A take a look at how the Invisalign Specifix Attachment System helps root management, aligner engagement, and therapy effectivity whereas simplifying attachment placement and elimination.
By Manal Ibrahim LaVacca, DDS
Attachments are generally used throughout clear aligner orthodontic therapy to enhance management of advanced tooth actions equivalent to anterior extrusion, posterior intrusion for open-bite correction, canine rotation, and root uprighting throughout area closure or implant web site growth. Widespread points related to composite attachments fashioned utilizing a thermoformed attachment template embrace overfill, underfill, voids, and formation of composite flash. Composite attachments additionally require cautious shade matching for optimum esthetics and should chip, stain, or put on down throughout therapy, which may compromise their look and efficiency. For a lot of sufferers, seen attachments on the anterior enamel can even scale back the esthetic enchantment that makes clear aligner remedy engaging.
The Invisalign Specifix Attachment System is a 3D-printed attachment answer that makes use of attachment positioners to precisely place attachments to the exact form, dimension, and correct location per the physician’s digital ClinCheck therapy plan. This supply mechanism eliminates the necessity to fill an attachment template with composite, so aligner adaptation points associated to template overfill and underfill are not an issue.
The Specifix attachment materials is esthetic and designed to optimize aligner engagement whereas mixing in with the underlying tooth shade. The result’s a good steadiness between perform and look for sufferers who require attachments on their enamel throughout their Invisalign therapy. In our expertise utilizing Specifix attachments, the medical workflow has been streamlined, requiring fewer steps and simplifying therapy course of.
Having handled greater than 6,000 clear-aligner sufferers throughout a variety of case complexity, our apply may be very aware of the challenges related to bonding and eradicating standard composite attachments. As an educator and advisor for Align Know-how Inc, I have handled a whole lot of Invisalign instances utilizing the Invisalign Specifix attachment system in the course of the technical design evaluation.
Case 1
The chief concern of this 49-year, 1-month-old male affected person was a maxillary diastema and an anterior open chew. He offered with bimaxillary protrusion, proper and left Class I canine and molar relationship, a reasonable anterior open chew, unfavorable overjet, slim arch kinds, mesially-tipped maxillary central incisors with divergent roots, maxillary midline frenum with midline diastemas in each arches, and a mandibular midline shift to the precise.
The therapy plan was to shut the anterior open chew utilizing Invisalign aligners with vertical rectangular Specifix attachments on U 5-5 to extrude the maxillary incisors and upright the maxillary central incisor roots. Lingual vertical rectangular attachments had been prescribed on U 3-3 to supply extra root management of the anterior phase.1 IPR was deliberate on L 4-4 to retract the mandibular incisors and create optimistic overjet. IPR between the U1s was deliberate to broaden the interproximal contact space and assist camouflage the poor interdental papilla.
Case 2
A 13-year, 6-month-old male affected person offered with a chief concern of spacing within the decrease arch attributable to a congenitally lacking mandibular left lateral incisor. He had a Class I molar and canine relationship on the left and proper, a reasonable deep overbite, reasonable elevated overjet, and a mandibular midline shift to the left because of the lacking decrease incisor.
The therapy plan was to idealize area for a resin-bonded bridge after which a dental implant and crown after his development was accomplished. To right the deep chew, the higher and decrease incisors can be intruded, so attachments on the canines and premolars had been prescribed to forestall vertical disengagement of the aligners throughout intrusion. IPR on U 2-2 was deliberate to cut back the anterior overjet. IPR between L1s was deliberate to optimize the interproximal contact space and scale back the obvious papillary deficiency.
Specifix attachments had been prescribed on the decrease incisors for root management. Lingual vertical rectangular attachments had been prescribed on LL1, 3 and UL2, 3 to boost root management and aligner coupling within the anterior area.1 Aligner cutouts for bonded buttons had been prescribed on U4, 5 (lingual) and L6s (buccal) for Class II elastics to enhance the overjet.
Dialogue
With out good root management of the incisors, the enamel would are likely to tip fairly than translate. Within the two instances offered, the specified root angulation was achieved within the anterior enamel after 12 months of therapy, and wholesome root morphology was noticed within the progress panoramic radiographs. The deliberate tooth actions gave the impression to be absolutely expressed, as demonstrated by the shut correspondence between the medical final result and the deliberate final result within the ClinCheck therapy simulation. The aligner adaptation throughout therapy has additionally been glorious.
In Case 1, the affected person efficiently underwent a laser frenectomy and is presently finishing orthodontic refinement with extra aligners. This section consists of IPR of the maxillary central incisors to maximise the interproximal contact space, plus IPR and retraction of the mandibular incisors to resolve heavy anterior contacts. The attachments had been left in place to make sure continued root management of the anterior enamel.
The affected person was extremely glad with the therapy effectivity and the speedy progress towards his therapy objectives. He had not realized how a lot closing the open chew and eliminating the spacing would enhance his self-confidence and smile esthetics. He additionally reported improved perform, which shocked him as a result of he had not realized his chewing means had been compromised. The staff noticed this affected person’s progress at how effectively the deliberate actions had been expressed and the way effectively the aligners match at every go to. The Specifix attachments didn’t stain all through the whole course of therapy, which galvanized all of us. They are going to be eliminated and Vivera retainers will likely be delivered as soon as the affected person completes his last 4 aligners.
Case 2: The affected person’s aligner match at 8 months of therapy (prime) and with the pontic area within the decrease aligner stuffed in for improved smile esthetics (backside). On the preliminary aligner supply appointment, we offered the affected person with a pontic-material equipment together with directions on tips on how to fill within the aligner pontic as wanted all through therapy.
In Case 2, the affected person was not conscious that he was lacking a tooth and was initially hoping to shut the mandibular anterior spacing. After studying that closing the areas would deepen the overbite and enhance the overjet, he agreed to create an area for a prosthetic alternative. Because the area was reopened, he instantly appreciated the development in his occlusion and perceived that his chew was functioning higher.
We had been impressed by how quickly the midlines aligned and smile esthetics improved. Evaluation of the basis positions utilizing CBCT revealed that the incisor roots adjoining to the edentulous web site had been in a super place for future implant placement. A resin‑bonded bridge with wings cemented to the adjoining enamel will likely be positioned first, adopted by supply of Vivera orthodontic retainers instantly thereafter. As soon as the affected person’s craniofacial development is completed, an implant-retained restoration will likely be positioned to definitively change the lacking incisor.
Throughout our apply, Specifix attachments have been effectively obtained by sufferers, medical doctors, and staff members alike, reflecting optimistic experiences with dealing with esthetics, streamlined workflows, and general therapy outcomes.
Our Invisalign sufferers say that the Specifix attachments are barely noticeable and really feel easy and cozy. They mix effectively with the pure coloration of the affected person’s enamel, and they’re stain-resistant in the course of the course of therapy due to the absence of composite flash.
For our staff members, a definite benefit of Specifix attachments is the less complicated supply course of in comparison with inserting composite attachments with a thermoformed template. Since Specifix attachments are 3D printed and packaged in ready-to-bond attachment positioners, our instrumentation for bonding attachments has been drastically decreased. Minimal clean-up is required after bonding Specifix attachments, and composite flash formation on the base of the attachments is not a problem since it’s not used.
As with most dental bonding procedures, one of many keys to environment friendly and profitable bonding of Specifix attachments is dry subject isolation. Moreover, it is very important keep away from adhesive contamination of the attachment positioners, the breakaway options, and the frames that join the attachments to the jig. The adhesive needs to be brushed onto the attachment base instantly earlier than seating the positioning jig, and never forward of time (ie, don’t place adhesive on the Specifix attachments earlier than the affected person arrives). We use a 1-mm superfine micro brush to make sure correct and constant placement of the bonding agent. We additionally don’t mild remedy the brushed adhesive earlier than seating the attachments, as a result of we wish the adhesive layer to be as skinny as attainable for optimum dimensional accuracy of the bonded attachment.
Removing of Specifix attachments is a fast and straightforward process. We favor eradicating Specifix attachments utilizing angled bracketelimination pliers that are designed to soundly debond orthodontic brackets in a single piece. In our expertise, this instrument performs fairly effectively for eradicating Specifix attachments.
Abstract
We’ve noticed that Invisalign Specifix attachments are designed to ship sturdy, dimensionally secure attachment surfaces that optimize aligner engagement from begin to end. The fabric blends effectively with the affected person’s pure tooth coloration, preserving glorious esthetics all through Invisalign therapy.
This innovation of 3D printed attachments to the exact form, dimension, and correct location per the physician’s ClinCheck therapy plan ends in a streamlined bonding workflow with no composite flash clear up.
On the completion of therapy, the attachments may be eliminated cleanly and effectively with angled bracket elimination pliers. OP
Photographs courtesy of Dr Manal Ibrahim LaVacca.
- Producer’s notice: Lingual Specifix attachments are usually not out there on the time of this publication, however an attachment template will likely be offered if these are a part of the affected person’s therapy plan.
Manal Ibrahim LaVacca, DDS, is a Diplomate of the American Board of Orthodontics and a twin‑skilled specialist in prosthodontics and orthodontics. She based Modern Orthodontic Facilities in Illinois and, together with her husband, prosthodontist Anthony LaVacca, DMD, MS, FACP, FICOI, co‑based Modern Dental Companions, a multispecialty group offering prosthodontic, pediatric, normal, and specialty care. She earned her dental and prosthodontic levels from the College of Illinois and accomplished her orthodontic coaching at New York College. Ibrahim may be reached at: [email protected]
