Invisalign attachments are small, tooth-coloured bumps of composite bonded to certain teeth for the length of your treatment. They give the aligner something to push against, so it can rotate, tip or lift a tooth that a smooth plastic tray on its own couldn’t move. Almost every adult Invisalign case needs some. They’re planned before you start and polished off at the end.

They’re also what patients ask about most once treatment starts. The aligner is nearly invisible, but the attachments are the bit other people might notice up close. Below: what they feel like, and what to do about stains, attachments that come off and the other practical bits.

Each aligner is made slightly ahead of where your teeth are now. The plastic flexes back towards its intended shape and pushes the teeth with it. On a flat, smooth tooth that push can only do so much. Rotating a rounded tooth like a canine, pulling a short tooth down into line, or tipping a root rather than just a crown all need a handle for the aligner to grip. The attachment is that handle.

Each attachment has a specific shape (rectangular, bevelled, sometimes wedge-like), chosen by the software and checked by your dentist for the movement that tooth needs. A tooth that only has a small, simple move to make often needs none. A tooth doing the heavy lifting may need one. So two people on the same package can have very different numbers of them.

Up close, yes, a little. They’re matched to your tooth colour and a few millimetres across, so at normal talking distance most people never notice them. With the aligner in, they’re covered and look like part of the tooth. In a flash photo, or if you point them out, you can see them. Attachments on the back teeth are effectively invisible. The ones on the upper front teeth are the ones you’ll be aware of.

Two things help. They’re tooth-coloured, so they blend in better the closer the shade match. (That’s one reason your included Boutique whitening is done after treatment, once the attachments are off, so the final shade is even.) And they come off at the end, so whatever you notice for a few months is temporary.

• ✓  The first few days. With the aligner out, the attachments feel rough to your lips and tongue, and you’ll keep running your tongue over them. That settles within a week. A little orthodontic wax helps if one is rubbing.
• ✓  Seating the aligner. Attachments make the aligner grip harder, so it needs pushing fully on and can be stubborn to remove at first. Bite on your Invisalign chewies for a few minutes after putting in each new set so it seats properly over the attachments. A poorly seated aligner is the most common reason a tooth falls behind the plan.
• ✓  Eating. Aligners come out to eat, so the attachments take the brunt. They’re tough, but biting into something hard directly on a front tooth with an attachment can knock it off.
• ✓  Staining. Composite picks up stain more readily than enamel. Coffee, tea, red wine, curry and smoking will yellow attachments over months. Rinse after eating and brush before the aligners go back in, and they’ll stay clear. Any stain on an attachment polishes off at the end anyway.
• ✓  Cleaning. Brush around and over each attachment; plaque collects at the edges. Your included Airflow hygiene clean deals with anything you miss.

Attachments do come off now and then, usually on food. Keep wearing your aligners as normal (the plan still works on every other tooth) and message us. We’ll tell you whether it needs replacing before your next review or can wait until you’re in. What we want to avoid is an attachment doing an important job staying off for weeks, because that tooth can fall behind. Replacing one is a short appointment and there’s no charge for it; attachments, refinements and reviews are all part of your package price.

At your final visit each attachment is carefully removed with a fine polishing bur and the enamel surface is polished smooth. It takes a few minutes per tooth and doesn’t hurt, though you may notice a faint vibration. There’s no drilling into the tooth and, done properly, no lasting mark, because the bond is to the surface of the enamel, not into it. Your teeth will feel oddly smooth for a day or two. Then it’s scans for your retainers, your fixed wire goes on, and you get the whitening you’ve been waiting for.

• → Invisalign in Edgware — our three fixed prices and what’s included
• → Does Invisalign hurt? Week by week
• → The 22-hour rule
• → What is IPR in Invisalign?
• → How long does Invisalign take?
• → Invisalign monthly payments

If you’re local to North London, our Invisalign in Edgware page explains the consultation, the iTero 3D scan and your package options.