3 Methods to Streamline Attachment Bonding

Attachments are an important aspect to clear aligner therapy. They serve several purposes during treatment. The most basic function is retention. To fully express prescribed movements, the aligners have to be fully seated to deliver the proper force. The second function of attachments is to facilitate movement by changing the tooth surface’s shape so that aligners can provide pressure onto active surfaces. In many cases, attachment bonding can take one of the longest appointment in treatment. Some patients only need a few attachments, and in more complex cases, they can be quite numerous.

When we want to keep consistent and streamlined clinical procedures in place and shortened clinical time, I recommend streamlining the bonding appointment. To control the time chairside, gain efficiency, and achieve consistency, I advise implementing these three effective methods:

1. Preload attachments

We use attachment templates to transfer the designed geometries onto the teeth. They are a thinner aligner material designed to replicate the attachment selected during the planning process. In the case of optimized attachments, we create the template in a smaller dimension, so there is a relief for the force systems integrated into the design. The template is more flexible to allow for better adaptation and easier removal after the bonding. We then load the attachment template before the bonding procedure in an area limited from light exposure or behind an orange acrylic case that prevents ambient light from curing the composite.

The attachment loading should incorporate enough material to fill the attachment wells, and the technician should pack it well into place. The composite should also flow beyond the attachment dimensions, so there is sufficient composite to adapt onto the tooth surface. We use a hand instrument to pack in the composite and remove excess beyond the attachment margins.

2. Two-step bonding

We fit the attachment template previously loaded with composite and adapt it to the tooth surfaces after preparing the tooth surface. Next, we use a hand instrument to press the template onto the facial surfaces. Biting onto cotton rolls fully seats the aligners with occlusal pressure. After this initial adaptation, we remove the template and remove excess composite from the margins. This two-step technique will minimize the amount of extra composite and decrease the amount of cleanup after bonding. Once again, we position and cure the template.

3. Blacklight

Once we complete curing the attachments, a flash of composite remains around the attachment margins that we remove. Maintaining the excess composite will affect the aligner fit and can introduce unwanted movements. The aligner’s deflection could also affect the adaptation and the forces that need to be transferred onto active surfaces and decrease the aligner’s effectiveness. For this reason, flash removal is very important to maximize the effectiveness of a clear aligner. We use a black light to fluoresce the composite material and visualize the flash better. We use a high-speed handpiece with a flame carbide bur to remove the excess and clean the tooth surface. We should use care to ensure the active surfaces of the attachments remain intact.