Use of Physics Forcep Versus Conventional Forcep in Extraction of Mandibular First Molar

Dental extractions are common. Atraumatic extractions utilizing various technologies are said to protect paradental structures. The new physics forceps can extract the teeth without stress. Objective: To compare the efficacy of physics versus conventional forcep in extraction of mandibular first molar. Methods: Patients aged 18 t0 40 requiring extraction of mandibular first molar were included in the study. The efficacy of extraction was evaluated based on bone loss, soft tissue tear, time required for extraction, postoperative pains, and root fracture. The participants were divided into two groups (Physics forcep and conventional forcep) using block randomization technique, and the pain and time between both groups were compared using independent samples t-test. Results: The two groups had a mean age of 2.85 ± 0.355 years. Physics Forceps (n=1, 6.7%) caused less soft tissue tears than Conventional Forceps (n=14, 93.3%) (p=0.01). 55.5% of the Physics Forceps group and 44.5% of the Conventional Forceps group took more than 10 minutes to extract (p=0.045). Physics Forceps had a greater rate of complete success (p=0.043) than Conventional forceps (p=0.043). In terms of overall instrument utility, physics forceps scored better than Conventional forces in both good and average scores (p=0.021). The difference in mean pain score in the two groups was statistically significant (p=0.0018) at day 3 and day 7 (p=0.0001) being lower in physic forcep. Conclusions: Physics forceps are a more favorable substitute to traditional forceps for atraumatic tooth extraction.

deformation of the dentoalveolar complex [5][6][7]. Aristotle, a well-known historical gure from 384-322 BC, identi ed forceps as a tool for extraction that worked by utilizing "two levers acting in anti-direction with one point fulcrum" [8]. To achieve a successful tooth extraction, a surgeon must possess nesse and the ability to apply controlled force. Traditional extraction techniques involve various methods, such as severing the periodontal ligament, using an elevator to loosen the tooth, and removing it with forceps [9]. In case the elevator technique is unsuccessful, forceps Physics Forcep Versus Conventional Forcep

I N T R O D U C T I O N
Dental extractions are common. Atraumatic extractions utilizing various technologies are said to protect paradental structures. The new physics forceps can extract the teeth without stress. Objective: To compare the e cacy of physics versus conventional forcep in extraction of mandibular rst molar. Methods: Patients aged 18 t0 40 requiring extraction of mandibular rst molar were included in the study. The e cacy of extraction was evaluated based on bone loss, soft tissue tear, time required for extraction, postoperative pains, and root fracture. The participants were divided into two groups (Physics forcep and conventional forcep) using block randomization technique, and the pain and time between both groups were compared using independent samples t-test. Results: The two groups had a mean age of 2.85 ± 0.355 years. Physics Forceps (n=1, 6.7%) caused less soft tissue tears than Conventional Forceps (n=14, 93.3%) (p=0.01). 55.5% of the Physics Forceps group and 44.5% of the Conventional Forceps group took more than 10 minutes to extract (p=0.045). Physics Forceps had a greater rate of complete success (p=0.043) than Conventional forceps (p=0.043). In terms of overall instrument utility, physics forceps scored better than Conventional forces in both good and average scores (p=0.021). The difference in mean pain score in the two groups was statistically signi cant (p=0.0018) at day 3 and day 7 (p=0.0001) being lower in physic forcep. Conclusions: Physics forceps are a more favorable substitute to traditional forceps for atraumatic tooth extraction. may be employed to use intermittent apical and lateral forces to extract the tooth [10]. However, if the tooth is already weakened due to decay or endodontic treatment, or if the roots are long and/or twisted, using conventional extraction forceps can result in fracturing of the tooth or the underlying bone. This can lead to more complex surgical procedures and adverse postoperative consequences [11]. Tooth extraction has been practiced for thousands of years using mechanical force, but technological advancements have primarily aimed to preserve the tooth crown rather than enhance the extraction process [12]. Atraumatic tooth extraction has become increasingly popular in the last decade as it helps to maintain bone integrity for implant placement. The Physics forceps are a groundbreaking tool in exodontia, utilizing biomechanics with minimal squeezing, gripping, twisting, or pulling forces. Its primary approach is to utilize rst-class lever, creep, and tension circulation to carry out the extraction process in a more e cient manner [13]. The main objective of atraumatic tooth extraction is to preserve the integrity of the bone while removing the tooth, minimizing any damage or trauma to the surrounding tissues [14]. In this regard, Physics forceps have gained a signi cant amount of attention due to their ability to extract teeth using a level 1 lever system, without requiring excessive squeezing, gripping, twisting, or pulling forces. To further investigate the effectiveness of Physics forceps in comparison to traditional forceps, a research study has been proposed. This study aims to evaluate the extraction of mandibular molars using both Physics forceps and traditional forceps, and to compare the outcomes of each method in terms of effectiveness, e ciency, and postoperative complications. By comparing the two methods, the researchers can determine if Physics forceps can be considered as a viable alternative to traditional forceps in atraumatic tooth extraction procedures. The study may also provide insights into the advantages and limitations of each method, helping to inform dental professionals on the best approach to use for different patient scenarios. Ultimately, the ndings of this research may help to improve the overall quality of dental care and patient outcomes. The objective of the study was to compare the effectiveness of physics versus conventional forcep in extraction of mandibular rst molar.

M E T H O D S
from all participants. The total sample size was 130 (65 in each group). The sample size for this study was calculated using the OpenEpi calculator based on the mean difference in pain after using physics forceps versus conventional forceps. Group A had a mean of 5.6, while group B had 14.3 (9). With a 95% con dence interval and 80% power, the total sample size was calculated to be 118 (59 in each group), with an additional 10% more cases to be recruited in each group to accommodate possible incomplete or missing responses. Participants aged 18 to 40 years, regardless of gender, who were willing to participate, and required extraction of mandibular 1st molar with straight root due to carious, prosthetic, or orthodontic reasons were included. Patients with uncontrolled systemic disease, pregnancy, lactating mothers, failed root canal treated teeth, abnormal root morphology (dilacerated), and periodontal compromised rst permanent molars were excluded. Patients who met the inclusion criteria were included in the study. All patients were assessed clinically and radiographically according to the inclusion criteria of the study. Participants were bifurcated into two groups using block randomization technique. Each block consisted of 10 participants who were randomized into two groups by simple random technique using the "Rand function" in an Excel sheet. The e cacy of extraction was measured in term of bone loss, soft tissue tear, time required for extraction, postoperative pains and root fracture. After the achievement of effective local anesthesia, the extraction of the rst molar was performed using either the physics forceps or conventional forceps. For physics forceps extraction, the instrument was placed on the buccal surface of the tooth and compressed to the root. The beak was then rotated to engage the root, and an apical force was applied to extract the tooth. On the other hand, for conventional forceps extraction, the instrument was positioned around the crown of the tooth and rocked back and forth to expand the socket. Once the socket was expanded, an apical force was applied to extract the tooth. After the tooth was extracted, the socket was inspected for any debris or bone spicules, and the patient was instructed to bite down on gauze to control bleeding. Postoperative instructions and medications were given to the patient as needed. The study collected data on several variables including age, sex, side of the mandibular rst molar (right or left), presence of soft tissue tear (yes or no), time of extraction (less than 10 minutes or more than 10 minutes), success of extraction (complete success, limited success needing osteotomy, or limited success with root tip fracture), pain score on visual analog scale (at day 3 and 7) and overall utility of the instrument (scored as 1 for good, 2 for average, and 3 for poor) in both groups. Pain was evaluated postoperatively by using visual analog scale. A This randomized clinical trial was conducted on 130 participants (65 per group) at the Department of Oral & Maxillofacial Surgery, Institute of Dentistry, Liaquat University of Medical Health & Sciences, Jamshoro using a non-probability sampling technique. After an explanation of the study aims, informed consent was obtained verbally The mean age of the participants was 2.85 ± 0.355 years. The most common age group in both groups was 31-40 years. In the Physic Forceps group, 54 (84.4%) participants belonged to the 31-40 age group, while in the Conventional Forceps group, the number was 56 (87.5%). The difference between the two groups was not statistically signi cant (p=0.46). Males outnumbered females in both groups, but the difference in gender distribution between the two groups was not statistically signi cant (p=0.51) ( Table 1). Table 3 is comparing the time of extraction between two interventions, Physic Forceps and Conventional Forceps. The Mean Difference with negative value (-0.18) indicates that on average, extraction time was shorter with Physic Forceps compared to Conventional Forceps. The 95% con dence interval (CI) for the mean difference (-0.296, -0.063) was statistically signi cant. This means that we can be 95% con dent that the true difference in mean extraction time between the two interventions falls between -0.296 and -0.063 minutes. The difference was statistically signi cant (p=0.0028). score of 0 indicate "no hurt", while 10 indicate "hurts worst". Normal antibiotics (Amoxicillin 500g/8hr for 3 days) and analgesic paracetamol 1g/6hr were supplied to the patients for pain relief. The patients were advised to consume a soft diet after surgery and to use mouthwash to keep their teeth clean. The data were analyzed using SPSS version 22.0. Frequency and percentage were calculated for the st categorical variables like gender, and side of mandibular 1 molar, soft tissue tear, success of extraction and utility of instruments in both groups. Mean and SD ± was calculated for continuous variables like age, post-operative pain score and time need for extraction in both groups. Comparison of pain and time between both groups was done using independent samples t test. Chi-square test was run to compare categorical outcomes variables between two groups. p<0.05 was signi cant level.  Physic Forceps had a signi cantly higher rate of complete success than Conventional Forceps (p=0.043). However, Conventional Forceps had a higher rate of limited success through osteotomy or root tip fracture. Finally, the overall utility of the instrument was assessed, and Physic Forceps were rated signi cantly higher than conventional forceps in terms of both good and average scores (p=0.021) ( Table  2).  Table 4 presents the comparison of postoperative pain scores between two interventions, Physic Forceps and Conventional Forceps, at day 3 and day 7 after the surgery. At day 3, the mean pain score was signi cantly lower in the group treated with Physic Forceps (2.58 ± 0.98) compared to the group treated with Conventional Forceps (3.26 ± 1.39). The difference in mean pain score between the two groups was statistically signi cant (p-value=0.0018).

D I S C U S S I O N
Similarly, at day 7, the mean pain score was signi cantly lower in the group treated with Physic Forceps (0.21 ± 0.11) compared to the group treated with Conventional Forceps (0.92 ± 0.88). The difference in mean pain score between the two groups was also statistically signi cant (p-value=0.0001).
This randomized controlled trial aimed to compare the e cacy of extraction using physics versus conventional forceps. The measurements were bone loss, soft tissue tear, time required for extraction, postoperative pain, and root fracture for rst molar extraction. Our ndings revealed that the physics forceps were effective in terms of all variables of outcome. For a long time, traditional methods of tooth extraction have been used to forcefully remove teeth without affecting the alveolar bone or surrounding tissue. Rodd created the elevator, which uses a single lever under the tooth to push it out of its socket. However, these traditional extraction techniques often cause harm to the gingival tissue, ranging from slight laceration to complete destruction of the buccal bony layer and interdentally bone crest [15]. As a result, patients may experience trismus, dry socket, postoperative discomfort, and bony dehiscence. Furthermore, the small size of the labial bone or apical to free gingival margin may cause signi cant resorption during the socket's healing period, leading to postoperative pain and di culties with prosthetic replacement. Additionally, even the quality of oral hygiene may decrease after nonsurgical tooth extraction [5]. Various devices and techniques are used for atraumatic tooth extraction, including driven peristomes, piezo surgery, lasers, orthodontic extrusion, and the Benex method. The Physics Forceps is a modern tool that uses biomechanical principles, including a rst-class lever, creep, and tension delivery, for more predictable, faster, and less stressful extractions. The forceps were designed using biomechanics to make them more effective, especially in atraumatic cases [16]. A randomized controlled trial compared physics forceps with conventional forceps for removing 28 mandibular single rooted teeth, measuring crown/root/bone fractures, gingival tear incidence and extraction time. Samples were randomly assigned to control (conventional forceps) and study (physics forceps) groups. They reported that in comparison to conventional forceps, physics forceps resulted in signi cantly faster extraction time (0.385 min. vs 3.971 min.) (p=0.011) and fewer incidents of buccal bone fracture (0.00% vs 28.57%), crown fracture (0.00% vs 21.43%), root fracture (3.57% vs 0.00%), and gingival tear (0.00% vs 50.00%), with the latter being highly signi cant (p=0.006). In these three studies, the mean time required for tooth extraction was evaluated. All of the studies found that using Physics forceps resulted in a signi cantly shorter operating time compared to conventional forceps. However, there was some variation in the way that the results were reported, with one study measuring the time in seconds and the other two studies measuring the time in minutes. Nonetheless, the consistency of the results across all three studies suggests that using Physics forceps can lead to faster and more e cient tooth extractions. The mean time required for tooth extraction was evaluated in previous four studies [17][18][19]. All the studies found that the use of Physics forceps resulted in a shorter operating time compared to conventional forceps. While one study reported the time taken in seconds, the other two studies reported the time taken in minutes [20].
Overall, these ndings suggest that the application of Physics forceps can substantially decrease the duration of tooth extraction and improve e ciency. Another study by El-Kenawy and Ahmed compared the e cacy of physics forceps with conventional forceps for uncomplicated dental extractions, the percentage of crown fractures was 3% for the physics forceps group and 10% for the conventional forceps group. The percentage of buccal bone fractures was 3% for the physics forceps group and 7% for the conventional forceps group. The percentage of root fractures was 8.5% for the physics forceps group and 16.6% for the conventional forceps group [21]. Our study's ndings regarding fewer soft tissue tears and less pain during tooth extraction with the Physics forceps compared to conventional forceps were supported by previous literature. Furthermore, these differences were found to be statistically signi cant [19,20]. This indicates that the use of Physics forceps may result in improved patient outcomes and decreased discomfort during the extraction procedure.

C O N C L U S I O N S
It can be concluded that for rst molar extraction, the use of physics forceps was superior to conventional forceps in terms of bone loss, soft tissue tear, time required for extraction, postoperative pain, and root fracture. These ndings emphasize the potential advantages of incorporating physics forceps in dental procedures.