Alternative Fulcrums

Cross-arch - Fulcrum finger on the same arch, opposite quadrant (Figure 61).

Opposite-arch - Fulcrum on the arch opposite the working area (Figure 62).

Finger-on-finger - Fulcrum on a finger of the non-dominant hand resting on the working arch (Figure 63).

Reinforced fulcrum - Near-tooth fulcrum; index finger of the opposite hand presses the shank to increase controlled lateral pressure (Figure 64).

Extraoral fulcrums - Back of hand or fingers rest extraorally to stabilize and improve angulation (Figure 65).

Figure 61. Cross Arch.

Figure 61. Cross Arch.

Figure 62. Opposite arch.

Figure 62. Opposite arch.

Figure 63. Finger-on-finger.

Figure 63. Finger-on-finger.

Figure 64. Reinforced Fulcrum.

Figure 64. Reinforced Fulcrum.

Figure 65. Extraoral Fulcrum.

Figure 65. Extraoral Fulcrum.

Benefits and cautions: Alternative fulcrums can improve access, angulation, activation, and stroke power. They can also increase risk of patient or operator injury if the rest is unstable or force is uncontrolled. Prioritize a stable rest, correct working angulation, controlled lateral pressure, and soft-tissue safety.²²