Elevators & Surgical Elevators & Surgical ExtractionsExtractions

2-28-20082-28-2008

ElevatorsElevators

1. Facilitate tooth removal1. Facilitate tooth removal 2. Minimize breakage of teeth2. Minimize breakage of teeth 3. Minimize trauma in area of 3. Minimize trauma in area of

tooth to be extractedtooth to be extracted 4. Reduces amount of force 4. Reduces amount of force

applied to forcepsapplied to forceps 5. Most importantly- Facilitates 5. Most importantly- Facilitates

root tip removal if crown broken root tip removal if crown broken off with forcepsoff with forceps

Use of ElevatorsUse of Elevators

Displacement/Wedge (inclined Displacement/Wedge (inclined plane)plane)

Lever actionLever action Wheel and AxleWheel and Axle

Displacement (Wedge)Displacement (Wedge)

The formula for the wedge The formula for the wedge indicates 2.5x mechanical indicates 2.5x mechanical advantageadvantage

Used like a shoe horn to Used like a shoe horn to displace:displace:

Residual root tipsResidual root tips Supernumerary teethSupernumerary teeth MesiodensMesiodens

Displacement (Wedge)Displacement (Wedge)

Root tips displaced by insertion Root tips displaced by insertion into the periodontal ligament into the periodontal ligament space.space.

This action will frequently This action will frequently dislodge the root tip.dislodge the root tip.

Note: You should not use this Note: You should not use this technique for removing root tips technique for removing root tips that are in close proximity to the that are in close proximity to the maxillary sinus.maxillary sinus.

Lever ActionLever Action

You can break the instrument You can break the instrument using this techniqueusing this technique

Place the lever under the height Place the lever under the height of contourof contour

Leverage off of interseptal boneLeverage off of interseptal bone Leverage off of crestal (buccal) Leverage off of crestal (buccal)

bonebone

Lever ActionLever Action

Used for prying a tooth root tip Used for prying a tooth root tip from its socket.from its socket.

The elevator engages the tooth The elevator engages the tooth through a through a purchase pointpurchase point (placed by a bur)(placed by a bur)

Or engages the tooth through Or engages the tooth through gripping the tooth with the edge gripping the tooth with the edge of the blade and using the bone of the blade and using the bone as a fulcrum to lift the tooth out as a fulcrum to lift the tooth out of the socketof the socket

Wheel and AxleWheel and Axle

RotationalRotational East/West, Potts, Cryer, Crane East/West, Potts, Cryer, Crane

Pick…Pick… T-bar elevators- mechanical T-bar elevators- mechanical

(advantage is the radius of the (advantage is the radius of the handle – the radius of the head)handle – the radius of the head)… force is 5x applied… force is 5x applied

25 lbs to handle = 125 lbs 25 lbs to handle = 125 lbs transferred to jaw = lawsuittransferred to jaw = lawsuit

Wheel and AxleWheel and Axle

Produced when the elevator Produced when the elevator engages a engages a purchase pointpurchase point

Using the bone as a fulcrum, Using the bone as a fulcrum, rotating the handlerotating the handle

Transmits rotation to tip of Transmits rotation to tip of elevator to root tipelevator to root tip

Good for elevating root tips from Good for elevating root tips from mandibular molarsmandibular molars

Elevator ReviewElevator Review

301 Elevator301 Elevator

Lever actionLever action DisplacementDisplacement Smaller root tipsSmaller root tips

46 Elevator46 Elevator

Lever actionLever action DisplacementDisplacement Most teeth and larger root tipsMost teeth and larger root tips

34S Elevator34S Elevator

Lever actionLever action DisplacementDisplacement Most teeth and larger root tipsMost teeth and larger root tips

Miller ElevatorMiller Elevator

Wheel and axleWheel and axle Impacted maxillary thirdsImpacted maxillary thirds NOT erupted maxillary thirdsNOT erupted maxillary thirds Place at MB of third molar below Place at MB of third molar below

HOC and roll to the distal HOC and roll to the distal

Potts ElevatorPotts Elevator

Wheel and axleWheel and axle Impacted maxillary thirdsImpacted maxillary thirds NOT erupted maxillary thirdsNOT erupted maxillary thirds

Cryer ElevatorCryer Elevator

Wheel and axleWheel and axle Adjacent empty socketAdjacent empty socket Mandibular first molarsMandibular first molars Needs sharp tip i.e. no purchase Needs sharp tip i.e. no purchase

pointpoint

East/WestEast/West

Wheel and axleWheel and axle Adjacent empty socketAdjacent empty socket Mandibular first molarsMandibular first molars Needs sharp tip i.e. no purchase Needs sharp tip i.e. no purchase

pointpoint

Crane PickCrane Pick

Wheel and axleWheel and axle Fulcrum on buccal boneFulcrum on buccal bone Bury tip into cementumBury tip into cementum Usually needs purchase pointUsually needs purchase point Roll the root outRoll the root out

Cogswell ElevatorCogswell Elevator

Wheel and axleWheel and axle Looks like an ice pickLooks like an ice pick ““Stick it anywhere and roll the Stick it anywhere and roll the

tooth out”tooth out”

Surgical ExtractionsSurgical Extractions

Surgical ExtractionsSurgical Extractions

Full-thickness (mucoperiosteal Full-thickness (mucoperiosteal flap)flap) Plus at least ONE of the following:Plus at least ONE of the following: Buccal bone removal and/orBuccal bone removal and/or Division of Crown/rootsDivision of Crown/roots

Indications for Surgical Indications for Surgical ExtractionsExtractions

Elevator and forceps technique failsElevator and forceps technique fails Teeth possessing divergent rootsTeeth possessing divergent roots Teeth with curved rootsTeeth with curved roots Devitalized teeth- old RCT teethDevitalized teeth- old RCT teeth Teeth with hypercementosisTeeth with hypercementosis Adults with retained primary teethAdults with retained primary teeth Impacted teethImpacted teeth Ankylosed teethAnkylosed teeth

Indications for Surgical Indications for Surgical ExtractionsExtractions

Teeth with extensive cariesTeeth with extensive caries Teeth with large amalgam or Teeth with large amalgam or

composite build-upscomposite build-ups Teeth in geriatricsTeeth in geriatrics Questionable path of deliveryQuestionable path of delivery Maxillary molar close to sinusMaxillary molar close to sinus Preserve buccal bone over max. Preserve buccal bone over max.

caninecanine Retained root fragment and/or tipRetained root fragment and/or tip

Root FragmentsRoot Fragments

Roots that have more than their Roots that have more than their apical third presentapical third present

Includes middle and cervical Includes middle and cervical thirdthird

Due to carious process, trauma Due to carious process, trauma or sectioning processor sectioning process

Root FragmentsRoot Fragments

Flap vs. no FlapFlap vs. no Flap

Flap No FlapFlap No Flap

Bone Removal Remove with Bone Removal Remove with forceps or forceps or

elevatorelevator

Remove withRemove with

forceps or elevatorforceps or elevator

Root TipsRoot Tips

The apical 1/3 of the rootThe apical 1/3 of the root Most likely due to root fracture Most likely due to root fracture

during extractionduring extraction

Root TipsRoot TipsLoose vs. AttachedLoose vs. Attached

LooseLoose

Forcibly irrigate w/salineForcibly irrigate w/saline

Remove with suction tip or apex Remove with suction tip or apex elevatorselevators

Root Tips Root Tips Loose vs. AttachedLoose vs. Attached

AttachedAttached

Loosen with explorer or elevatorLoosen with explorer or elevator

ororExtend bone removal from alveolar Extend bone removal from alveolar

crestcrest

ororUse curved flap; approach as though Use curved flap; approach as though

doing an apicoectomydoing an apicoectomy

Maxillary 1Maxillary 1stst Molars Molars

Frequently sectioned and Frequently sectioned and removed one root at a time:removed one root at a time:

Their roots are large and Their roots are large and trifurcatedtrifurcated

Their roots diverge forming solid Their roots diverge forming solid anchors in boneanchors in bone

The max. sinus often encroaches The max. sinus often encroaches into the bone surrounding their into the bone surrounding their rootsroots