Dental Elevator Fracture During Exodontia: A Scoping Review with Risk Stratification and Clinical Management Framework

Abstract

Background: Fracture of dental elevators during exodontia is a rare but clinically significant intraoperative complication that may result in retained foreign bodies, infection, delayed healing, and medico-legal implications. The available evidence remains fragmented and predominantly limited to case reports and small case series [1,5,7].
Aim: To map and synthesize existing evidence on dental elevator fracture during tooth extraction and to develop a structured clinical framework for risk stratification, prevention, and management.
Methods: A scoping review was conducted in accordance with PRISMA-ScR guidelines. Electronic databases including PubMed, Scopus, and Google Scholar were systematically searched using predefined keywords. Studies comprising case reports, case series, and relevant review articles were included. Data were extracted on etiology, contributing factors, clinical presentation, management strategies, and outcomes. The findings were analyzed using qualitative thematic synthesis and used to develop a novel Operator–Instrument–Procedure (OIP) risk model.
Results: A total of 142 records were identified, with 11 studies included after screening. Dental elevator fracture was most commonly associated with mandibular third molar extractions [5,14]. Contributing factors were categorized into operator-related, instrument-related, and procedure-related domains [4,7,10,14]. Most fractures were detected intraoperatively and managed by immediate retrieval [4,5], although delayed presentations were also reported [1,2].
Conclusion: Dental elevator fracture is a multifactorial and largely preventable complication. The proposed OIP-based framework provides a structured approach to risk assessment, prevention, and management.