Importance of Attachments in Treatment with Clear Aligners: A Narrative Review Attachments in clear aligner therapy (running title)
Journal of Dental School, Shahid Beheshti University of Medical Sciences,
Vol. 38 No. 1 (2020),
21 April 2021
Objectives At present, clear aligners are widely used for treatment of complicated orthodontic cases such as severe crowding, and class II or III malocclusion. However, some movements such as extrusion, derotation, torque formation, or closing of large spaces are still challenging to perform with clear aligners. Resin attachments, elastics, some certain gingival margin designs, and thermopliers have been suggested to increase the predictability of tooth movement with aligners. At present, it is well understood that attachments are a non-negligible part of treatment with aligners. Different experimental and clinical studies have assessed these features, but there is still no exact guideline for indications of each feature, or their effectiveness. Thus, the aim of this study was to review in vitro and clinical studies and to discuss the best approach to achieve more predictable tooth movement with clear aligners.
Methods Different databases including PubMed, Google Scholar and Scopus were searched and articles evaluating retention of aligners, different approaches to increase retention, and characteristics of attachments were included in this review.
Results 39 experimental and clinical studies were included for this narrative review.
Conclusion The composition of aligner material probably plays a more important role than material thickness in retention. However, more comprehensive studies should be performed to confirm this. There is no doubt upon the necessity of using attachments to increase the retention of aligners and predictability of tooth movements. It seems that rectangular attachments are more efficient than ellipsoid ones. Also, quarter-sphere shaped attachments are preferred for rotational and root movements.
- Composite Resins
- Orthodontic Appliances, Removable
- Tooth Movement Techniques
How to Cite
Kesling HD. Coordinating the predetermined pattern and tooth positioner with conventional treatment. Am J Orthod Oral Surg. 1946;32:285-93.
Boyd RL, Waskalic V, editors. Three-dimensional diagnosis andorthodontic treatment of complex malocclusions with the invisalign appliance. Semin Orthod; 2001;7(4):274-293.
Rosvall MD, Fields HW, Ziuchkovski J, Rosenstiel SF, Johnston WM. Attractiveness, acceptability, and value of orthodontic appliances. Am J Orthod Dentofacial Orthop. 2009;135(3):276.e1-12.
Cai Y, He B, Yang X, Yao J. Optimization of configuration of attachment in tooth translation with transparent tooth correction by appropriate moment-to-force ratios: Biomechanical analysis. Biomed Mater Eng. 2015;26 Suppl 1:S507-17.
Goto M, Yanagisawa W, Kimura H, Inou N, Maki K. A method for evaluation of the effects of attachments in aligner-type orthodontic appliance: Three-dimensional finite element analysis. Orthod Waves. 2017;76(4):207-14.
Frongia G, Castroflorio T. Correction of severe tooth rotations using clear aligners: a case report. Aust Orthod J. 2012;28(2):245-9.
Rossini G, Parrini S, Castroflorio T, Deregibus A, Debernardi CL. Efficacy of clear aligners in controlling orthodontic tooth movement: a systematic review. Angle Orthod. 2015 Sep;85(5):881-9..
Buschang PH, Shaw SG, Ross M, Crosby D, Campbell PM. Comparative time efficiency of aligner therapy and conventional edgewise braces. Angle Orthod. 2014;84(3):391-6.
Zheng M, Liu R, Ni Z, Yu Z. Efficiency, effectiveness and treatment stability of clear aligners: A systematic review and meta‐analysis. Orthod Craniofac Res. 2017;20(3):127-133.
Ercoli F, Tepedino M, Parziale V, Luzi C. A comparative study of two different clear aligner systems. Prog Orthod. 2014;15(1):31.
Robertson L, Kaur H, Fagundes NCF, Romanyk D, Major P, Flores Mir C. Effectiveness of clear aligner therapy for orthodontic treatment: A systematic review. Orthod Craniofac Res. 2020;23(2):133-42.
Hennessy J, Al-Awadhi EA. Clear aligners generations and orthodontic tooth movement. J Orthod. 2016 Jan;43(1):68-76.
D’Antò V, Muraglie S, Castellano B, Candida E, Sfondrini MF, Scribante A, et al. Influence of Dental Composite Viscosity in Attachment Reproduction: An Experimental in Vitro Study. Materials (Basel). 2019;12(23):4001.
Djeu G, Shelton C, Maganzini A. Outcome assessment of Invisalign and traditional orthodontic treatment compared with the American Board of Orthodontics objective grading system. Am J Orthod Dentofacial Orthop. 2005;128(3):292-8.
Dasy H, Dasy A, Asatrian G, Rózsa N, Lee HF, Kwak JH. Effects of variable attachment shapes and aligner material on aligner retention. Angle Orthod. 2015;85(6):934-40.
Hahn W, Dathe H, Fialka-Fricke J, Fricke-Zech S, Zapf A, Kubein-Meesenburg D, et al. Influence of thermoplastic appliance thickness on the magnitude of force delivered to a maxillary central incisor during tipping. Am J Orthod Dentofacial Orthop. 2009;136(1):12.e1-7.
Al Noor HSS, Al-Joubori SK. Retention of different orthodontic aligners according to their thickness and the presence of attachments. Int J Med Sci & Health Sci. 2018;7(11):115-21.
Simon M, Keilig L, Schwarze J, Jung BA, Bourauel C. Forces and moments generated by removable thermoplastic aligners: incisor torque, premolar derotation, and molar distalization. Am J Orthod Dentofacial Orthop. 2014;145(6):728-36.
Cowley DP. Effect of gingival margin design on retention of thermoformed orthodontic aligners. 2012. P:87
Jones ML, Mah J, O'Toole BJ. Retention of thermoformed aligners with attachments of various shapes and positions. J Clin Orthod. 2009;43(2):113-7.
Tuncay OC. The invisalign system: Quintessence Publishing Company; 2006. PP:330.
Mantovani E, Parrini S, Coda E, Cugliari G, Scotti N, Pasqualini D, et al. Micro computed tomography evaluation of Invisalign aligner thickness homogeneity. Angle Orthod (2021).
Hilliard K, Sheridan JJ. Adjusting Essix appliances at chairside-these simple adjustments can be made in the operatory. J Clin Orthod. 2000;34(4):236-8.
Sheridan JJ. Tooth movement with Essix mounding. J Clin Orthod. 2004;38:435-41.
Momtaz P. The effect of attachment placement and location on rotational control of conical teeth using clear aligner therapy. 2016.
Elkholy F, Mikhaiel B, Repky S, Schmidt F, Lapatki BG. Effect of different attachment geometries on the mechanical load exerted by PET‑G aligners during derotation of mandiJ Orofac Orthop. 2019 Nov;80(6):315-26.
Owen 3rd A. Accelerated Invisalign treatment. J Clin Orthod. 2001;35(6):381-5.
Garino F, Castroflorio T, Daher S, Ravera S, Rossini G, Cugliari G, et al. Effectiveness of composite attachments in controlling upper-molar movement with aligners. J Clin Orthod. 2016;50(6):341-7.
Smith RJ, Burstone CJ. Mechanics of tooth movement.Am J Orthod. 1984 ;85(4):294-307.
Comba B, Parrini S, Rossini G, Castroflorio T, Deregibus A. A three-dimensional finite element analysis of upper-canine distalization with clear aligners, composite attachments, and class II elastics. J Clin Orthod. 2017;51(1):24-8.
Costa R, Calheiros FC, Ballester RY, Gonçalves F. Effect of three different attachment designs in the extrusive forces generated by thermoplastic aligners in the maxillary central incisor. Dental Press J Orthod. 2020;25:46-53.
Yokoi Y, Arai A, Kawamura J, Uozumi T, Usui Y, Okafuji N. Effects of attachment of plastic aligner in closing of diastema of maxillary dentition by finite element method. J Healthc Eng. 2019 Mar; 2019.
Gomez JP, Peña FM, Martínez V, Giraldo DC, Cardona CI. Initial force systems during bodily tooth movement with plastic aligners and composite attachments: A three-dimensional finite element analysis. Angle Orthod. 2015;85(3):454-60.
Kim WH, Hong K, Lim D, Lee JH, Jung YJ, Kim B. Optimal Position of Attachment for Removable Thermoplastic Aligner on the Lower Canine Using Finite Element Analysis. Materials. 2020;13(15):3369.
Chen Zhouyan ZR, He Song, Wu Dingdan, Wu Xi, Bai Rui, Huang Yue. Effects of the changes of thickness and placement position of rectangular attachment on canine tooth torsion correction. Chinese J Tissue Eng Res. 2020;24(16):2513-9.
Kravitz ND, Kusnoto B, BeGole E, Obrez A, Agran B. How well does Invisalign work? A prospective clinical study evaluating the efficacy of tooth movement with Invisalign. Am J Orthod Dentofacial Orthop. 2009;135(1):27-35.
Savignano R, Valentino R, Razionale A, Michelotti A, Barone S, D’Antò V. Biomechanical effects of different auxiliary-aligner designs for the extrusion of an upper central incisor: A finite element analysis. J Healthc Eng. 2019; 2019.
Durrett SJ. Efficacy of composite tooth attachments in conjunction with the Invisalign Tm system using three-dimensional digital technology: University of Florida; 2004.
Kravitz ND, Kusnoto B, Agran B, Viana G. Influence of attachments and interproximal reduction on the accuracy of canine rotation with Invisalign: a prospective clinical study. Angle Orthod. 2008;78(4):682-7.
Weckmann J, Scharf S, Graf I, Schwarze J, Keilig L, Bourauel C, et al. Influence of attachment bonding protocol on precision of the attachment in aligner treatments. J Orofac Orthop. 2020;81(1):30-40.
Feinberg KB. Translucency, stain resistance and hardness of composites used for invisalign attachments: The University of Alabama at Birmingham; 2015.
Barreda GJ, Dzierewianko EA, Muñoz KA, Piccoli GI. Surface wear of resin composites used for Invisalign (R) attachments. Acta Odontol Latinoam. 2017;30(2):90-5.
Ranjbar ND. Method for placement of dental attachments for use with dental aligners. Google Patents; 2015. https://patents.google.com/patent/US20150216626A1/en
Zhang N, Bai Y, Ding X, Zhang Y. Preparation and characterization of thermoplastic materials for invisible orthodontics.Dent Mater J. 2011 ;30(6): 954-9.
Yaosen C, Mohamed AM, Jinbo W, Ziwei Z, Al-balaa M, Yan Y. Risk factors of composite attachment loss in orthodontic patients during orthodontic clear aligner therapy: A prospective study. BioMed Res Int. 2021;2021.
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