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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
engage tooth with
Malposed teeth :
Titlted teeth : Beaks
not parallel to long
axis of tooth
Roots fractured at :
-- Gingival line
--- Roots left in
alveolus from previous
Never use adjacent tooth as fulcrum, unless it is to be
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
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
The elevator consists of the following
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
Second most common.
Pairs – right and left.
Use – when a broken root remains in socket
and adjacent socket is empty.
Used to remove roots.
-Used as lever to elevate root from
-Hole drilled 3mm deep into the
root, pick is inserted into the hole,
root is elevated using buccal plate
Root tip pick/ Apex elevator
-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
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-
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
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
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
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
Warwick James (Hockey stick Pattern)
Uses Lever and Wedge Principle.
Biangulated, sharp, straight working tip
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
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
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
Double elevators and the preceding techniques
are used on lower
cuspids,bicuspids,centrals,lateral incisors and
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
- Pull stroke: Tends to tear tissue if not careful.
Cross bar elevators are used on the mandible
- 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
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
When one root is removed & the other left
When both roots present but one is fractured at
a lower level than other or when furcation is
Shank at right angle to the angle.
Working tip almost similar to Cryer’s elevator
except that it meets the shank at a greater
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
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
Only condition when adjacent tooth is used as
Used during multiple extractions.
Elevators should be used with caution.
Excessive forces damage or displace adjacent
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