Dental Elevators

Elevators used in oral surgery for ug

1. ELEVATORS Dr. Shafi Md Anis OMFS

2. 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

3. 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

4. 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

5. Concave/flat surface of the elevator faces the tooth/root to be elevated Do not use luxator as lever

6. 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

7. COMPONENTS The elevator consists of the following components: 1 ) Blade 2) Shank 3) Handle

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

9. 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

10. 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.

11. 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.

12. Root tip pick/ Apex elevator - delicate -to remove small root tips from sockets

13. 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 3 rd 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.

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

15. PRINCIPLES OF ELEVATORS There are 3 principles- Lever Principle Wedge Principle Wheel and Axle Principle

16. 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

17. 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

18. 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.

19. 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

20. 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

21. 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

22. 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)

23. 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.

24. 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

25. 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

26. 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

27. PERIOSTEAL ELEVATOR Dyles ’ 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.

28. 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

29. MILLER’S AND POTT’S ELEVATOR

30. 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.

31. 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.

32. 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.

33. 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.

34. 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.

35. STOBI’S TECHNIQUE Only condition when adjacent tooth is used as a fulcrum. Used during multiple extractions.

36. 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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