When undergoing orthodontic treatment, the primary goal is to move teeth into a healthier, straighter position. While brackets and wires handle much of the basic alignment, certain complex movements or bite corrections require auxiliary tools. These tools, known as orthodontic buttons, are small, temporary attachments that allow the orthodontist to apply specific, directional forces that the main appliances cannot achieve alone. They are a common addition, especially in cases involving correcting how the upper and lower jaws fit together, acting as anchors to deliver the precise force needed for intricate adjustments.
What Orthodontic Buttons Are
Orthodontic buttons are specialized attachments bonded directly to the surface of a tooth, serving as a fixed point for force application. These devices are typically quite small, often measuring only a few millimeters across, and may be round or have a varied shape depending on their intended function. They are usually made of stainless steel for maximum strength, or a tooth-colored composite resin or ceramic material for a less noticeable appearance. The button is affixed to the tooth enamel using a strong dental adhesive, similar to how brackets are attached.
The button is distinct from a traditional bracket because it lacks the slot for the main archwire. Instead, it features a small hook or shape designed to securely catch other components. Buttons are placed with precision, sometimes on the outer (buccal) surface, but frequently on the tongue-side (lingual) surface to keep them out of sight. Their placement transforms a smooth tooth surface into a functional anchoring point that can withstand the tension and force of auxiliary mechanics.
How Buttons Function in Tooth Movement
Buttons are biomechanical handles that allow the orthodontist to apply forces for complex movements beyond simple tipping or straightening. Their primary function is to serve as an anchorage point for elastic bands, which are stretched between a button on an upper tooth and a corresponding point on a lower tooth. This connection applies constant, gentle force to correct bite issues, such as overbite (Class II) or underbite (Class III) correction, by adjusting the relationship between the upper and lower jaws.
The application of force through buttons is also essential for achieving the specific rotation of severely misaligned teeth. A power chain or specialized thread can be attached to a button on a rotated tooth to twist it accurately into alignment, using the button as a precise leverage point. Buttons are also utilized to facilitate vertical tooth movement, known as extrusion (pulling a tooth down) or intrusion (pushing a tooth up) into the gumline. By creating a fixed point, the button allows for the directed application of force, making these challenging movements possible.
Common Types and Placement
Orthodontic buttons come in several variations, with the material choice depending on aesthetic concerns and required mechanical strength. Traditional buttons are small, circular metal pieces, typically made of stainless steel, which offer maximum durability and are used when high forces are necessary. Ceramic or composite buttons are tooth-colored, making them much less visible, and are often preferred for placement on teeth in the front of the mouth.
The decision regarding button placement is strategic, determined by the specific movement planned for the tooth. Buttons are frequently placed on the lingual surface, facing the tongue, to hide them from view while still providing a secure point for elastics or chains. In modern orthodontics, particularly with clear aligner therapy, composite buttons—often referred to as attachments or engagers—are bonded to the teeth. These provide the aligner tray with a surface to grip for greater control over movements like rotation or vertical shifts.
Caring for Buttons and Handling Issues
Maintaining excellent oral hygiene is important when wearing orthodontic buttons, as they can easily trap food particles and plaque around the bonded base. Patients should meticulously clean the area around each button using a soft-bristled toothbrush and specialized tools, such as proxabrushes or floss threaders, to prevent buildup. Tooth-colored composite buttons can be susceptible to staining from dark liquids like coffee, tea, or red wine, so rinsing the mouth immediately after consuming these items is advisable.
Initial discomfort is common, as the buttons may cause minor irritation to the inner cheek or tongue until the mouth adjusts. Applying a small amount of orthodontic wax directly over the button can create a smoother surface and help alleviate any rubbing or soreness. If a button debonds or falls off, contact the orthodontist immediately, as this issue can stop the intended tooth movement and delay the overall treatment timeline. Patients should also avoid hard or sticky foods, which can easily shear the button off the tooth surface.