Periosteal Elevators: Molt, Prichard, Buser and P24G Compared
Almost every oral surgical procedure begins with an incision and a flap. Whether osteotomy, apicoectomy, implant placement or bone grafting: the mucosa is detached from the bone together with the periosteum so that the surgical site is exposed. This is the job of periosteal elevators, known in German as "Raspatorium". A well-raised, undamaged flap heals better and can be repositioned cleanly. This guide presents the common periosteal elevators, including Molt, Prichard, Buser and P24G, and explains how to use them correctly.
Key points at a glance
- A periosteal elevator detaches the mucoperiosteal flap from the bone.
- Most dental periosteal elevators are double-ended, with two blades of different width or shape.
- The Molt No. 9 has a more pointed end and a broad, rounded end and is considered the standard instrument.
- The Prichard has a large and a small blade and is also suitable for retracting the flap.
- The Buser has a narrow blade and is used in implantology on narrow ridges.
- The blade is always guided in contact with bone so that the periosteum does not tear.
What does a periosteal elevator do?
The periosteum adheres firmly to the bone. If a flap is raised in the mucosa only, the periosteum remains on the bone, and the flap becomes thin and bleeds more. In a mucoperiosteal (full-thickness) flap, mucosa and periosteum are raised together. The periosteal elevator is placed beneath the periosteum and moved along the bone with short, pushing strokes. The edge is shaped to glide between periosteum and bone without perforating the flap.
Besides elevation, many periosteal elevators are also used for retraction: once the flap is raised, the broad blade holds it back and protects it from rotary instruments.
The most important periosteal elevators
Molt periosteal elevator
The Molt No. 9 is the classic instrument for oral surgery. It is double-ended: the narrower, more pointed end is suitable for releasing the papillae and the sulcus area and lifting the flap. The broad, rounded end is then used to raise the flap over a larger area and retract it. The Molt 9 is used for extractions, osteotomies and implant placement. In our shop: Molt No. 9 periosteal elevator.
Prichard periosteal elevator
The Prichard periosteal elevator has a large, broad blade and a smaller blade. It is used mainly in periodontal surgery, flap operations and for exposing graft sites. The broad blade retracts the flap well. In our shop you will find the Prichard PR3 periosteal elevator.
Buser periosteal elevator
The Buser periosteal elevator has a particularly narrow blade with one round and one pointed end. It is an established design in implantology and is suitable for flap preparation on narrow ridges and in confined areas. In our shop: Buser periosteal elevator.
P24G periosteal elevator
The P24G is a double-ended periosteal elevator with two blade widths. It is also used to raise and retract mucoperiosteal flaps and is an alternative to the Molt 9. In our shop: P24G periosteal elevator.
Other designs
There are numerous other designs. The Freer elevator has two narrow, flat blades and is also used outside dentistry, for example in ENT surgery. The Williger elevator is widespread in oral surgery in German-speaking countries. In general surgery and orthopaedics, considerably larger periosteal elevators are used that have little in common with dental applications.
Comparison of periosteal elevators
| Periosteal elevator | Blade shape | Typical use |
|---|---|---|
| Molt No. 9 | Double-ended, one more pointed and one broad, rounded end | Standard for extraction, osteotomy, implant placement |
| Prichard | Double-ended, large and small blade | Periodontal surgery, flap retraction |
| Buser | Narrow blade, round and pointed end | Implantology, narrow ridge |
| P24G | Double-ended, two blade widths | Raising and retracting flaps |
| Freer | Two narrow, flat blades | Fine dissection, also ENT |
How to use a periosteal elevator correctly
- Incise down to the bone: the flap can only be raised cleanly if the incision fully divides the periosteum. Read more about blades and handles in our guide scalpel blade sizes.
- Start at the papilla: use the narrower end to lift the flap at the papilla or the incision margin.
- Work with pushing strokes: the blade stays in contact with bone and is advanced beneath the periosteum with short, controlled strokes. Avoid levering or tearing movements.
- Raise over a larger area: use the broad end to release the flap to the desired extent.
- Retract: the periosteal elevator or a retractor holds the flap back during the procedure. Suitable retractors are presented in our guide wound retractors.
Care and inspection
The edge of the periosteal elevator must be smooth and free of nicks. A damaged edge tears the periosteum instead of releasing it cleanly. Check the working ends after every reprocessing cycle. Minor irregularities can be smoothed with a fine sharpening stone, preserving the original shape. Bent blades should be replaced. Advice on cleaning and sterilisation is given in our guide care and reprocessing.
Frequently asked questions
Is a "Raspatorium" the same as a periosteal elevator?
Yes. Both terms describe the instrument used to detach the periosteum from the bone. "Raspatorium" is the term commonly used in German.
Which periosteal elevator for tooth extraction?
The Molt No. 9 is the most commonly used periosteal elevator for extractions and osteotomies. A narrow elevator such as the Buser complements it in confined areas.
What is the broad end for?
The broad end is used to raise the flap over a larger area and to retract it during the procedure.
Can a periosteal elevator be sharpened?
Yes, periosteal elevators can be reground. The shape of the edge must be preserved so that the instrument still glides between periosteum and bone.
Conclusion
A cleanly raised mucoperiosteal flap is the basis of every oral surgical procedure. With a Molt 9 as standard and a narrow elevator such as the Buser for confined areas, you are well equipped for most situations. You will find all periosteal elevators in the category elevators, excavators and root elevators and under oral surgery. Which other instruments belong in a basic surgical set is shown in our oral surgery checklist.