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how elevators look like ?! work principles in use of elevators: lever
wheel and axle indications to reflect the mucoperiosteum
to luxate teeth before forceps
remove remaining roots
for expansion of alveolar bone guiding principles for the use of elevators: an elevator should never be used blind in the socket the concave or flat surface of the elevator should face the root or tooth to be elevated. avoid the use of excessive force if the tooth resists fluxation by gentle rotation then stop look for obstruction and then continue. the elevator should be well grasped and tip of index finger rests on the elevator to avoid slippage and damage of soft and hard tissue structures. always use finger guards to protect soft tissues. never use an adjacent tooth as a fulcrum unless the tooth itself is to be extracted in the same visit...(the fulcrum should always be bony. never use a buccal and lingual plate as a fulcrum expect in lower 7 and 8---------------------(external oblique ridge) Classification of elevators: handle: shank blade •Handle: is usually of generous size, so it can be held comfortably in the hand to apply substantial but controlled force. In some situations, cross bar or T-bar handles are used.
•Shank: simply connects the handle to the working end, or blade of the elevator. It is generally of substantial size, and is strong enough to transmit the force from the handle to the balde.
•Blade: This part engages the crown or root and transmit force to the tooth, bone or both. The working side of the blade either concave or flat. the end 3 basic components:
the effort how can we get the mechanical advantage of a first lever arm???
first:the effort side should be longer than the other side of the fulcrum
resistance*short arm=effort*long arm
For example:straight elevator coupland Wedge principle: wedge elevators are forced between tooth and investing bone with mallet force
chisel Wheel and axle it is a machine made up of two circular objects of different size
effort applied to the wheel turns the axle.
wheel and axle principle is used in conjugation with wedge principle. cross bar elevator cryers elevator The straight elevator: is the most commonly used elevator to luxate teeth, elevator in which the blade, shank, and the handle are straight. The blade of the straight elevator has a concave surface on one side that is placed toward the tooth to be elevated
I. The small straight elevator, No. 301, is frequently used for beginning the luxation of an erupted tooth, before application of the forceps.
II. Larger straight elevators are used to displace roots from their sockets and are also used to luxate teeth that are more widely spaced or once a smaller-sized straight elevator becomes less effective. The most commonly used large straight elevator is the No. 34S, but the No. 46 and No. 77R are also used occasionally.
The shape of the blade of the straight elevator can be angled from the shank, allowing this instrument to be used in the more posterior aspects of the mouth. Two examples of the angled-shank elevator with a blade similar to the straight elevator are the Miller elevator and the Potts elevator.
coupland chisel Coupland’s chisel (elevator): It is similar to straight elevator but the working end is sharp and straight cut, used for chiseling of bone to create point of application or to split of teeth. It’s of different sizes, size 1, size 2, size 3. Depending on the width of the working end. War-wick James elevators: It is a light duty elevator. It’s like Cryer’s elevator, also we have two angled (mesial and distal) and one straight. The blade is short and the end is rounded and the handle is flattened, it’s used for extraction of retained roots, deciduous teeth, anterior lower teeth extraction, and where there is less resistance area. E.g. extraction of upper 8.
Winter’s elevator (cross-bar handle): In which the working end is the same that of Cryer’s elevator but the handle is in right angle to the shank so it is called winter’s (T-bar) Winter’s elevators are very powerful and great force maybe applied or generated (sufficient to fracture the mandible) so the use of this elevator with great care to avoid fracture of the jaw having 2 types
_ Socket applicator (90 angle).
_ Buccal applicator (No 90 angle).
The pick type elevator:
A. Crane pick elevators: its third type of elevator that is used with some frequency.The heavy version of the pick is the Crane pick This instrument is used as a lever to elevate a broken root from the tooth socket.
B. Apexo elevators: (|root tip pick) The apexo elevator is a delicate instrument. The working blade is long, the margins are sharp, we have 3 apexo, 2 angled and 1 straight (mesial, distal, straight). The blade forming an angle with the shank, this elevator is used mainly for removal of apical fragments of root deeply present in the socket of the lower jaw especially morals. It must be emphasized that this is a thin instrument and should not be used as a wheel-and-axle or lever type of elevator. We push it between the socket and the root to loosen the fractured tip and remove it from the socket.ie wedging principle
crane apexo dangers of using elevators Dangers of Using Elevators
Danger of damaging or loosening of adjacent teeth.
I. Fracture maxilla or Mandible
II.Perforation of great blood vs.
III. Forcing apical root into (maxillary sinus, Mandibular canal,
IV. Fracture alveolar process.
V.Slipping & plunging the point of instrument into the soft tissues.
So most problems with elevators arise from:-
a)Miss-judgment of amount of force exerted.
b)Improper positioning of the elevators.
So these factors should be remembered and kept in our mind when using elevators