Updated: Apr 26
Invisalign attachments are temporarily bonded onto your teeth so it is not unusual for them to fall off since they're not permanent. Although if they did fall off, you should contact your dentist and have them replaced as soon as possible. Fallen attachments are not an emergency but it is advisable to fix them sooner rather than later since it can affect Invisalign treatment.
There are a lot of possible reasons that may have caused the attachments to come off but it is impossible to predict whether or not it will happen. The most important thing to remember is that Invisalign buttons weren't intended to be permanent to begin with.
However, there are still some good practice guidelines which may help decrease the likelihood and incidence of attachments falling off.
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What you should do if an Invisalign attachment falls off
If your attachment falls off for whatever reason, there is no need to panic because you have ample time to get it fixed. Here is what you should do if it happens:
Don't look for fallen attachment. It is not necessary to recover the Invisalign attachment that fell off. Therefore, don't waste your time digging through your meal or attempting to scavenge the floor for it.
Contact your dentist. Give your dentist a call immediately or as soon as possible. Inform them of what happened so that they can schedule an appointment for you to have a new attachment bonded on again.
Keep wearing your trays. Do not stop wearing your Invisalign trays. You must continue to wear them so that you proceed with the treatment. It will also prevent your teeth from trying to relapse. The missing attachment, which fell off will not affect the other teeth.
Go to your appointment. Now all you gotta do is wait for your appointment and have the attachment replaced. The procedure itself should be quick and take about five minutes. The check-in and check-out probably takes longer than that though!
How your dentist reattaches the Invisalign attachment
The first appointment for when you had ALL of your Invisalign attachments put on may have taken a long time. However, if your dentist only needs to re-bond one or two attachments, it should take significantly less time. It would most likely take about 5-10 minutes at most.
The process to replace a fallen attachment is identical to putting them on the first time around:
Dry the teeth.
Apply conditioner to the tooth.
Rinse off and dry again.
Apply a bonding agent to the tooth surface.
Cure the bond with a blue LED light.
Fill the attachment template with a translucent composite resin.
Place the template over the tooth with the fallen off Invisalign button.
Adapt the attachment template by applying pressure all around the button.
Cure the new attachment completely.
Remove excess bonding around the attachment.
That is the entire process and may have sounded like a mouthful but it should be an extremely quick procedure. You'll be in and out of the dental office at lightning speed.
Here is a video of placing Invisalign attachments:
In case you were wondering, the process to remove the attachments are even faster than putting them on. The total time it takes to remove all of them may take about 15-20 minutes.
How serious is it to have an attachment fall off?
If your Invisalign attachment falls off, it is not an emergency in the sense that you need to drop everything that you're doing to have it fixed. You should schedule the appointment for as soon as possible but it is not the end of the world if it is a few days out.
A single attachment or two which have come off will not derail the entire treatment plan for two reasons:
The tooth was already finished moving. Most people will lose the attachment while they're in the middle of wearing their tray. It may be of interest to you to know that your tooth is usually done moving to its new position after 1-2 days of wearing your tray (that is also when the trays feel the most painful). However, you continue to wear the tray for the next 7-14 days in order to allow the tooth to adapt to its new position. This means that the purpose of attachment was already completed.
Replace attachment prior to inserting the next tray. It is important to remember that you should not put in your next set of trays until you have the fallen off Invisalign attachment re-bonded. The reason is because you want the attachment to assist in moving the tooth. If you move to the next tray and the tooth has no attachment, it may not move as intended. It is safer to wait for the new attachment prior to proceeding.
Overall, the point that we are trying to make is that you will be okay. You don't need to panic and it won't really derail your entire treatment plan. The great thing about Invisalign is that you can always pause at whatever stage you're in for as long as you want. You simply have to keep wearing your current trays to hold the teeth in place. You can continue to move forward with treatment once you fix the problem.
We've had plenty of people pause their treatment due to other obligations in their life such as weddings or traveling abroad. They simply continue to wear whatever tray they are at until they are ready to continue again.
The worse that can happen if your attachment falls off is that you'll be adding a few extra days to your total length of treatment. Although there is a possibility that it won't affect it at all! Nonetheless, in the grand scheme of things the effect is negligible.
Possible causes for the attachments to come off
There is a plethora of ways that can cause the Invisalign attachments to come off. Some of them are within our control while others are not. Here are some of the ways
Path of removal. If you have very crowded teeth, the path that you remove the trays can cause excessive force on certain attachments, which may pop them off. In our experience, this is most likely to happen during the beginning of the treatment but once your teeth straighten out more, it becomes less of an issue.
Insufficient initial bond. Sometimes the initial bonding of the attachment may not have been optimal. If one of your buttons weren't optimally attached, it risks falling off. The most common cause for bond interference is the presence of saliva. If your tongue was curious and touching all of your tooth surfaces during the attachment process, they may pop off later!
Acidic foods. Highly acidic food can accelerate cavity formation and also cause enamel erosion. In addition to those two, it can also erode through the bond which holds the attachments on your enamel. If you like to eat a lot of acidic foods, you may be at risk for the buttons to pop off more frequently.
While eating. Accidents can happen while you're eating such as biting into something the wrong way and you can pop off an Invisalign attachment. It is also not uncommon to damage the buttons if you eat a lot of hard foods or like biting animal bones.
Not following instructions. If you're very aggressive with taking off the trays you can accidentally hook onto the attachments and pop them off. Remember to release the trays from the tongue side and not the cheek side.
Alleged causes for the Invisalign buttons to come off, which aren't actually true:
Trays are too tight. Having tight trays should have no bearing on the attachments if they were bonded on properly in the first place. Your Invisalign trays are meant to be tight because if they were loose, they wouldn't be able to grab onto the teeth and move it.
Attachments too big. The size of the attachments do not cause them to pop off more easily. Rather, having larger attachments actually help them stay on better. Larger attachments have a larger surface area for the bond to adhere to. Smaller attachments on the other hand have a smaller surface area to adhere to. This means that larger attachments are actually more stable and retentive than smaller ones.
A great analogy for the size argument is if you were hanging off of a cliff. If you had your entire arm over the cliff, you would have more surface area to grab onto and thus more likely to pull yourself up. However if you were only hanging onto the cliff by your finger tips, which is less surface area you'll be more likely to fall.
How common is it for the attachments to fall off?
At our long island city dental office, we actually don't have the attachments coming off that frequently. If we had to put a number to the statistic, it only happens in about one out of ten cases that we do. The vast majority of our patients do not experience the attachments coming off at all.
It is also usually at the very beginning of treatment that the Invisalign buttons are most likely to pop off and that is due to the teeth being more crowded and patient's inexperience with the product.
Beginning of treatment. When you first start treatment, your teeth are the most crowded and that sometimes puts a lot of pressure on the buttons. However as your teeth start getting less crowded, it removes a lot pressure on the buttons. The pressure gets spread out more evenly.
Patient's inexperience. As patients get more use to wearing the trays, they begin to know what to do and what not to do. This decreases user error and increases compliance.
What you can do to prevent the Invisalign attachments from coming off again
Sometimes it can be out of your control when the attachments fall off but there are precautions that you can take, which minimizes the possibility of it occurring.
Don't force the trays in. If you didn't align the trays correctly, don't force them in. You can potentially damage the trays or pop off one of the buttons.
Remove trays from tongue side first. To take the trays out, you should unhook your aligners from the tongue side. The reason is because the attachments are on the cheek side. If you try to pull from the cheek side, you run the risk of removing the attachments accidentally.
Avoid biting into hard foods. Biting into a whole fruit like an apple can definitely detach any attachments which may be on your front teeth. Instead you should cut the fruit up into smaller pieces before eating it. That should minimize the chances of damaging your buttons.
If you simply follow the above three recommendations, it should minimize the chances of it happening. Even though the process of reattaching the buttons are quick, you can save yourself a lot of time if you don't have to take time out of your day to have them repaired.
Last but not least, don't forget that it is also important to treat your trays with care so that you don't damage them. This means you should clean them as best as you can because stained trays don't look good and any sort of stuck food may cause problems.
It is not unusual for Invisalign attachments to come off because there are many ways in which that can happen. The most important thing to remember is to not panic because it won't completely derail your treatment. You should try to have them put back on as soon as possible so that your teeth move as planned.
The process to have them rebonded on is a simple one and should only take about 5-10 minutes at most. Its just a slight inconvenience but a straight smile will be worth it at the end.
When in doubt you can always ask your cosmetic dentist about what to do!