Orthotown August 2018 - 32

Fig. 5: Excess flash on the attachments
was removed using finishing stones.

Fig. 6: The patient examines the
appearance of the 14 attachments.

the case sent to the clear aligner company.10
By using the 3D software, proper tooth
alignment was achieved, attachments were
chosen to facilitate the tooth movements with
the clear aligners, interproximal reduction
was prescribed in specific areas on the lower
arch to assist in maxillary space closure,
and the proper staging of tooth movement
was assigned.
For the first batch of aligners, treatment
was staged with weekly aligner changes
over 54 aligner stages. All attachments-14
in total-were placed during Stage 1 on
teeth #4-7, #10-13, #20-22 and #27-29.
Interproximal reduction was prescribed at
Stage 7, at the contacts between teeth #22-27.

Attachment placement
and aligner delivery
An appointment was scheduled to place
the attachments and begin the 54 weeks
of orthodontic treatments. During this
appointment, the teeth were isolated using
a flexible latex-free OptraGate lip and cheek
retractor from Ivoclar Vivadent (Fig. 1,
p. 30), which reduces salivary contamination
of the attachment teeth. The prefabricated

32

JULY/AUGUST 2018 // orthotown.com

attachment template was then tried into the
patient's mouth to ensure a proper fit, after
which it was removed, and the first aligner
tried in to confirm an ideal fit.
The shape and location on the teeth
for the composite attachments had already
been determined. Clear aligner attachments
may be ellipsoid, rectangular or beveled,11
depending upon the type of movement
required to achieve the desired outcome. For
example, certain rotations require ellipsoid
attachments, while others are best achieved
with vertical rectangular attachments.12
The enamel was etched and rinsed in the
areas and on those teeth in the predetermined
shape and location for the attachments.
Transbond Plus Self Etching Primer bonding
agent from 3M Unitek was applied to the
teeth where attachments would be placed,
then light-cured (Fig. 2, p. 30).
Because patients who choose clear
aligners are usually very self-conscious
about their appearance and aesthetically
aware, it is imperative that attachments
appear as seamless and invisible as possible.
Therefore, the composite material selected for
creating the attachments was a translucent


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Table of Contents for the Digital Edition of Orthotown August 2018

Orthotown August 2018 - Cover1
Orthotown August 2018 - Cover2
Orthotown August 2018 - 1
Orthotown August 2018 - 2
Orthotown August 2018 - 3
Orthotown August 2018 - 4
Orthotown August 2018 - 5
Orthotown August 2018 - 6
Orthotown August 2018 - 7
Orthotown August 2018 - 8
Orthotown August 2018 - 9
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Orthotown August 2018 - 12
Orthotown August 2018 - 13
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Orthotown August 2018 - 15
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Orthotown August 2018 - 18
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Orthotown August 2018 - 27
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Orthotown August 2018 - 31
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Orthotown August 2018 - Cover3
Orthotown August 2018 - Cover4
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