Instead of treating the patient, an instrument used with the wrong technique can lead to serious complications. There’s a right principle of using every medical tool. Although medical practitioners know well how to use an instrument correctly, there might be a mistake with some special and modern instruments, such as the anglevator.
For instance, in dentistry, dental surgeons have to work inside the patient’s oral cavity. Therefore, they need to be conscious while driving the tools to prevent trauma.
As we see, dental elevators are very sharp instruments that make direct contact with the gum and roots. So a wrong method of using the elevator dental tool can tear the gumline, causing severe trauma.
Here, we will discuss the three principles of using tooth elevators during luxation and elevation of the teeth for extraction.
But first, let’s learn when and on what teeth dentists need to use elevators.
When to Use Dental Elevators?
Dental surgeons have to use tooth elevators in the following conditions.
- In the first stage of extraction, to reflect the mucoperiosteal membrane or gingiva around the tooth that needs extraction.
- For luxating and removing the impacted teeth that are overlapping and hard to engage with the forceps.
- For loosening broken and decayed teeth that are subgingival and challenging to grasp and with forceps.
- To divide the teeth into two pieces after making grooves around them.
To cut it short, dental practitioners use elevators to remove the impacted, malpositioned, and those teeth that exert pressure on adjacent ones.
Moreover, dentists use elevator dental tools to remove severely decayed and titled teeth without a good crown.
In the case of root extraction, elevators help cut
- Roots with gingival line fractures
- Roots with fractures in the center of the apical third
- Root stumps in the alveolus
Principles of Using Dental Elevators
As already discussed, it’s crucial to use an instrument with the correct technique following the proper protocol. In this context, dentists have to use tooth elevators with the most appropriate methods.
The principles of using dentistry elevators are as follows.
- Lever Principle
- Wedge Principle
- Wheel and Axle Principle
Let’s discuss each one in detail.
- Lever Principle
The lever principle is the most common and frequently used concept for tooth elevation.
Fulcrum, effort, and load are the three fundamental parts of the lever principle. Basically, the tooth elevator is the Class I or first-order lever.
In the lever principle,
- The Fulcrum should be between effort and resistance.
- For optimal mechanical advantage, the load arm on the other side of the fulcrum should be longer than the effort arm on the opposite side.
- The mechanical force generated through the force at the long effort arm is directed towards the tooth by the short load arm.
The Lever Principle is most beneficial when combined with forceps and used in a wheel and axle configuration.
While working with the forceps, the hinge of the forceps serves as the fulcrum, while their arms serve as a part of a lever.
To ensure the maximum force, the user’s hand grip on the handle must be away from the hinge or fulcrum.
When the lever principle is used with elevators, the instrument’s handle acts as an effort, while the working end of the blade applies the weight to the tooth where it rests.
- Wedge Principle
- It is the second most common principle of using a dental elevator in the extraction procedure.
Actually, the wedge expands, divides, and moves the thing on which the force is applied. To overcome a significant resistance at an angle to the force, a wedge has two moveable inclined planes with a base on one end and a blade on the other.
Following the wedge principle, the elevator is driven parallel to the long axis of the root into the gap between the root and the bone. When force is applied to the plane’s base, resistance on the flat side turns into force.
When and How to Use The Wedge Principle?
The wedge principle is to elevate the tooth or root and remove it from the socket. Combining it with the lever concept helps remove the tooth from the socket completely. Actually, the wedge force splits, expands, and pushes the tooth out of the socket.
Primarily, the wedge principle applies by inserting a straight elevator tip between a tooth and the alveolar bone. As a result, it helps loosen a tooth’s root or tooth by slowly and steadily exerting apical pressure on the periodontal ligament attachment.
Besides that, this principle is also possible to apply with forceps. In doing so, the bone expands by pushing the beaks of the forceps apically into the PDL gap. Resultantly, the periodontal ligaments separate from the bone, leading to tooth luxation and elevation.
- Wheel and Axle Principle
The Wheel and Axle Principle is the hardest of all the three principles of using dental elevators. It involves applying pressure to the wheel’s circumference, which causes the axle to revolve and raise the weight of the tooth.
Crossbar Elevators are the major application of the Wheel and Axle concept; the handle remains at a right angle to the rotating shank and engages into the area between the root and the bone.
However, mandibular fracture can result from the inappropriate application of the wedge principle. The reason is that the elevator handle is positioned at a right angle to the shank, increasing the force.
Key Points For Using Dental Elevators
The following are guidelines for utilizing elevators to prevent any complications during tooth extraction.
- It is not advisable to utilize an adjacent tooth as a fulcrum. Doing so will luxate the encompassing tooth too. Instead, use your finger or the interdental bone as the fulcrum.
- Since the buccal or lingual plate is thin and prone to breaking when under strain, avoid using it as a fulcrum.
- Always perform elevation from the mesial side of the targeted tooth.
- Use finger protectors to avoid injury to nearby sensitive tissues from elevator slippage.
- The elevator’s blade should face the targeted tooth or root, while its concave or flat surface should face outward.
- Always apply the forces in the extraction direction.
Common Elevators Used in Dentistry
There are several types of dental elevators. Dentists use different tooth elevators for different procedures.
The three most common are as follows.
It is the most innovative and advanced form of dentistry elevator. It combines 6 different dental tools. So this hybrid instrument is versatile in functions and absolute in structure.
The anglevator works on the lever principle during the tooth extraction procedure.
- Dental Periosteal Elevators
These are usually double-ended tooth elevators. Dental surgeons use dental periosteal elevators to separate the roots from the tooth. In addition, these are helpful in lifting the tissue flap thickness.
- Crane Pick Elevators
These dental elevators are similar in structure to the common elevators but with slightly angled sharp tips. Basically, the crane pick elevators are surgeons’ hand extensions for removing the pieces of broken teeth and roots during the extraction procedure.
Any kind of medical or dental instrument needs to be used with the correct technique devised by professionals. Above, we have discussed the working principles of dental elevators. So to ensure optimum results during extraction procedures, dentists must follow these principles. It would minimize the risks of procedural complications.
Besides that, dental surgeons should buy quality instruments from reliable sources, such as GerDentUSA. They have German stainless steel dentistry equipment and are open to customizing their instruments for dental professionals.