Why do so Many Struggle with Invisalign’s Optimizations?
I frequently hear orthodontists lamenting the advent of Invisalign’s optimized attachments. I think this frustration stems from several factors all of which result from an inadequate understanding what these optimizations are and how they are meant to function. To think of optimized attachments as simply little bumps on teeth made for pushing is the fundamental misconception. As opposed to conventional attachments, which are simply crude handles, optimized attachments (and features) have moved away from the old approach focused only on changing the shape of the tooth and are almost entirely reliant upon aligner forming elements in order to produce customized force systems based on the prescribed movements.
This dramatic shift in thinking has been driven by the huge piles of treatment data gathered by Invisalign, free from the observational bias of the individual. Failure to acknowledge data-driven optimizations and attachment design is simply not science based and utilizes Invisalign as an inferior product so it is important that you able to keep pace with the current best practices. We will spend some time helping you treat your patients more efficiently with Invisalign by briefly examining the Top 7 sources of operator error with Invisalign’s aligner optimizations.
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Your point and diagram in #2, regarding Placement Errors, is well taken. Unfortunately, production of flash is an inevitable consequence of Align’s ‘back-assward’ procedure for placing attachments. In every other discipline in the dental profession, it is a universally accepted tenet that one impresses or scans the prepared surface, and then fabricates a final restoration to fit the impression or scan. Only in the world of Invisalign do we scan, fabricate the final appliance, and then manually modify the scanned surface to fit the appliance.
I would be much happier with a smaller catalog of attachments that were placed BEFORE the scan, so I could be certain that the aligners would engage the attachments consistently. I have no idea why they do it this way; perhaps complexity or expense in manufacturing?
In any event, however, it is hard to get too excited about the high-order capabilities of optimized attachments given that precision Align thoughtfully built into the system goes out the window when an assistant puts a little too much adhesive in the attachment template.
Your point about the little bit of ‘flash’ is exactly right, and yet another reason for the optimized attachments to be utilized over traditional attachments. They provide specific relief so there aren’t interferences with flash (you’ll notice the aligner pocket is much larger than the attachment template). Additionally, in the occasional instances where traditional attachments need to be placed to retain elastics, etc. they should not be removed from the intra-oral scans for additional aligners (much better data capture from a direct scan of the traditional attachments).
Why not use “extrusive” attachments exclusively?
The trays cover the entire tooth surface. As long as the tooth is in maximum contact with the tray, the tray will exert the desired force on the tooth. How best to get the tooth in maximum contact with the tray? Extrusive attachment. Just make sure that the attachment is large enough to prevent it slipping out.
The optimizations are a pivot away from changing the tooth surface to changing the shape of the aligners Most of what represents an “optimized attachment” is actually not readily apparent on the ClinCheck. This is even more so with SmartStaging. The “attachment” part of Force system is not where your focus should be anymore.