Dr.

Shafi Md Anis
OMFS
 Reflect mucoperiosteal membrane

 Luxate,remove teeth which cannot be engaged by

forceps (impactions and mlapositons)

 Remove carious or fractured roots

 Loosen teeth prior to application of forceps

 Split teeth which have grooves cut into them

 Remove intra radicular bone

REMOVAL OF TEETH REMOVAL OF ROOTS

 Imapctions : Unable to  Roots fractured at :

engage tooth with  -- Gingival line
forceps  --- Midlength
 Malposed teeth :  ---Apical third
Impinging,pressure on
adjacent teeth  --- Roots left in
alveolus from previous
 Decayed teeth: extractions
Fracture easily
 Titlted teeth : Beaks
not parallel to long
axis of tooth
 Never use adjacent tooth as fulcrum, unless it is to be
extracted also
 Never use buccal plate at the gingival line as fulcrum
,except in Odontectomy
 Never use lingual plate at gingival line as fulcrum
 Always use finger guards for protection against slipping
 Controlled forces and pressure exerted in the correct
direction
 Always elevate from mesial side of tooth
 When cutting through interseptal bone, not to engage
adjacent tooth root and force it out of socket
 Concave/flat surface of the elevator faces the
tooth/root to be elevated
 Do not use luxator as lever
 Damaging or extracting adjacent teeth
 Fracturing maxilla or mandible
 Fracturing the alveolar process
 Accidental penetration of maxillary antrum and
soft tissues (may perforate greater blood vessels)
 Forcing root or a third molar into antrum
 Forcing apical third of root of man.molar into
man.canal,or lingual plate or pterygomandibular
space
 The elevator consists of the following
components:
1) Blade
2) Shank
3) Handle
 Straight Type – Straight Elevator
 Triangular Type – Cryer Elevator
 Pick up Type – Apical Pick
 Most commonly used to luxate teeth.
 Blade – concave surface on one side.

 Small type – No. 301

 Large type – No. 34S, 46, 77R

 Blade at an angle from shank – for use in

posterior teeth.
-Miller’s elevator
-Pott’s elevator
 Second most common.
 Pairs – right and left.
 Use – when a broken root remains in socket
and adjacent socket is empty.
 Cryer’s elevator.
 Used to remove roots.
Crane pick
-Heavy version
-Used as lever to elevate root from
socket
-Hole drilled 3mm deep into the
root, pick is inserted into the hole,
root is elevated using buccal plate
as fulcrum.
Root tip pick/ Apex elevator
- delicate
-to remove small root tips from sockets
 ACCORDING TO USE:

1) Elevators designed to remove the entire tooth [1L – 1R]

2) Elevators designed to remove roots broken off at the

gingival line [30 – 40 – 5]

3) Elevators designed to remove roots broken off halfway to

the apex [30 – 4 – 5, or 14L – 14R, or 11L -11R]

4) Elevators designed to remove the apical 3rd of the root

[apical fragment ejectors No. 1,2 and 3]

5) Elevators designed to reflect the mucoperiosteum

[Periosteal elevators] before forceps or extracting elevators
are used.
 ACCORDING TO FORM:
1) Straight- wedge type [straight apex]
2) Angular- right and left.
3) Cross bar [handle at right angles to shank]
There are 3 principles-
 Lever Principle

 Wedge Principle

 Wheel and Axle Principle

 Most commonly used principle.
 Elevator is lever of the first order.
 Fulcrum is between effort and resistance.
 In order to get mechanical advantage, effort
arm must be longer than resistance arm.
 It is used to remove roots.
 Eg: Straight elevator, Cryer’s elevator,Apexo
elevator
 Small force,Large movement

 Large force,small movement

 Wedge is a movable inclined plane which
overcomes large resistance at right angles to
the applied effort.
 Wedge elevator is forced between the root and
the bone parallel to the long axis of the tooth.
 Used to remove small root tips.
 Instrument tip should always be as small as or
smaller than the root tip.
 Excessive force should be avoided.
 E.g Apexo elevator,Cryer’s elevator
 It is a modified form of lever principle.
 The effort is applied to the circumference of the
wheel which turns the axle so as to raise a
weight.
 Eg: Crossbar elevators.
 Can cause most trauma – fracture of mandible.
 Elevators produce a great multiplication of
force when in use. Principles to be applied in
protection
1. His jaws must be supported to prevent
dislocation of mandible
2. Other tissues in oral cavity must be protected
against potential tissue damage,i.e accidental
slipping and plunging of the point of elevator
in adjacent or distal soft and hard tissues.—
Important when using WEDGE type elevators
 Careful and continuous control of direction of force,
so it is directed into bone surrounding the tooth or
against the tooth being luxated
 Surrounding immediate operating area with fingers
Maxilla : Grasp dental arch with index finger and
thumb so that alveolus is in between
Mandible : First and second fingers should straddle
alveolus and thumb placed below mandible,
supporting it and off setting downward pressure of
elevator which may dislocate mandible
 This placing of fingers, buccally,labially and
lingually gives operator immediate information,
whether or not pressure is being created on
adjacent teeth which are not to be extracted
 Adjacent teeth should never be used as fulcrums
unless they are to be extracted as well
 This position also means that if the working point
of elevator slips, it will affect the operator’s finger
rather than patient’s surrounding soft tissue,nerves
and blood vessels
 Apexo Elevator
 Periosteal Elevator
 Miller’s Elevator
 Cryer’s Elevator
 Winter’s Crossbar
 Coupland Elevator
 Pott’s Elevator
 Warwick James (Hockey stick Pattern)
 Uses Lever and Wedge Principle.

 Biangulated, sharp, straight working tip

 Paired

 Used to remove root tip from socket

 Used first as a wedge to dislodge the root tip & then

as a lever to remove it from the socket.
 Primarily used on Maxilla---upper central or
lateral cuspid or bicuspid has fractured at
gingival line
 Used as a wedge
 Blade is at 45 degrees to handle
 Used as a wedge
 Maybe be used on all lower teeth with fractures
occurring at gingival line
 Mucoperiosteum is first reflected with
Periosteal elevator
 No.4 Apexo elevator in the left hand, No.5
Apexo elevator in the right hand
 Place points of both in against the root on
opposite surfaces and using both elevators
with lever pressure occlusally elevate root to
the surface

 Double elevators and the preceding techniques

are used on lower
cuspids,bicuspids,centrals,lateral incisors and
lower molars
Dyles’ mucoperiosteal elevator
No. 9 Molt Periosteal Elevator. Mucoperiosteal Elevator

 Used to raise ginigval tissue at cervical region

which is to be detached for extraction of tooth.
Reflecting mucoperiosteum away from bone to prevent it being
crushed- as fulcrum is bone

2 ends: Sharp pointed end to reflect dental papilla.

- Broader flat end to elevate tissue from bone.
 3 methods to reflect soft tissues:
- Pointed end used in prying motion to elevate soft tissue. Most
commonly used to elevate dental papilla from between teeth.
- Push stroke: Broad end pushed under flap to separate periosteum
from bone.
- Pull stroke: Tends to tear tissue if not careful.
 Cross bar elevators are used on the mandible
for
- removing molar roots fractured at or below
the gingival line
- fracture off crown or split roots after a groove
has been cut
- to loosen teeth
- for removal of imapctions
 Uses Lever, Wedge and Wheel & Axle
Principle.
 It is a straight elevator.
 It has a triangular blade.
 Working tip is angulated with one convex and
another flat surface.
 Right & left.
 Used for removing root stumps of mandibular
molars.
 When one root is removed & the other left
behind.
 When both roots present but one is fractured at
a lower level than other or when furcation is
intact.
 Shank at right angle to the angle.
 Working tip almost similar to Cryer’s elevator
except that it meets the shank at a greater
angle.
 Used for extraction of mandibular molar roots.
 Most commonly used.
 3 types- Types 1, 2 & 3.
 Type 3 has the widest blade.
 Blade has a concave surface on the side which
faces the tooth.
 Sometimes the blade can be at an angle to the
shank.
 It is placed parallel to the long axis of the roots
between the socket walls and the roots and
worked towards the apex.
 Resemble hockey stick.
 Blade is straight and at an angle to the shank.
 Blade has convex and flat surface.
 Flat surface is working end and has transverse
serrations on it for better contact with root
stumps.
 Only condition when adjacent tooth is used as
a fulcrum.
 Used during multiple extractions.
 Elevators should be used with caution.
 Excessive forces damage or displace adjacent
teeth.
 It must be kept in mind that this is the initial
step in extraction process and that forceps is
the major instrument for tooth luxation and
removal.