And here is where the problem shows up and science can help us!
The popularity of selfies has made us look with much more attention to smiles. Ours and those of others. The perfect photo also asks for a perfect smile.
In this search for aesthetics, the demand for the use of braces to improve the alignment of the teeth has increased. However, while restoring the harmony of a beautiful smile, again aesthetics is required. According to a recent article, technological advances have enabled the evolution of clear aligner treatments. By offering comfort and being discreet, they have become the first choice of patients1 with a 66% increase in internet searches since 20222.
For the teeth to be moved, it is necessary to apply a force in the direction you want to take them. Conventional fixed appliances could do so easily by using brackets and wires.
And what about aligners? How do these transparent trays actually move teeth? It was necessary to find out a way to transmit this necessary force to the tooth. This was when attachments were developed: they are small tooth-colored bumps made of resin that are bonded to the tooth with the same adhesive technique that a filling is.
Unlike restorations that were made to be stable in the mouth for as long as possible, attachments are temporary and only useful while having orthodontic treatment. Then, what happens next? They need to be removed and – along with them – tooth enamel.
You may be wondering: why does this matter? Where is the nightmare? Why so much drama?
Well, let's make it clear! Tooth enamel is the most mineralized tissue in the human body, it is the outer layer of your tooth, which provides its protection. Sounds perfect, but – there is always a but - it does not regenerate. Once lost, it is irreversible.
There are different types of resins and adhesives that can make the process of building attachments easier and predictable. However, what about when taking them off? What would be the consequences for the underlying enamel? Scratches, irregularities, loss of structure? In clinical practice these changes are almost impossible to detect by naked eye, but – even so – they can lead to the dental biofilm accumulation, bacterial plaque and caries; compromising the health and longevity of the tooth.
A recent study was carried out to verify the effect on the integrity of the enamel after the removal of the attachments built with different resins, adhesives and removed by 2 different methods. The final evaluation was done with a 3D-microscope capable of taking images and showing the true condition of the enamel surface. The researchers concluded that a lower-viscosity resin, associated with an adhesive capable of chemically bonding to the calcium in the tooth, led to greater preservation of the enamel surface, as long as a zirconia bur is used during the removal. In addition, surface polishing was considered a fundamental step to try to achieve perfect enamel surface.
The choice of the orthodontic treatment should be followed by the awareness that the final aesthetic result does not only comprehend straight teeth, but that – over the long term – it also depends on the enamel preservation that protects the teeth.
The need to balance adhesive retention plus the need to get minimal aggression to enamel surface is highly recommended. Understanding it helps patients to search for qualified professionals.
More than aligning teeth, part of the treatment is to ensure the invisible integrity of the enamel and preserve long-term health and aesthetics.
Marilia Canadas
I’m a PhD candidate at the Institute of Dentistry. My field is dental materials, mainly related to orthodontics. My interests focus on preserving enamel structure, both after orthodontic treatment and appliance removal, as well as during the treatment to prevent caries formation.
References:
1- Wu J, Zhang J, Yu X, Jia Y, Wei X. Evolving Trends and Emerging Frontiers in Clear Aligner Therapy: A Bibliometric and Social Impact Analysis (2015-2024). Int Dent J. 2026 Apr;76(2):109372. doi: 10.1016/j.identj.2025.109372. Epub 2026 Jan 22. PMID: 41576729; PMCID: PMC12861249.
