance, avoid engagers on certain teeth, etc.
See: How to Place an Attachment
After reviewing the treatment plan and making your decisions, explain the procedure to the patient (or parent) and answer any questions.
This includes possible, but not probable, negative effects, including:
Diminished aesthetics of the tooth
Discomfort or tissue awareness
Debonding
What composite should I use?
If you have a preference and a brand that works for you, continue to use it. Here is an in vitro study that compared different composite resins - flowable (FNC) and conventional; composite (CNC): https://www.frontiersin.org/articles/10.3389/fmats.2021.789143/full
"CNC showed greater performance and resistance under mechanical stresses than the flowable ones, resulting in being more suitable for clinical needs"
Follow these steps to place the attachments:
If you don’t already have one, get an informed consent signed.
Gather your equipment.
Using lip retractors, prepare the tooth with bonding and etching.
Load the proper cavity on the matrix with composite material. You will want a simple hemisphere shape. It is better to overfill than underfill.
Fit the matrix over the patient’s teeth, making sure it fits tightly.
Cure the attachment using the UV lamp nozzle.
Remove the matrix and the uncured excess composite material.
Check the new aligner for a tight fit.
Document the procedure, including date, step, and location of attachment.
Watch our video that shows the attachment placing process, including using the matrix and UV lamp nozzle (on a dental model instead of a live patient).
Removing Attachments
Once attachments are no longer needed, they should be removed.
Also, a patient may demand the removal of an attachment for any number of reasons. They do have this right, but you will want to make sure you inform them about possible consequences. You will also want to document this. (Please also notify Orthosnap if any attachments implemented into the treatment plan were removed).
Removing attachments is the same procedure as removing orthodontic bracket adhesive or composite restorations.
You can use:
Multi-fluted composite finishing burs (this can cut enamel)
White Stone finishing burs (this will not cut enamel)
What to Expect When Attachments Are Recommended
Orthosnap’s lab technicians will make recommendations for the location and number of attachments to achieve ideal results with the prescribed treatment plan. As the providing doctor, all final decisions are yours. If you do not intend to place attachments, please inform Orthosnap's clinical team before approving the treatment plan.
When the treatment plan requires attachments, we will send you a Matrix (template) to help place the attachment. The matrix looks similar to the aligners, but it is thinner and will be clearly marked. The thinner material makes it flexible and allows for easier curing of the composite with the UV light.
In addition, we will send you a special nozzle we designed to use with your UV lamp. This tool perfectly fits over the attachment on the matrix. It allows for firm pressure and focuses the UV light exactly where it needs to be. The novel prevents over-flashing the excess composite material, so clean-up is a breeze.
If you need further help after reviewing this and watching our video, don’t hesitate to contact our support team!
Related Topics and Information:
Click to learn more Attachments Fall Off and if there Are There Still Attachments? in clear aligner systems.
If you have questions or need to speak with someone at Orthosnap, please reach out to us at support@orthosnap.com.