Application
This section is based on a detailed video by Dr. Brian Gray, the Chief Dental Officer of CandidPro, who expertly demonstrates how to place attachments for clear aligners. Our goal is to assist CandidPro providers in accurately placing attachments on teeth using clear aligners. Below, you will find a step-by-step procedure including all necessary equipment and materials to ensure effective tooth movement and patient comfort.
Step-by-Step Procedure:
Step 1: Setup Your Work Area
Prepare your dental tray with all necessary instruments and materials. Ensure everything from the curing light to gauze and cotton rolls is within easy reach.
Step 2: Prepare the Patient
Place the Optragate or another dental retractor to keep the mouth dry and open. Use a bite block or Isolite system if needed for patient comfort.
Step 3: Position the Template
Use the zero-aligner, a specialized template aligner with no tooth movement, to check the alignment and fit on the patient’s teeth. This aligner helps in accurately marking where attachments need to be placed.
Step 4: Clean the Teeth
Thoroughly clean the teeth using prophy paste applied with an appropriate dental tool. Enhance the tooth surface for bonding by using an air abrasion tool to remove any residual plaque or debris.
Step 5: Mark the Attachment Sites
With the zero-aligner in place, pinpoint the precise locations for attachments and mark them with a dental pencil or marker.
Step 6: Etch the Marked Spots
Apply a 33% phosphoric acid solution to the marked spots. Allow the etch to process for 30 seconds before rinsing and drying, keeping the area isolated and moisture-free.
Step 7: Apply Bonding Agent
Dab a small amount of bonding agent on the etched areas using a micro brush. Ensure coverage is confined to the marked spots. Air dry the agent slightly for about 15 seconds to set it before proceeding.
Step 8: Place the Composite
Fill the prepared attachment sites on the zero-aligner with your chosen composite resin. Seat the aligner back onto the teeth and firmly press down to embed the attachments correctly. Remove any excess composite around the attachments using a dental tool.
Step 9: Cure the Composite
Use your dental curing light to solidify the composite. Cure each attachment for about 15 seconds to ensure it is fully secured.
Step 10: Final Cleanup and Adjustments
Once cured, remove the aligner and clean up any remaining excess material using a dental scaler. Ensure that each attachment is neatly finished and securely in place.
Step 11: Educate and Inform the Patient
Explain the purpose and function of the attachments to the patient before the procedure. Discuss any concerns they might have and reassure them about the benefits and necessity of the attachments for successful treatment.
Removal
Required Equipment
Before you begin the removal process, it's essential to have the right tools at your disposal. Here's what you'll need:
- High-Speed Handpiece with Water Irrigation: Essential for efficient and safe removal of attachments.
- White Stone or Multi-Fluted Composite Finishing Burs: These burs are designed to smoothly finish the tooth surface after composite removal.
- Fine Diamond Burs: Ideal for detailed composite removal, ensuring precision without harming the tooth enamel.
- Optional: Ceramic Bracket Remover Pliers. While not necessary for all cases, these pliers can be useful in specific situations.
Removal Techniques
To effectively detach orthodontic attachments, consider the following five approaches:
- Most Efficient Technique: Begin with a high-speed handpiece equipped with water irrigation, using a multi-fluted composite finishing bur. This method is ideal for eliminating most of the composite. For initial removal, consider a diamond bur or a more abrasive option, focusing on preserving the tooth enamel. Finalize the process with a multi-fluted finishing bur or a stone bur to achieve a smooth finish.
- Routine Polishing: After the composite has been removed, apply your standard enamel polishing technique to restore the tooth's natural shine.
- Most Costly Approach: Utilize a series of diamond burs, varying from coarse to fine grades, for a comprehensive removal process. This method allows for meticulous attention to detail but comes at a higher cost.
- Least Effective Method: Using ceramic bracket remover pliers in combination with white stone polishing burs is an alternative option, though it is generally considered the least effective method. These tools are commonly found through orthodontic supply outlets.
Verifying Complete Composite Removal
Ensuring that all composite material has been fully removed is a crucial final step. Here are two effective strategies:
- Metal-Tipped Tool Method: Use a scaler or explorer to gently scrape the tooth's surface. Marks from the metal tool on the composite indicate areas that require additional attention. This approach helps minimize the risk of enamel damage, particularly important when using diamond burs.
- Lead Pencil Marking: Another strategy involves marking the composite with a lead pencil. This enhances the visibility of any remaining composite fragments, allowing for thorough removal.