Attachments explained: the small detail that matters

What attachments are

An attachment is a small shape of tooth-coloured composite resin, the same material used for white fillings, bonded to the front or back surface of a tooth. Each one is about the size of a grain of rice, and the aligner has a matching recess moulded into it. When the aligner is seated, the recess fits over the attachment, and the aligner can then push or pull on that tooth in directions a smooth aligner could not manage.

What they do

Aligners on their own are good at tipping teeth. Some movements need more than a tip: rotating a round tooth such as a canine or premolar, moving a tooth bodily along the arch with its root as well as its crown, pulling a tooth down into line (extrusion), or holding back teeth steady while others move. Attachments give the aligner a handle for those movements. Different shapes do different jobs, and Invisalign's software places them automatically for each movement; Louise then reviews every one on the plan and removes any that are not needed.

Where they go, and how many

It depends entirely on the plan. A simple case might have two or three on side teeth; a comprehensive case might have one on most teeth for part of the treatment. They are placed wherever the movement needs them, which sometimes means the front teeth. Louise shows you on the 3D plan exactly which teeth will have attachments before anything is made, so there are no surprises on fitting day.

What they look like

Matched to your tooth colour and small, they are hard to see at a normal speaking distance, and with the aligner over them they are even less visible; the aligner smooths the surface. Most people's friends and colleagues do not notice. They are more visible with the aligners out, which is one reason to keep aligners in as much as possible.

How they are fitted

At the fitting appointment, the tooth surface is cleaned and lightly conditioned, a template aligner with the attachment shapes pre-filled with composite is seated over the teeth, and the composite is set with a light. The template is peeled away, leaving the attachments bonded in place. It takes a few minutes per tooth and is not usually painful; there is no drilling and no anaesthetic is needed.

Living with them

For the first day or two they feel odd against your lip and cheek when the aligner is out; that passes. Brush around them normally, giving the edges a little attention, as plaque collects there. Occasionally one comes off, usually on something chewy; it is not an emergency. Tell us and it is replaced at your next visit, or sooner if it is one the current aligner relies on.

Removing them

At the end of treatment the attachments are polished off with a fine bur and the enamel is smoothed. It takes a few minutes, is not usually painful, and leaves the enamel smooth. Your retainers are then fitted over clean, smooth teeth.

Questions people ask

Does everyone need attachments?

Most plans use some. Very simple movements, such as a small relapse, sometimes need none.

Do attachments hurt?

Not usually. Fitting and removal need no anaesthetic, and they can feel odd for a day or two.

Can people see them?

Rarely. They are tooth-coloured and small, and the aligner smooths them further.

Can I choose not to have attachments?

You can ask. Louise will explain which movements they are needed for and what the result would look like without them, which is usually a poorer finish.

Do attachments damage the enamel?

No. They are bonded to the surface and polished off at the end without cutting into the tooth.