12.1 Bonding Attachments Protocol

The following Align Technology recommendations are suggested for a bonding attachments protocol, as summarized below and in Fig. 12.1.

• Check the adjustment of the attachment template
• Isolate with Nola dry field cheek retractor and prepare teeth: apply etching for 30 s, wash the surface carefully and then dry until the surface of the teeth become completely white.
• Use the bond on the surface of the teeth and cure it following manufacturer’s instructions.
• Apply the composite roughly in the attachment template. Clinician must use one of the composites recommended by Align Technology to prevent erosion of the attachment or debonding. SmartForces are only guaranteed with certain composites, as attachments might change their shape or surface easily if made with different brands from those tested (refer to the Invisalign Doctor Site to check suggested composite brands).
• Place the template in the mouth and apply pressure while curing the attachments.
• Remove template and remove excess composite with a bur.
• Test first aligner fit. The active bevel of the attachment must be in contact with the aligner.

Repeat the same process in the other arch.

Show the patient how to insert and remove the first aligner.

Following Align Technology’s instructions on composites is strongly advised, as they have been previously tested, and results optimised, which cannot be ensured when using other brands.¹

12.2 Interproximal Reduction Procedure

Interproximal reduction (IPR) is the term usually applied to the Invisalign technique for stripping. This is a clinical procedure characterized by the interproximal enamel reduction of the teeth.

When applied to orthodontics, the space created is used for tooth alignment in cases of crowding² and the camouflage of class II/III malocclusions with an overjet excess/lack,³