Using attachments significantly improves the retention of Invisalign aligners, meaning they help keep the aligners securely in place on the teeth. In particular, rectangular attachments placed on premolars have a stronger effect in retaining the aligners compared to similar attachments placed on incisors.
However, these attachments can fall off due to a number of reasons, including sugar, overzealous chewing, or even a simple case of growing pains. Whatever the reason, losing attachments can disrupt your smile journey.
So let’s look at a few tips to keep them firmly in place and your smile on track.
Factors influencing success of Orthodontic Treatment
For starters, you should understand that the effectiveness of orthodontic tooth movement is influenced by various factors. These include:
- The thickness of the aligners
- The way the treatment is planned and staged
- The timing and amount of enamel reduction between teeth
- The cooperation of the patient
- The use of other tools or devices like elastics, temporary anchorage devices (TADs), or segmental orthodontic appliances.
Another important aspect to consider is the visibility and acceptability of the composite attachments by the patient. If there are too many attachments or they are too large on the outer surface of the teeth, it can compromise the invisibility of the aligner treatment. Patient satisfaction with the aesthetics of the treatment is an essential consideration when designing the treatment plan.
Invisalign attachments fell off!
Several reasons can explain why your Invisalign attachments keep falling off. Here are some of the most common culprits:
a. Bonding issues:
Insufficient initial bond: Sometimes, the initial bonding process might not be optimal, leaving the attachment vulnerable to dislodging. Saliva contamination during placement can also weaken the bond.
Expired or weak bonding materials: The composite bonding used to adhere the attachments can wear down or expire, losing its grip over time.
b. Eating habits:
Sugary or acidic foods and drinks: These can erode the enamel and weaken the bond between the attachment and your tooth.
Chewing hard foods: Excessive pressure from hard foods can dislodge the attachments.
c. Attachment fit:
Attachments too snug: If the attachments fit too tightly on your teeth, they can create pressure points that contribute to them popping off.
Attachments too small: Smaller attachments have less surface area for the bonding material to adhere to, making them more prone to falling off.
d. Other factors:
Teeth shifting: As your teeth move with treatment, the pressure on the attachments can change, causing them to loosen or fall off.
Incorrect aligner removal: Twisting or pulling the aligners can put undue stress on the attachments and dislodge them.
Tips for Attaching Aligners to Teeth
When it comes to attaching the aligners to your teeth, there are two main aspects to consider: the materials and procedures used for bonding, and the shape and positioning of the attachments.
a. Transfer tray rigidity
If your Invisalign attachments are falling off, it’s possible that your dentist used a less rigid transfer tray called Spark, which tends to be easier to remove and often results in fewer attachment detachments during bonding. Conversely, studies have shown that using harder and thicker transfer trays leads to more accurate transfer of attachments to the teeth.
It’s important for clinicians to choose trays that are more rigid for accuracy, but they may be more difficult to work with. The viscosity of the composite material used for bonding doesn’t affect the shape and volume of the attachments, but it does impact the bonding strength.
b. Amount of filler content
Orthodontic composites with more filler content provide better shear bond strength and transfer accuracy. Condensable composites require more time to bond compared to flowable composites.
Kerr Sonicfill is a promising material that is easy to apply and maintains bond strength and accuracy better than solid composites.
c. Prior chemical treatment
When bonding attachments to ceramic restorations, prior chemical treatment is crucial. Better force transfer from the aligner to the tooth is associated with higher stress between the aligner and the composite attachment, so it’s important to design attachments that are resistant to detachment.
Should I use aligner attachments after falling off?
Studies indicate that aligner treatment with attachments allows for better control and a wider range of tooth movement compared to treatment without attachments. Even if a specific tooth doesn’t need to be moved, having attachments on it can still influence the success of the overall treatment, especially when it serves as anchorage for other tooth movement.
While aligner treatment with labial (front surface) attachments is not completely invisible, palatal (towards the roof of the mouth) attachments are less visible and provide a better expression of orthodontic movement.
Palatal attachments have different effects on tooth movement as they are positioned closer to the center of resistance.
The position of the attachment is critical to avoid undesired movements, sometimes more so than the shape of the attachment. In more challenging tooth movements like incisor extrusion, canine rotation, and lateral segment distalization (moving teeth towards the back of the mouth), it is advised to place attachments on the entire lateral segment (from the canine to the second molar) to improve predictability and anchorage.
What to do When an Invisalign Attachment Falls off
Don’t panic: Losing an attachment occasionally is not uncommon. However, if it happens frequently, consult your orthodontist.
Avoid the triggers: Limit sugary and acidic foods, skip hard foods, and be gentle when removing your aligners.
Contact your orthodontist: If an attachment falls off, don’t try to reattach it yourself. Schedule an appointment with your orthodontist to have it replaced as soon as possible. They can also assess the root cause and suggest preventive measures.
In summary, the choice of bonding materials and techniques, as well as the shape and placement of attachments, play a crucial role in the effectiveness of aligner treatment. It’s important for clinicians to consider these factors to achieve the best possible results for each patient.