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Dental elevators

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Principles of using dental elevators

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Dental elevators

  1. 1. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Principles Of Using Dental Elevators Dr. Hesham El-Hawary Assoc. Prof. OMFS
  2. 2. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY REMOVAL OF TOOTH STRUCTURE Surgical Extraction Of Teeth And Roots - ELEVATORS
  3. 3. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Removal of tooth structure Methods • Forceps • Elevators Elevators • Instruments used in luxation &/Or removal of teeth or tooth fragments, which cannot be grasped by the blades of the forceps e.g. impacted teeth, malposed teeth, roots etc
  4. 4. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Removal of tooth structure Elevators Parts of an Elevator • Handle • Shank • Blade
  5. 5. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Elevator handling and grip
  6. 6. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Forms of Elevators Straight elevators Curved elevators Cross bars elevators
  7. 7. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Indications for the use of elevators • Luxation of teeth prior to application of forceps • To luxate or remove teeth that cannot be grasped by the forceps – Impacted teeth – Malposed teeth – Fragile teeth – Teeth with cervical caries • When the initial application of forceps is difficult or liable to cause trauma • Removal of roots broken at the time of operation • Removal of remaining (residual) roots, either visible or buried in the bone
  8. 8. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Dangers in elevator use • Loosening or extraction of adjacent teeth • Fracturing alveolar process, tuberosity, maxilla or mandible • Forcing teeth or roots into nearby vital structures – Maxillary sinus – IAC – Tissue spaces • Slippage leading to tissue injury – Lingual nerve – Soft palate – Oral mucosa – Tongue – Floor of the mouth – Pharynx and tonsils
  9. 9. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Rules in the Use of Elevators • Never use the adjacent tooth as a fulcrum unless that tooth is going to be extracted in the same operation • Never use the buccal plate at the gingival line as a fulcrum except when extracting the lower third molar • The movements of the elevator should be controlled to avoid slipping of its tip and damage to the soft and hard tissues
  10. 10. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Classification of Elevators According to Use • Elevators used to luxate or remove the entire tooth • Elevators used to remove roots broken off at the gingival line or halfway to the apex • Elevators designed to remove apical thirds of the root • Elevators designed to cut bone as well as to remove roots or teeth (ossisectors) • Periosteal elevators
  11. 11. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY MECHANICS
  12. 12. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Type I Lever Type II Lever Type III Lever
  13. 13. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY
  14. 14. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY F R FA RA F: force R: resistance FA: Force arm ( distance from the force to the fulcrum) RA: Resistance arm 9 distance from the resistance to the fulcrum ) : Fulcrum
  15. 15. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY F x FA = R x RA So increasing the force arm and decreasing the resistance arm will decrease the resistance and increase the force This is obtained during extraction by increasing the force arm which starts from the point of tooth grip till the elbow joint of the dentist ( the movement should be from the elbow making the forceps the hand the wrist and the elbow as one unit)
  16. 16. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY F R FA RA
  17. 17. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Wheel And Axel
  18. 18. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Wheel And Axel F R Fr Rr Increasing the radius of the force (fr) and decreasing the radius of the resistance (Rr) will decrease the resistance and increase the force F x Fr = R x Rr F: force R: resistance Fr: radius of the force wheel Rr: Radius of the resistance wheel
  19. 19. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Wedging Action F
  20. 20. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Wedging Action F
  21. 21. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Wedging Action F
  22. 22. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Wedging Action F
  23. 23. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Wedging Action F
  24. 24. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Straight elevators Straight elevator Coupland elevator Straight apexo elevator
  25. 25. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Straight elevator Blade has one convex side inserted toward the bone And one flat serrated side toward the tooth With tapered end
  26. 26. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Straight elevators • Straight elevator – Luxation of mandibular 3rd molars with distally curved roots – Mesial application of force – Principal of action • Lever type I • Rotational movement
  27. 27. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY
  28. 28. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY
  29. 29. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY
  30. 30. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Coupland elevator Blade has one convex side inserted toward the bone And one concave side inserted toward the root surface With flat end
  31. 31. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Coupland elevators • Used as the Straight elevator • Used to elevate the free gingiva from all around the tooth prior to forceps application • Used to luxate and elevate fractured roots of maxillary anterior teeth at the crest level By wedging action along side the root
  32. 32. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Coupland elevator Point of application : Along side the root surface in the periodantal membrane space in opposing line angles
  33. 33. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Straight apexo elevator Blade has one convex side inserted toward the bone And one concave side inserted toward the root surface With fine tapered end
  34. 34. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Straight Apexo elevators • Used to luxate and elevate fractured apical thirds of maxillary anterior teeth by wedging action along side the root surface
  35. 35. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Straight apexo elevator Point of application : Along side the apical third of root surface in the periodantal membrane space Used in opposing line angles
  36. 36. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Cross bar elevators Socket applicator elevator Buccal applicator elevator
  37. 37. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Socket applicator elevator Buccal applicator elevator
  38. 38. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Socket applicator elevator • Mode of action: wheel and axel • Uses: – Removal of Mandibular remaining root of birooted teeth – Socket application of force – It is introduced through the empty socket of one root of multi rooted mandibular molar to engage and remove the interseptal bone and the other remaining root
  39. 39. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY
  40. 40. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY
  41. 41. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Buccal applicator elevator • Mode of action: wheel and axel • Uses: – Removal of both roots united at the trunk – Buccal application of force – It is used for luxation and or extraction of mandibular molars with straight roots – Using the buccal application of force
  42. 42. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY
  43. 43. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY
  44. 44. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Curved elevators Cryer’s elevator Miller elevator Apexo elevator
  45. 45. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Curved Apexo elevators • Apexo – Removal of fractured single roots (after separation) • In maxillary posterior teeth • In mandibular teeth – Removal of apical fragments • Principal of action – wedging
  46. 46. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY
  47. 47. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY
  48. 48. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Miller Elevator • Primary luxation of maxillary wisdom teeth with distally curved roots • Principle of Action – Simple lever • P.S. caution not to fracture max. tuberosity
  49. 49. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Cryer’s Elevator 1. Same as socket applicator cross bar elevator - Principle of action is wheel and axel – It is introduced through the empty socket of one root of multi rooted mandibular molar to engage and remove the interseptal bone and the other remaining root
  50. 50. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY
  51. 51. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY
  52. 52. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Cryer’s Elevator 2. Same as buccal applicator elevator - Principle of action is Buccal application of force – In surgical removal of lower molars,. The tip of the elevator blade is introduced in the root bifurcation and the tooth is removed by elevation using the buccal cortical plate as fulcrum
  53. 53. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY
  54. 54. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY Cryer’s Elevator • Less mechanical advantage • Can be used in the maxilla • Principle of action – Wheel and axle
  55. 55. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY
  56. 56. Surgical Extraction Of Teeth And Roots - ELEVATORS Dr.ELHAWARY

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