It seems recently my Invisalign cases are coming back needing more and more attachments. I know that with some of the recent improvements in their technology, the extra buttons have added the ability to do more precise tooth movements. Depending on how you feel about placing the buttons you may see this as a good thing or not. Over the years I have had my fair share of stressful attempts to place composite buttons and ones that came off quickly after delivery of the first tray. In an attempt to learn from my own mistakes I have created some systems that have streamlined the process and made a button popping loose very rare.
- Don’t work on both sides of the arch, cut the tray through the centrals and place one side at a time.
- Pre-load tray with composite and protect from the light.
- Always use isolation (cotton rolls do not count), Optragate or Isolite.
- Etch enamel with phosphoric acid for 40 seconds.
- Air abrade porcelain or apply porcelain etch ( 5% for 20 sec on eMax, 120 seconds on traditional porcelain).
- Dry with clean uncontaminated air.
- Apply Dentin Adhesive and dry.
- Seat tray.
- Apply pressure on mesial and distal embrasures with cotton pliers while light curing.
- Gently release attachment tray with a plastic instrument before removing.
I hope some of these ideas are helpful and I’d love to hear any others that have made this process more predictable.