2-28-08 elevators & surgical extractions (1)

7/28/2019 2-28-08 Elevators & Surgical Extractions (1)

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Elevators & Surgical Extractions

2-28-2008


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Elevators

1. Facilitate tooth removal2. Minimize breakage of teeth

3. Minimize trauma in area of tooth tobe extracted4. Reduces amount of force appliedto forceps5. Most importantly- Facilitates roottip removal if crown broken off withforceps


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Use of Elevators

Displacement/Wedge (inclined plane)Lever action

Wheel and Axle


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Displacement (Wedge)

The formula for the wedge indicates2.5x mechanical advantage

Used like a shoe horn to displace:Residual root tipsSupernumerary teeth

Mesiodens


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Displacement (Wedge)

Root tips displaced by insertion intothe periodontal ligament space.

This action will frequently dislodgethe root tip.Note: You should not use this

technique for removing root tips thatare in close proximity to the maxillarysinus.


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Lever Action

You can break the instrument usingthis technique

Place the lever under the height of contourLeverage off of interseptal bone

Leverage off of crestal (buccal) bone


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Lever Action

Used for prying a tooth root tip fromits socket.The elevator engages the tooththrough a purchase point (placedby a bur)Or engages the tooth through

gripping the tooth with the edge of the blade and using the bone as afulcrum to lift the tooth out of thesocket


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Wheel and Axle

RotationalEast/West, Potts, Cryer, Crane Pick

T-bar elevators- mechanical(advantage is the radius of the handle the radius of the head) force is 5x

applied25 lbs to handle = 125 lbs transferredto jaw = lawsuit


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Wheel and Axle

Produced when the elevator engagesa purchase point

Using the bone as a fulcrum, rotatingthe handleTransmits rotation to tip of elevator

to root tipGood for elevating root tips frommandibular molars


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Elevator Review


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301 Elevator

Lever actionDisplacement

Smaller root tips


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46 Elevator


Most teeth and larger root tips


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34S Elevator


Most teeth and larger root tips


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Miller Elevator

Wheel and axleImpacted maxillary thirds

NOT erupted maxillary thirdsPlace at MB of third molar below HOCand roll to the distal


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Potts Elevator

Wheel and axleImpacted maxillary thirds

NOT erupted maxillary thirds


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Cryer Elevator

Wheel and axle Adjacent empty socket

Mandibular first molarsNeeds sharp tip i.e. no purchase point


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East/West

Wheel and axle Adjacent empty socket

Mandibular first molarsNeeds sharp tip i.e. no purchase point


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Crane Pick

Wheel and axleFulcrum on buccal bone

Bury tip into cementumUsually needs purchase pointRoll the root out


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Cogswell Elevator

Wheel and axleLooks like an ice pick

Stick it anywhere and roll the toothout


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Surgical Extractions


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Surgical Extractions

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


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Indications for SurgicalExtractions

Elevator and forceps technique failsTeeth possessing divergent roots

Teeth with curved rootsDevitalized teeth- old RCT teethTeeth with hypercementosis

Adults with retained primary teethImpacted teeth

Ankylosed teeth


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Indications for SurgicalExtractions

Teeth with extensive cariesTeeth with large amalgam orcomposite build-upsTeeth in geriatricsQuestionable path of deliveryMaxillary molar close to sinusPreserve buccal bone over max.canineRetained root fragment and/or tip


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Root Fragments

Roots that have more than theirapical third present

Includes middle and cervical thirdDue to carious process, trauma orsectioning process


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Root Fragments

Flap vs. no Flap

Flap No Flap

Bone Removal Remove with

forceps or elevatorRemove with

forceps or elevator


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Root Tips

The apical 1/3 of the rootMost likely due to root fracture during

extraction


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Root TipsLoose vs. Attached

Loose

Forcibly irrigate w/saline

Remove with suction tip or apexelevators


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Root TipsLoose vs. Attached

Attached

Loosen with explorer or elevatoror

Extend bone removal from alveolar crest

orUse curved flap; approach as though doing

an apicoectomy


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Maxillary 1 st Molars

Frequently sectioned and removedone root at a time:

Their roots are large and trifurcatedTheir roots diverge forming solidanchors in bone

The max. sinus often encroaches intothe bone surrounding their roots


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2-28-08 elevators & surgical extractions (1)

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