1. Elevators & Surgical Extractions 2-28-2008

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

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

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

5. Displacement (Wedge) Root tips displaced by insertion into the periodontal ligament space. Root tips displaced by insertion into the periodontal ligament space. This action will frequently dislodge the root tip. 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. 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 You can break the instrument using this technique Place the lever under the height of contour Place the lever under the height of contour Leverage off of interseptal bone Leverage off of interseptal bone Leverage off of crestal (buccal) bone Leverage off of crestal (buccal) bone

7. Lever Action Used for prying a tooth root tip from its socket. Used for prying a tooth root tip from its socket. The elevator engages the tooth through a purchase point (placed by a bur) 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 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 Rotational East/West, Potts, Cryer, Crane Pick… 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 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 25 lbs to handle = 125 lbs transferred to jaw = lawsuit

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

10. Elevator Review

11. 301 Elevator Lever action Lever action Displacement Displacement Smaller root tips Smaller root tips

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

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

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

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

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

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

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

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

20. Surgical Extractions

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

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

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

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

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

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

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