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The lower canines present different problems. They are angled from
buccal to medial within the alveolus and not along the long axis
of the body of the mandible. The root, therefore, disappears away
from the operator's vision and access during removal.
Envelope flaps from the area of the central incisor to the premolar
2 on both sides - lingual and buccal - will provide access to the
alveolar bone. Bone removal can then take place in order to provide
a channel for the luxator blades. Be aware that the root is bulbous,
with a greater width than the crown.
An alternative technique describes making a large flap on the floor
of the mouth in order to approach the root from the lingual aspect,
where the bulk of bone is less (Smith,
1996).
Lingual aspect exposure for some individuals will allow much better
visualisation of the apical area than palatal exposure.
Buccal aspect exposure requires some disruption of the lip frenulum
and care is necessary when approaching the middle mental foramen
and its contents. The middle mental foramen is located under premolar
1 and carries the sensory mental nerve and blood vessels.
Once the flap is made the procedure requires removal of alveolar
bone, as necessary, to allow access of the luxator blade to the
root. Beware of applying too much force, as either symphyseal separation,
rostral mandibular fracture or root fracture are common features
of poor technique.
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