Stop the Wiggle by Dr. Jackson Bean

Why the wiggle was never a technique, and what to do instead

by Dr. Jackson Bean

I can usually tell how an extraction will end within the first 15 seconds, and it has nothing to do with the tooth. It has to do with what the doctor’s hand is doing.

If the wrist is oscillating—that quick back-and-forth wiggle-wiggle most of us were taught—I already know where this is going. There will be a root tip; if not now, then soon. Over the course of 100 cases, there will be many, and the doctor will conclude that molars are hard and some teeth just break.

It’s akin to an endodontic file separation, which is just a clever way around the fact that we broke it. When I get an associate to stop wiggling, their broken root tips fall off a cliff. I’ve watched it happen enough times that I no longer treat it as an opinion.


Why the wiggle fails
Here’s what should end the argument: Teeth are built for high-force, repetitive motion.

The periodontal ligament is a nonlinear viscoelastic tissue: collagen fiber bundles in a fluid ground substance of proteoglycans and glycoproteins.¹ Its job description is absorbing cyclic load during mastication. The literature is blunt about the consequence: The PDL responds rigidly to rapid deformations while deforming elastoplastically only under low-grade continuous force.¹ Wiggle it and it stiffens, yet hold it, and it yields.

A tooth’s PDL dissipates roughly 50 times more energy than a dental implant under an axial intrusive load—7.35 × 10^-2 mJ versus 1.47 × 10^-3 mJ—owing entirely to its fluid and viscoelastic properties.² When you wiggle, you are feeding the ligament the one type of load it welcomes with open arms.

That oscillation isn’t free, either. The root is taking cyclic fatigue loading, and in an endodontically treated tooth, already structurally depleted by access preparation, instrumentation, and restorative history,^3,4 cyclic fatigue is precisely the failure mode you cannot afford. You are loading the ligament in the way that helps it and the root in the way that hurts it.

Under sustained load, the PDL behaves completely differently. It creeps: At constant stress it keeps deforming as the collagen network structurally rearranges. And it stress-relaxes: at constant deformation, internal stress decays.^1,5,6 Polarized microscopy has shown collagen fibrils in stretched bundles progressively aligning along the direction of deformation during relaxation.⁷ That is a ligament reorganizing and giving up, in real time, under a load that doesn’t let go.


The PDL doesn’t tear from motion; it tears from load held
The endodontically treated molar is where extraction philosophy gets tested. Root canal therapy means a brittle tooth to extract, grabbing the crown gives your forceps nothing, and it shears at the worst possible moment. Stack on dense cortical plates, curved roots, and the occasional root that’s decided it’s part of the jaw, and the conventional sequence of elevator, wiggle, and cow horns is a coin flip.

But the stakes aren’t just whether it came out. The alveolar ridge loses roughly 40–60% of its bone within three months of extraction, and the facial plate goes first and worst.⁸ When I’m placing immediately, the extraction is the site development. Fracture that plate and I haven’t made the graft harder; I’ve changed the case, converting an immediate into a staged one or into a compromise I’ll manage for a decade.


What the expanders are actually doing
The Xpanders (ArtCraft Dental) aren’t a new elevator so much as a relocation of the work. Each carries a double-pronged tip establishing two-point contact: one prong seats against the crest of bone, the other engages the neck of the tooth. The prong on bone becomes a fulcrum; the prong on the tooth converts rotation into lateral force.

Fig. 1

Fig. 2

But the design only pays off if the motion is right, and this is where the instrument gets misused by people who describe it correctly.

It is not a prying action. It is apical seating, then twist and hold.

You work apically down the palatal or lingual PDL, patiently, letting the tip find the ligament space and advance along it. You are not levering against the tooth. You are seating the instrument down the ligament. Then you twist, and you hold (Figs. 1 and 2). Not twist-and-release. Not twist-twist-twist. A twist, and a held load, sustained long enough for viscoelastic tissue to do what viscoelastic tissue does: creep, relax, and let go.

You will feel it—not a lurch or a crack, but a slow, progressive give. That is stress relaxation happening under your hand. Once you’ve felt it, you won’t go back to oscillating.

Work around the tooth and you aren’t extracting so much as expanding the socket around it, toward genuine 360-degree expansion. This is the principle underlying periotome-based atraumatic technique, which has a reasonable evidence base for ridge preservation, reduced postoperative pain, and implant site preparation.^9,10 The expanders execute it with more authority, because two points of contact deliver more lateral movement per cycle than a single blade sliding down a root.

The set is organized around the job: an anterior pair (straight and curved) and a posterior pair (an “in” and an “out”). They’re 420 surgical stainless and thin by design, which is exactly why they demand correct technique. Don’t lean back on them like a shovel; don’t come in flat at 90 degrees. Do either and you’ll bend a tip and blame the instrument. That isn’t a defect. It’s the trade-off that lets a tip enter the ligament space at all.

What you want at the end is a socket with intact plates and clean walls—intact single roots are nice, but the emphasis is now on having no flap and no bur touching bone. That is the deliverable, and the expanders translate into less risk and trauma for our surgery patients (Fig. 3).

Fig. 3

Where it fits and where it doesn’t
The manufacturer positions the expanders as faster and more powerful than luxators and proximators. In my hands the category claim holds: The two-point design delivers more controlled lateral movement per cycle than any single-blade instrument I’ve used, and they’re now the first thing I reach for on compromised, endodontically treated teeth or any site where I’m protecting a plate for implant reasons (Fig. 4).

Fig. 4

But I won’t quote you a number, and you should be suspicious of anyone who does. There is no independent randomized trial on this specific instrument. What exists is a substantial body of evidence that atraumatic, ligament-based, socket-expanding technique preserves ridge and sets up implant sites,^8,9,10,11 plus well-characterized PDL viscoelasticity explaining why sustained load works and oscillation doesn’t.^1,2,5,6,7 The expanders are a clean execution of both. That’s an honest place to plant the flag.

They’re also not magic. A truly ankylosed root, a severe curvature, a root already fractured subcrestally: those still call for judgment, and sometimes a bur is the atraumatic choice. And they reward the clinician who slows down for the first dozen cases.


The bottom line
Many things changed over time with my extraction technique. The first was understanding that the ligament fails under held load, not under motion, which means the wiggle was never a technique but a habit we inherited. The next was grasping a flapless approach, letting the implant benefit from the scaffold of hard and soft tissue architecture instead of rebuilding it later. Equally significant was picking up an instrument engineered to leverage all of the above for a clinical advantage.

If you only remember one thing, it might be to stop wiggling. The real message is to parlay your knowledge of biology and PDL composition and use the expanders’ double-purchase-point tip to maximize PDL realignment as you twist and hold. Seat it, twist it, hold it, and let the ligament do what the science says it will do. Then look at your socket. If the plates are intact and the roots are whole, you didn’t just take out a tooth. You prepared an ideal implant site.

And in the day of the immediate implant, that socket is either intact and your best asset or the first problem you must surmount with a compromised outcome. The Xpanders are a tool to help reduce that risk and trauma for patients.

Disclosure: A set of Xpanders was provided to the author by ArtCraft Dental, Inc. for the purpose of independent evaluation. The author has no financial interest in, or financial relationship with, ArtCraft Dental, Inc., and received no compensation for this review. The author is a key opinion leader for Noris Medical and Septodont.

References
1. Fill TS, Carey JP, Toogood RW, Major PW. Experimentally determined mechanical properties of, and models for, the periodontal ligament: critical review of current literature. J Dent Biomech. 2011;2011:312980.
2. Chang HH, Yeh CL, Wang YL, Huang YC, Tsai SJ, Li YT, Yang JH, Lin CP. Differences in the biomechanical behaviors of natural teeth and dental implants. Dent Mater. 2021;37(4):682–689.
3. Tang W, Wu Y, Smales RJ. Identifying and reducing risks for potential fractures in endodontically treated teeth. J Endod. 2010;36(4):609–617.
4. Yuan Y, Chen P. Timing and method of restoration affect fracture resistance of endodontically treated teeth: an in vitro study. Medicine (Baltimore). 2025. doi:10.1097/MD.0000000000046421.
5. Natali AN, Pavan PG, Carniel EL, Dorow C. Viscoelastic response of the periodontal ligament: an experimental–numerical analysis. Connect Tissue Res. 2004;45(4–5):222–230.
6. Huang H, Tang W, Yan B, Wu B. Mechanical responses of the periodontal ligament based on an exponential hyperelastic model: a combined experimental and finite element method. Comput Methods Biomech Biomed Engin. 2016;19(2):188–198.
7. Komatsu K. Mechanical strength and viscoelastic response of the periodontal ligament in relation to structure. J Dent Biomech. 2010;2010:502318.
8. Van der Weijden F, Dell’Acqua F, Slot DE. Alveolar bone dimensional changes of post-extraction sockets in humans: a systematic review. J Clin Periodontol. 2009;36(12):1048–1058.
9. Alraqibah MA, Rao JKD, Alharbi BM. Periotome versus piezotome as an aid for atraumatic extraction: a randomized controlled trial. J Korean Assoc Oral Maxillofac Surg. 2022;48(6):356–362.
10. Bora J, Das A, Gupta H, et al. Effectiveness of periotomes in atraumatic extractions: a clinical study. J Family Med Prim Care. 2022;11(10):6201–6205.
11. Chen ST, Buser D. Aesthetic outcomes following immediate and early implant placement in the anterior maxilla: a systematic review. Int J Oral Maxillofac Implants. 2014;29(Suppl):186–215.

Jackson Bean, DDS, DIADI, FICOI, is an implant surgeon and owner of Complete Dental Care in Greenville, Texas, and founder of Productive Dental Mentors, a clinician mentorship program. He serves on the Global Expert Academy Faculty for Noris Medical, is a Zero Bone Loss Concepts Ambassador, a diplomate of the International Academy of Dental Implantology, and a fellow of the International Congress of Oral Implantologists. A recognized “Full Arch Master” and the first dentist in Texas certified in Vectra 3D facial scanning, he holds two clinical patents, has an implant abutment currently under FDA review, and authored a bone-density-based osteotomy preparation protocol for tapered implant systems. His clinical focus is immediate implant placement, full-arch rehabilitation, and iCam 4D photogrammetry workflows.