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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 7  |  Issue : 3  |  Page : 202-204

Knocking out maxillary third molar with a hockey stick elevator


1 Department of Oral and Maxillofacial Surgery, KVG Dental College and Hospital, Sullia, Dakshina Kannada, Karnataka, India
2 Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Mangalore, Karnataka, India

Date of Web Publication22-Aug-2016

Correspondence Address:
Vaibhav Jain
Department of Oral and Maxillofacial Surgery, KVG Dental College and Hospital, Kurunjibag, Sullia, Dakshin Kanadda - 574 327, Karnataka
India
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DOI: 10.4103/0976-433X.188797

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  Abstract 

Extraction of maxillary third molar always comes as a challenge for any dental practitioner owing to its limited accessibility and minimal space for instrument placement. Moreover, the complications related to faulty extraction technique can never be ignored. We have here described a simple and easy method of extraction of the maxillary third molar tooth using hockey stick elevators which can solve most of the problems that are faced by dental surgeons in the extraction of maxillary third molars. This technique has proved its efficacy and has been time tested for removal of a maxillary third molar providing a good alternative for routine extraction techniques of maxillary third molars.

Keywords: Extraction, hockey stick elevator, maxillary third molar


How to cite this article:
Jain V, D'Silva J, Garg H, Mendonsa JP. Knocking out maxillary third molar with a hockey stick elevator. SRM J Res Dent Sci 2016;7:202-4

How to cite this URL:
Jain V, D'Silva J, Garg H, Mendonsa JP. Knocking out maxillary third molar with a hockey stick elevator. SRM J Res Dent Sci [serial online] 2016 [cited 2021 Mar 3];7:202-4. Available from: https://www.srmjrds.in/text.asp?2016/7/3/202/188797


  Introduction Top


The extraction of maxillary third molars is one of the commonly practiced procedures in oral and maxillofacial surgery and is rarely associated with severe complications.[1] Most frequently confronted complications are fracture of maxillary tuberosity, root fracture, and maxillary sinus perforation. Other rare complications include buccal fat pad herniation and displacement of the roots or tooth into the maxillary sinus or infratemporal fossa.[2]

Removal of maxillary third molar has always been a challenging task for a dentist as well as for an oral surgeon. The main reason for this is the limited accessibility and difficult vision that often requires overstretching of the cheek to gain accessibility. The presence of anterior border of the ramus of mandible lateral to the maxillary third molar is an additional factor that makes the removal of this tooth difficult. Very minimal space exists between the ramus and upper third molar which becomes even less when patient opens the mouth due to anterior and downward movement of the coronoid process of mandible [Figure 1]a.
Figure 1: (a) Space available around maxillary third molar and (b) fractured maxillary tuberosity with extracted third molar

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Keeping all these problems in mind, we have devised a simple and easy way of removing maxillary third molar teeth just using hockey stick elevator also known as Warwick James elevator. This technique can be used very effectively for removing distally, buccally, or lingually placed tooth as well as an impacted maxillary third molar.


  Technique Top


Warwick James/hockey stick elevators are one of the commonly used instruments in oral surgery. Hockey stick elevators are a paired set of instruments used separately for right and left sides. It is a two plane instrument with blade bent at right angle to the shank with a built-in concavity [Figure 2]a. In this technique after administration of appropriate local anesthesia, the patient is asked to partially open the mouth, and the blade of hockey stick elevator is placed precisely between the interdental area of the second and third molar with concavity facing distally [Figure 2]b. The elevator is applied as apically as possible on the third molar, and controlled force is applied, pushing the tooth distally and downward. Once the accurate placement of elevator is confirmed tooth can be removed just by tactile sensation and does not require direct visualization. Because the path of removal of maxillary third molar is distally downward, this instrument makes it very easy to apply appropriate forces to deliver the tooth in that direction [Figure 2]b.[3] Moreover, because the head of this elevator is very small when compared to other instruments such as Cryer's elevator or Coupland's elevator, it can be easily applied in the limited space available and delivers controlled forces thus minimizing the chances of tuberosity fracture [Figure 1]b.[4],[5] Also, as this is a two plane instrument with blade bent at right angle to the shank it does not require overstretching of the cheek and minimizes trauma at angle of mouth [Figure 2]c. Overall this technique has proved to be an easy and safe alternative to forceps extraction for maxillary third molar extraction with minimal complications of displacement of the tooth into the sinus or infratemporal fossa.[6] This instrument can also be used in case of impacted maxillary third molars and can be easily engaged in the purchase point created with bur on the mesiobuccal aspect of the impacted tooth, and subsequent removal of the tooth can be done by applying adequate distal and downward forces.
Figure 2: (a) Hockey stick (Warwick James) elevator

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  Conclusion Top


This technique has proved its efficacy and has been time tested for removal of a maxillary third molar. We have been routinely using this technique with satisfactory results and hope that this technique will provide a good alternative for routine extraction techniques of maxillary third molars.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Sverzut CE, Trivellato AE, Sverzut AT, de Matos FP, Kato RB. Removal of a maxillary third molar accidentally displaced into the infratemporal fossa via intraoral approach under local anesthesia: Report of a case. J Oral Maxillofac Surg 2009;67:1316-20.  Back to cited text no. 1
    
2.
Dimitrakopoulos I, Papadaki M. Displacement of a maxillary third molar into the infratemporal fossa: Case report. Quintessence Int 2007;38:607-10.  Back to cited text no. 2
    
3.
Badawi Fayad J, Levy JC, Yazbeck C, Cavezian R, Cabanis EA. Eruption of third molars: Relationship to inclination of adjacent molars. Am J Orthod Dentofacial Orthop 2004;125:200-2.  Back to cited text no. 3
    
4.
Shah N, Bridgman JB. An extraction complicated by lateral and medial pterygoid tethering of a fractured maxillary tuberosity. Br Dent J 2005;198:543-4.  Back to cited text no. 4
    
5.
Chrcanovic BR, Freire-Maia B. Considerations of maxillary tuberosity fractures during extraction of upper molars: A literature review. Dent Traumatol 2011;27:393-8.  Back to cited text no. 5
    
6.
Selvi F, Cakarer S, Keskin C, Ozyuvaci H. Delayed removal of a maxillary third molar accidentally displaced into the infratemporal fossa. J Craniofac Surg 2011;22:1391-3.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]



 

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