Principles of using dental elevators

1. Surgical Extraction Of Teeth And Roots - ELEVATORS
Dr.ELHAWARY
Principles Of Using Dental
Elevators
Dr. Hesham El-Hawary
Assoc. Prof. OMFS

2. Surgical Extraction Of Teeth And Roots - ELEVATORS
Dr.ELHAWARY
REMOVAL OF TOOTH STRUCTURE
Surgical Extraction Of Teeth And Roots - ELEVATORS

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. Surgical Extraction Of Teeth And Roots - ELEVATORS
Dr.ELHAWARY
Removal of tooth structure
Elevators
Parts of an Elevator
• Handle
• Shank
• Blade

5. Surgical Extraction Of Teeth And Roots - ELEVATORS
Dr.ELHAWARY
Elevator handling and grip

6. Surgical Extraction Of Teeth And Roots - ELEVATORS
Dr.ELHAWARY
Forms of Elevators
Straight
elevators
Curved
elevators
Cross bars
elevators

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. 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. 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. 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. Surgical Extraction Of Teeth And Roots - ELEVATORS
Dr.ELHAWARY
MECHANICS

12. Surgical Extraction Of Teeth And Roots - ELEVATORS
Dr.ELHAWARY
Type I Lever
Type II Lever
Type III Lever

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Dr.ELHAWARY

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. 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. Surgical Extraction Of Teeth And Roots - ELEVATORS
Dr.ELHAWARY
F
R
FA
RA

17. Surgical Extraction Of Teeth And Roots - ELEVATORS
Dr.ELHAWARY
Wheel And Axel

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. Surgical Extraction Of Teeth And Roots - ELEVATORS
Dr.ELHAWARY
Wedging Action
F

20. Surgical Extraction Of Teeth And Roots - ELEVATORS
Dr.ELHAWARY
Wedging Action
F

21. Surgical Extraction Of Teeth And Roots - ELEVATORS
Dr.ELHAWARY
Wedging Action
F

22. Surgical Extraction Of Teeth And Roots - ELEVATORS
Dr.ELHAWARY
Wedging Action
F

23. Surgical Extraction Of Teeth And Roots - ELEVATORS
Dr.ELHAWARY
Wedging Action
F

24. Surgical Extraction Of Teeth And Roots - ELEVATORS
Dr.ELHAWARY
Straight elevators
Straight elevator
Coupland elevator
Straight apexo elevator

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. 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

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Dr.ELHAWARY

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Dr.ELHAWARY

29. Surgical Extraction Of Teeth And Roots - ELEVATORS
Dr.ELHAWARY

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. 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. 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. 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. 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. 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. Surgical Extraction Of Teeth And Roots - ELEVATORS
Dr.ELHAWARY
Cross bar elevators
Socket applicator elevator
Buccal applicator elevator

37. Surgical Extraction Of Teeth And Roots - ELEVATORS
Dr.ELHAWARY
Socket applicator elevator
Buccal applicator elevator

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. Surgical Extraction Of Teeth And Roots - ELEVATORS
Dr.ELHAWARY

40. Surgical Extraction Of Teeth And Roots - ELEVATORS
Dr.ELHAWARY

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. Surgical Extraction Of Teeth And Roots - ELEVATORS
Dr.ELHAWARY

43. Surgical Extraction Of Teeth And Roots - ELEVATORS
Dr.ELHAWARY

44. Surgical Extraction Of Teeth And Roots - ELEVATORS
Dr.ELHAWARY
Curved elevators
Cryer’s elevator
Miller elevator
Apexo elevator

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. Surgical Extraction Of Teeth And Roots - ELEVATORS
Dr.ELHAWARY

47. Surgical Extraction Of Teeth And Roots - ELEVATORS
Dr.ELHAWARY

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. 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. Surgical Extraction Of Teeth And Roots - ELEVATORS
Dr.ELHAWARY

51. Surgical Extraction Of Teeth And Roots - ELEVATORS
Dr.ELHAWARY

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. Surgical Extraction Of Teeth And Roots - ELEVATORS
Dr.ELHAWARY

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

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Dr.ELHAWARY

56. Surgical Extraction Of Teeth And Roots - ELEVATORS
Dr.ELHAWARY