Attachments for the Orthodontic Aligner Treatment-State of the Art-A Comprehensive Systematic Review

Int J Environ Res Public Health. 2023 Mar 2;20(5):4481. doi: 10.3390/ijerph20054481.


Background: In recent years the burden of aligner treatment has been growing. However, the sole use of aligners is characterized by limitations; thus attachments are bonded to the teeth to improve aligner retention and tooth movement. Nevertheless, it is often still a challenge to clinically achieve the planned movement. Thus, the aim of this study is to discuss the evidence of the shape, placement and bonding of composite attachments.

Methods: A query was carried out in six databases on 10 December 2022 using the search string ("orthodontics" OR "malocclusion" OR "Tooth movement techniques AND ("aligner*" OR "thermoformed splints" OR "invisible splint*" AND ("attachment*" OR "accessor*" OR "auxill*" AND "position*").

Results: There were 209 potential articles identified. Finally, twenty-six articles were included. Four referred to attachment bonding, and twenty-two comprised the influence of composite attachment on movement efficacy. Quality assessment tools were used according to the study type.

Conclusions: The use of attachments significantly improves the expression of orthodontic movement and aligner retention. It is possible to indicate sites on the teeth where attachments have a better effect on tooth movement and to assess which attachments facilitate movement. The research received no external funding. The PROSPERO database number is CRD42022383276.

Keywords: CAD; aligners; attachments; clinical effectiveness; orthodontics; position; positioning; tooth movement.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Humans
  • Malocclusion*
  • Tooth Movement Techniques
  • Tooth*

Grants and funding

This research received no external funding.