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Elevators

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Elevators & Surgical Extractions 2-28-2008 Elevators 1. Facilitate tooth removal 2. Minimize breakage of teeth 3. Minimize trauma in area of tooth to be extracted 4. – PowerPoint PPT presentation

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Title: Elevators


1
Elevators Surgical Extractions
  • 2-28-2008

2
Elevators
  • 1. Facilitate tooth removal
  • 2. Minimize breakage of teeth
  • 3. Minimize trauma in area of tooth to be
    extracted
  • 4. Reduces amount of force applied to forceps
  • 5. Most importantly- Facilitates root tip removal
    if crown broken off with forceps

3
Use of Elevators
  • Displacement/Wedge (inclined plane)
  • Lever action
  • Wheel and Axle

4
Displacement (Wedge)
  • The formula for the wedge indicates 2.5x
    mechanical advantage
  • Used like a shoe horn to displace
  • Residual root tips
  • Supernumerary teeth
  • Mesiodens

5
Displacement (Wedge)
  • Root tips displaced by insertion into the
    periodontal ligament space.
  • This action will frequently dislodge the root
    tip.
  • Note You should not use this technique for
    removing root tips that are in close proximity to
    the maxillary sinus.

6
Lever Action
  • You can break the instrument using this technique
  • Place the lever under the height of contour
  • Leverage off of interseptal bone
  • Leverage off of crestal (buccal) bone

7
Lever Action
  • Used for prying a tooth root tip from its socket.
  • The elevator engages the tooth through a purchase
    point (placed by a bur)
  • Or engages the tooth through gripping the tooth
    with the edge of the blade and using the bone as
    a fulcrum to lift the tooth out of the socket

8
Wheel and Axle
  • Rotational
  • East/West, Potts, Cryer, Crane Pick
  • T-bar elevators- mechanical (advantage is the
    radius of the handle the radius of the head)
    force is 5x applied
  • 25 lbs to handle 125 lbs transferred to jaw
    lawsuit

9
Wheel and Axle
  • Produced when the elevator engages a purchase
    point
  • Using the bone as a fulcrum, rotating the handle
  • Transmits rotation to tip of elevator to root tip
  • Good for elevating root tips from mandibular
    molars

10
Elevator Review
11
301 Elevator
  • Lever action
  • Displacement
  • Smaller root tips

12
46 Elevator
  • Lever action
  • Displacement
  • Most teeth and larger root tips

13
34S Elevator
  • Lever action
  • Displacement
  • Most teeth and larger root tips

14
Miller Elevator
  • Wheel and axle
  • Impacted maxillary thirds
  • NOT erupted maxillary thirds
  • Place at MB of third molar below HOC and roll to
    the distal

15
Potts Elevator
  • Wheel and axle
  • Impacted maxillary thirds
  • NOT erupted maxillary thirds

16
Cryer Elevator
  • Wheel and axle
  • Adjacent empty socket
  • Mandibular first molars
  • Needs sharp tip i.e. no purchase point

17
East/West
  • Wheel and axle
  • Adjacent empty socket
  • Mandibular first molars
  • Needs sharp tip i.e. no purchase point

18
Crane Pick
  • Wheel and axle
  • Fulcrum on buccal bone
  • Bury tip into cementum
  • Usually needs purchase point
  • Roll the root out

19
Cogswell Elevator
  • Wheel and axle
  • Looks like an ice pick
  • Stick it anywhere and roll the tooth out

20
Surgical Extractions
21
Surgical Extractions
  • Full-thickness (mucoperiosteal flap)
  • Plus at least ONE of the following
  • Buccal bone removal and/or
  • Division of Crown/roots

22
Indications for Surgical Extractions
  • Elevator and forceps technique fails
  • Teeth possessing divergent roots
  • Teeth with curved roots
  • Devitalized teeth- old RCT teeth
  • Teeth with hypercementosis
  • Adults with retained primary teeth
  • Impacted teeth
  • Ankylosed teeth

23
Indications for Surgical Extractions
  • Teeth with extensive caries
  • Teeth with large amalgam or composite build-ups
  • Teeth in geriatrics
  • Questionable path of delivery
  • Maxillary molar close to sinus
  • Preserve buccal bone over max. canine
  • Retained root fragment and/or tip

24
Root Fragments
  • Roots that have more than their apical third
    present
  • Includes middle and cervical third
  • Due to carious process, trauma or sectioning
    process

25
Root Fragments
  • Flap vs. no Flap
  • Flap No Flap
  • Bone Removal Remove with
    forceps or elevator
  • Remove with
  • forceps or elevator

26
Root Tips
  • The apical 1/3 of the root
  • Most likely due to root fracture during extraction

27
Root TipsLoose vs. Attached
  • Loose
  • Forcibly irrigate w/saline
  • Remove with suction tip or apex elevators

28
Root Tips Loose vs. Attached
  • Attached
  • Loosen with explorer or elevator
  • or
  • Extend bone removal from alveolar crest
  • or
  • Use curved flap approach as though doing an
    apicoectomy

29
Maxillary 1st Molars
  • Frequently sectioned and removed one root at a
    time
  • Their roots are large and trifurcated
  • Their roots diverge forming solid anchors in bone
  • The max. sinus often encroaches into the bone
    surrounding their roots

30
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31
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