Have you ever wondered if there is an easier protocol for attachment bonding, than at the first stage in the clear aligner treatment?
In this post, I'll walk you through our recommended 4 week waiting period from the delivery of clear aligners until bonding attachments/engagers to the teeth.
Why use attachments / engagers at all
Before we look at the recommendations and protocols, let's look at the reason for this post.
Attachments are composite retention elements bonded to the surfaces of the teeth to achieve retention between the aligner and the teeth so that certain planned orthodontic movements can take place during an aligner treatment.
Most aligner manufacturers call these composite elements "attachments".
ClearCorrect has chosen to call them "engagers".
This means that attachments are exactly the same as engagers.
De-selecting attachments / engagers
If you choose not to use attachments or engagers, there will be a number of tooth movements that are completely unrealistic to perform with clear aligners.
It is important to be aware of this when designing your digital treatment plan (ClinCheck/Setup). If the planned movements are not taken into account, there is a high probability, that you will experience tracking issues.
Attachments or egngagers are not only used to control the movement of a single tooth but segments of teeth as well. It all depends on the overall treatment plan.
Specially designed attachments
Some aligner manufacturers have developed specially designed attachments (optimized attachements). These special shapes don't seem to have any particular effect, other than taking up less space and being less aesthetically distracting than conventional attachment/engager shapes.
In addition, there is a challenge associated with these specially designed attachments (optimized attachments) as they often only facilitate a single type of movement. In practice, this means that sometimes optimized attachments need to be removed and replaced by new ones with a different shape. This can often be prevented with conventional attachments.
If you have a very aesthetically conscious patient who can hardly stand the thought of visible plastic elements on their front teeth. You can choose to use optimized attachments. Most other cases benefit from the use of standard attachments as they offer you greater flexibility.
Timing of the first attachments/engagers
It takes 4 weeks from the start of a clear aligner treatment until the teeth start to move. At AlignerService, we therefore recommend that all clear aligner treatments are started with an aligner change every 2 weeks for the first 4 weeks.
After that, you CAN let the patient change the aligners every 7-10 days. The wear schedule should however depend on the complexity of the planned movements and the aligner system used during treatment.
To make it easier to start treatment and to give the patient a great experience when receiving their first aligners. We also recommend that in your digital treatment plan (ClinCheck/Setup) you first plan to bond attachments / engagers to the teeth at the 3rd aligner stage.
This way, you make it much easier for the patient to get used to putting their aligners in place on their teeth and removing them from their teeth again.
After all it is a lot easier to place and remove clear aligeners if no attachments or engagers are present.
When the patient returns to the practive after 4 weeks to have the attachments bonded to their teeth. It will be significantly easier for the patient to get used to the new conditions, where there is a significantly increased resistance during insertion and retention during removal.
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Jesper Hatt DDS
Phone: +41 78 268 0078
AlignerService helps dentists create realistic, safe and predictable treatment plans with clear aligners.
Currently, we help approximately 1500 dental practices in 19 different countries. AlignerService is a preferred partner of ClearCorrect.
In addition AlignerService clear aligner experts work with Invisalign, SureSmile and Spark.