For information on best practices for engagers, refer to the following:

• Best Practices Overview
• Know before you go
• Preparation
  • Staff Preparation
  • Patient Preparation
• Placing Engagers
• Removing Engagers

Best Practices Overview

Engagers (also know as "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 placing engagers.

Know before you go

• ClearCorrect's technicians may recommend the use of engagers and their location, but you can always override those recommendations.
• Engager preferences are always at the discretion of the clinician and it’s up to you to communicate any necessary changes.
• Let ClearCorrect know your preferences for engagers (whether to avoid engagers on certain teeth, specific instructions, etc.) in the “Additional information” section when you submit your case or in the Treatment Preferences section in the "MyAccount" menu in the Doctor Portal.

Preparation

It's important to be prepared for appointments where engagers are being placed. The clinician or a member of the staff can take actions to prepare for these types of appointments. 

It's also vital to prepare the patient for appointments where engagers are being placed. Make sure that you talk through what engagers are, why they are being used and what the patient can expect before proceeding with placing engagers.

Staff Preparation

• Review the treatment plan sent with the case or the treatment setup in ClearPilot™ to see if engager placement is scheduled at this appointment.
• If engagers are planned, confirm that the patient or parent has signed an informed consent form.
• Prepare instrumentation as required by clinician.
• Identify locations for engagers on treatment plan.

Patient Preparation

• Fully describe engagers to the patient (and the parent or guardian, 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 patient consent before placement.

Placing Engagers

Let's look at some best practices for placing engagers. 

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 or mineral oil inside the engager bubble or void.
• Use an explorer to put a hole in the engager bubble for composite emission.
• Fill the engager bubble about 2/3 full with paste composite.
• Fill last 1/3 with flowable composite.

Finish engagers

• 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 paperwork.
• Alternatively, note the step, date and location in the patient’s chart.

Removing Engagers

Engagers can be removed at the patient’s request, 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
• Multi-fluted composite finishing burs

Following these best practices can help make the task of placing engagers quick and easy.

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