1. The first step when placing attachments for clear aligners for the first time is to prophy paste all of the teeth that will be getting attachments. Allow the patient to b rush and rinse, making sure there is no paste remaining.

2. Place the cheek retractors and a large cotton underneath the cotton and have the patient bite on a small suction. This helps keep the lower arch isolated.

3. Go through and dry all of the teeth. You want to dry the surrounding teeth because you do not want any of the saliva to contaminate or affect the bond of the attachments.

4. Once the teeth are dry, gently dab as small amount of etch on the teeth that are getting attachments, starting from the lower left, working to the lower right. Continue to the upper right and then finish on the upper left side. Let the etch sit on each tooth for 30 seconds. Then with the large suction in one hand and the water syringe in the other, thoroughly rinse the etch. You do not want a single drop of etch left on any tooth! Replace the wet cotton with a dry one.

5. Dry all the teeth again and apply a light layer of ortho solo, again only on the teeth that are getting attachments that were etched. Proceed to Dry one last time.

6. While making sure the teeth are staying isolated, add composite (A1 or B1) to the attachment aligner. Start with the lower arch first since it is harder to keep the lower arch isolated. Remove the cotton roll underneath the tongue and make sure to sit the aligner down completely. Cure the attachments for 10 seconds each. Do not push down onto the aligner because the attachment aligner is soft and it can distort the attachments.

7. Continue to follow the same steps for the upper arch. If you are worried about isolation or contamination then you can re-dry and add another layer of ortho solo.

8. Once all the attachments are cured, remove the aligners and allow the patient to go rinse, they will have a sour taste from the prepping process.

9. When the patient comes back to the chair, go through and clean up the attachments, removing any flash. Make sure the attachments are not sharp and are comfortable for the patient.

10. On the patients blueprint, it will be noted if the patient needs any IPR, or RB's, so have the doctor check and complete these as needed. You will deliver initial trays and go over instructions. This all depends on the patients treatment, but typically you deliver the first 10 trays, the bite sticks/ mouth piece, and retainer cases. The patient will wear each tray for 1 week, or 5 days if they have the accelerated mouth piece, and then will come back after they finish the first 10 trays. When they come back, we will check the attachments, perform IPR as needed, and deliver the remaining trays.

11. Once the patient has finished all of the trays, they will come back for a debond/refinement where we will remove attachments, take photos, and decide if we will rescan for another refinement, or make plans to debond and be done. This will be decided between the doctor and the patient! Schedule the patient as needed.