During Invisalign treatment you will see small, tooth-colored bumps on some of your teeth. These are called attachments. You also see each of them on the plan screen, that is, in ClinCheck. On this page we explain how attachments fit into the plan. If you are curious about the day-to-day side, take a look at the article that explains attachments from an everyday-life perspective.
Why are attachments part of the plan?
An aligner wraps around the tooth like a soft mold. But on a flat, smooth enamel surface it cannot carry out every movement on its own. To rotate a tooth, tilt its root, or move it down or up, the aligner needs something to hold on to. The attachment provides that spot.
Think of a small bump. The aligner sits on this bump, and the force that guides the tooth goes to the right place. Not every tooth needs an attachment. Some teeth only need a slight glide, and there the aligner alone is enough.
How does an attachment look in ClinCheck?
ClinCheck is the three-dimensional treatment plan created from your iTero scan. Your doctor opens the plan and follows the starting and target positions of your teeth step by step. On this screen the attachments are marked as separate small shapes on the teeth. You can see which tooth has one, which direction it faces and at which step it starts to work.
When reviewing the plan, these points are checked:
- Which teeth are suggested to have attachments
- The shape and direction of each attachment
- The order in which the teeth move
- At which aligner steps the movement that needs an attachment takes place
The plan is shown to you and you are welcome to ask questions. It is not like a document you sign; it is more like a draft you talk through together. If needed, your doctor adjusts the plan.
What are optimized attachments?
In general, attachments fall into two groups. Some are conventional anchor points with a set shape defined in advance. Others are optimized attachments, which the software shapes according to what the tooth needs. Taking the movement and the size of the tooth into account, the software suggests which tooth should get an attachment and in what form. Your doctor reviews the suggestion and changes it if it does not seem suitable.
So the decision starts in the software but ends with the doctor. Even two people with the same two teeth can end up with a different arrangement of attachments.
The relationship between attachments and IPR
IPR is the careful thinning of a very thin layer of enamel between the teeth. When teeth are crowded, they need room to move. Sometimes that room is created with IPR. ClinCheck also shows separately which contacts will receive IPR and at which step.
In most plans the two are considered together. First room is made, then the teeth held by attachments move. But not every plan contains both. Some people get only attachments, some only IPR, some both and some neither. The doctor's assessment and the scan determine this.
Switching aligners and attachments
Attachments stay on the tooth throughout treatment. When you move on to each new set of aligners, the attachment does not shift. The new aligner is manufactured with the attachment taken into account and fits right over it. While taking the aligner out and putting it back in, you can feel with your finger that the attachment is still in place.
The aligner schedule is generally set out in the plan. Your doctor will tell you how often to change aligners, and you can find how the daily routine works on the aligner change schedule page.
Types of attachments at a glance
| Purpose | How it appears in the plan | What the doctor pays attention to |
|---|---|---|
| Rotating the tooth around its own axis | A small bump on the tooth surface for the aligner to grip | Shape of the tooth and amount of rotation |
| Moving the tooth vertically | A horizontal or vertical ridge matching the length of the tooth | Fit with the bite |
| Changing the tilt of the root | An optimized shape suggested by the software | Position of the root within the bone |
| Helping the aligner seat better on the tooth | A small supporting attachment | How the aligner holds and seats |
This table only draws a general framework. Which shape goes on which tooth varies from plan to plan.
How is an attachment placed and removed?
To place attachments, the inside of an aligner is used like a clear template. The tooth surface is prepared, tooth-colored material loaded into the template is seated on the tooth and hardened with a special light. The edges are smoothed. Most people do not need anesthesia for this procedure.
When treatment is finished, the attachments are carefully removed with polishing instruments and the tooth surface is smoothed. No mark is expected to remain on the tooth from the attachment, and your doctor checks the surface.
What is checked when new aligners arrive?
At check-up appointments your doctor looks at whether the aligner fits fully over the attachments. If there is a gap between the aligner and the tooth, it is important to resolve it before moving on to the next set of aligners. If an attachment falls off or breaks, let us know by phone and we will work out together how to continue.
You can find what to do about aligner problems on the aligner problems and solutions page. Your doctor re-evaluates the plan at regular intervals. If attachments need to be added or removed at that stage, this is again shown on ClinCheck. The original version of the plan can be compared with the current one.
Good questions to ask at your appointment
- Which teeth were suggested to have attachments, and why?
- Is IPR planned, and between which teeth?
- What should I do if an attachment falls off?
- How often are check-ups during aligner changes?
For broader information about the plan and the process, see the what is Invisalign page, and to prepare for your first visit, the orthodontic examination page. The technology side is described on our technology page.
This information is general; the treatment that suits you is decided after an examination.