Ortho Tribune Middle East & Africa No.6, 2023
The necessity of multiple aligner attachments—a reality check
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DTMEA_No.6. Vol.13_OT.indd
PUBLISHED IN DUBAI
www.dental-tribune.me
Vol. 13, No. 6
The necessity of multiple aligner
attachments—a reality check
By Dr Bruce McFarlane,
Canada
In my practices, lecturing and
life, I live by the acronym I:CAN—
Improvement: Constant and Never-Ending. This means a constant
search for better ways of doing
things and not simply accepting
the status quo.
Most modern clear aligner systems rely a great deal on composite
resin attachments for various orthodontic movements, and attachments are becoming increasingly
prevalent: nearly 60% of dentists
survey in a poll conducted by
Orthotown from 25 January to
8 March 2019.1 I personally do not
like attachments. I find them tedious, labour-intensive, ugly and irritating. They stain, wear and fall
off. Patients do not like them either,
especially on anterior teeth. My
teams object to them also; applying and maintaining attachments
are not their favourite tasks.
I do, however, want to utilise
clear aligners for most of my cases,
and I am always pushing the limits
of aligner capabilities in my practices. If I could crack the code to
performing complex orthodontic
movements with no or fewer composite attachments, that would be
an absolute game-changer for my
practices. Henry Schein Orthodontics (HSO) has developed clear
aligner systems that help me towards that goal. They are available
in over 30 markets globally as
Reveal and SLX aligners. There are
three key differences with these
aligners that allow them to deliver
predictable tooth movements with
minimal or no attachments in many
cases. The three differences are fit,
trim line and material.
Fit
Thanks to high-resolution
moulds and automated thermoforming, HSO’s processes create
micron printing that is approximately 30% finer than that of the
leading brand and produces minimal striations. This helps create remarkably well-fitting aligners that
are very clear.
Trim line
Teeth are like slippery pumpkin
seeds when it comes to grabbing
hold of them for efficient movement with clear aligners. A nonslipping design is therefore vital for
aligners to be able to achieve the
movements planned in the soft▶ Page D2
3
Fig. 3: Visual comparison of (a) the material used to fabricate the leading brand aligners compared with (b) the material used
for Henry Schein Orthodontics aligners.
1
Fig. 1: Grip on teeth for aligners with gingival scalloping.
4
Fig. 4: Excessive spacing in a 29-year-old male patient.
2
Fig. 2: Grip of Henry Schein Orthodontics aligners on teeth.
5
Fig. 5: : Movement achieved after nine months.
[2] =>
DTMEA_No.6. Vol.13_OT.indd
ORTHO TRIBUNE
D2
Ortho Tribune Middle East & Africa Edition | 06/2023
◀ Page D1
ware. Other aligners in the market
have heavy gingival scalloping,
their trim lines extending only to
the gingival margin (Fig. 1). This design will often result in slippage,
loss of tracking, less reliable
achievement of the plan and
greater dependence on attachments.
HSO aligners have trim lines extending beyond the zeniths of the
gingival margins and into the undercut areas of the teeth (Fig. 2).
This trim line is intended to provide
a much better grip on teeth, less
slippage and reliability regarding
the software prediction and the actual clinical outcome. A less intuitive advantage of this is elimination
of the need to employ overcorrection in one’s clear aligner plan, an
inherently inaccurate endeavour.
Material
The third difference with HSO
clear aligners is the plastic they are
made of. The ClearWear material is
considerably more robust and less
yielding than most of its contemporaries, resulting in reduced distortion, better grip and closer fit to
the tooth surface with minimal attachments. It is also very clear and
remarkably stain-resistant (Fig. 3).
The three differences add up to
a system that is very predictable,
efficient and clear. This means more
profound achievement of the
movement plan with the goal of
minimising attachments and refinements. In fact, it has now become routine for me to promptly
identify cases that can be started
without any attachments. The first
round will reveal by its end where
there is need for attachments for a
given manoeuvre. This results in a
much more educated application
of attachments in the second round
and only exactly where they are
needed. I employ the same concept
for interproximal reduction.
Case 1
A 29-year-old male patient presented with the chief complaint of
excessive tooth spacing in the anterior (Fig. 4). From the situation
nine months after treatment was
begun (Fig. 5), it was evident that
two attachments were required to
correct the tip of the maxillary incisors. These will be introduced at
the refinement stage for this case.
Long vertical attachments were indicated for the lateral incisor root
tip control (Fig. 6).
Case 2
A 54-year-old female patient
presented with crowding and overjet (Fig. 7). Only one case refinement was necessary in the
11 months of treatment—during
which time no attachments were
used (Fig. 8)—including some interproximal reduction for dark triangles between the mandibular incisors.
6
Fig. 6: Studio Pro 4.0 model with new attachments.
7
Fig. 7: Crowding and overjet in a 54-year-old female patient.
Case 3
A 17-year-old male patient presented with crowding and deep
bite (Fig. 9). I would not have at-
AD
8
Fig. 8: Movement achieved after 11 months without attachments.
9
10
Fig. 9: Crowding and deep bite in a 17-year-old male patient.
Fig. 10: Movement achieved after seven months without
attachments.
tempted this case without attachments had I been using the leading
brand’s aligners. I was able to
achieve substantial corrective
movement in this patient in seven
months without attachments or interproximal reduction (Fig. 10).
There will indeed be some interproximal reduction prescribed for
case refinement between the mandibular incisors, but no attachments will be required to finish this
case.
The idea of treating clear
aligner cases without attachments
or with minimal attachments is indeed compelling. One can imagine
the many advantages of this aligner
system for a busy practice with a
desire for greater efficiency, patient
satisfaction and profitability. Truly,
a large number of attachments for
clear aligner cases is not always
necessary or desirable.
Reference
Orthotown. Clear aligners and aesthetic options. 2019 Mar; Orthotown.
16 & 18.
Editorial note: This article was first published in aligners international magazine of aligner orthodontics, Vol. 2, Issue
2/2023.
Dr Bruce
McFarlane
graduated
in dentistry from the University of
Manitoba in Winnipeg in Canada
in 1984 and certified as a specialist
in orthodontics at the University
of Western Ontario in London in
Canada in 1992. He is a fellow of the
Royal College of Dentists of Canada
and a diplomate of the American
Board of Orthodontics. Furthermore,
he is a fellow of the Pierre Fauchard
Academy and a Mensan. He has two
practices in Ontario and teaches
orthodontics all over the world.
[3] =>
DTMEA_No.6. Vol.13_OT.indd
SAVE THE DATE
1 Kuwaiti Orthodontics Symposium
st
12-13 January 2024 | Radisson Blu Hotel, Kuwait
Total of 6 international speakers.
Keynote lecture (12 January) and hands-on course (13 January)
by Dr Maximilian Küffer, Germany
Organised by
[4] =>
DTMEA_No.6. Vol.13_OT.indd
From wow to
yes in minutes.
ORTHO TRIBUNE
Ortho Tribune Middle East & Africa Edition | 06/2023
Introducing
Invisalign Outcome
Simulator Pro
A powerful tool for driving treatment
acceptance, providing highly realistic in-face
visualizations of your patient’s potential future
smile at chairside. Exclusively available on the
iTero Element Plus Series.
Together,
T
To
gether,
g
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s
streamline your
y ur workflow
yo
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improv
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rom first
fi consultation
l i to final
fi l smile.
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and improve
from
Together, Invisalign clear aligners and iTero scanners help you deliver
enhanced patient experiences and practice outcomes.
©
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© 2022 Align Technology, Inc. All Rights Reserved. Invisalign, iTero, ITero Element, iTero Element 5D Plus, the iTero logo, among others, are trademarks
acce
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increase patient acceptance
)
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