The Infamous Attachments

No aspect of Invisalign treatment inspires more trepidation than the tooth attachments, also called buttons or bumps. I experienced more than a smidgen of trepidation myself. Last Tuesday, after five weeks of wearing the aligners (three of those with aligners that had the attachment wells, or “bumps”), I finally got my attachments put on my teeth!

Before I go into details about the attachments and the process of getting them on, let’s flash backward to my first week of “bumpy” aligners. I related in my last Invisalign blog that I had mixed feelings about the aesthetics of the bumpy aligners. In the meantime, I’ve gotten pretty much accustomed to them, aesthetically. People don’t really seem to notice. Most of the time, when the subject of my Invisalign treatment comes up in conversation among people “in the know” (i.e. people who I’ve told about the treatment), people can’t tell whether the aligners are in or not, and don’t notice the bumps until I specifically point them out. In fact, my orthodontist’s assistant had me flat on the dentist chair and under the lights, ready to prep me for the attachments, when I said, “Should I take my aligners out?”

Attachments With Aligner OnThe biggest hurdle I faced the first week of my bumpy aligners was mouth irritation. My mouth, being unaccustomed to bumps on my teeth, got irritated at the places on the inside of my lips where the bumps rubbed against them (for some reason only on the right side of my face). I got canker-like stores and it took about five or six days from the start of the irritation for it to heal, and luckily I didn’t have the attachments actually on my teeth, so I could take my aligners out during periods of heavy conversation to keep them from getting further inflamed (unlike actual canker sores, they felt fine when the aligners weren’t on). And so, my mouth had the opportunity to get accustomed to the bumps without a 24 hour barrage of irritation.

Also in the time since my last blog, my orthodontist posted the animation of my treatment projection. Check it our here.

Now I come to my appointment Tuesday where I got my attachments. I was in the middle of aligner three, which was good, but not typical. Because my orthodontist was on vacation last week I had to wait five weeks rather than four to get my attachments. As a result, I was fully adjusted to the present aligner, so I don’t have to deal with getting used to a new aligner on top of the addition of the attachments.

I had more or less resolved myself to getting all the attachments, even the one on my right eye tooth that I find most aesthetically bothersome. Good thing, too, because the first chance I had to talk to my orthodontist, my mouth was already trussed up with all the appliances for keeping my mouth open and lips peeled back during the attachment application.

The procedure for getting the attachments on was really no big deal. Many Invisalign bloggers online seem to weather this experience with much physical and emotional trauma. I don’t get what the big deal is. They propped my lips open with plastic spreaders (not something I’d like to wear every day, but by no means uncomfortable for the space of 15 minutes). The orthodontist’s assistant cleaned the surfaces of the teeth where the attachments would be put on, inserted pads and suction to absorb excess saliva. She tried to put in a tongue guard to keep my tongue basically caged up, but I couldn’t bite down with it on, so she took it off and basically told me just to keep my tongue out of the way, which I did with little difficulty.

The assistant then did some mysterious preparatory things including, I believe, putting glue on my teeth. Then the orthodontist came in, literally put them on (via a template which is fundamentally a softer version of my current aligner) then left again. I respect his wanting to be involved and being the one to “put on the attachments” officially, but I think the assistant probably could have handled sticking these templates on my teeth. From there she “cured” the attachments with some manner of light on a small hand-held wand. Once my attachments were properly cured, she removed the template and set to cleaning up the glue. This is the only part of the process that I could imagine anyone would find unpleasant, but unless one has a severe dental phobia, I can’t imagine why. She used some manner of vibrating instrument to clean away the excess glue that got between my teeth and other places it shouldn’t been. Interestingly enough, they glue was not cleaned off the outer fronts of my teeth, leaving my teeth feeling a little rough; she said it would come off bit by bit as I brushed my teeth and took the aligners on and off. She also polished my attachments so to smooth out rough edges. I was told that they would smooth ever further as I take my aligners in and out.

Attachments Without Aligner OnAll in all, no where near the traumatic process that so many bloggers have bemoaned. At no time did I experience any discomfort above and beyond that of an ordinary teeth cleaning.

Now for the aesthetic issue. First of all, I had a minor misunderstanding about what the attachments would look like. When the orthodontist originally told me that they use “clear” material for the attachments, I pictured clear like glass. Well, this “clear” material is actually a “foggy” clear so that it appears to match your tooth color while still looking like a part of your tooth. On the upside, it blends in fairly well, and doesn’t look like a glass bead on my teeth (which I had imagined). On the downside, it is opaque-ish, and so you can easily catch sight of it when you catch it on a side angle, rather than looking at it straight on.

The bottom line is, it looks less obvious that I expected with my aligners off, and it is a little more visible when the aligners are on, but not really that much more than when the bumpy aligners were on my bare teeth. The aligners fit a little tighter with the attachments, and it is a bit harder to get them off (I broke the tip on one of my retainer “outie” tools trying to pop the bottom ones free). They certainly aren’t the “vice grip” one Invisalign patient described in my online research. My experience leads me to the conclusion that most Invisalign bloggers are either overly dramatic or woefully misinformed about their treatment such that all of these events prove to be so shockingly traumatic.

It strikes me that a lot of Invisalign patients who blog or comment online really overemphasize the bad parts of this process. Many times these “traumatic events” are the results of bad research (“OMG I never heard of these attachment things before my doctor put them on!”); in this day and age of the Internet, you have no excuse not to do extensive research before making a decision to undergo an expensive, cosmetic, medical procedure. I’ve known fundamentally what to expect at every stage of the game, with the exception of the Aligner Chewies (which are, frankly, one of my favorite parts of this experience).

Invisalign Attachment Side ViewMost of all, especially in regard to the attachments, people seem to be enormously self conscious. Now, I don’t claim to be a stranger to self-consciousness about the attachments; I did enough research and asked enough questions beforehand that I knew I could opt out of having attachments on my lateral incisors (the teeth on either side of my “two front teeth”). I was not at all pleased when my doctor insisted on having attachments on my top eye teeth, but now I’m glad he did insist. The attachments aren’t as noticeable as I had feared, and my eye teeth really do need rotation; the left eye tooth is one of the teeth I find most aesthetically bothersome.

This process has led me to some conclusions about human nature. We all think that people are playing a hell of a lot more attention to us than they really are. Before I started the process to get Invisalign, I never noticed people’s teeth. Now, it’s one of the first things I notice about a person (because I’m currently obsessed with teeth as a result of this process.), but the majority of people aren’t paying close enough attention to see little bumps on my teeth. Lots of people have all kinds of crazy and funky things going on with their teeth (I know, because now I pay attention), but most people are too busy thinking about their own lives, their own concerns and their own self-conscious hang-ups to scrutinize my teeth, or anyone else’s for that matter. Even if they do notice the bumps (which are a lot less visible than ANY other type of braces, including the ones that go inside your teeth), they probably won’t register the fact long enough to care. This is coming from a person who works in a profession where my teeth are extremely visible. I talk and smile with people at close range when I’m dancing, and that’s a whole lot more teeth visibility than most people experience in their daily lives. If people don’t notice my attachments, whose are they going to notice? Perhaps if you need attachments on all your top front teeth, but again, they are so much less visible than even clear braces!

And so, in the wake of getting my attachments, I have taken a decidedly “embrace my braces!” attitude. As I mentioned above, I got my attachments put on halfway through my time wearing the third aligner. My teeth had already gone through the initial move, stopped aching and had grown accustomed to the third set when I got the attachments put on. After a day with the attachments and the same aligner, my left eye tooth (the protruding one) was hurting anew, so I know the attachments are doing important work that the aligners could not accomplish on their own. Again, this pain isn’t some excruciatingly traumatic event, it’s just initial soreness that abates after a day or so.

In sum, attachments aren’t as bad as everyone makes them out to be, most people aren’t paying as much attention to your teeth as you think they are, and I feel like I’m finally a full-fledged Invisalign patient! It doesn’t get any worse from here.

28 thoughts on “The Infamous Attachments

  1. Thanks for your blog. I got my attachments last week and have been curious to think what everyone else thought about them.

    I worry about people seeing them but hardly anyone has even noticed them.

  2. Hi Sarah-
    Thank you for your blog. I agree with you,no one really has noticed my aligners or attachments, and I had attachments on one of my front teeth. I knew about the attachments but my treatment over all will be done in 25 aligner sets, which i think is about 11 months time. That is not bad at all considering how many things I want changed to have my teeth look the way I have always wanted.
    My one question, which you mentioned earlier in a post, one of my aligners is rubbing against the inside of my mouth and causing a “cranker” like sore. Is there anything I can do to help this? Or will it just ware down in time or my mouth will get used to it?

    Thanks for letting us in on your journey, it is nice to read what is about to come.


  3. In my experience, the attachments will wear down over time as you take the aligners in and out. I had the same issue when I first got my attachments, but as they wore down and my mouth “toughened up,” it wasn’t a problem. I also swish with hydrogen peroxide as part of my regular cleaning regimen, so you might find that helps as well.

  4. I’m interested if your story and others. I started my treatment with invisalign in late February. I met with the Dr. at my consultation and then I have worked with the assistant since. Once I got the buttons put on, I had trouble keeping my upper aligner up. It never felt like it fit right. I would pose a question at the appointment but the assistants always said it was ok. The assistants always put the buttons on and gave me my new trays as I never saw the Dr. In July, the Dr. came to the appointment and went on a rant that I was non-compliant with the wearing of the trays as they were not fitting right. He was very rude! He threatened to charge me for new trays and went on and on. I started a new set for my upper trays. I have had my new trays on for 7 hours and I have already lost 2 buttons.

    Do you always see the doctor? Does the assistants ever do the buttons and give you your new trays?
    Thanks for all of your help!

  5. My first question is: How is your orthodontist rated on Use the “Find a Doctor” search for your area and find out. My orthodontist is an Elite provider, and my advice is always to use one if you have one in the area. My experience with my doctor has been great, but when I was first researching Invisalign, I read about a lot of experiences that weren’t so great. Most bad experiences I’ve read about come from providers who aren’t rated, or even who are dentists, not orthodontists.

    Next question: Do they give you aligner chewies? When my trays didn’t fit too well, I always found that gnawing on the chewies solved the problem. Sometimes it took 15 to 20 minutes of chewing, but I always got them to fit.

    I have lost attachments in the past. I called my orthodontist’s office and they simply made an appointment for me to get them put back on. I always see my doctor at least briefly when I come in for any appointment. He does put the attachments on, but it’s really sort of ceremonial, as the assistants do all the prep and curing; he just sticks the trays in and holds them for a second.

    It sounds like your office isn’t very customer-service oriented. I would encourage anyone considering Invisalign to assess the customer service value of your orthodontist’s office upon first consultation. Get second opinions so you can compare.

  6. Hi Shelly and Sarah-
    I wanted to weigh in on this as well. I have always seen my doctor, Sarah was right that I spend most of the my time with the assistant, however I always see the doctor and he checks the aligners, attachments and looks at my mouth and teeth. I absolutely love both the assistant and doctor and would find a new provider if I didn’t.
    My aligners are tight with every new set and I do use the chewies with the new sets but the aligners do go on., sometimes reluctantly, but the go all the way on. I have had a great experience, other than the soreness and a few mouth sores when I first got the attachemtns but otherwise it has been great. But I have to say that I don’t know that it would be such a “great” experience if I didn’t like and trust my providers. I have not lost an attachment, but they told me it could happen and to call and they would have me come in to put it back on, so far I have been lucky.
    Shelly- good luck and maybe consider a new provider if you have that option.
    Sarah- I have really enjoyed your blog and found it so helpful along my invisalign journey. I still have a ways to go, but am seeing results which makes me happy!

  7. What a refreshing view. I just got my first Invisaline on top and bottom today. Included were 12 attatchments. He also drilled between teeth instead of pulling them. Lots of food gets stuck between the teeth now. I wonder how much weight I will lose due to the eating hassle. What are the easiest choices ? Salad was a nightmare, I will have the most trays he’s ever done.

    • Admittedly, I did avoid eating in front of people when I could because food got stuck in my teeth more often. Most dates were for drinks, not dinner. I actually lost no weight at all due to the Invisalign. I was never a big snacker to begin with, and I found that I just packed more “punch” into the time when my aligners were out and I could eat.

  8. I got attachments yesterday after 3 weeks without and it is AGONY taking my trays out and ESP bad putting them back in with attachments. Maybe it will get better BUT at this point of time it is so so sore I dont want to eat. Not to mention when I do eat the attachments get in the way when I bite so pull my teeth making even more pain.

    • I’ve gathered that some people experience more tooth pain than others. I always had pain at the beginning days of a new tray, but only one time in the whole process did I have pain that could have been described as “agony.” Your teeth with the attachments on them will hurt more than the other teeth. If the pain is that bad, perhaps you should ask your orthodontist, or even your primary care physician, for a prescription painkiller to take during those initial days. Last month, I had some painful but minor issues with my right wisdom tooth (I have two on the bottom) and the Ibuprofen 800’s my doctor perscribed me were a god-send. They worked even when Tylenol with Codeine did not.

      With time, your attachments will wear down a bit and not get in the way as much when you eat. Still, I was admittedly more self-conscious when I ate in front of people during my time with the attachments. I was always quick to suggest meeting a date for drinks, rather than dinner, until I got to know a person and was able to explain the Invisalign.

  9. Sarah,

    Thank you for your wonderful blog. I got attachments today and this is only my 2nd tray. I have many attachments on upper and lower. Some of them in the back are extremely sharp and I couldn’t eat today. I’m going a way for a week so I’m concerned but… it’s done and I have to see how I feel the next few days. I’m hoping when I get back I could maybe ask my orthodontist to smooth out some of the sharp ones…. not only eating was horrible, just to take off aligned… it’s like I have small rocks all over my mouth. I’m very nervous about the next few days… I almost want to cry… I’m hungry.. lol I appreciate your blog… feel somehow encouraged…

    Thank you


    • Certainly, ask your orthodontist for help if they continue giving you trouble. But the attachments should smooth out on their own — taking the aligners on and off will eventually wear down the sharp edges. If you’re really having a lot of trouble eating, try something liquid like milkshakes or smoothies or creamy soup.

  10. Thank you so much for your support.

    I feel that my dentist should have been more conpassionate and informative after giving me those attachments. This experience is not easy and I’m someone who is not a cry baby… I’m starting to get used to it a little but it’s because I have to haha.

    Thanks again!

    • I don’t know what sort of Invisalign experience your dentist has, so I can’t speak to that… but in all my research a lot of the not-so-great experiences I’ve read about have been reported by people who got treatment from a provider without a high Invisalign rating. lets you search providers in your area and see how Invisalign rates them (based on the volume of work they have done over the years, thus how much invisalign-specific experience they have). I went with an Elite provider (who has since become at Top 1% VIP provider), and I recommend everyone who can do so find an Elite provider. If not, then one with the highest rating in your metro area. It seems like provider experience makes the biggest difference in patient experience.

  11. I’d like to get Invisalign fitted but would like to know if providers can assess where attachments would be likely to go before signing up and paying for the
    treatment, so I can be prepared. Has anyone been able to do that?

    • My Elite Provider offered a complimentary consultation before committing to treatment. He was able to tell me where the attachments would be during that consultation. But when I got my second round (called refinements) the attachments were different. In general, my advice is don’t worry too much about attachments. Before Invisalign, I was convinced that my aligners and attachments would be so obvious to everyone looking at me, but very few people noticed. A few people noticed, but they generally just said, “Good for you!” when I explained I was wearing Invisalign. The Invisalign experience taught me that people really aren’t paying as much attention to the subtleties of your appearance as you think they are.

  12. Reading these comments has made me nervous (not too much, just a little. Well, more curious, I guess). I went to the orthodontist that my dentist recommended for Invisalign, but he’s not listed as a provider on the Invisalign website. Is this because maybe they need so many cases before they can be listed? He seems great and I have had no problems. He and his staff are extremely professional, knowledgable, and friendly. I’m just thinking it’s weird how he is not listed as a provider on the Invisalign website. Hmm. I have had Invisalign since late October and everything is going really well, but tonight as I was brushing and flossing I noticed that it looks like a food particle made it’s way under the attachment on one of my front teeth (of course, front and center!). It was not there earlier today. At first I thought it was just discoloration of the attachment (I don’t know how that could happen because I brush at least 5 times a day and NEVER put my aligners in without brushing and flossing first), but the closer I looked, there is a very distinct line that is a different color – not the entire attachment. Has anyone else experienced this? I’m assuming it means that this attachment is loose and should be replaced so food doesn’t keep getting jammed under it? I hope whatever it is eventually makes its way out soon. My next appointment is in two weeks. If it doesn’t work it’s way out as soon as sometime tomorrow, I will be calling to go in sooner. The last thing I want is a cavity forming right on the front of my tooth! :(

    I enjoyed your post. I have 10 attachments that I got right away with my first set of aligners. They were super annoying at first, but now I couldn’t care less.

    • In all honesty, I don’t remember. It was several years ago now. My orthodontist was always very prompt and running on-time so I don’t recall any of the appointments taking an inordinate amount of time.

  13. Hi,
    Thought I would add my 2 cents worth as I have just started my second go around with the trays. 35 first time and new set for refinement 20. I will be changing them weekly so not so bad. My new buttons..none on top front (YAY) are very rough and hoping with time they will wear down a little. I actually have to put a piece of wax on my bottom front tooth (small piece of gum works too) while I eat or it digs up my lip inside..ouch. I half think my orthodontist did this to make sure I wear my trays more LOL . My process has just approached the year mark and 20 more weeks don’t seem so bad.
    I really like my orthodontist and his assistant and makes a huge difference when trying to see this through…at this price I will do it!!! :)
    Just a little insight on me and I am so grateful to be able to read this blog and check out the other invisalign warriors out there. Here’s to some great new smiles. :)

  14. Maybe the difference between your experience and the other posts you read is in the amount of attachments. It looks like you have only a few and none on your front teeth. I went in today to get my attachments and first set and had no idea how many (if any) attachments I’d be getting.

    I have 24! My top teeth are pretty straight and look fine to me but my bottom are so crooked. I have an attachment on EVERY SINGLE ONE of my top teeth and then 5 on each side on the bottom back. The process took a LONG time. I could cry right now that I felt like I didn’t even necessarily NEED anything done to my top teeth but understood that it would be likely because of bite, etc. and now I have a stupid, rough, sharp, attachment on every tooth and it definitely makes the Invisalign more obvious. I’m old to be doing this (44) and I think had known it would look like this/I’d have all of these attachments, I wouldn’t have done it.

    • That’s quite a lot of attachments. I don’t know your particular case, of course… and it’s been a number of years now since I had my treatment so they might have different strategies or approaches. They for sure have a different aligner material. The type of plastic they use for aligners changed from one on my refinements to the next. It may be even something different now. What I did do in terms of attachments is that for the first (and longest) course of treatment, I asked specifically NOT to have attachments on my four front teeth. My orthodontist told me the downsides, of course, and perhaps the overall treatment did take longer because of it, but he honored my request for the first 42 aligners. By the time I got to refinements (I had two courses of refinement), I had a lot of faith in the process and told him to go ahead and put attachments wherever he thought I needed them.

  15. This blog was very helpful to me. I am only on day 3 of my Invisalign treatment and one attachment on my lower front tooth created such a bad sore in my inside lip that I was worried something was wrong. This is clearly a common occurrence and will either pass in time, get remediated by my dentist or can be potentially handled with a bit of wax. Very reassuring on all fronts. My treatment is 22 trays at 5 days each and daily use of the the Propel Vpro 5. I am already 60 years old and am using Invisilign for non-cosmetic reasons. My bottom teeth are shifting and falling into each other changing the shape of my mouth and causing bone deterioration due to my bite shifting. Never too old to take care of yourself…

  16. Maybe I’m a little silly for not looking it up beforehand but I’m only 17 and wanted perfect teeth you know? Without the downside of braces at least. I have 3 attachments on bottom and 5 on top, I got them put in before I even started my first aligner. Day 2 right now and oh my god the sores, I’m a pansy when it comes to pain so that’s probably why. For some reason no one has mentioned the drilling.. I had spaces drilled between my teeth so that they could move, literally the worst part of the whole process because after that little electric pizza cutter she sand papered in between those teeth.. ALONG THE GUMS! I am very very sore right now I think what makes everyone so different is of course their teeth problems.

    • It’s certainly true that everyone has a different experience and different tolerance for pain. It surprises me, though, that your doctor put on the attachments and did the electric shaving of your teeth so early in the process. My orthodontist put me through at least two sets of aligners before putting the attachments on. Not only did that get me accustomed to the idea of where they would be on my teeth, but stepped me into the process slowly, rather than hitting me with all the new uncomfortable things at once. I did get some space shaved between a few of my teeth, but that was much much later in the process after my doctor had already assessed how well my teeth were moving. I’m surprised your doctor is doing everything at once.

  17. Last week my attachment ( bumps) brake off, I called and told me to go this week, now they said that next week. Because the template didn’t arrived yet. I’m confused I thought for put in new (bumps) isn’t a big deal.

    • I’ve been done with my Invisalign for several years now, so I don’t know the current protocol for what to do if attachments break off. In your position, I would probably call to inform my orthodontist, but keep wearing the aligners I do have as scheduled. The orthodontist should deal with it next time you have an appointment.

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