What types of attachements are available?

Decades of technological advancements in the orthodontic sector have now allowed us to enjoy one of the greatest innovations of all time – the clear aligners. Patients treated with clear aligners have reported enhanced satisfaction and convenience during their orthodontic treatment process and fewer negative impacts on their social and personal lives.

As more adults began seeking orthodontic treatment, clear aligners were able to completely substitute for fixed appliances. Almost completely. There still stood a major obstacle to clear aligners. They worked best for only mild to moderate cases of malocclusions. It soon became widely known that clear aligners were not recommended for complex orthodontic malalignment.

After this blip in their reputation, companies like Invisalign® began pouring millions of dollars into advanced research and development to further improve their clear aligners. They were then able to add attachments to the treatment process that allowed them to treat more complicated and severe cases of malocclusion.

As with any other kind of orthodontic treatment, aligner therapy also varies from patient to patient. This means that the type of attachment with aligners may also be different for different patients.

Types of attachments (references: 1, 2)

Broadly speaking, attachments may be of two types – conventional attachments and optimized attachments.

1. Conventional attachments: Also known as passive attachments, they are passive in nature and are dedicated to enhancing the aligners’ engagement with the tooth surface. Think of them as the handle of a door. They act as “handles” for the aligners that help bring about successful teeth movements.

Some examples of conventional attachments are:

(The nomenclature of the attachment is decided by the direction of the bevel)

• Gingivally bevelled rectangular attachments: The bevel is slanting towards the gingival aspect of the tooth.
  • Used for posterior teeth
  • Aids in the retention of the aligners

• Occlusally bevelled attachments: The bevel is slanting towards the occlusal surface of the tooth.
  • Used for posterior and anterior teeth
  • Aids in absolute extrusion on the posterior teeth and to level the Curve of Spee. (an imaginary curve that extends from the incisal edges of the front teeth to the buccal cusp tips of the posterior teeth in the lower jaw)

1. Optimized attachments: Also known as active attachments, they are uniquely designed for each tooth using proprietary software in order to bring about successful tooth movements. They are specifically customized to suit the dimensions, contour, and long axis of each tooth.

These optimized attachments are fitted into pre-formed pockets within the aligners.

Some examples of optimized attachments are:

• Extrusion attachments:
  • Used for upper and lower front teeth.
  • The active surface of the attachment is placed in such a way that the force applied by the aligner is perpendicular to it, thus allowing to achieve extrusion of the teeth.
  • Can be used to close open bites.

• Root control attachments:
  • Used for upper front teeth.
  • The attachments help the root of the tooth to change and adopt the optimal position.
  • Aids in the correction of midline diastemas.

• Rotational attachments:
  • Used for cone-shaped teeth (canines and premolars).
  • They apply more force that allows the teeth to turn or rotate more quicker.

• Multiplane attachments:
  • Used for upper lateral incisors.
  • Aids in bodily movements when extrusion and root movement are simultaneously required.

The type of attachment you’ll get will depend on the type of tooth movement that is required to achieve your desired tooth movements.

Images from:

https://eonaligner.com/doctors/blog/what-are-dental-attachments-orthodontic-treatment