Extruding with auxiliaries is a technique used to extrude a tooth that has not erupted as desired.
Below are step by step instructions on how to extrude teeth with auxiliaries.
Download a printable guide here.
Using a coarse sandpaper disc, roughen enough area on the tray to place an orthodontic bracket on the facial gingival 1/3 of the tooth to be extruded.
You can see the relative size of the roughened area circled here in green.
Prepare a 50/50 mixture of resin cement base and catalyst and place a small amount onto the ceramic bracket.
Place the ceramic bracket on the roughed-out area of the aligner tray. Adjust as needed, then wait 2-3 minutes for the resin cement to set.
Using a coarse football diamond bur, start at the top of the tray on the lingual side and cut a space to clear the bracket, leaving room for the tooth to extrude.
Once the tray is cut, it should look something like this.
Remove the engager from the tooth to be extruded.
Etch the tooth to be extruded on the lingual side.
Rinse the acid and dry with the air/water syringe.
Bond the metal bracket with a composite resin recommended for bonding orthodontic brackets.
Break contact on the mesial side of the tooth being extruded using a metal diamond strip, then break contact on the distal side the same way.
Insert tray and place the elastic over the facial bracket (on the tray) and the lingual bracket (on the tooth).