Dentaltown February 2021 - 50

The main advantage
to choosing an aligner
hook is simplicity. Not
only does it save chair
time at the delivery
appointment by not
having anything to
bond, but it also
avoids the dreaded
debond emergency.

Orthodontists have been using elastic bands with clear aligners to correct malocclusions
throughout the past decade.
The earliest attempts to attach elastics to aligners often involved manually cutting
windows in the plastic to circumvent bonded brackets or buttons. To streamline
the process, orthodontists began requesting their Invisalign ClinCheck setups
to raise the simulated gingiva so the trimmed plastic would not extend fully
to the cementoenamel junction.
Align Technology began offering prefabricated cuts in its Invisalign
aligners in 2010. These cuts took the form of notches or slits in the plastic,
called " hooks " or " cutout windows, " that allowed for an auxiliary to
be directly bonded to the tooth.
It's now routine for orthodontists to incorporate elastic bands with
aligner therapy. Situations where the orthodontist would want to
attach elastic bands in the anterior canine region include Class II,
Class III, triangle or box elastic patterns. Many orthodontists
will routinely set up their aligner cases in a similar fashion, but
what factors should be considered when selecting a hook versus a
button for elastic wear?

On the hook

The main advantage to choosing an aligner hook is simplicity.
Not only does it save chair time at the delivery appointment by not
having anything to bond, but it also avoids the dreaded debond
emergency. Hooks may also be ideal for situations where no additional
extrusion of the teeth is desired, such as while intruding canines to
level a deep Curve of Spee.
On the downside, hooks can be challenging for patients to secure
the elastics at the outset. Also, heavier elastic bands can potentially
unseat the aligners when using hooks. Depending on the rigidity of the
plastic, the dovetail created by the notch may bow outward and irritate
the cheeks or lips.
Elastic hooks are an option offered with Invisalign, 3M Clarity, Henry
Schein SLX and Ormco Spark aligners. They are not currently available from
Dentsply SureSmile or Straumann ClearCorrect aligners, but they are anticipated
with future updates.
Aside from crown and bridge scissors, there are instruments that can manually
form hooks, such as Dr. Jay Bowman's Tear Drop plier from the Hu-Friedy Clear
Collection (Fig. 1).

Buttoned up
*
*
*

50

Bondable buttons can prove effective in a variety of clinical situations:
They're advantageous when extrusion of the attached tooth is desired, such as an
anterior open bite.
If a patient has an ectopic maxillary canine, buttons are an effective way to simultaneously extrude and provide AP correction.
For patients with retroclined maxillary incisors-such as Class II, Division 2

FEBRUARY 2021 // dentaltown.com

DT0221_Cetta-Hughes_Buttons_MM.indd 50

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Dentaltown February 2021

Table of Contents for the Digital Edition of Dentaltown February 2021

Dentaltown February 2021 - Intro
Dentaltown February 2021 - Cover1
Dentaltown February 2021 - Cover2
Dentaltown February 2021 - 1
Dentaltown February 2021 - 2
Dentaltown February 2021 - 3
Dentaltown February 2021 - 4
Dentaltown February 2021 - 5
Dentaltown February 2021 - 6
Dentaltown February 2021 - 7
Dentaltown February 2021 - 8
Dentaltown February 2021 - 9
Dentaltown February 2021 - 10
Dentaltown February 2021 - 11
Dentaltown February 2021 - 12
Dentaltown February 2021 - 13
Dentaltown February 2021 - 14
Dentaltown February 2021 - 15
Dentaltown February 2021 - 16
Dentaltown February 2021 - 17
Dentaltown February 2021 - 18
Dentaltown February 2021 - 19
Dentaltown February 2021 - 20
Dentaltown February 2021 - 21
Dentaltown February 2021 - 22
Dentaltown February 2021 - 23
Dentaltown February 2021 - 24
Dentaltown February 2021 - 25
Dentaltown February 2021 - 26
Dentaltown February 2021 - 27
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Dentaltown February 2021 - 30
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Dentaltown February 2021 - 64
Dentaltown February 2021 - Cover3
Dentaltown February 2021 - Cover4
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