For a downloadable PDF version of this information click here.

Materials and instruments needed for button cutouts: 

	Phosphoric acid 35%
	Orthodontic resin for bonding
	Ceramic/plastic button for anterior teeth to preserve esthetics
	Metal button for posterior teeth
	Aligner hole punch plier
	Elastic band
	Clear aligner

For button cutouts for Class II correction, refer to the following:

1. Modify the aligner(s) to prepare for bonding of the buttons:

Use a hole punch plier or acrylic or diamond bur, to remove a semi-circular area of the aligner’s gingival margin above the upper canine and lower first molar, where you will be bonding buttons.

 Button Cutout above Upper Arch Canine

2. Tooth preparation using conventional etch and bonding protocols:

Etch the area on the teeth where the buttons will be placed. Rinse the acid and dry with the air/water syringe.

3. Button placement:

Bond the button to the cervical third of the clinical crowns, close to the gingival margin and centered on the teeth.

4. Elastic placement: 

Insert the aligner and stretch the elastic between the facial buttons that you placed.

Button to Button Cutouts

Slit to Button Cutouts

5. Carefully monitor the progress of the correction at each appointment.

The elastic is worn until the Class II malocclusion is corrected or slightly overcorrected. Overcorrection can be planned in the treatment setup as well to prevent relapse.

For button cutouts for Class III correction, refer to the following:

1. Modify the aligner(s) to prepare for bonding of the buttons:

Use a hole punch plier or acrylic or diamond bur, to remove a semi-circular area of the aligner’s gingival margin above the upper first molar and lower canine, where you will be bonding buttons.

 Button Cutout below Lower Arch First Molar

2. Tooth preparation using conventional etch and bonding protocols:

Etch the area on the teeth where the buttons will be placed. Rinse the acid and dry with the air/water syringe.

3. Button placement:

Bond the button to the cervical third of the clinical crowns, close to the gingival margin and centered on the teeth.

4. Elastic placement: 

Insert the aligner and stretch the elastic between the facial buttons that you placed.

Button to Button Cutouts

Slit to Button Cutouts

5. Carefully monitor the progress of the correction at each appointment.

The elastic is worn until the Class III malocclusion is corrected or slightly overcorrected. Overcorrection can be planned in the treatment setup as well to prevent relapse.

480.817_en_01