CLINICAL GUIDE

Guide to Attachments

What composite attachments are, the equipment you need, how to bond them step by step, and the guidelines, precautions and FAQs for predictable placement.

Download the full guide (PDF)
Download the handy hints sheet (PDF)
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What attachments are

Attachments (sometimes called “buttons”) are small, tooth-coloured composite shapes affixed to the teeth during clear aligner treatment. Because teeth are round and smooth, attachments give the aligner something to grip so it can move teeth with precision, in the correct direction, to achieve the best result efficiently. They’re virtually invisible, barely noticeable with or without the trays in place, and are trimmed back when treatment is over. Everything required at the first appointment is shown in the Smile Summary PDF, which indicates whether IPR, attachments, or both are needed. The attachment template is supplied in the Active Aligners packaging.

Equipment and material

  • Cheek retractors
  • Non-residue cleaning agent
  • Polishing cups
  • Attachment template
  • Composite material to form the attachments
  • Composite applicator
  • Bonding agents

HOW TO ATTACH, STEP BY STEP

1

Test the template and the first aligner fit

Insert a retractor to isolate the teeth and reduce salivary contamination; confirm the template snaps into place and fits, then check the first aligner fits too; air-dry the template with an air-water syringe.

2

Teeth preparation

Acid-etch the enamel where the attachment will sit (etch for 20 seconds, only the specific shape/location), rinse for 15 seconds and dry; mix and apply bonding agent, wait 10 seconds, dry with light air for 5 seconds, then light-cure for 10 seconds.

3

Load the template with composite

Fill the template window, slightly overfilled (some doctors use a slightly darker or lighter composite to aid removal later).

4

Conform to the teeth

Fully seat the loaded template; use a spatula to apply gentle pressure around each attachment for full adaptation and squeeze excess composite away from the etched area.

5

Cure the attachment

Firmly hold the composite and light-cure per the composite’s instructions; only remove the template once fully cured.

6

Remove the template and flash

Remove all excess material and bonding resin around the attachments and between teeth.

7

Repeat if needed

Repeat for any additional attachments.

8

Test the first aligner fit

Seat the first aligner and demonstrate insertion/removal (aligners are best removed by lifting at the posterior teeth).

9

Keep the template

Store it; the template should never be given to the patient.

Guidelines and precautions

  • Ensure teeth are free of contamination and dry before bonding
  • Distribute composite evenly in the template well, level to slightly above the top; use packable (not flowable) composite and avoid overfilling to prevent excess flash, while keeping enough to contact the surface
  • If there are many attachments, sectioning the template (e.g. between 8/9) helps avoid misplacing one during curing
  • Don’t disturb the template while it’s in the mouth, movement can cause bonding failure; don’t pull it off aggressively (bend the attachment area to avoid ripping an attachment off)
  • After bonding, remove excess material and inspect for voids, cracks and bubbles, excess can interfere with tray fit; check aligner 1 fits before and after placement
  • Use quality composite so attachments keep their shape and don’t de-bond
  • Keep attachments clean without too much excess; make sure the template is seated correctly, as it affects all future aligners; if attachments don’t engage, the aligner pushes in the wrong direction and causes unplanned movement

FAQS

When and why are attachments used?

For rotations over 28°, any extrusion, angulation (tipping) greater than 7°, and intruding more than four teeth in the same arch over 0.5mm. They let the tray grip the tooth to achieve the planned movements.

What types are used?

Vertical or horizontal rectangular attachments depending on the case, our protocols use attachments to help intrusion, extrusion, rotations and space-closure movements.

Can aligner 1 be used to place attachments?

No, aligner 1 already has movement built in, so the attachment template (built from the teeth’s original position) must be used to bond the attachments.

What composite should I use?

Any packable composite (not flowable, which is more susceptible to wear). There’s also a YouTube video, How to Place Attachments.