How to use elevators/luxators?

[danyaalshah]

Hi guys, the title.
I've just started doing extractions at dental school and our supervisors constantly tell us to use elevators as it will make the extraction process easier but everytime I try to elevate, I feel like I'm doing nothing. I insert the elevator mesially and perpendicular to the tooth and try to rotate but nothing. I see some of the supervisors elevating teeth and I always hear a crack of some sort when they do it and I just know they're doing it right because the tooth comes out so easily with the forceps and at other times they can elevate the entire out out...
Extractions aren't really my strong point right now so I'm just trying to learn everything that would make it easier for me.
Am I not using enough force? Is there a technique I can follow. Please helps and thanks in advance.

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[Saddleshoes]

1) For this point in your development lets just forget luxators. (You can move to luxators later when you have learned to use an elevator.)
2) Get pine 2x4 and some 10 penny (or larger) nails. Drive the nails 1 inch into the 2X4. Now use an old elevator to get the nail out.
------ Do that a few times and you will teach yourself how to use an elevator without putting a patent though your lenthy learning exercise.

 

[bracketbuster68]

Insert the elevator mesial/distal to the tooth until you find a purchase point. Go as apical as you can. Then firmly push and rotate (towards the tooth) steadily and hold for a few seconds. Then do the other side. Always elevate buccal, never lingual.

 

[gunner4ever]

Insert the elevator mesial/distal to the tooth until you find a purchase point. Go as apical as you can. Then firmly push and rotate (towards the tooth) steadily and hold for a few seconds. Then do the other side. Always elevate buccal, never lingual.

I never understood what towards the tooth meant. Rotating either direction is towards the tooth, whether it's the apical or coronal side of the blade

 

[bracketbuster68]

I never understood what towards the tooth meant. Rotating either direction is towards the tooth, whether it's the apical or coronal side of the blade

Let's say you're elevating #20. If you insert the elevator on the distal, you will elevate clockwise (righty tighty) with the apical end going towards the tooth and the coronal end away from the tooth. Switch to the mesial and you'll elevate counterclockwise (lefty loosey), same concept.

 

[TanMan]

Hi guys, the title.
I've just started doing extractions at dental school and our supervisors constantly tell us to use elevators as it will make the extraction process easier but everytime I try to elevate, I feel like I'm doing nothing. I insert the elevator mesially and perpendicular to the tooth and try to rotate but nothing. I see some of the supervisors elevating teeth and I always hear a crack of some sort when they do it and I just know they're doing it right because the tooth comes out so easily with the forceps and at other times they can elevate the entire out out...
Extractions aren't really my strong point right now so I'm just trying to learn everything that would make it easier for me.
Am I not using enough force? Is there a technique I can follow. Please helps and thanks in advance.

Are you looking for fast or conservative extractions? If you're looking for fast and don't care about the bone or adjacent for future site prep, get a surgical 557 and trough the bone all around the roots. and flick all the teeth/roots out.

If you're looking for conservative extractions, then you need to plan how to save as much bone as possible, especially the buccal plate. Every tooth is different in that there's different strategies for each one. If it's an anterior tooth that still has some coronal structure and fairly straight, I prefer to go straight to a forcep, grip the coronal part as apically as possible, and rotate. If it's a max premolar, you need to be more cautious since the root concavities can throw off your elevator fulcrum and I'd still stick to a forcep or M-D section. For mandibular premolars, your bigger enemy is severe decay, mental foramen, and harder bone. When it's easy, it's easy, when it's hard, it's a PITA.

Elevators, for me, shine on badly decayed maxillary and mandibular molars, with a handpiece. Convert those 2-4 root systems into individual roots by sectioning, elevatate each root out against each other with an apexo 301.

Also remember that removing the tooth is not always in the coronal direction. If you have a mandibular molar that curves distally, you need to think of it like a hook. You cannot pull it straight out, the only easy way to remove it is by rotating it towards the direction of the hooked root. If you understand the anatomy of the tooth you are pulling, that's when you know how to elevate the tooth. Brute force rarely solves the problem.

 

[danyaalshah]

Insert the elevator mesial/distal to the tooth until you find a purchase point. Go as apical as you can. Then firmly push and rotate (towards the tooth) steadily and hold for a few seconds. Then do the other side. Always elevate buccal, never lingual.

When you say apical, that would mean the elevator isn't being inserted perpendicular right? It would actually be at angle because you need to go towards the root surface?
Sorry if this is a dumb question, the faculty at my school aren't helpful. We're just presented with a bunch of theory and expected to make sense of things by ourselves...

 

[danyaalshah]

Are you looking for fast or conservative extractions? If you're looking for fast and don't care about the bone or adjacent for future site prep, get a surgical 557 and trough the bone all around the roots. and flick all the teeth/roots out.

If you're looking for conservative extractions, then you need to plan how to save as much bone as possible, especially the buccal plate. Every tooth is different in that there's different strategies for each one. If it's an anterior tooth that still has some coronal structure and fairly straight, I prefer to go straight to a forcep, grip the coronal part as apically as possible, and rotate. If it's a max premolar, you need to be more cautious since the root concavities can throw off your elevator fulcrum and I'd still stick to a forcep or M-D section. For mandibular premolars, your bigger enemy is severe decay, mental foramen, and harder bone. When it's easy, it's easy, when it's hard, it's a PITA.

Elevators, for me, shine on badly decayed maxillary and mandibular molars, with a handpiece. Convert those 2-4 root systems into individual roots by sectioning, elevatate each root out against each other with an apexo 301.

Also remember that removing the tooth is not always in the coronal direction. If you have a mandibular molar that curves distally, you need to think of it like a hook. You cannot pull it straight out, the only easy way to remove it is by rotating it towards the direction of the hooked root. If you understand the anatomy of the tooth you are pulling, that's when you know how to elevate the tooth. Brute force rarely solves the problem.

I'm trying to do fast and conservative extractions whilst at the same time not cause any harm to my patients. I do not aim to be aggressive when extracting to the point where I'll fracture the bone. I know in some cases it may happen (fracture bone) but that's not what I want to do. I just want to be able to take out teeth easier. We're not allowed to use the surgical bur at this point in time so elevators and forceps it is. I find some teeth to be much more resistant to forceps only extractions hence I'm trying to improve my skills with elevators/luxators.

 

[bracketbuster68]

When you say apical, that would mean the elevator isn't being inserted perpendicular right? It would actually be at angle because you need to go towards the root surface?
Sorry if this is a dumb question, the faculty at my school aren't helpful. We're just presented with a bunch of theory and expected to make sense of things by ourselves...

Correct. I always started perpendicular then adjusted to find a purchase point.

 

[schmoob]

If you’re in dental school you aren’t using luxators.

Start with the periosteal circumferentially. Then take your narrowest elevator and insert it PARALLEL to the long axis of the tooth to obtain a purchase point. THEN angle the instrument perpendicular. If you are in the mesial, start slowly elevating clockwise, in the distal counterclockwise. Keep your index finger along the shank and use your other hand to protect the buccal plate.

If you’re talking lower molars, elevate and use those cowhorns and pump as well as gently and slowly rock buccolingually. If the tooth snaps at the furcation that’s fine. Just removed each half individually. Or you can just section it as previously mentioned.

 

[BYU4you]

Let's say you're elevating #20. If you insert the elevator on the distal, you will elevate clockwise (righty tighty) with the apical end going towards the tooth and the coronal end away from the tooth. Switch to the mesial and you'll elevate counterclockwise (lefty loosey), same concept.

If we are “going by the book” this is the opposite of what you should do. As long as you aren’t applying excessive force to the tooth adjacent it doesn’t matter. But doing it this way is more likely to out extra force on the adjacent tooth.

As far as basics for dental students are concerned. The elevator should be between the socket bone and tooth.
The top portion “coronal” should go into the tooth when elevating. This is allows the apical portion to be butting up against and using the bone as leverage.

Of course this is situational but for simple extractions and basics thats what the books teach.

 

[I_Love_Huskies]

Luxators >>>> elevators

 

[Ivy.ch]

When turning the elevator, it should feel like stretching a rubber band. If it twists freely or feels like solid granite, you’re in a bad spot. Find a new one.