Dental Elevators

ELEVATORS Dr. Shafi Md Anis

OMFS

INDICATIONS FOR USE Reflect mucoperiosteal membrane

Luxate,remove teeth which cannot be engaged by forceps (impactions and mlapositons)

Remove carious or fractured roots

Loosen teeth prior to application of forceps

Split teeth which have grooves cut into them

Remove intra radicular bone

Indications :REMOVAL OF TEETH REMOVAL OF ROOTS

Imapctions : Unable to engage tooth with forceps

Malposed teeth : Impinging,pressure on adjacent teeth

Decayed teeth: Fracture easily

Titlted teeth : Beaks not parallel to long axis of tooth

Roots fractured at : -- Gingival line --- Midlength ---Apical third --- Roots left in

alveolus from previous extractions

RULES TO BE FOLLOWED Never use adjacent tooth as fulcrum, unless it is to

be extracted also Never use buccal plate at the gingival line as

fulcrum ,except in Odontectomy Never use lingual plate at gingival line as fulcrum Always use finger guards for protection against

slipping Controlled forces and pressure exerted in the correct

direction Always elevate from mesial side of tooth When cutting through interseptal bone, not to

engage adjacent tooth root and force it out of socket

Concave/flat surface of the elevator faces the tooth/root to be elevated

Do not use luxator as lever

HAZARDS OF USING ELEVATORS

Damaging or extracting adjacent teeth Fracturing maxilla or mandible Fracturing the alveolar process Accidental penetration of maxillary antrum

and soft tissues (may perforate greater blood vessels)

Forcing root or a third molar into antrum Forcing apical third of root of man.molar

into man.canal,or lingual plate or pterygomandibular space

COMPONENTS The elevator consists of the following

components: 1) Blade 2) Shank 3) Handle

Types of Blades Straight Type – Straight Elevator Triangular Type – Cryer Elevator Pick up Type – Apical Pick

Straight/Gouge Type Most commonly used to luxate teeth. Blade – concave surface on one side.

Small type – No. 301 Large type – No. 34S, 46, 77R

Blade at an angle from shank – for use in posterior teeth.

-Miller’s elevator -Pott’s elevator

Triangular/Pennate Shaped Second most common. Pairs – right and left. Use – when a broken root remains in

socket and adjacent socket is empty. Cryer’s elevator.

Pick Type Used to remove roots.

Crane pick-Heavy version-Used as lever to elevate root

from socket-Hole drilled 3mm deep into the

root, pick is inserted into the hole, root is elevated using buccal plate as fulcrum.

Root tip pick/ Apex elevator

- delicate-to remove small root tips from sockets

CLASSIFICATION ACCORDING TO USE:

1) Elevators designed to remove the entire tooth [1L – 1R]

2) Elevators designed to remove roots broken off at the gingival line [30 – 40 – 5]

3) Elevators designed to remove roots broken off halfway to the apex [30 – 4 – 5, or 14L – 14R, or 11L -11R]

4) Elevators designed to remove the apical 3rd of the root [apical fragment ejectors No. 1,2 and 3]

5) Elevators designed to reflect the mucoperiosteum [Periosteal elevators] before forceps or extracting elevators are used.

ACCORDING TO FORM: 1) Straight- wedge type [straight apex] 2) Angular- right and left. 3) Cross bar [handle at right angles to

shank]

PRINCIPLES OF ELEVATORSThere are 3 principles- Lever Principle Wedge Principle Wheel and Axle Principle

LEVER PRINCIPLE M.A=3

Most commonly used principle. Elevator is lever of the first order. Fulcrum is between effort and resistance. In order to get mechanical advantage, effort

arm must be longer than resistance arm. It is used to remove roots. Eg: Straight elevator, Cryer’s elevator,Apexo

elevator Small force,Large movement

Large force,small movement

WEDGE PRINCIPLE M.A = 2.5

Wedge is a movable inclined plane which overcomes large resistance at right angles to the applied effort.

Wedge elevator is forced between the root and the bone parallel to the long axis of the tooth.

Used to remove small root tips. Instrument tip should always be as small as or

smaller than the root tip. Excessive force should be avoided. E.g Apexo elevator,Cryer’s elevator

WHEEL AND AXLE PRINCIPLE M.A=4.6

It is a modified form of lever principle. The effort is applied to the circumference

of the wheel which turns the axle so as to raise a weight.

Eg: Crossbar elevators. Can cause most trauma – fracture of

mandible.

PATIENT PROTECTION Elevators produce a great multiplication

of force when in use. Principles to be applied in protection

1. His jaws must be supported to prevent dislocation of mandible

2. Other tissues in oral cavity must be protected against potential tissue damage,i.e accidental slipping and plunging of the point of elevator in adjacent or distal soft and hard tissues.—Important when using WEDGE type elevators

Protection is best accomplished by:

Careful and continuous control of direction of force, so it is directed into bone surrounding the tooth or against the tooth being luxated

Surrounding immediate operating area with fingers

Maxilla : Grasp dental arch with index finger and thumb so that alveolus is in between

Mandible : First and second fingers should straddle alveolus and thumb placed below mandible, supporting it and off setting downward pressure of elevator which may dislocate mandible

This placing of fingers, buccally,labially and lingually gives operator immediate information, whether or not pressure is being created on adjacent teeth which are not to be extracted

Adjacent teeth should never be used as fulcrums unless they are to be extracted as well

This position also means that if the working point of elevator slips, it will affect the operator’s finger rather than patient’s surrounding soft tissue,nerves and blood vessels

ELEVATORS IN COMMON USE

Apexo Elevator Periosteal Elevator Miller’s Elevator Cryer’s Elevator Winter’s Crossbar Coupland Elevator Pott’s Elevator Warwick James (Hockey stick Pattern)

APEXO ELEVATOR Uses Lever and Wedge Principle.

Biangulated, sharp, straight working tip

Paired

Used to remove root tip from socket

Used first as a wedge to dislodge the root tip & then as a lever to remove it from the socket.

NO.301 STRAIGHT APEXO ELEVATOR

Primarily used on Maxilla---upper central or lateral cuspid or bicuspid has fractured at gingival line

Used as a wedge

NOS.4 (302) AND 5 (303) APEXO ELEVATORS (R & L) ON THE MANDIBLE

Blade is at 45 degrees to handle Used as a wedge Maybe be used on all lower teeth with

fractures occurring at gingival line Mucoperiosteum is first reflected with

Periosteal elevator

DOUBLE APEXO ELEVATOR TECHNIQUE

No.4 Apexo elevator in the left hand, No.5 Apexo elevator in the right hand

Place points of both in against the root on opposite surfaces and using both elevators with lever pressure occlusally elevate root to the surface

Double elevators and the preceding techniques are used on lower cuspids,bicuspids,centrals,lateral incisors and lower molars

PERIOSTEAL ELEVATORDyles’ mucoperiosteal elevator No. 9 Molt Periosteal Elevator. Mucoperiosteal Elevator

Used to raise ginigval tissue at cervical region which is to be detached for extraction of tooth. Reflecting mucoperiosteum away from bone to prevent it being

crushed- as fulcrum is bone

2 ends: Sharp pointed end to reflect dental papilla. - Broader flat end to elevate tissue from bone. 3 methods to reflect soft tissues: - Pointed end used in prying motion to elevate soft tissue. Most

commonly used to elevate dental papilla from between teeth. - Push stroke: Broad end pushed under flap to separate periosteum from

bone. - Pull stroke: Tends to tear tissue if not careful.

USE OF CROSS BAR ELEVATORS ON THE MANDIBLE

Cross bar elevators are used on the mandible for

- removing molar roots fractured at or below the gingival line

- fracture off crown or split roots after a groove has been cut

- to loosen teeth - for removal of imapctions

MILLER’S AND POTT’S ELEVATOR

CRYER’S ELEVATOR

Uses Lever, Wedge and Wheel & Axle Principle.

It is a straight elevator. It has a triangular blade. Working tip is angulated with one convex

and another flat surface. Right & left.

USES… Used for removing root stumps of

mandibular molars. When one root is removed & the other

left behind. When both roots present but one is

fractured at a lower level than other or when furcation is intact.

WINTER’S CROSSBAR ELEVATOR

Shank at right angle to the angle. Working tip almost similar to Cryer’s

elevator except that it meets the shank at a greater angle.

Used for extraction of mandibular molar roots.

COUPLAND ELEVATOR Most commonly used. 3 types- Types 1, 2 & 3. Type 3 has the widest blade. Blade has a concave surface on the side

which faces the tooth. Sometimes the blade can be at an angle to

the shank. It is placed parallel to the long axis of the

roots between the socket walls and the roots and worked towards the apex.

WARWICK JAMES ELEVATOR/ HOCKEY STICK PATTERN

Resemble hockey stick. Blade is straight and at an angle to the

shank. Blade has convex and flat surface. Flat surface is working end and has

transverse serrations on it for better contact with root stumps.

STOBI’S TECHNIQUE Only condition when adjacent tooth is

used as a fulcrum. Used during multiple extractions.

To conclude… Elevators should be used with caution. Excessive forces damage or displace

adjacent teeth. It must be kept in mind that this is the

initial step in extraction process and that forceps is the major instrument for tooth luxation and removal.

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