Embodiments are provided for forming a patterned dental positioning appliance. One method includes forming a virtual shell shaped to receive one or more teeth of a virtual model of a patient's dentition, and digitally applying a pattern on an inner surface within cavities of the virtual shell, where the pattern contacts at least a portion of the one or more teeth and modifies repositioning forces exerted on the one or more teeth. In some cases the pattern is a raised pattern, such as a raised mesh pattern. In forming the dental appliance, in some cases, the shell and the pattern are formed of the same material to form a unitary piece of the polymer material.