You are about to start clear aligners, and you have heard that small things get bonded onto your teeth. These are called attachments. Hearing about them for the first time can feel unsettling, but they are much more ordinary than you might think. Let us explain them from the patient's point of view.
What is an attachment?
An attachment is a small, tooth-colored bump bonded to the surface of a tooth. Its shape is sometimes a small square and sometimes a slightly slanted ridge. When the aligner goes over the tooth, it seats around this bump, so the aligner grips the tooth better.
An aligner slides easily over a smooth tooth surface. Some movements, however, need a handle to hold on to the tooth. Rotating a tooth, moving a tooth down or up, and tipping a root are in this category. The attachment lets the aligner hold on to the tooth.
Not every treatment involves attachments. In mild cases they may not be needed at all. When preparing the plan, the clinician decides which teeth get attachments and in what shape, and shows you. If you are curious about the technical side of planning, the explanation within the Invisalign system is on the attachment plan page.
How are they bonded?
The procedure is done in a single appointment, and you usually feel nothing. Step by step:
- Your teeth are cleaned and the surface is prepared.
- The clinician seats a template aligner, which marks the attachment positions, over your teeth.
- A tooth-colored, filling-like material is placed into the openings in the template.
- It is hardened with a special light.
- The template is removed, and the attachments stay on the teeth.
No drill is used and the tooth is not cut. Most people only get tired of keeping their mouth open for a long time; other complaints are rare. After bonding, the aligner may feel a little tighter. That is a sign the attachments are doing their job.
When are attachments needed?
Not all teeth move as easily with an aligner. Round, small teeth, such as canines, tend to slip within the aligner. Attachments are often used on these teeth for rotation. Attachments may also be added while closing gaps between teeth or correcting crowding, so that the aligner grips the tooth fully as it moves. The clinician does this when it is needed and only as much as is needed; they are not added for decoration.
Are they visible from the outside?
Attachments are tooth-colored, meaning the shade is chosen to be close to your tooth. They can be noticed up close, as a slight bump on the tooth surface. At conversation distance, most people do not notice them. With the aligner over them, the two blend into the tooth color anyway.
Still, let us be honest about this: clear aligners being the least noticeable option does not mean attachments will never be noticed. They may show in a photo with a flash or from very close up. If visibility worries you, tell the clinician at your consultation. The placement can be planned with the teeth that are most prominent in mind.
| Topic | What to expect |
|---|---|
| Bonding | One appointment, no drill; most people feel nothing |
| Appearance | Small tooth-colored bumps; noticeable up close |
| Speech | A slight effect is possible in the first days, and you get used to it quickly |
| Eating and drinking | Eat with the aligners out; because the attachments stay on the teeth, cleaning becomes more important |
| Cleaning | Brush carefully around the attachments |
| End of treatment | The clinician removes the attachments and polishes the tooth surface |
Eating, drinking, and cleaning
Because you take the aligners out for meals, attachments do not cause problems while you eat. A little care when biting hard foods is enough. Remember that when the aligner is out, the attachments are still on your teeth: a very hard pit or bone can damage an attachment.
The main point to watch is cleaning. Food debris can build up around an attachment. You must brush your teeth, with extra care around the attachments, before putting the aligners back in. For details, see the pages on aligner and oral hygiene and eating and drinking. Colored drinks can stain aligners, and the same sensitivity applies to attachments, so drinking only water while the aligners are in is the surest way.
What should I do if an attachment comes off or falls off?
From time to time an attachment may come off a tooth. If this happens, do not panic. Here is how to proceed:
- Keep wearing your aligner; even without the attachment, the aligner usually still seats.
- Call the clinic and let them know. The clinician will tell you whether it needs to be bonded again.
- Do not try to glue the attachment back yourself.
- The right thing is to let the clinic know without waiting for your next checkup, because that tooth may fall behind the plan.
Detachment is most often caused by biting hard foods or playing with them using a fingernail or pen. Gently holding the aligner by its edge with your fingertips when you remove it also protects the attachments.
For other situations that can come up during aligner treatment, see our clear aligner problems page.
What happens to attachments when treatment ends?
When treatment is complete, the attachments have done their job. The clinician lifts them off the tooth with a special instrument and polishes the tooth surface. This is usually done in a single appointment and often without anesthesia. The tooth's own surface is preserved.
Next comes retention. A retainer is used to keep your teeth in their new positions. The difference between aligners and retainers is a separate topic, which we cover on the clear aligners or retainers page.
Should I worry about attachments?
These small bumps are there so that the aligner can do its job. Without them, some tooth movements may not be possible with aligners. What worries people is usually the appearance and the adjustment period, and for most people both become acceptable quickly. About getting used to them, know this: in the first few days it is very natural to keep feeling the attachments with your tongue. After that, the brain learns to ignore them. If you feel slight rubbing at the corner of your mouth or inside your cheek, tell your clinician; if needed, the rough spot is smoothed. Questions you can ask your clinician: which teeth need them, why they are needed, how many times they will be checked during treatment, and what to do if one falls off.
If you are wondering whether you are suitable for treatment, you can take a look at the suitability quiz or plan an orthodontic consultation.
This information is general in nature; the treatment that suits you is decided after an examination.