Engagers (a.k.a. "attachments" or "buttons") are composite shapes added to the teeth to
engage the aligner and assist with movements. They act like small handles for moving teeth. Engagers are often recommended when treating patients with clear aligners.
There are a number of important things to keep in mind when you need to place engagers.
Know before you go
- ClearCorrect's technicians will recommend a number and location of engagers, but you can always override those recommendations.
- Engager preferences are always at the discretion of the clinician and it’s up to you to make any necessary changes.
- Let us know your preferences in the Engagers, Avoid engagers on these teeth, and Additional instructions sections of the case submission form, when you submit your case.
- Review the treatment plan sent with the case or the treatment setup to see if engager placement is recommended at this appointment.
- If yes, confirm that the patient or parent has signed an informed consent form.
- Prepare instrumentation as required by doctor.
- Identify locations for engagers on treatment plan.
Fully describe engagers to the patient (and the parent if patient is a minor) before placing them.
Discuss possible negative side effects, including:
- Tissue awareness
- Diminished esthetics
- Possible debonding – not an emergency
- Always get signed consent before placement.
Prepare the teeth
- Use lip retractors.
- Consider using air abrasion with 50 micron aluminum oxide.
- Acid etch only the area beneath the engager.
- Thoroughly rinse off the acid etch.
- Use warm air to dry the teeth.
Prepare the templates & place engagers
- Trim the template(s) if desired.
- Put a light, thin coat of petroleum jelly, Pam, or mineral oil inside the engager bubble or void .
- Use an explorer to put a hole in the engager bubble for composite extrusion.
- Fill the engager bubble about 2/3 full with paste composite.
- Fill last 1/3 with flowable composite.
- Apply bonding agent to the etched & dry tooth.
- Place the template on the teeth and light cure.
- Remove the template and any composite flash.
- Check the fit of the new aligner.
Document placement of all engagers
- You can use the treatment plan enclosed with every case.
- Note the date of placement next to the engager graphic on the treatment plan.
- Alternatively, note step, date and location in the patient’s chart.
Engagers can be removed at the patient’s demand, but be sure to inform them that the aligners may not move the teeth as well as expected without them.
Use the same methodology as one would for removing composite restorations or orthodontic bracket adhesive:
- White stone finishing burs (will not cut enamel)
- Multi-fluted composite finishing burs (will cut enamel)
Following these best practices can help make the task of placing engagers quick and easy.