Attachments only work if they're accurately shaped and stay bonded for the whole treatment. Most attachment failures trace back to a handful of chairside steps. This protocol covers the essentials; always follow the instructions for the specific materials you use.
Before you start
- Confirm the template tray fits and the attachment wells are clean.
- Check which teeth receive attachments against the approved plan.
- Identify any restorations that need a material-specific bonding protocol.
Step-by-step protocol
1. Clean
Clean the bonding surfaces with pumice or a non-fluoride prophy paste, rinse thoroughly and dry. Plaque and pellicle left on the enamel weaken the bond.
2. Isolate
Use a cheek retractor and cotton rolls or other isolation to keep the field dry. Moisture contamination is the most common cause of early debonding.
3. Etch
Apply phosphoric acid etch to the attachment sites only, following the manufacturer's etch time. Rinse and dry until the enamel appears frosty. Avoid etching areas you don't intend to bond.
4. Bond
Apply a thin layer of bonding agent and air-thin it so it doesn't pool. Pooled adhesive can create excess flash and alter the attachment shape.
5. Load the template
Fill each attachment well with composite, avoiding air bubbles. Don't overfill; excess material becomes flash around the attachment.
6. Seat and cure
Seat the template fully with even finger pressure, check it's stable, and light-cure each attachment according to the curing light and composite instructions, including from multiple angles if recommended.
7. Remove and clean up
Remove the template carefully, then remove flash with a scaler or finishing bur without reducing the attachment itself. Check that each attachment is complete and well defined, and that the first aligner seats fully.
Choosing a composite
| Option | Advantages | Considerations |
|---|---|---|
| Packable or paste composite | Holds shape well and resists wear | Harder to load without voids |
| Flowable composite | Easy to load into wells | May wear faster and slump before curing |
| Composites marketed for attachments | Designed for template loading | Follow the specific handling instructions |
Choose a shade that blends with the teeth, and consider stain resistance for attachments on visible teeth.
Bonding to restorations
Porcelain, zirconia, metal and composite restorations each need their own surface preparation — typically roughening plus a material-specific primer, such as silane for glass ceramics. Follow the primer manufacturer's protocol and protect soft tissues.
Replacing a lost attachment
Keep the template tray. A missing attachment can be rebonded chairside using the same steps, which is usually quicker than waiting for a new template.
Infinity Aligner certified providers receive attachment templates with applicable cases and can contact our clinical team with bonding questions.
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