Elevators - A Review

Elevators, are one of the key instruments that makes extraction easier to a dental surgeon. Loosening of the teeth from the surrounding bone is performed by elevators which makes application of forceps to extract the teeth out of the socket much simpler.

Classification of elevators

-Based on types 

   Straight type/gouge type 

   Triangle or pinnate shaped 

   Pick  type 

-Based on mechanical techniques of elevators 

Lever principle

• Cooplands 
• Straight 
• Crane pick 

Wedge Principle  

• Apex 

Wheel and axle principle  

• Sreusers Crossbar 

Mechanical/Working principles/technique

Mode of use of elevators revolve around mainly 3 principles 

1. Lever principle: 

• Most common Elevator is a lever of 1st order with the mechanical advantage being long lever arm and a short effort arm, i.e., small movement against great resistance 

      Clinical consideration: 

• Care to be taken to avoid traumatizing the soft tissue and loosening the adjacent teeth 

      Example: Coopland’s elevator, Straight elevator, Crane pick 

 2. Wedge principle: 

• The elevator working on this principle is used in such a manner where it is placed parallel with long axis of the tooth 
• The elevator is forced between the root and the bone 
• The elevators bur work in conjunction with lever principles 
• The mechanical advantage is the movable inclined plane overcomes a large resistance at right angles to the applied effort 

      Clinical consideration: 

• Excessive force should be avoided during use to prevent complications like pushing the root piece into contiguous regions like maxillary semis, mandibular canal or submaxillary space 
• Small elevator should be wedged 

      Example: Apex elevators 

3.Wheel and Axel principle: 

• It is modified lever principle where handle of the elevator acts as axle and triangular tip acts as wheel 

      Example: Creyer’s elevator, Crossbar elevator(4.6 value) 

      Clinical consideration: 

      When one of the root of a multi-rooted teeth remains back in the socket 

Types of Elevators

Straight Elevator - 

They aid in loosening tooth or root from bony socket prior to use of forcep 

• It has single handle and working end in several sizes 
• Can be used in 2 ways 
• Either can be placed parallel to long axis of tooth root between socket and root using alveolar bone as fulcrum or right angle to tooth axis by placing 
• Can be placed between tooth to be extracted and adjacent tooth and rotation movement can be achieved 
• Works on lever principle  

Coopland’s Elevator - 

• Works on lever principle 
• It is made in 3 sizes 
• Used as pulley lever, the handle has greater diameter on the blade
• The handle is rotated to pull the teeth out of the socket when it is inserted horizontally between tooth and bone 

Apex Elevator - 

• Elevator that works on wedge principle is also known as root-tip pick elevator 
• It is used in knocking out very small root tips by placing it between the socket wall by root tip 

Creyer’s Elevator - 

Working end is thick, curved, triangular which can import huge rotational force. 

• It is a most commonly used triangular elevator which works on wheel and axle principle 
• It is engaged into the one of the socket of multi rooted teeth by the remaining root is expelled out by engaging tip of the elevator of remaining root 

Cross bar/T bar - 

Elevator based on wheel and axle principle should be used with great caution as it can exert tremendous force and can also lead to the fracture of the jaw 

Pott’s Elevator - 

Elevator employed in knocking out deciduous teeth 

Winter’s Elevator, Warwick James etc are other elevators 

Take home message 

Knowing the function of various elevators, manner of use and principles which govern their use is important from the dentist’s point of view before using them in clinical practices. 

Article by Dr. Siri P.B.