Amit Patel advises young dentists how and why the luxator can be used instead of a Couplands elevator for extractions.
The appropriate use of a luxator in dental extractions can be a godsend for the patient and for you when performing atraumatic dental extractions.
As young dentists, the appropriate use of these instruments may not have been demonstrated properly to you.
I was always taught to use the Couplands before any extraction, and for some reason, even though we may not need it, we find ourselves picking up a Couplands elevator and destroying the soft tissues around the tooth as well as loosening adjacent teeth.
Going straight for the forceps can be stressful for the patient and can cause loss of alveolar bone as well as a difficult and lengthy extraction process. We’ve all been there. Hence I want to talk about the luxator.
What factors do we need to overcome when taking out a tooth?
- The periodontal ligament: the periodontal ligament is very strong and very resistant to removal of the tooth
- Bony undercuts: essentially the bone is what is holding the root in place. Look for undercuts or irregularities that will prevent an easy removal of the root
- The vacuum: it’s simple physics. Pushing a tooth out of its socket will create a vacuum at the apex.
These three factors mean the sockets of the teeth must be dilated just enough to allow a path of withdrawal that is not obstructed by any bony undercuts. (Images below)
How can the luxator help?
Choosing your luxator should be easy. Pick a luxator that has a tip width similar to the root diameter (Figure 1). The angle of a luxator’s working blade is important and is chosen for best access: for example, a straight luxator for anterior teeth.
When you insert the luxator into the gingival margin, it should be directed towards the root surface (Figure 2).
Apply axial pressure as you work the instrument down the root surface. Always ensure that your index finger is supporting the shank of the instrument and that another finger is protecting the soft tissue incase you slip.
As you work down the root surface, gently rock the luxator to sever the periodontal fibers; this is now providing space for the path of withdrawal of the root.
As you create space, air will spell into the apical socket breaking the vacuum allowing easier removal of the tooth.
Choose your forcep and voila, an atraumatic extraction site (Figure 3).
Remember the luxator is not an elevator, using too much force inappropriately and in the wrong direction could fracture the instrument or harm the patient. Work slowly to dilate the socket is my advice.
Don’t be scared to use the luxator because it will get you out of sticky situations. It’s much kinder to the alveolar bone compared with elevators (these have their own place). The end result is less pain for the patient and less traumatic hemorrhage to worry about.