What is aligner treatment?
What is aligner treatment — and what are refinement scans?
If you are considering aligner treatment or are already partway through your journey, this guide covers everything you need to know — from how aligners work, to what attachment bonding involves, what refinement scans are, and why they are a completely normal and expected part of the process.
What is aligner treatment?
Aligner treatment is a modern orthodontic approach that uses a series of custom-made, clear removable trays to gradually move your teeth into their desired positions.
Unlike traditional braces which use brackets and wires bonded to the teeth, aligners are:
Virtually invisible — made from clear medical-grade plastic that is barely noticeable when worn
Removable — taken out for eating, drinking, and brushing, making oral hygiene significantly easier than with fixed braces
Custom-made — each set of aligners is digitally designed and manufactured specifically for your teeth based on a 3D scan of your mouth
Changed regularly — each set of aligners is typically worn for 1–2 weeks before progressing to the next set in the series, with each new set moving the teeth a small, controlled amount
How does aligner treatment work?
Records and assessment — your doctor takes a 3D digital scan of your teeth, X-rays, and photographs. These records are used to plan your treatment digitally
Treatment planning — using specialist software, your doctor designs the entire tooth movement sequence from your current tooth positions to the final desired result. You may be shown a digital preview — of how your teeth are expected to move throughout treatment
Aligner fabrication — your custom aligners are manufactured and delivered to the clinic
Attachment bonding appointment — before or alongside receiving your first set of aligners, your doctor will bond small tooth-coloured attachments onto specific teeth. More on this below!
Active aligner wear — you wear each set of aligners for the prescribed duration, progressing through the series as directed by your doctor
Regular review appointments — your doctor monitors your progress at regular intervals — typically every 6–10 weeks — to check that your teeth are tracking correctly with the aligners and to address any concerns
Refinements if needed — more on this below!
Retention — once treatment is complete, retainers are worn to maintain your results
What happens at your attachment bonding appointment?
Before your active aligner treatment begins, your doctor will place small tooth-coloured bumps called attachments onto specific teeth. These act as handles that give your aligners something to grip onto — allowing more precise and complex tooth movements that would not be possible with smooth tooth surfaces alone.
Here is what to expect at this appointment:
The appointment typically takes 30–60 minutes depending on how many attachments are being placed
Your teeth are cleaned and lightly prepared to help the composite bond securely
A clear template is used to position each attachment in exactly the right location — precision is everything
Tooth-coloured composite resin is applied through the template and hardened with a blue curing light — completely safe and painless
The template is removed, any rough edges are smoothed, and your first set of aligners is fitted to confirm everything seats correctly
What to expect after attachment bonding:
Your mouth may feel slightly different and unfamiliar for a few days — completely normal
Aligners may feel tighter and harder to remove with attachments than without — an aligner removal tool is highly recommended!
Some minor cheek or gum irritation where attachments contact soft tissue — usually settles within 1–2 weeks
Attachments occasionally fall off — if this happens, note which tooth and inform your doctor at your next visit. If multiple fall off, contact your doctor sooner as this may affect your treatment progress
Never pick at or try to remove attachments yourself
💡 Tip: Removing aligners feels tricky at first — especially with your very first set and with attachments in place. Give yourself a few days to get the hang of it. An aligner removal tool makes a world of difference and it becomes second nature very quickly!
What does tracking mean?
You will often hear your doctor talk about whether your teeth are tracking with the aligners. Tracking refers to how well your teeth are following the planned tooth movements in the digital treatment plan.
Good tracking means your teeth are moving as planned and the aligners are seating fully and correctly over your teeth
Poor tracking means your teeth have not moved as much as planned — the aligners may not seat fully, or certain teeth may appear to lag behind where they should be at that stage of treatment
Poor tracking can occur for several reasons:
Insufficient aligner wear time — not wearing aligners for the full 20–22 hours per day
Individual biological variation — some teeth move more predictably than others
The complexity of the tooth movement required
Attachments falling off — reducing the aligner's ability to grip and move the tooth
If your doctor identifies tracking issues, they may ask you to wear certain aligners for longer, use chewies to help seat the aligners more fully, or recommend a refinement scan.
What are chewies and how do they help?
Chewies are small soft cylindrical cushions that you bite down on to help seat your aligners fully onto your teeth. They are particularly useful:
When starting a new set of aligners — to help them seat properly from the beginning
When tracking is slightly behind — to help close the gap between the aligner and the tooth
After eating and reinserting your aligners
Bite down on the chewie and work it along all your teeth for 5–10 minutes when instructed by your doctor. Make it part of your aligner reinsertion routine.
What are refinement scans?
Refinement scans are additional 3D digital scans taken of your teeth during or at the end of your aligner treatment — used to generate a new series of aligners to continue or fine-tune your tooth movements.
Think of your original aligner series as the main treatment plan. Refinements are the additional chapters that continue the story — addressing any movements that were not fully achieved in the original series, or fine-tuning the result to get your teeth exactly where they need to be.
Why do I need a refinement scan?
This is one of the most common questions patients ask — and it is important to understand that needing refinements does not mean something has gone wrong. It is a completely normal, expected, and built-in part of aligner treatment for the vast majority of patients.
Here is why refinements are needed:
Teeth do not always move exactly as digitally planned — the software predicts tooth movement based on averages, but every patient's biology is different. Some teeth respond differently than expected
Complex tooth movements — certain movements such as rotations, vertical movements, and root torque are particularly challenging to achieve precisely with aligners and often require refinement to complete fully
Tracking issues — if certain teeth have lagged behind the planned movements during the active series, a refinement scan captures where the teeth actually are now and plans the remaining movements from that point
Fine-tuning — even when the main movements are complete, small refinements to the bite, spacing, or rotations may be needed to achieve the best possible final result
Refinements are not a sign of failure — they are a sign that your doctor is paying close attention to your result and is committed to getting it exactly right.
What happens at a refinement scan appointment?
A new 3D digital scan of your teeth is taken — this is quick, comfortable, and uses the same scanning technology as your initial records
Your doctor reviews the scan alongside your original treatment plan to assess what has been achieved and what still needs to be done
A new aligner series is designed and ordered based on the current position of your teeth
You continue wearing your current aligners or are given refinement retainer aligners to wear in the interim while your new aligners are being manufactured — do not stop wearing your aligners during this waiting period or your teeth may shift
Your new refinement aligners arrive and your treatment continues
How many refinements will I need?
This varies from patient to patient and depends on:
The complexity of your original tooth movements
How well your teeth tracked throughout treatment
Your aligner wear compliance throughout treatment
The precision required for your final result
Some patients need one round of refinements, others may need more. Your doctor will assess this at each stage and be transparent about what is still needed to achieve the best result. There is no set number — what matters is that the final outcome is right.
How long does aligner treatment take in total?
Treatment duration varies widely depending on the complexity of your case:
Mild cases — as few as 3–6 months
Moderate cases — typically 12–18 months
Complex cases — 18–24 months or more, particularly when refinements are factored in
It is important to understand that the initial number of aligners in your series is an estimate — not a guaranteed end date. Refinements are factored into the overall treatment journey and should be expected rather than treated as a surprise.
How to get the best results from your aligner treatment
The outcome of your aligner treatment is significantly influenced by how well you follow your doctor's instructions throughout. Here is what you can do to maximise your results:
Wear your aligners for 22 hours a day — without exception. This is the single most important factor in achieving good tracking and keeping treatment on schedule
Change aligners on time — do not delay changing to the next set unless specifically instructed by your doctor
Use your chewies — especially when starting a new set and after reinserting aligners after meals
Keep all your appointments — your doctor needs to monitor your tracking regularly to catch any issues early
Take care of your attachments — avoid very hard and sticky foods that could dislodge them. Without attachments the aligner cannot execute the planned movements
Never throw away your previous aligners — always keep the set before your current one as a safety net in case of loss or damage
Communicate with your doctor — if something does not feel right, an aligner does not seat properly, or an attachment falls off, let your doctor know promptly rather than waiting until your next scheduled appointment
💡 Dr Watt's tip: The patients who wear their aligners consistently are the ones who finish on time with the best results. Your compliance is the biggest variable in this equation — make it work for you! 😊
