Clear Aligners with Crowns, Veneers, Bridges and Implants
For adults with crowns, veneers, bridges or implants considering aligners: implant anchorage, ceramic attachments, restoration planning. In a 2008 single-group study, all 93 implants anchoring braces stayed firm on mobility tests after forces stopped. Ceramic attachment bond tests are laboratory studies, not clinical results. A 2024 braces paper says patients with restorations should know of an increased risk of bond failure and a risk of damage to restorations or teeth.
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Medical disclaimer: This page is for general information only. It does not replace an examination or treatment by a dentist.
Why does existing dental work matter for aligner treatment?
Aligner attachments are bonded to teeth and can add surface area and more points where force acts, a 2025 expert consensus on aligner treatment says.
An attachment placed on a crown or veneer is bonded to the restoration, and a 2026 review found nine laboratory studies, published 2015 to 2025, of attachments on crown materials. The British Orthodontic Society counts preparing teeth for advanced dental work, such as crowns, bridges or implants, among the benefits of orthodontic treatment. See aligner attachments for how they work, or browse this section for other suitability factors.
Crowns, bridges, veneers and implants themselves are described on separate pages: restorative dentistry, porcelain veneers and dental implants. Whitening and bonding at the end of aligner treatment have their own page, on finishing your result after treatment.
Do dental implants move during orthodontic treatment?
In a 2008 study, all 93 implants used as anchors to move nearby teeth with braces stayed firm, without movement, when the forces were removed.
Its 38 adults aged 22 to 64, all with missing teeth, had brackets on temporary crowns fitted to the implants, and springs of 100 to 200 g for 2 to 9 months moved teeth 0.6 to 7.5 mm. Mobility was tested with a metal instrument, and bone levels around the implants did not change significantly. The study used one implant system, had no comparison group and did not use aligners.
How has an implant been used in aligner treatment?
In a 2026 study of 80 adults having aligner treatment, aligners aimed to push over-erupted upper molars up, opposite temporary crowns on lower molar implants.
Bite ramps built into the aligners over the implant crown (35 people) did not significantly improve the result against no ramps (45 people): the molars moved up 1.03 and 0.82 mm on average, against 1.49 and 1.28 mm planned, by the refinement scan. The adults, aged 22 to 58, were treated by one clinician with one aligner system. The study was retrospective, did not assess the teeth beside the implant and did not measure aligner wear objectively.
Have aligner studies included bridges?
None of the aligner studies on this page included a bridge, and the 2026 review of attachment bonding covered crown materials only.
A bridge, in NHS guidance, is fixed in place to replace one or more missing teeth and is supported by the surrounding teeth.
To ask about orthodontic treatment, book online or call 0114 288 2121.
What have studies found on bonding attachments to ceramic crowns?
In a 2022 laboratory study on lithium disilicate, attachments bonded after phosphoric acid etching held significantly more weakly than after hydrofluoric acid or air abrasion. Mean shear bond strengths were 5.22, 15.82 and 14.91 MPa after 10,000 cycles of hot and cold water; hydrofluoric acid and air abrasion did not differ significantly.
A 2026 review of nine laboratory studies of attachment bond strength on crown materials (lithium disilicate, zirconia and resins; searched 2015 to 2025) could not pool results. It concluded that its lithium disilicate and zirconia studies found the most favourable results with hydrofluoric acid etching and one composite, with sandblasting close behind. For clinical use, it said, sandblasting may not be the protocol of choice, and hydrofluoric acid's use is limited because it is highly corrosive. It said these conclusions must be interpreted with caution and clinical studies are needed before definitive protocols.
In a 2024 laboratory study within the 2026 review, lithium disilicate etched with 5% hydrofluoric acid for 20 seconds, with a universal primer, had the lowest micro-shear bond strength after temperature cycling, 6.02 MPa. That was significantly lower than lithium disilicate treated with a self-etching ceramic primer instead (12.58 MPa) and two sandblasted zirconia groups, one with each primer (14.20 and 12.48 MPa).
A 2024 paper on bonding braces to restorations says patients with restorations should be told of an increased risk of bond failure and a risk of damage to restorations or teeth.
How well do attachments bond to ceramic veneers?
In a 2026 laboratory study, attachments on lithium disilicate veneers fitted to extracted premolars bonded significantly less strongly than on enamel with a high-viscosity composite.
Mean shear bond strengths were 15.4 against 19.6 MPa. With a flowable composite they were 14.5 against 15.9 MPa, and only teeth with composite fillings bonded significantly weaker. The veneers were etched with hydrofluoric acid for 20 seconds, then given a universal adhesive, and tested after 24 hours in water, without temperature cycling. The authors judged both composites' bonds clinically acceptable on enamel and lithium disilicate. The 2026 review, searching 2015 to 2025, found no attachment studies on feldspathic porcelain, so drew no conclusions for it.
How is restoration replacement planned around orthodontic treatment?
A 2024 article on orthodontic-restorative care says the treatment plan can be broken into stages, depending on the teeth's condition and planned restorative treatment.
The British Orthodontic Society's archived 2016 adult guide says that if crooked teeth have been present for most of your life, other problems may have arisen, such as wear caused by badly positioned teeth, which your dentist will need to treat once the teeth have been straightened.
For braces, the 2024 bonding paper advises keeping roughening of ceramic for when bonding has failed or where replacement restorations are planned, as removing the glaze compromises the ceramic's appearance when braces come off.
Who is orthodontic treatment at Deepcar Dental Care for?
Orthodontic treatment at Deepcar Dental Care is for adults only.
The main aligner page covers clear aligner therapy at the practice.
Frequently asked questions
Does using an implant as an orthodontic anchor harm it?
One braces study found no significant difference in bone loss, or in peri-implantitis (bone loss over 1 mm). In 24 closely monitored patients treated for severe gum disease, followed 5 to 17 years, bone loss averaged 0.43 mm around 29 anchor implants and 0.28 mm around 29 others; 5 and 4 had peri-implantitis. It was retrospective and small.
Can removing attachments damage a crown or veneer?
No damage was seen in one 2024 laboratory test of 40 lithium disilicate and zirconia specimens, which are not restorations in a mouth. Attachments were sheared off after temperature cycling. For braces, a 2024 paper says patients should know that any bonding technique can compromise a ceramic surface, especially roughening it.
Do attachments bond to white fillings?
Attachments bonded significantly less strongly to white fillings than enamel in one 2026 laboratory study. On month-old composite fillings, etched with phosphoric acid without roughening, bonds were 7.3 MPa (flowable) and 10.4 MPa (high-viscosity), against 15.9 and 19.6 MPa on enamel, at 24 hours without temperature cycling. The authors judged high-viscosity bonds more reliable on fillings.
Do attachments bond to zirconia crowns?
Laboratory results vary widely. In a 2026 review's table, zirconia shear bond strengths ranged from 1.58 to 3.32 MPa in one study (silane after diamond bur or air abrasion). In another, after hydrofluoric acid etching, they ranged from 4.55 MPa (bonding agent alone) to 33.25 MPa (silane and resin cement). None of its studies was clinical.
Why do bonding studies urge caution with hydrofluoric acid?
Hydrofluoric acid is corrosive and toxic to living tissues, a 2024 paper on bonding braces to restorations says. It advises protecting all soft tissues, using a minimal amount and high-volume suction while rinsing. The 2026 review of attachment studies on crown materials urges caution or a gum barrier, such as a rubber dam.
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