Let’s outline the basic steps to deliver Sheena’s Invisalign case, with a focus on the attachments!

1. As there were several attachments, first try in the aligner “template” to ensure an intimate fit to the teeth (see figure 1- We check the fit closely to be sure that the teeth fit intimately in the template. Check the occlusal of the attachment template to evaluate that there is no space between the teeth and the occlusal of the template).

Removal of the aligner template can be easily done using a “plastic” instrument commonly used to handle composite resin material. The end with the blade perpendicular to the long axis of the tool works best with a “pull” to the buccal and “lift’ to the occlusal to use the tool like a “can opener” (see figure 2).

2. It seems to work best to place attachments working in quadrants, controlling moisture with cotton rolls and suction. Using the standard bonding techniques of etch, rinse, dry and bond and light cure, Scotchbond was applied to the prescribed attachment teeth in the first quadrant.

3. After identifying the attachment location in the template, the composite material was placed in the reservoir in the template. Express the material directly from the delivery syringe into the attachment reservoir. Using the “plastic instrument”, manipulate the material so that it is just flush with the reservoir to allow minimal excess (see figure 3 to demonstrate what it looks like to properly fill the attachment reservoir with composite material. This will ensure a small amout of excess without too much "flash". An insufficient fill of the reservoir will result in a void that results in a weak attachment that may debond and fail).

4. Place the attachment template with the resin filled reservoir over the entire arch and push it securely to place. An important tip is to push the curing light against the template directly against the outside of the reservoir. This ensures minimal excess with a full reservoir of material and reduces the possibility of excessive prominence of the attachment material (see figure 4). It is important to note that the light is used to both cure and to apply direct pressure against the template to push the template tightly against the buccal aspect of the tooth. This helps to ensure that the composite material will "flow" out of the reservoir and produce an accurate attachment shape. If this is not done the attachment shape may in fact be more prominent than desired. This will then hold the aligner off of the teeth reducing the "glove" effect of the aligners).

5. Working quadrant to quadrant, after all of the attachments are bonded, the excess composite material is removed using a multi-fluted carbide bur.

6. The first aligner is tried in and carefully evaluated for an intimate fit of aligner to teeth as well as attachments in each aligner attachment reservoir (see figure 5). The plastic instrument works nicely to remove the aligner effectively. Start at the most distal posterior buccal, gently place the perpendicular end blade of the instrument under the buccal aspect and “lift” and “pull” to help remove the aligner.
After some basic instructions from the staff, Sheena left the office, excited to begin her Invisalign treatment. She practiced placement/removal, learned about proper care and maintainence of her aligners.

In the blog for our patients, Justin and Stephanie, I will further detail the aligner delivery instructions!