Let’s take a look at the attachment rationale for Stephanie.

The following attachments were placed automatically according to Align’s standard protocols:

Generally, vertical attachments serve two purposes. First they provide retention for the aligner and second they aid in movement control for rotation.

Initial ClinCheck files

Final ClinCheck files

In Stephanie’s case, there are a number of round teeth (canines and bicuspids) that have rotations. Rotations of relatively flat teeth like incisors are not as difficult to express with aligners. Generally significant rotations of round teeth will need an attachment to help express the force. As you can see in Stephanie’s case, several vertical rectangular attachments were placed even without me specifically requesting them as part of Align’s standard protocol for attachments and rotations of round teeth.

By asking for extrusion on the maxillary right central to optimize the anterior aesthetics through the ClinCheck modification process, I received a revised version that incorporated the requested extrusion and automatically included the horizontal ellipsoid attachment to aid in this movement.

The ellipsoid attachments act as a handle to aid in the expression of the vertical movement. I prefer to use Align’s default here, the ellipsoid attachment, because it’s the most esthetic out of all choices and I’ve had good success with the horizontal ellipsoid attachment to aid anterior extrusion.

In many cases you will find the attachments placed by default give you a great starting place in the review process. You may, however, find there are occasions you want to request additional attachments or change orientation or placement. In Stephanie’s case, I was comfortable with the recommendations and protocols for attachments that Align proposed.

To learn more about Align’s Attachment protocol, click here.

We will continue to follow Stephanie’s clinical progress to evaluate the success of our attachment design in future blog postings.