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
Lever actionDisplacement
Most teeth and larger root tips
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34S Elevator
Lever actionDisplacement
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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