Elastics, buttons, and cutouts are critical components in the treatment of moderate to severe malocclusion, particularly in achieving a sagittal correction to attain an ideal Class I occlusion.
Elastics: Elastics, also known as small rubber bands, when used alongside cutouts in clear aligners, form a powerful method for addressing various types of malocclusion. This technique is highly effective for correcting Class II and Class III malocclusions, as well as open bites and crossbites. Success heavily depends on the patient's adherence to wearing the elastics consistently as instructed by the dental professional.
Buttons: Unlike typical attachments, buttons are small, prefabricated fixtures that may be made of metal, plastic, or ceramic and have a mushroom-like shape. These are bonded onto a tooth or onto the aligner itself, functioning similarly to fixed orthodontic brackets. Buttons serve as robust anchorage points for attaching elastics.
Cutouts: Designed with multiple geometries, cutouts enhance the versatility of aligners, allowing for the execution of more complex tooth movements. This feature is especially beneficial in treating teens and managing Class II and Class III malocclusions more confidently.
What’s the difference between curved buttons and flat buttons?
When clear aligner cases call for elastics, bonded buttons may be required to provide appropriate anchorage for elastic bands. Orthodontic buttons often feature a curved or flat surface on the side that they are bonded to a tooth.
Curved buttons are recommended for curved tooth surfaces like those often found on the cuspids and canines.
Flat buttons are recommended for flatter tooth surfaces like those found on lower molars.
Some dentists stock flat and curved buttons chairside, and will choose one based on the patient’s unique biology. Dentists may test a flat button on the tooth surface. If it rocks when pressed, a curved button may be the better option.
How do orthodontic buttons affect oral hygiene?
Orthodontic buttons and bonded attachments can promote the accumulation of dental plaques. For best results, patients should take extra care when brushing their teeth to clear food particles and plaque from around the surface of any orthodontic buttons or attachments placed on the teeth.
Required Materials and Instruments
For successful button cutouts, the following materials and tools are necessary:
- Phosphoric acid (35%)
- Orthodontic resin for bonding
- Ceramic or plastic button for anterior teeth (to maintain aesthetics)
- Metal button for posterior teeth
- Aligner hole punch plier
- Elastic band
- 1/4" bands is recommended for most cases by Dr. Brian Gray, but is dependent upon the space between buttons
- Clear aligner
Procedures for Class II or Class III Correction
- Aligner Modification (optional): Start by modifying the aligner to accommodate the buttons. Utilize a hole punch plier or an acrylic or diamond bur to create a semi-circular cutout at the gingival margin above the upper canine and lower first molar, where the buttons will be attached.
- Tooth Preparation: Follow conventional etching and bonding protocols. Apply phosphoric acid to etch the targeted areas on the teeth, rinse thoroughly, and dry using an air/water syringe.
- Button Placement: Affix the button to the cervical third of the clinical crown, ensuring it is close to the gingival margin and centered on the tooth.
- Elastic Placement: Insert the modified aligner and attach the elastic between the facially positioned buttons.
- Monitoring Progress: Regularly assess the correction progress at each appointment. Continue using the elastic until the Class II malocclusion is corrected or slightly overcorrected. Plan for overcorrection during the treatment setup to minimize the risk of relapse.
Patient Instructions
- Elastics should be worn 24/7 by the patient during treatment
- It is recommended to have the patient regularly put on new elastics to maintain the proper force. Ideally, each time they take their aligners out and put them back on is when a new elastic should be used.