Are Attachments Really Needed for Evenly Clear Aligners?

Are Attachments Really Needed for Evenly Clear Aligners?

Dr. Wayne Hickory, DMD, MS, MDS By Dr. Wayne Hickory, DMD, MS, MDS Thu, Mar 21, 24

Patients love Evenly clear aligners because they are effective and convenient. We use attachments, which are tooth-colored bumps bonded onto the teeth to give better grip and help us properly straighten teeth with clear aligners.

Why Evenly Uses Attachments

For experienced practitioners, aligners typically outperform braces, since old school braces just can’t compete with the high-tech computer modeling of our aligner system. However, aligners have one potential challenge. Since they are not bonded to the teeth like braces, they can lose grip for certain types of movement. We use the attachments, which are bonded to the tooth easily and precisely using a template, in conjunction with a corresponding bubble in the aligner, to give the aligner a handle on the tooth.

Evenly has taken attachments to another level. Some attachments are even “optimized” because their size, shape and position is uniquely designed for each tooth by proprietary software. Also, the bubble in the aligner is designed to have an activation built into it. This enables the aligner to put a three-dimensional force on the attachment leading to very precise tooth movement. Importantly, while some attachments are on a tooth to facilitate its movement, other attachments are used as anchors to move other teeth. This means teeth that you don't want to move, may have attachments to aid in the movement of other teeth.

How Evenly Attachments Work

Each attachment helps the aligners fit well and resist any tendency to slip, but some are more important than others are. If aligners start fitting poorly, the non-fit will typically get worse until the aligners need to be remade, greatly extending treatment time and compromising the quality of the result. Therefore, there has been a tendency to use increasingly more attachments.

In addition, some types of tooth movement are more prone to aligner slippage than others are. For example, rotating a tooth or bringing an upper incisor down are examples of movements that will not track without attachments. Without attachments, aligners on these teeth will slip, much like trying to grab a watermelon seed with your fingers.

We don’t hear many concerns about attachments on the lower teeth or upper back teeth. The upper front six teeth, “the social six,” are a different story, because while attachments are tooth-colored, they are not completely invisible. Some patients want to use all the aligner features to get the best result as efficiently as possible, while other patients have a desire to minimize attachments. An experienced doctor will evaluate if an attachment is worth any possible inconvenience while understanding the patient’s preferences. An experienced doctor will know which attachments are helpful versus which ones are critical and should educate and guide the patient to make the best decision for their individual needs.

Some patients also recognize that they will only wear their aligners at home or at night, and attachments compensate for less than full-time wear. Committing to only nighttime wear and declining attachments will make it doubly challenging to achieve a great result in a reasonable time-frame. 


Advanced aligner systems consist of aligners and attachments, just like braces systems consist of brackets and wires. While patients should discuss their preferences with their orthodontic professional, for best results, it may be best to leave the final decision to a doctor with significant aligner experience.

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