GAP Magazine Clear Idea Volume 5

24 www.acasociety.com | info@acasociety.com A ttachments, engagers, or “buttons” as some call them can be thought of as small “handles” you put on teeth to help them move. Because some teeth are shaped or positioned in a way that can be difficult for an aligner to “grab” onto, small composite-resin bumps are placed onto the facial surfaces of the teeth so that the aligner has something to hold on to. Depending on which aligner company you use there are many different sizes and shapes have been discussed in literature and professional forums. Regardless, the principles of bonding them onto the teeth are the same. The following article describes methods to increase efficiency by decreasing the excess resin flash, decrease debonds and decrease chair time. How much is enough? One of the most frustrating parts is putting in too much or too little composite into the template. Too little and you end up with voids or they come off when you go to remove the tray. Too much and you have excess flash to remove for days. So, how much is just right? Here are two principles I work with: 1. No flash should be around the edges of the well of the template 2. The composite should be SLIGHTLY raised in the well – convex, not concave 3. Place composite on to a flat plastic and use this to transfer the resin to the template well. Pack well with the flat plastic and use dipping resin sparingly Removing excess – the fried egg Leaving excess composite around an attachment means that from the start of treatment, the aligner is never fully seated. One of the tenets of successful aligner therapy is full contact of the plastic with the surfaces of the teeth. This discrepancy early on in treatment inevitably leads to a lack of movement of the tooth and can adversely affect the movement of the surrounding teeth as well. It is imperative that this flash is removed prior to issuing the aligners. A common clinical situation is encountered when too much composite is placed in the well (Figure 2). This can lead to the ‘Fried Egg’ look on patient’s teeth (Figure 3). With the ideal amount of resin placed in the well, the flash can be minimal (Figure 4). This leads to less work for the clinician and savings in terms of time and materials. Accurate placement of attachments is a necessary part of aligner therapy. When placed incorrectly and inaccurately, they can hinder the progression of your treatment. Knowing how much to place in the well and how to perform this procedure efficiently is on the most key fundamentals that is overlooked in successful aligner therapy. In the next article we will focus on a novel way to remove the excess resin flash that will not make your surgery look like you are on the set of long-running TV show CSI! Increasing efficiency with your attachment appointments By Dr Jeff Kho Figure 2: An overfilled well which leads to excess flash. Figure 1: The ideal amount of composite to put into the well, note no flash around the edges and composite slightly convex. Figure 3: Excessive resin flash note in particular around the 22 attachment – Fried Egg look due to overfilled template. The removal can often be tedious but can be avoided with mindful placement of resin in the well. Figure 4: Ideal amount of resin with minimal excess to remove. BIO: Dr Jeff Kho is a very knowledgeable speaker on clear aligners from QLD, Australia and will be speaking on all things troubleshooting at ACAS2021. He also runs hands on aligner courses – visit www.ahcdentaled.com for more information.