Elevators & Surgical Extractions

2-28-2008

Elevators
1. Facilitate tooth removal 2. Minimize breakage of teeth 3. Minimize trauma in area of tooth to be extracted 4. Reduces amount of force applied to forceps 5. Most importantly- Facilitates root tip removal if crown broken off with forceps

Use of Elevators
Displacement/Wedge (inclined plane) Lever action Wheel and Axle

Displacement (Wedge)
The formula for the wedge indicates 2.5x mechanical advantage Used like a shoe horn to displace: Residual root tips Supernumerary teeth Mesiodens

Displacement (Wedge)
Root tips displaced by insertion into the periodontal ligament space. This action will frequently dislodge the root tip. Note: You should not use this technique for removing root tips that are in close proximity to the maxillary sinus.

Lever Action
You can break the instrument using this technique Place the lever under the height of contour Leverage off of interseptal bone Leverage off of crestal (buccal) bone

Lever Action
Used for prying a tooth root tip from its socket. The elevator engages the tooth through a purchase point (placed by a bur) Or engages the tooth through gripping the tooth with the edge of the blade and using the bone as a fulcrum to lift the tooth out of the socket

Wheel and Axle

Rotational East/West, Potts, Cryer, Crane Pick T-bar elevators- mechanical (advantage is the radius of the handle the radius of the head) force is 5x applied 25 lbs to handle = 125 lbs transferred to jaw = lawsuit

Wheel and Axle

Produced when the elevator engages a purchase point Using the bone as a fulcrum, rotating the handle Transmits rotation to tip of elevator to root tip Good for elevating root tips from mandibular molars

Elevator Review

301 Elevator
Lever action Displacement Smaller root tips

46 Elevator
Lever action Displacement Most teeth and larger root tips

34S Elevator
Lever action Displacement Most teeth and larger root tips

Miller Elevator
Wheel and axle Impacted maxillary thirds NOT erupted maxillary thirds Place at MB of third molar below HOC and roll to the distal

Potts Elevator
Wheel and axle Impacted maxillary thirds NOT erupted maxillary thirds

Cryer Elevator
Wheel and axle Adjacent empty socket Mandibular first molars Needs sharp tip i.e. no purchase point

East/West
Wheel and axle Adjacent empty socket Mandibular first molars Needs sharp tip i.e. no purchase point

Crane Pick
Wheel and axle Fulcrum on buccal bone Bury tip into cementum Usually needs purchase point Roll the root out

Cogswell Elevator
Wheel and axle Looks like an ice pick Stick it anywhere and roll the tooth out

Surgical Extractions

Surgical Extractions

Full-thickness (mucoperiosteal flap)

Plus at least ONE of the following: Buccal bone removal and/or Division of Crown/roots

Indications for Surgical Extractions

Elevator and forceps technique fails Teeth possessing divergent roots Teeth with curved roots Devitalized teeth- old RCT teeth Teeth with hypercementosis Adults with retained primary teeth Impacted teeth Ankylosed teeth

Indications for Surgical Extractions

Teeth with extensive caries Teeth with large amalgam or composite build-ups Teeth in geriatrics Questionable path of delivery Maxillary molar close to sinus Preserve buccal bone over max. canine Retained root fragment and/or tip

Root Fragments
Roots that have more than their apical third present Includes middle and cervical third Due to carious process, trauma or sectioning process

Root Fragments
Flap vs. no Flap Flap Bone Removal No Flap Remove with forceps or elevator

Remove with forceps or elevator

Root Tips
The apical 1/3 of the root Most likely due to root fracture during extraction

Root Tips Loose vs. Attached

Loose

Forcibly irrigate w/saline

Remove with suction tip or apex elevators

Root Tips Loose vs. Attached

Attached
Loosen with explorer or elevator

or
Extend bone removal from alveolar crest

or
Use curved flap; approach as though doing an apicoectomy

Maxillary 1st Molars

Frequently sectioned and removed one root at a time: Their roots are large and trifurcated Their roots diverge forming solid anchors in bone The max. sinus often encroaches into the bone surrounding their roots