A dental elevator is an instrument used during exodontia, the process of tooth extraction. Its function is to luxate, or loosen, a tooth or retained root fragment from its bony socket before extraction forceps are applied. This initial loosening is achieved by disrupting the periodontal ligament (PDL) fibers that anchor the tooth to the alveolar bone. The instrument also serves to expand the alveolar bone surrounding the tooth, creating a wider path for removal and minimizing trauma.
Understanding the Types of Dental Elevators
The selection of a dental elevator is a fundamental step in the procedure, as the instrument’s design dictates the appropriate application technique. Elevators can be broadly categorized based on the shape and angle of their working ends. The most common category is the Straight Elevator, which features a blade in line with the handle. Clinicians use straight elevators, also known as luxators, for the initial separation of the periodontal ligament and for wedging the tooth prior to the use of forceps.
Another group is the Angled Elevator category, often used when access to posterior teeth or roots is difficult. The Cryer and Winter elevators are examples of this design, typically featuring a triangular or pointed working end set at an angle to the handle. Cryer elevators, which usually come in right and left pairs, are employed for the removal of retained root fragments in the mandibular molar region after the adjacent root has been extracted.
The final category includes Pick Elevators, such as root tip picks, which are characterized by a fine, pointed tip. These instruments are reserved for the retrieval of small, fractured root fragments that remain deep within the socket after the main portion of the tooth has been removed.
The Biomechanics of Tooth Elevation
Dental elevators function by applying controlled mechanical forces to the tooth to overcome the resistance of the periodontal ligament and bone. The Wedge Principle is often the first mechanism employed, typically using a straight or luxating elevator. The thin, sharp blade of the instrument is inserted into the periodontal ligament space parallel to the long axis of the tooth. Apical pressure then forces the blade deeper, severing the ligament fibers and simultaneously expanding the bony socket laterally, which effectively loosens the tooth.
The Leverage Principle is a common technique where the elevator acts as a Class I lever, with the fulcrum positioned between the effort and the load. The tip of the elevator engages the tooth or root surface, and the crest of the alveolar bone serves as the fulcrum point. By applying force to the handle, the working end generates a magnified force that rotates or lifts the tooth out of the socket. Using an adjacent tooth as a fulcrum is discouraged unless that tooth is also scheduled for extraction, as it risks fracturing the healthy structure.
The Wheel and Axle Principle is associated with crossbar elevators, such as the Winter’s T-bar design, often used for removing mandibular molars or retained roots. The handle acts as the wheel, and the shank acts as the axle, generating significant rotational force. The working end engages a purchase point on the root, and the rotation of the handle applies a controlled torque to lift the root out of the socket.
Step-by-Step Application Technique
The initial step in applying a dental elevator is ensuring that the area is anesthetized and that the dental professional has a stable finger rest and proper control. The operator must first identify the optimal purchase point on the tooth or root, typically the interproximal space or an exposed root surface. A straight elevator is generally used first, with the concave side of the blade oriented toward the tooth surface to be removed.
The working end of the elevator is then inserted into the periodontal ligament space, keeping the blade parallel to the root surface. Controlled, firm apical pressure is applied to start the wedging action, which separates the ligament and expands the bone. The instrument should be advanced slowly, with a slight back-and-forth rotational movement to facilitate its entry into the socket.
Once the blade is securely engaged, the luxation process is initiated by applying slow, steady force, often by rotating the handle to utilize the leverage principle. Sustained pressure, held for several seconds, is often more effective than sudden, forceful movements, as the prolonged force allows for the bone to expand. This gradual bone expansion minimizes the risk of a fracture.
Throughout the luxation process, the non-operating hand must maintain a stable grip on the patient’s jaw to provide support and protect the soft tissues. The operator continuously assesses the degree of tooth mobility, incrementally increasing the luxation force until the tooth is noticeably loosened from the socket. This controlled mobilization prepares the tooth for final removal, often requiring minimal force with extraction forceps afterward.