You are on page 1of 48

Dental Elevators

Indications
To reflect muco periosteal flap
Luxate the tooth which cannot be removed with
forceps like
1. Removal of impacted teeth 2. Removal of malposed teeth
3. Removal of extensively decayed teeth
4. Removal of anteriorly tilted teeth
. Loosen teeth before forceps application
. To split teeth once a bur groove has been placed
. To remove intra radicular bone
. Removal of retained root
. To remove the fractured roots ( gingival, middle ,
apical)

Classification

According to form
straight
Angular
Cross bar type

Principles for use of


elevators
1. Lever principle
2. Wedge principle
3. Wheel and axle principle

Components
Three components
Handle
Shank
Blade

Components
Handle
Handle large size to facilitate a good grip on the
instrument while working.
It may be 180 0 to the shank eg. straight elevator or at
right
angles to the shank(cross bar elevator)
Shank
It connects handle to the blade
It should be strong enough to withstand and transmit the
forces applied to the handle.
Blade
Working tip
Used to transmit forces to the tooth or root
Blade might be straight , triangular or pick type

Level principle
Depending on the position of the fulcrum the lever
may be divided into
First order ,
Second order and
Third order levers.

Lever principle
Effort arm
(a)

Lever
arm(b)

Effort arm

Lever principle
In case of elevators ,
the handle of the elevator is the Effort arm,
the place where the elevator touches the crestal
bone is the Fulcrum and
the point where the blade of the elevator
contacts the tooth, is the Resistance

Lever principle
Maximum mechanical advantage is gained by keeping
the effort arm longer than the resistance arm
Moving the fulcrum closer to the side where the effort
is exerted increases the force required to lift the same
object
For eg to lift a heavy load from the ground with a
stick , if the fulcrum is kept closer to the side where
the effort is exerted( short effort arm ) , the effort
exerted has to be much more to lift the load.
On the other hand longer effort arm, lesser the effort
to lift the same load

Lever principle

R
Effort arm
(a)

Lever
arm(b)

Mechanical advantage=
Ratio of length of long arm(a) to the length of the
short arm(b)
Resistance
(R)=toa/b
effort(
Mechanical
advantage
: R/E =E)3
if calculations are made based on the actual dimensions of an
elevator , it is seen that each pound of pressure applied on the
effort arm is multiplied by 3 times using lever principle

Wedge principle

Wedge is comparable to a movable inclined plane


in which , when the effort is exerted at the base
of the inclined plane, the resistance is seen on the
slope side of the inclined plane .

Resistance is at right angles to the applied Effort

Wedge principle
The wedge elevator is forced between the root
and the bone, parallel to the long axis of the tooth

wedge is a movable inclined plane which


overcomes a large resistance at right angles to
the applied effort

Usually used in conjunction with the lever


principle

Wedge principle
Mechanical advantage =
length of slope (a)
Height of the base of inclined plane (b)
a/b = R/E = 2.5 times
If calculations are made based on the actual
dimensions of an elevator , it is seen that each
pound of pressure applied on the effort arm is
multiplied by 2.5 times using the wedge principle.

Wheel and axle principle


This works on a principle resembling a wheel of a
vehicle which is attached to a axle around which
the wheel moves.

A small rotation of the wheel creates a large


rotation of the axle which helps to lift the load

Mechanical advantage
When the blade of the elevator engages on to the
tooth (load) and the handle (which serves as
wheel) is rotated, the force created on the blade
of the elevator (which serves as the axle) is
multiplied , created a greater mechanical
advantage to elevate the tooth out of socket.
ME = Ratio of

radius of the wheel(a)


radius of the axle(b)

ME= a/b = R/E = 4.6


Maximum mechanical
advantage

Rules to be followed while using the


elevators Never use the adjacent tooth as the fulcrum,
unless that adjacent tooth is also to be extracted
Never use buccal cortical plate or lingual cortical
plate as the fulcrum
Only the crest of the alveolar bone is to be used
as fulcrum
Always use finger guards to protect the soft
tissues if the elevator slips.

Rules to be followed while using the


elevators Support the shank of the elevator with the index
finger to control the forces applied to the elevator
Do no cross the midline when applying the
elevator
Always elevate from the mesial side of the tooth
The concave or flat surface of the elevator faces
the tooth / root to be elevated

Type of Grips used in application of


elevator
Palm grip
Used for heavy forces where the handle rests
against the heel of the palm

Finger grip
Used for delicate applications

Elevators used in
removal
of tooth

Straight elevators
Eg coupland elevator
Large pear shaped handle with straight shank
Blade and shank in same plane
Shank narrows down in dimension gradually from
handle to blade
The blade has concave groove on one side, that
faces tooth to be elevated
Based in lever and wedge principle

Coupland elevator

Coupland elevators blade

Uses
To luxate impacted or mal-aligned teeth prior to
forceps extraction.
Working of this elevator is based on wedge
principle and first order lever principle.
The elevator is placed at 45 degree angle to the
long axis of the tooth with concavity of the blade
facing tooth to be extracted
The crest of the inter septal bone is used as
fulcrum
It also may be applied parallel to long axis of the
tooth when it is wedge into the periodontal
ligament space to luxate the tooth.

Removal of premolar
using straight elevator

Hospital pattern elevator


Description
The blade, handle and shank are in same plane.
Handle design is different from other elevators it
is flat, triangular in shape with deep criss cross
groves for an enhanced grip.
The second is an smooth inclined al the way from
the handle and the blade with an enhanced
inclination closer to the tip.
One side of blade is flat and has vertical
serrations.
Other side of blade is convex and tip is pointed

Hospital pattern

Hospital pattern - blade

Uses
To luxate tooth prior to placing forceps
The serrated flat side of the blade is placed facing
the tooth to be extracted.
It is placed at a 45 degree angle to the long axis
of the tooth or may alternatively be wedged into
the periodontal ligaments space vertically along
the long axis of the tooth.
This elevator works based on the wedge and 1st
order lever principle.

Straight elevator

Cryers elevators
Offset blade as the blade is at an angle to the shank
and handle.
Blade is curved and triangular in shape with the pointed
tip
The working tip is angulated, with one convex and
another flat surface.
The flat surface is the working side
Based in lever and wedge principle
This elevator is available in pairs.

Cryer s elevator

Uses
To remove impacted molars the pointed tip is
placed in buccal furcation to luxate the tooth from
the socket.
To remove the fracture root tips in mandibular
molars
When one root tip of mandibular is fractured, the
elevator is placed in to empty alveolar socket of the
root which is removed. The inter radicular is first
removed and then tip of elevator is engaged into the
cementum of the fracture root.
To assist removal of erupted maxillary third molar.

Cryers elevator

Cryers elevator

Winters cross bar


elevator
The blade appears similar to cryers elevator
Offset blade design where blade is at an angle to shank
Shank is at right angles to the handle
Working tip is at an angle to the shank
Flat surface is the working side
Works on Wheel and axle principle
This elevator has maximum mechanical advantage due
to the cross bar handle and the offset blade design

Blade offset design

The blade is curved and triangular in shape


and has a convex and a flat surface

Winters cross bar


elevator

Uses of crossbar elevator


Used with rotational forces based on wheel and
axial principles
Used for removal of impacted mandibular tooth
Used with caution for removal of impacted
mandibular third molar as the force may cause
fracture of the angle region of mandible.
Used for removal of root fragments of mandibular
molars similar to the way, a cryers elevators is
used.
Not used in maxillary arch.

Crossbar elevator

Warwick James
handle is less bulky and flat
Comes in set of 3 elevators
Has convex and flat surface . Flat surface is the
working surface
Working blade is at an angulation to the shank or
straight
Available in Straight, right and left

Looks like hockey stick

Warwick James

Apexo elevators
These straight elevators of offset blade.
Blade is at an angle to the shank
The blade is narrow with concavity on one side
and ends in a sharp pointed tip.
It has large pears shaped handle.
Paired right and left

Apexo elevators

Uses
To remove fracture root fragments at the cervical,
middle or apical one third.
The pointed tip and concave surface of the blade
is wedge between the tooth fragments and the
alveolar bone from the mesial and distal aspect
with the slight push motion.
This elevator works based on the wedge principle.

Apexo elevator

Complications

Damage or extraction of adjacent tooth


Fracture of maxilla and mandible
Fracture of alveolar bone
Slippage of instrument leading to damage to
adjacent structures
Puncture wounds
Root forced into antrum
root forced into mandibular canal
Root displaced into space