What Are Clear Aligner Attachments and Why Do You Need Them?

If you're considering clear aligners or have already started treatment, you may have heard about "attachments" — small tooth-coloured bumps bonded to certain teeth during treatment. They're sometimes called aligner buttons or buttons on teeth, and they're one of the most common questions patients ask about. This guide explains what aligner attachments actually are, why they're used, what they feel like, and how they fit into the bigger picture of clear aligner treatment.

Who This Guide Is For

This article is for UK patients who want to understand the role of attachments in clear aligner treatment. It may be particularly relevant if you:

• Have been told your treatment plan includes attachments and want to know what that means
• Are worried about aligner attachments being visible and want honest information about how noticeable they are
• Are comparing invisible braces options and want to understand the full treatment process
• Have seen terms like "buttons on teeth" or "aligner buttons" online and want a clear explanation
• Want practical tips on living with attachments — eating, cleaning, and what to expect day-to-day

Important: Whether attachments are needed, where they're placed, and what type is used are clinical decisions made by your treating clinician based on your specific tooth movements. This guide explains the general principles — your individual treatment plan will be tailored to your case.

Key Definitions in Plain English

What Are Aligner Attachments?

Aligner attachments are small shapes made from dental composite (the same tooth-coloured material used for white fillings) that are bonded directly to the surface of specific teeth. They're typically 2–3mm in size — roughly the size of a small grain of rice — and are shaped to match a corresponding indentation in your aligner tray.

When the aligner snaps over the attachments, it creates a grip point that allows the tray to apply force in specific directions that a smooth aligner alone couldn't achieve. Think of them as tiny handles that help the aligner "steer" individual teeth more precisely.

What Are Buttons on Teeth?

The terms "buttons on teeth" and "aligner buttons" are informal names for the same thing — attachments. Some patients also use these terms to describe metal or ceramic buttons used for elastic hooks (which serve a different but related purpose). In this guide, we're focusing on composite attachments used with clear aligners.

Other Terms You May Encounter

• Composite: The tooth-coloured resin material used to make attachments (and white fillings). It's bonded to the tooth using a light-curing adhesive.
• IPR (Interproximal Reduction): Removing tiny amounts of enamel between teeth to create space for alignment. Often used alongside attachments in treatment plans.
• Refinements: Additional sets of aligner trays produced after the initial series to fine-tune the result. Attachments may be repositioned or added during refinement stages.
• Tracking: How well teeth are following the planned movement sequence. Attachments improve tracking by giving the aligner better grip on the teeth.
• Retainers: Custom-made devices worn after treatment to hold teeth in their new positions. Attachments are removed before retainers are fitted.
• 3D scan: A digital impression of your teeth used for treatment planning. The scan determines exactly where attachments need to be placed.
• Bite ramps: Built-in features on the inside of aligner trays (not bonded to teeth) that help guide the bite. Different from attachments but sometimes confused with them.

Why Attachments Are Needed: The Problem They Solve

To understand why aligner attachments exist, it helps to understand the fundamental challenge of moving teeth with smooth plastic trays.

The Limitation of Smooth Aligners

A clear aligner tray is essentially a smooth plastic shell that fits snugly over your teeth. It can apply gentle pressure to push teeth in certain directions — particularly tipping movements (tilting a tooth). However, smooth plastic sliding over smooth enamel has limited grip. Some movements require force to be applied in very specific directions, at specific points on the tooth, which a smooth tray alone cannot reliably achieve.

What Attachments Add

By bonding small composite shapes to specific teeth, clinicians create anchor points that the aligner can "lock onto." This transforms what the aligner can do:

• Rotations: Turning a twisted tooth requires grip — a smooth tray tends to slide over a round tooth. An attachment provides the ledge the tray needs to rotate the tooth.
• Extrusion: Pulling a tooth downward (or upward in the lower arch) — the tray needs something to grip to apply pulling force.
• Intrusion: Pushing a tooth upward into the gum — attachments direct force more precisely for this movement.
• Bodily movement: Moving the entire tooth (root and crown together) rather than just tipping it. This requires controlled force at specific points.
• Root torque: Changing the angle of the root within the bone. One of the more challenging movements for aligners, improved significantly by well-placed attachments.

Types of Attachments

Attachments aren't one-size-fits-all. Different movements require different shapes, sizes, and placements:

Your clinician doesn't choose these arbitrarily — the treatment planning software analyses the movements needed for each tooth and recommends specific attachment shapes, sizes, and positions. Your clinician then reviews and may adjust these recommendations based on clinical judgement.

Do Attachments Hurt, Stain, or Fall Off? What to Expect

These are the three questions patients ask most often about aligner attachments. Here are honest, practical answers.

Do Attachments Hurt?

Placement: No. Bonding attachments is painless and doesn't require anaesthetic or drilling. Your clinician etches the tooth surface lightly with a conditioning gel, applies a bonding agent, places the composite using a template (provided with your aligners), and cures it with a blue light. The process takes a few minutes per attachment.

During treatment: Attachments themselves don't cause pain. However, you may notice increased pressure when wearing aligners over attachments — this is the aligner engaging with the attachment to move the tooth, which is the whole point. Any pressure typically settles within 1–3 days of starting a new tray.

Removal: At the end of treatment, attachments are polished off using a gentle handpiece. This is quick, painless, and doesn't damage the underlying enamel. The tooth surface is polished smooth afterwards.

Are Attachments Visible?

This is a legitimate concern for patients choosing clear aligners for discretion. The honest answer is nuanced:

• With aligners in: Attachments are generally not noticeable because the aligner covers them. The tray's indentations sit over the attachments, so they're hidden beneath the plastic.
• With aligners out: Attachments may be visible at close range, particularly on front teeth. They're tooth-coloured, so they blend in reasonably well, but they do create a slight texture or bump on the tooth surface that can catch light.
• In photographs: Attachments are rarely noticeable in photos, with or without aligners.
• Colour match: Your clinician will shade-match the composite to your natural tooth colour. The match is usually very good, though attachments may discolour slightly over time (see staining section below).

Overall, most patients find that attachments are far less visible than they feared. They're a significant step up from traditional brackets in terms of aesthetics, even if they don't make the treatment completely invisible.

Do Attachments Stain?

Composite material can pick up surface staining over time, particularly from:

• Coffee, tea, and red wine
• Turmeric, curry, and tomato-based sauces
• Smoking
• Coloured mouthwashes

Practical tips to minimise staining:

• Remove your aligners before eating and drinking anything other than water
• Brush your teeth (including over the attachments) before reinserting your aligners
• Use a non-abrasive whitening or stain-removing toothpaste if recommended by your clinician
• If attachments do stain noticeably, your clinician can polish or replace them at a routine appointment

Minor staining is cosmetic and doesn't affect how the attachments function. Since they're removed at the end of treatment, any discolouration is temporary.

Do Attachments Fall Off?

Occasionally, yes. Attachments can debond (come loose) if:

• You bite into very hard or sticky foods
• The bonding surface wasn't optimally prepared (rare with experienced clinicians)
• The tooth surface has particular characteristics that make bonding less reliable
• You remove your aligners by pulling from the attachment side rather than the back

If an attachment comes off, it's not an emergency — but you should let your clinician know at your next appointment (or sooner if instructed). A missing attachment means the aligner can't apply the planned force to that tooth, which could affect tracking. Re-bonding an attachment is quick and straightforward.

What Clear Aligners Can Do (and What They Can't)

Attachments significantly expand the range of movements clear aligners can achieve, but even with attachments, there are limits.

With Attachments, Clear Aligners Can Typically Address

• Mild to moderate crowding and spacing
• Tooth rotations (particularly with well-placed attachments)
• Many cases of overbite, overjet, and mild to moderate crossbite
• Intrusion and extrusion of individual teeth
• Arch alignment and levelling
• Relapse from previous orthodontic treatment

Even With Attachments, Aligners May Struggle With

• Severe skeletal jaw discrepancies (where the problem is bone position, not just teeth)
• Very large rotations of round-rooted teeth (like premolars) — these are among the least predictable movements even with attachments
• Significant vertical movements requiring substantial extrusion
• Complex multi-directional bite corrections that need continuous fixed forces
• Cases requiring extraction of premolars and large-distance space closure

Attachments make many of these movements possible with aligners, but they don't make every movement equally predictable. Your clinician's assessment will determine whether your specific movements are within the reliable range for aligner treatment.

Step by Step: How Attachments Fit into Your Aligner Treatment

How Many Attachments Will I Have?

This varies widely depending on the complexity of your case:

• Simple alignment cases: May need few or no attachments (some mild cases can be treated without them)
• Moderate cases: Typically 8–15 attachments across both arches
• Complex cases: May have 15–20+ attachments, particularly if rotations, bite correction, or significant tooth movements are needed

Not every tooth needs an attachment. The treatment plan places them only where specific force application is required. Some teeth may have attachments placed early and removed midway through treatment if those movements are completed.

Suitability Checklist: Understanding Attachments in Your Treatment

Attachments are a clinical decision, not something you opt into or out of independently. However, understanding when they're typically used can help you set expectations.

When to Seek Advice

Attachments are managed by your clinician as part of routine treatment. However, you should get in touch if:

• An attachment falls off — let your clinician know so it can be re-bonded before tracking is affected
• An attachment feels sharp or is irritating your cheek or lip — it may need smoothing
• You notice your aligner isn't fitting as snugly over a particular tooth — this could indicate the attachment has shifted or debonded
• You're experiencing persistent pain around a tooth with an attachment (some pressure is normal; persistent pain is not)
• You have questions about why specific attachments are placed where they are — your clinician should be happy to explain

Risks, Side Effects, and Limitations

Attachments are a well-established part of aligner treatment, but like any dental procedure, they come with considerations.

Common Side Effects (Usually Minor)

• Initial awareness: You'll feel the attachments with your tongue for the first few days. Most patients stop noticing them within a week.
• Mild lip or cheek irritation: When aligners are removed (for eating), attachments may rub slightly against soft tissue. This usually improves as you adapt. Orthodontic wax can help in the meantime.
• Surface staining: Attachments can discolour over time, particularly with coffee, tea, or smoking. This is cosmetic only and doesn't affect function.
• Increased aligner tightness: Aligners fit more snugly over teeth with attachments, which can mean slightly more pressure when inserting a new tray. This settles within a day or two.

Potential Risks (Uncommon)

• Attachment debonding: Attachments can come off, particularly when eating hard or sticky foods. Re-bonding is straightforward but requires a visit to your clinician.
• Minor enamel surface changes: The bonding and removal process may leave very subtle surface roughness. This is polished smooth during removal and is not clinically significant.
• Allergic reaction: Extremely rare, but some patients may be sensitive to composite materials or bonding agents. Inform your clinician if you have known allergies to dental materials.

Limitations

• Not invisible: While far more discreet than traditional brackets, attachments are not completely invisible — particularly on front teeth when aligners are removed
• Don't guarantee perfect tracking: Even with well-placed attachments, some tooth movements remain less predictable with aligners than with fixed braces
• May need repositioning: If refinements are needed, existing attachments may need to be removed and new ones placed in different positions
• Bonding challenges on restorations: Attachments may not bond as reliably to porcelain crowns, veneers, or large composite fillings

How Long Treatment May Take

Attachments don't significantly change treatment duration — they're there to ensure movements happen correctly, not to speed things up or slow them down. Treatment timelines depend on case complexity.

What Affects Treatment Time?

• Case complexity: More complex movements (requiring more attachments) generally correlate with longer treatment
• Compliance: Wearing aligners approximately 22 hours per day is essential — attachments can only work when the aligner is engaged with them
• Refinements: Most moderate-to-complex cases need one or two rounds of refinement trays, adding 2–5 months per round
• Attachment loss: If attachments fall off frequently, it can delay treatment by compromising tracking
• Biology: Individual variation in how teeth respond to orthodontic forces

Costs in the UK: What Drives Price

Attachments are almost always included in the overall aligner treatment fee — they're a standard part of the process, not an optional add-on. The figures below relate to aligner treatment costs more broadly.

For a detailed breakdown of what affects aligner pricing, see our guide on invisible braces costs in London.

How to Keep Results: Retention and Aftercare

Once treatment is complete and attachments are removed, retention keeps your teeth in their new positions.

Attachment Removal

At the end of treatment (or when specific attachments are no longer needed), your clinician removes them by gently polishing the composite off the tooth surface. This process:

• Is painless — no anaesthetic needed
• Takes a few minutes per attachment
• Leaves the tooth surface smooth and clean
• Does not damage enamel when done correctly

Some patients report that their teeth feel noticeably smoother after attachments are removed — a small but satisfying moment at the end of treatment.

Retention Strategy

• Fixed retainers: A thin bonded wire behind the front teeth provides continuous passive retention
• Removable retainers: Clear plastic trays worn nightly to maintain all tooth positions
• Combination: Many clinicians recommend both for maximum stability

Aftercare Tips

• Wear your retainers exactly as prescribed — the movements your attachments helped achieve will only stay if retained
• Clean retainers daily with a soft brush and lukewarm water
• Attend follow-up appointments as recommended
• If a retainer breaks or feels loose, contact your provider promptly
• Maintain good oral hygiene with regular brushing, flossing, and dental check-ups

Frequently Asked Questions

What are aligner attachments made of?

Aligner attachments are made from dental composite resin — the same tooth-coloured material used for white fillings. It's shade-matched to your natural tooth colour and bonded to the tooth surface using a light-curing adhesive. The material is biocompatible, durable enough to last through treatment, and can be polished off cleanly at the end.

Do all aligner patients need attachments?

Not necessarily. Very mild cases involving simple tipping movements may not require any attachments. However, the majority of moderate-to-complex aligner cases do use attachments to achieve controlled, predictable tooth movements. Your treatment plan will specify whether attachments are needed and where they'll be placed.

Can I remove attachments myself?

No — and you shouldn't try. Attachments need to be removed professionally using a dental handpiece to avoid damaging the tooth surface. Attempting to pick, scrape, or lever them off yourself could chip enamel or damage the tooth. If an attachment is bothering you, contact your clinician.

Do attachments damage teeth?

When placed and removed correctly by a trained clinician, attachments should not cause meaningful damage to teeth. The bonding process involves a mild etch of the enamel surface (similar to what's done for sealants or white fillings), and removal involves gentle polishing. Research shows that any enamel surface changes are minimal and clinically insignificant.

How long do attachments stay on?

Attachments typically remain in place for the duration of your active aligner treatment — which may range from a few months to two years or more depending on complexity. Some attachments may be removed partway through if specific movements are completed, and new attachments may be added during refinement stages. They're all removed before retainers are fitted.

Can I eat normally with attachments?

Yes — you remove your aligners to eat, so food doesn't interact with the aligners themselves. However, you should be mindful of very hard or sticky foods that could dislodge an attachment (toffees, hard nuts, biting directly into apples, etc.). Brush your teeth and over the attachments after eating before reinserting your aligners.

Will attachments affect my speech?

Attachments alone rarely affect speech. Any minor speech changes with clear aligners are usually caused by the aligner trays themselves (a slight lisp with new trays that resolves within a day or two), not the attachments. Since attachments are on the outer surface of teeth and are very small, they don't typically interfere with tongue placement for speech.

What if I don't want attachments on my front teeth?

Discuss this with your clinician. In some cases, attachment placement can be adjusted — for example, using smaller attachments, placing them in less visible positions, or relying on alternative mechanics. However, if attachments on front teeth are clinically necessary for your planned movements, removing them from the plan may mean those movements can't be achieved as predictably. It's a trade-off worth discussing.

Are attachments the same as brackets?

No. Traditional orthodontic brackets are metal or ceramic pieces permanently bonded to teeth, with a wire threaded through them to apply force. Aligner attachments are smaller, tooth-coloured, and work with the aligner tray rather than a wire. They serve a similar conceptual purpose (providing a grip point for force application) but are much less visible and feel very different.

How do I clean my teeth with attachments on?

Brush as normal, paying extra attention around the edges of each attachment where plaque can accumulate. Use a soft-bristled toothbrush and brush gently over and around each attachment. Flossing is still important — attachments don't obstruct flossing. An interdental brush can help clean around attachments on the sides of teeth. Your clinician or hygienist can demonstrate the best technique for your specific placement.

Do attachments make aligners less invisible?

Slightly, but less than most patients expect. With aligners in, the attachments are covered by the tray and are generally not noticeable. With aligners out, attachments are visible at close range but blend reasonably well with tooth colour. They're dramatically more discreet than traditional metal brackets. Most patients find they're far less of a cosmetic issue than anticipated.

Can attachments be replaced if they fall off?

Yes — re-bonding a fallen attachment is a quick, straightforward procedure. Your clinician uses the same template and process as the original placement. If you lose an attachment, inform your clinician at your next appointment (or sooner if they've asked you to). Continuing to wear your aligners without the attachment is usually fine short-term, but prolonged absence can affect tracking.

Disclaimer: This article is for general information only and does not constitute dental or medical advice. Treatment needs, timelines, and costs vary by individual case. All cost figures are approximate UK ranges for reference and are not quotations. Whether attachments are needed and where they are placed can only be determined through an in-person clinical assessment by a GDC-registered dental professional.