Attachments - Video demonstration

In a previous post, I described a procedure for bonding attachments.

In this post, I've uploaded a video where I show you how to bond attachments (or engagers, as ClearCorrect calls them).

In addition, there are a number of tips and tricks to make it easier to bond attachments to the teeth.

Clinical tips

As you can see in the video, there are some clinical tips along the way.

If you have a sandblaster, use it to clean the tooth surface and remove any aphismatic enamel. This will improve the adhesion.
Use a dark background color when filling your template. You can use a regular napkin or a dark patient napkin if you have one. Just keep it simple and easy for yourself.
Divide your template in the middle if you have a lot of attachments or engagers that need to be bonded. Or if you have a patient who produces a lot of saliva or has a large tongue. (Most often a challenge in the lower jaw).
Don't use vaseline or glycerine in your template. No matter how little you put in your template, it will still affect the shape of your attachments. If your composite is bonding to the template material, try a different type of composite. Personally, I like the Kuraray flowable composite (Clearfil), but I've also found that it works well with both 3M and Tetric products.
(Not in this video) Put a Drytip in each cheek, use an Optragate and put some sort of suction in the patient's mouth, that will keep the tongue away. This way you have the best and driest conditions when bonding your attachments.

Choice of composite for attachments and engagers

In the video I show how I use a flowable composite to create my attachments.

There are no strict guidelines on which type of composite is best to use.

It is clear that flowable composites will wear faster than regular composites, as there are fewer filler particles in the flowables.

Wear of attachments / engagers

The aligner slowly wears down the attachments every time it is removed and repositioned on the teeth. So over time, it will definitely wear on the composite. Especially if you're planning a lengthy treatment, you may be inclined to use a regular composite with a high filler content.

Additional aligners and revisions

The reality is that you should expect additional aligners or revisions if the treatment requires more than 25 aligners.

Therefore, I don't think it's that crucial which type of composite is used. In many cases, the composite will need to be changed anyway if a correction needs to be made during the course of treatment.

Your choice

Clinically, in rare occations, I've seen attachments become so worn that they may no longer have the optimal effect. But I've still managed to achieve my goals with the treatments I've performed. If it happens to you. Make sure to take a look at your digital setup/ClinCheck, to see what kind of movement you planned the attachment to help performing. If you have already achieved the desired repositioning of the tooth, the attachment might no longer be of any use. (Unless it helps retain the tooth in its new position)

So ultimately, it's up to you to decide which type of composite works best in your hands and meets your clinical criteria/preferences.

Video of clinical procedure

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