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DEFAULT PROTOCOLS FOR POWER RIDGE FEATURES & ATTACHMENTS

Invisalign® offers a series of Power Ridge features and attachments, including Optimised Attachments in order to enhance predictability of the clinical outcomes. With Invisalign G3 and G4, we expanded the range of these features by now including new and improved SmartForce® features.

Engineered to deliver the force systems to achieve predictable tooth movements.

Customised to each tooth using advanced virtual modelling, includingsuch features as the width, long axis, and contour of the entire tooth.

Positioned precisely to deliver the forces while eliminating interferences.

SMARTFORCE FEATURES ARE:

• Optimised Attachments• OptimisedExtrusionAttachmentsforincisorsandcanines• OptimisedRotationAttachmentsforcaninesandpremolars• OptimisedRootControlAttachmentsforuppercentralandlateralincisors,upperandlowercaninesandpremolars• OptimisedMulti-ToothExtrusionAttachmentsforupperincisors• OptimisedMulti-PlaneMovementfeatureforupperlateralincisors

• Power Ridge Features• BuccalPowerRidgefeatureforlingualroottorqueforupperandlowerincisors• LingualPowerRidgefeaturepairedwiththebuccalPowerRidgefeatureforlingualroottorqueandlingualtranslation

forupperincisors

SmartForce features are custom placed to the patient’s specific tooth anatomy. Changing the size, shape and location is NOT possible and may not be requested for any teeth or movements, in that case conventional attachments need to be requested.

SmartForce features are automatically placed in accordance to the desired movement.

ATTACHMENT PROTOCOL SUMMARY

The table below shows the default attachments that are placed for Invisalign treatments unless otherwise specified by the Doctor in Clinical Preferences or on a prescription form for a specific patient.

MOvEMENT DEFAULT PROTOCOL1 EXAMPLES

Root Control (Upper Central and Lateral Incisors*)

Optimised Root Control Attachments

Root Control (Upper and Lower Canines)

Optimised Root Control Attachments

Root Control (Upper and Lower Premolars**)

Optimised Root Control Attachments

Multi-Plane Movement (Upper Lateral Incisors)

Optimised Multi-Plane FeaturesOptimised Attachment on buccal and Pressure Point on lingual when needed

Canine Rotation2

Optimised Rotation Attachment2

Premolar Rotation2

Anterior Extrusion2

(Individual and Multi-tooth)

Optimised Extrusion Attachment2

SmartForce® feature

SmartForce® feature

SmartForce® feature

SmartForce® feature

SmartForce® feature

SmartForce® feature

*On upper lateral incisors one Optimised Root Control Attachment will be placed on the buccal plus up to two pressure points on the labial and lingual.**On premolars, when there is insufficient tooth surface to place two attachments or interferences are predicted throughout treatment, one Optimised Root Control Attachment will be placed on the buccal plus a buccal pressure point.

ATTACHMENT PROTOCOL SUMMARY

The table below shows the default attachments that are placed for Invisalign treatments unless otherwise specified by the Doctor in Clinical Preferences or on a prescription form for a specific patient.

MOvEMENT DEFAULT PROTOCOL1 EXAMPLES

Anterior Intrusion(No premolar rotation orRoot Control)

Horizontal bevelled occlusally, on first premolar (1 in each quadrant) 1mm thick attachments placed bilaterally

Anterior Intrusion(Plus Premolar Rotation or Root control)

Horizontal bevelled occlusally, 1mm thick. Optimised Attachments are applied to premolars needing rotation; if both are rotating, no horizontal bevelled occlusal attachment is placed

Lower Incisor ExtractionVertical Rectangular, 1mm thickPlacement on two teeth adjacentto the extraction site

Premolar Extraction

For first premolar extraction: Optimised Root Control Attachment on canine and second premolarFor second premolar extraction: Optimised Root Control Attachment on first premolar and Vertical Rectangular 1mm thick on two teeth distal

Aligner Retention3 ATTACHMENTS NOT OFFERED BY DEFAULT

Ellipsoid attachment. Dimension: height 3mm, width 2mm Prominence: 0.75 or 1.0mm Rectangular (CRT) attachment. Dimension: height 3, 4 or 5mm, width 2mm Bevelled attachment. Dimension: Rectangular 3, 4 or 5mm by 2mm, horizontal bevelled to occlusal/incisal or gingival or vertical bevelled to mesial or distal. Conventional attachments may be requested in a vertical or horizontal orientation.

1. The default protocols described in this document are used to create the initial ClinCheck® treatment plan, based on your prescription. However, the final treatment plan remains the responsibility of the treating doctor and should be reviewed carefully and modified as necessary before the ClinCheck treatment plan is approved.

2. Limitation for Optimised Attachments: Optimised Attachments cannot co-exist with lingual attachments or with a Power Ridge feature. Optimised Attachments are custom placed to the patient’s specific tooth anatomy. Changing size, shape and location is NOT possible and may not be requested for any teeth or movements, in that case conventional attachments need to be requested. Conventional attachments cannot co-exist on a tooth with a Power Ridge feature.

3. Note about Aligner Retentiveness: Doctors may request attachments when aligner retentiveness is a concern.

Ellipsoid Rectangular Bevelled

Attachment images illustrate most common situations, actual attachment placement may vary according to ClinCheck software.

MOvEMENT DEFAULT PROTOCOL1 EXAMPLES

POWER RIDGE PROTOCOL SUMMARY

The table below shows the default Power Ridge features that are automatically placed for Invisalign treatments. Buccal Power Ridge features on upper and lower incisors will be placed after 3 degrees of lingual root torque is present. Lingual Power Ridge features will be placed on the upper incisors only when lingual translation and lingual root torque are present. Lingual Power Ridge features will not be placed alone, they will always be placed in combination with the buccal Power Ridge feature. Power Ridge features cannot be placed in combination with any other feature or attachments (except for bite ramps).

Rotation Extrusion Retention.

Lingual root torque for upper incisors2

Power Ridge feature on buccalfor upper incisors

Power Ridge feature on buccalfor upper incisors

Lingual root torque+ lingual translationfor upper incisors2

Lingual root torquefor lower incisors

Root Torque for other teeth than incisors

Power Ridge feature on buccal and lingual Power Ridge feature for upper incisors. Lingual Power Ridge features will be placed on the upper incisors only when lingual translation and lingual root torque are present. Lingual Power Ridge features will not be placed alone, they will always be placed in combination with the buccal Power Ridge feature.

1. The default protocols described in this document are used to create the initial ClinCheck treatment plan, based on your prescription. However, the final treatment plan remains the responsibility of the treating doctor and should be reviewed carefully and modified as necessary before the ClinCheck treatment plan is approved.

2. A second lingual Power Ridge feature is placed automatically always when lingual root torque is combined with retraction and sometimes when retraction is present alone but the software detects is required.

Power Ridge feature not available at this time. Doctor may request conventional attachments.

ce featureSmartForce® feature

SmartForce® feature

SmartForce® feature

INvISALIGN DEFAULT FEATURE PROTOCOLS

The table below shows the defaults that are placed for Invisalign treatments unless otherwise specified by the doctor in Clinical Preferences or on a prescription form for a specific patient.

MOvEMENT DEFAULT PROTOCOL1 DOCTOR NEEDS TO REQUEST

Root Control (Upper central and lateral incisors)

Optimised Attachments are activated, unlike conventional attachments.3 If an Optimised Attachment debonds during treatment, the attachment must be re-bonded using the template and not the aligner due to the activation in the attachment. It cannot be combined with lingual attachments or any other attachment or Precision Cuts.

Optimised Multi-Plane Features

Optimised Attachment on buccal and Pressure Point on lingual when needed.

If an Optimised Attachment is not desired, a Doctor needs to request a conventional attachment3; however, clinical results may vary.

Root Control (Upper and lower canines and premolars)

Multi-Plane Movement (Upper Lateral Incisors)

Canine Rotation2 Optimised Attachments are activated, unlike conventional attachments3. If an Optimised Attachment debonds during treatment, the attachment must be re-bonded using the template and not the aligner due to the activation in the attachment. It cannot be combined with lingual attachments or any other attachment or Precision Cuts.

If an Optimised Attachment is notdesired, a Doctor needs to request aconventional attachment3; however,clinical results may vary.

Premolar Rotation

Rotation of other teeth Doctor may request conventional attachments3 for rotations not included in default. Recommendation: best length fit; 1mm prominent vertical rectangular (CRT) or vertical bevelled.

SmartForce® feature

SmartForce® feature

MOvEMENT DEFAULT PROTOCOL1 DOCTOR NEEDS TO REQUEST

Anterior Extrusion (Incisors & Canines)

Optimised Extrusion Attachment(upper and lower incisors and caninesonly). It cannot be combined withlingual attachments or any otherattachment or Power Ridge featuresor Precision Cuts.

If Optimised Attachment is not desired, a Doctor needs to request a conventional attachment3: however, clinical results may vary.

Posterior Extrusions Optimised Extrusion Attachments arenot available for posterior teeth (forpremolars and molars). Doctor needsto request a conventional attachment3.

Recommendation: horizontal rectangular (CRT) bevelled to gingival.

Anterior Intrusion / No Premolar Rotationor Root Control

Horizontal bevelled occlusally, on 1st premolar (1 in each quadrant), 1mm thick.

Attachments3 placed bilaterally on 1stpremolar (1 in each quadrant).

Anterior Intrusion / Premolar Rotation or Root Control

Horizontal bevelled occlusally,1mm thick.

Optimised Attachments are applied to premolars needing rotations or root control; if both are rotating or have root control movement no horizontal bevelled occlusal attachment is placed.

SmartForce® feature

MOvEMENT DEFAULT PROTOCOL1 DOCTOR NEEDS TO REQUEST

Incisor Extraction Vertical Rectangular (CRT), best lengthfit; 1mm thick on each tooth on eitherside adjacent to the incisor extractionsite3.

Premolar Extraction

For first premolar extraction: Optimised Root Control Attachment on canine and second premolar.

For second premolar extraction: Optimised Root Control Attachment on first premolar and Vertical Rectangular 1mm thick on two teeth distal.

Lingual Root Torque* Power Ridge features on buccal forupper and/or lower incisors after3 degrees of lingual root torque ispresent. No attachments needed.Power Ridge features cannot becombined with any attachment at thesame time.

Lingual Root Torquecombined withLingual Translation

Power Ridge features on buccal andlingual Power Ridge features forupper incisors. The lingual Powerridge features will always be placedin combination with the buccal PowerRidge features. This feature cannot becombined with any attachment at thesame time.

SmartForce® feature

SmartForce® feature

*A second lingual Power Ridge feature is placed automatically always when lingual root torque is combined with retraction and sometimes when retraction is present

alone but the software detects is required.

MOvEMENT DEFAULT PROTOCOL1 DOCTOR NEEDS TO REQUEST

Root Uprighting orRoot Tip(When a Root Control Optimised Attachment is not being used)

Doctor needs to request a conventional attachment3.Recommendation: best length fit; 1mm prominent vertical rectangular (CRT).

Bite Ramps Doctor needs to request the biteramps on the lingual of the anteriorincisors. The default bite ramp shape is horizontal rectangular (CRT) bevelled to gingival3.

Aligner Retention Doctor may request attachments3

when aligner retentiveness is a concern.

1. The default protocols described in this document are used to create the initial ClinCheck treatment plan, based on your prescription. However, the final treatment plan remains the responsibility of the treating dental professional and should be reviewed carefully and modified as necessary before the ClinCheck treatment plan is approved.

2. If rotation and extrusion are present on an incisor tooth, then an Optimised Anterior Extrusion Attachment will be placed, as no attachments are placed for rotations on incisor teeth by default. If rotation and extrusion are present on a canine, then Optimised Rotation Attachments will be placed and not an additional one for extrusion, as rotation attachments prevail over extrusion attachments (unless requested by doctor to separate out the rotation and extrusion movements).

3. Ellipsoid attachment. Dimension: height 3mm, width 2mm Prominence: 0.75 or 1.0mm Rectangular (CRT) attachment. Dimension: height 3, 4 or 5mm, width 2mm Bevelled attachment. Dimension: Rectangular 3, 4 or 5mm by 2mm, horizontal bevelled to occlusal/incisal or gingival or vertical bevelled to mesial or distal. Conventional attachments may be requested in a vertical or horizontal orientation.

Attachment images illustrate most common situations, actual attachment placement may vary according to ClinCheck software.

FEATURES AvAILABLE ON THRESHOLD MAXIMUMvELOCITY

Buccal Power Ridge Upper and lower incisors 3° of torque 1° per stage

Buccal Power Ridge + Lingual Power Ridge

Upper incisors 3° of torque, and retraction 1° per stage

Optimised Rotation Attachment

Upper and lower canines and premolars

5°of rotation 2° per stage

Optimised Extrusion Attachment

Upper and lower incisors and canines

0.5mm of extrusion 0.25mm per stage

Multi tooth anterior extrusion

Upper incisors 0.5mm of extrusion of the 4 incisors

0.25mm per stage

Optimised Root Control Attachment

Upper central and lateral incisors

Upper and lower canines and premolars

0.75mm for central and lateral incisors

>0.5 mm translations from the center of resistance for canines and premolars

Optimised Multi-Plane Movement Features

Upper lateral incisors Absolute extrusion >0.1mm AND crown tipping and/or rotation

INvISALIGN FEATURE PROTOCOL SUMMARY