Effect of Clear Aligner Attachment Design on Extrusion of Maxillary Lateral Incisors

Attachments are small tooth-colored shapes that are bonded (attached) to teeth before or during treatment with clear aligners. They are like handles, giving aligners something to gently push teeth into correct positions. There are 4 different shapes of attachments that are commonly used to extrude lateral incisors (incisally-beveled, gingivally-beveled, optimized and horizontal). All 4 of these attachments are successful in extruding lateral incisors but there is not enough research evidence to know for sure which attachment would be ideal for a specific circumstance.

Inclusion criteria

• Patients 16 years or older to be treated with either Comprehensive Invisalign or Invisalign Teen,
• Maxillary lateral incisor requiring 0.3 mm or more extrusion (as determined by ClinCheck),
• Maxillary arch with less than 6 mm of crowding or spacing,
• All teeth present and fully erupted (excluding third molars).

Exclusion criteria

• Presence of anterior crossbite
• Any missing teeth in the maxillary arch
• Treatment plan includes surgery or extraction of any maxillary teeth,
• Maxillary lateral incisors with pathology or large restorations (crowns)
• Maxillary lateral incisors have a less than 0.3 mm of extrusion prescribed in the Tooth Movement Table on the Invisalign ClinCheck