Systems, methods, and devices for improved orthodontic treatment of a patient's teeth are provided herein. A method may include determining a movement path to move one or more teeth from an initial arrangement to a target arrangement, determining an appliance geometry for an orthodontic appliance comprising a shell and one or more integrally formed components, wherein the shell comprises a plurality of teeth receiving cavities shaped to move the one or more teeth from the initial arrangement to the target arrangement, and generating instructions for direct fabrication of the orthodontic appliance, wherein the instructions are configured to cause direct fabrication of the shell using a first material and direct fabrication of the one or more integrally formed components using a second, different material.