This is my setup for upper central incisors, it's pretty minimal again and
what we have is the periosteal, the EL3SX elevator and we've got the 76S forcep.
Now you can also use a number one forcep, which is designed for central
incisors it's very, very straight and it's totally fine as well but this is
just what I've grown comfortable with; it works for me so it could work for you...
something to try if you're interested. We have our periosteal that we're going to
start with and we're going to be approaching this tooth and releasing the
papilla, so we're going to be pushing between the teeth all the way to bone
and we're going to twist to get the papilla away. Now, again I'll often use it in this
direction with the concavity away from the tooth which allows me to more easily
kind of lever and twist the papilla off of there. So we're going to do that in all
four corners and then we're going to go back with the concavity now toward the
tooth and we're going to sink that into the bone and we're just going to kind of
undermine and push on the tissues to get everything reflected like a mini flap
around that tooth. Again, the reason is to get our instruments deeper down on the
root to get a mechanical advantage to get it out. The next step is to use our
luxating elevators or three millimeter luxating elevator you can again use your
301 or whatever elevator you'd like to use or are comfortable using... this is mine
that I like to use. I will use it on the distal aspect of this tooth and I
will do it on the mesial aspect of the tooth and I will also do the palatal and
I typically prefer the palatal and do most of my elevation from the palatal
while pushing apically along this tooth and kind of wiggling side-to-side as I
get pushing. Now what this does is it forces the instrument down along that
root and it will begin to displace it because two objects can't occupy the
same space, so as we do that you can see what happens.
Solely from a little elevation that tooth just squirts right out. Now you
won't always get that happening but you can get some good movement on the tooth
and the palate is a terrific place to elevate that we don't often think of and
you should be thinking of in these cases. Now when you're doing it from the
palatal, we need to be cognizant of the fact that
the facial bone is very, very thin so do not be levering in that direction
or pushing that tooth out through the facial bone because you're going to do some
damage and that's going to heal up to be pretty ugly and it's not going to be a
good place for an implant or even a bridge or some type of prosthetic if
that bone doesn't heal nicely. The facial bone is very thin we don't want
to be doing this approach on the facial of this tooth; only to the palatal and
the distal and the mesial. So we're going to do that to loosen things up. Often times
if the tooth is moving a bit, we're going to finish with our forceps. The 76S adapts
nicely in my hand and nicely to the tooth and what I do is I squeeze as hard
as I can once I'm under the height of contour of that tooth and I'm going to
be pushing also apically as I am squeezing. I'm pushing in this
direction, I'm squeezing very hard and what that's doing is its allowing the
forcep to seat farther down the tooth. The cool thing is if you look at the
way that this is shaped and you look at the way that the tooth is shaped, as
you're squeezing and as you're pushing you're eventually going to get to a
point where that forcep starts to kind of come together so you get over this
contour in the tooth and that tooth will sometimes shoot right out solely from
the squeezing pressure that you're using. We're squeezing and pushing apically
and we're also going to be rotating. That's our main movement, just
rotating back and forth, back and forth and we're going to do it for about five seconds.
This way hold... and then we're going to come back five seconds the other way... hold... and
just do it very slowly to allow that root to expand the bone. As you get to a
certain point that root is just going to twist completely and it's going to
deliver out of the socket. You'll be amazed at this technique. It's a better
way than going with your buccal lingual movements. It's easier on the bone, easier
on the facial bone, you're not going to break so much bone if you're just
pulling to the buccal. You're just going to be rotating and applying traction so
that's a terrific way to approach these. Hope you have a good success with it.
Central incisors are always very concerning to patients and they're an
aesthetic nightmare if you do these incorrectly or you don't manage the bone
properly. The other thing that I should have mentioned is that with this thin
facial bone you're pushing and as you're applying
your pressure, you again want to have your pinch grasp with your fingers to
make sure that you're having feedback of that bone to make sure you're not
applying too much pressure in the facial direction and you're also supporting the
facial bone with your finger to try to prevent those fractures.