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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