Winter Cryer Elevator Cross Bar Tooth Extraction

• The “Winter Cryer Elevator Cross Bar” is not a single instrument but a set of two paired elevators designed for the surgical removal of a specific tooth, typically a large molar with robust, divergent roots. The technique is a mechanical, lever-based system that uses opposing force to luxate (loosen) and ultimately extract a tooth without crushing it.

  The name breaks down as follows:

  • Winter & Cryer: The names of the dentists who designed or popularized these instruments (Dr. George B. Winter and others).

  • Elevator: A tool used to loosen a tooth from its periodontal ligament and socket (alveolus).

  • Cross Bar: Describes the technique where the two instruments are inserted on opposite sides of the tooth and are crossed and pressed together, acting against each other to provide the lifting force.

  ---

  The Instruments

  A matched pair is used, often labeled “Right” and “Left” or “N” and “S” (for North and South).

  1. Design: Each elevator has a long, sturdy handle for grip and leverage. The working end, or blade, is the critical part:

     • It is straight and tapered.

     • One side of the blade is flat.

     • The opposite side has a distinct, sharp, V-shaped groove or notch.

  2. Function of the Groove: This groove is designed to fit snugly around the root bifurcation (the point where the two roots of a tooth separate). The sharp edges of the “V” bite into the cementum of the root, providing a secure purchase and preventing the instrument from slipping during the application of force.

  ---

  The Technique: Step-by-Step

  This procedure is performed under anesthesia.

  1. Access and Visualization: The gum tissue (gingiva) around the tooth is flapped back, and often some of the surrounding bone is removed (a procedure called osteotomy) to expose the roots and the bifurcation area fully.

  2. Placement: The two elevators are positioned on opposite sides of the tooth.

     • The grooved side of each blade is facing towards the tooth.

     • The tip of each elevator is carefully wedged into the root bifurcation on its respective side. The flat side of the blade faces outward, resting against the bony socket wall.

  3. The “Cross” and Application of Force: The key step.

     • The handles of the two elevators are crossed over each other.

     • The surgeon applies controlled, simultaneous force in two directions:

       • Apical Force: Pushing the handles downward (towards the apex of the root) seats the grooves more firmly into the bifurcation.

       • Leveraging Force: The surgeon then squeezes the handles together in a scissor-like motion. Because the tips are anchored in the bone and on the root, this squeezing force is translated into a powerful coronal lifting motion (up and out of the socket).

  4. Luxation and Delivery: This combined action creates immense controlled force that:

     • Stretches and tears the periodontal ligament holding the tooth in place.

     • Compresses the bony socket slightly.

     • Luxates the tooth upward until it can be delivered from the socket, often with forceps for the final removal.

  Visual Analogy

  Imagine pulling a fence post out of the ground by crossing two long bars against each other just below the post’s head and squeezing them together. The crossed bars act as a powerful lever system. The Winter Cryer technique applies this exact principle to a tooth.

  Primary Use Case

  • Veterinary Dentistry: This is the most common modern application. It is the gold-standard technique for extracting mandibular cheek teeth (molars) in horses, which have deep, long roots embedded in strong mandibular bone.

  • Historical Human Dentistry: It was used for removing human mandibular molars, especially broken-down ones with strong roots. However, with advances in modern dentistry (like precision drills and ultrasonic tips), its use in humans has become very rare, replaced by less traumatic sectioning techniques.

  Key Advantages

  • Preservation of Tooth Structure: Allows for the removal of a tooth that is too broken down to be gripped by standard forceps.

  • Preservation of Bone: When done correctly, it can be less traumatic to the surrounding jawbone than wiggling with forceps.

  • Controlled, Powerful Force: Provides a mechanical advantage that direct force cannot match.