In dental surgery, elevators are essential instruments used to luxate (loosen) teeth or roots from the bony socket before using forceps, or to remove fractured root fragments. Unlike forceps, which grasp the tooth, elevators act as levers to break the periodontal ligament (PDL) and expand the alveolar bone.
Description
An elevator consists of three main parts:
- Handle: Large and ergonomic to allow for a firm palm grip, providing the necessary torque.
- Shank: The connecting rod between the handle and the blade, often angled to reach posterior areas.
- Blade (Working Tip): The part that contacts the tooth or root. It can be straight, curved, or triangular (pointed).
Key Features
- Mechanical Advantage: They function based on three physical principles: the Lever (most common), the Wedge (driven between the root and bone), and the Wheel and Axle (rotation of the handle).
- High-Grade Stainless Steel: Constructed to withstand significant force without bending or snapping.
- Serration (Optional): Some blades feature micro-serrations to better grip the root surface.
- Variety of Tips: Designed specifically for different anatomical challenges (e.g., thin tips for narrow PDL spaces or sharp tips for retrieving root tips).
Common Types and Usage
| Type | Description | Primary Usage |
| Straight Elevator | The blade is in a straight line with the shank (e.g., Coupland or Luxator). | Used to luxate teeth and expand the socket. It is the most frequently used elevator for initial loosening. |
| Cryer Elevator | Triangular-shaped blades that are angled from the shank. | Excellent for removing a remaining root when the adjacent socket is empty (utilizing the “Wheel and Axle” principle). |
| Apexo / Root Tip Pick | Very thin, sharp, and delicate pointed tips. | Used to tease out small, fractured root fragments from the bottom of the socket (the apex). |
| Warwick James | A set of three (straight, left, and right) with small, flattened blades. | Ideal for extracting wisdom teeth or roots where space is limited. |
| Bein Elevator | Features a thin, concave blade. | Used for gentle luxation and to preserve the alveolar bone, common in immediate implant cases. |
Clinical Usage Guidelines
- Grip: Held in a palm-thumb grip, where the index finger is placed along the shank to act as a “stop,” preventing the instrument from slipping and injuring the patient’s soft tissues.
- The Fulcrum: The alveolar bone is used as the fulcrum. Never use an adjacent tooth as a fulcrum unless that tooth is also scheduled for extraction.
- Force Application: * Wedge: Inserted into the PDL space to create vertical lift.
- Rotation: Twisted to expand the socket and tear the ligament fibers.