Download Rajiv Gandhi University of Health Sciences, Karnataka

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA
BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1.
NAME OF THE
Dr. ANUBHAV AGARWAL
CANDIDATE AND
POST GRADUATE STUDENT
ADDRESS
DEPARTMENT OF ORAL AND
MAXILLOFACIAL SURGERY,
COLLEGE OF DENTAL SCIENCES ,
DAVANGERE – 577 004,
KARNATAKA.
2.
NAME OF THE
COLLEGE OF DENTAL SCIENCES
INSTITUTION
DAVANGERE – 577 004
KARNATAKA
3.
4.
COURSE OF STUDY
MASTER OF DENTAL SURGERY (M.D.S),
AND SUBJECT
ORAL & MAXILLOFACIAL SURGERY
DATE OF ADMISSION
31th MAY 2012
TO COURSE
5.
TITLE OF THE TOPIC
“ PHYSICS FORCEPS VERSUS
CONVENTIONAL FORCEPS FOR TOOTH
EXTRACTION: A COMPARATIVE STUDY ”
6.
BRIEF RESUME OF THE INTENDED WORK:
6.1 Need for the Study:

Tooth extraction is a traumatic procedure often resulting in immediate destruction
and loss of alveolar bone and surrounding soft tissues which leads to complex
cascade of biochemical and histological events then ensues during the wound
healing process which further leads to physiologic alterations to alveolar bone
and soft tissue architecture. One such atraumatic extraction technique using the
‘PHYSICS FORCEPS’ can reduce the degree of damage and extent of resorption
that physiologically occurs following tooth extraction. Extraction socket with an
undamaged alveolus and well preserved soft tissues can be successfully treated
with post extraction procedures like immediate implant placement or fixed partial
denture.
6.2 REVIEW OF LITERATURE:

This article reviews and highlights exodontia tips as well as new techniques to
make simple and complex exodontia more predictable and with improved patient
outcomes. This article have a brief discussion on physics forceps, a new type of
exodontia forceps, which uses class 1 lever mechanics to extract teeth without
having to use excessive force or squeezing motion, on basic and complex
exodontia.1

This article deals with technological advances in extraction techniques. The
physics forceps used first-class lever mechanics to atraumatically extract a tooth
from its socket. One handle of the devices is connected to a bumper, which act as
fulcrum during the extraction. This bumper is usually placed on the facial aspect
of the dental alveolus, typically at mucogingival junction. The beak of the
extractor is positioned most often on the lingual or palatal root of the tooth and
into the gingival sulcus. Unlike conventional forceps, only one point of contact is
made on the tooth being extracted. A squeezing motion should not be used with
these forceps. By contrast, the handles are actually rotated as one unit using a
steady yet gentle rotational force with wrist movement only. Once a tooth is
loosened, it may be removed with traditional instruments such as conventional
forceps or rongeur.2

In this article the author has evaluated a new extraction method for intentional
replantation. Many authors emphasize that safe extraction without crown or root
fracture is the primary prerequisite for successful intentional replantation.
However many teeth indicated for intentional replantation are weakened by
repetitive root canal treatments and root canal post. Moreover, molar tooth
require a significant amount of load during extraction due to broad root surface,
curved and divergent roots also make fracture-free safe extraction difficult.
Nonetheless, little is known about the practical extraction method for intentional
replantation, except that an elevator should not be used and the beak of the
conventional forceps should be placed on the crown above cemento-enamel
junction. Atraumatic safe extraction using newly developed physics forceps
along with preoperative orthodontic treatment has been introduced recently. The
aim of their study was to evaluate the reliability of atraumatic safe extraction for
intentional replantation.3

This article deals with assessment and classification of extraction defects. Tooth
extraction is a traumatic procedure resulting in immediate destruction and loss of
alveolar bone and surrounding soft tissue. The clinical presentation of alveolar
defects seen immediately following tooth removal varies from simple to
complex. This evaluation can only be accurately made immediately following
extraction, since damage often occurs during the process of tooth removal. A
classification of extraction the extraction defect, as it presents immediately
following
tooth
removal
associated
with
dental
implant
treatment
recommendations would be beneficial for the clinician in establishing the most
appropriate plan for treatment. This paper presents a novel extraction –defect
classification system which categorizes extraction defects and provide guidelines
for dental implant treatment.4

This article states about biomechanical rational for atraumatic tooth extraction.
Biomechanical aspects of force have been applied to tooth extraction for
centuries. However, the mechanical advantages available to extract the tooth
were primarily applied to hold the crown of the tooth, rather than extract it. An
extraction device physics forceps has been developed to apply a biomechanical
rational to the extraction process of a tooth using a class 1 lever, creep and shear
component of force. The physics forceps is really a dental extractor than a
forceps and uses first-class lever mechanics. Creep is a phenomenon whereby a
material continues to change shape over time under a constant load. In tooth
extraction, creep may occur in bone and periodontal ligament. Under a constant
load of 60 Mega pascals, the bone over time changes shape in three different
stages. This action contributes to the creep rupture of the ligament and usually
elevates the tooth few millimeters from socket. At this point the tooth is loose
and ready to be removed from the socket using conventional extraction forceps.
When a rotating force is applied to the physics forceps on the tooth, the stress to
the tooth and periodontal complex is a shear component of force. The force
applied to the gum and bone by the bumper is over a greater surface area and is a
compressive force, thus bracing the buccal bone. This permits the lingual plate to
expand more and protects the facial plate from fracture.5
6.3 AIMS & OBJECTIVES OF THE STUDY:
•The purpose of this study is to evaluate the effectiveness of physics forceps over
conventional forceps in atraumatic dental extraction.
•The purpose of this study is to compare the advantages and disadvantages of
physics forceps over conventional forceps.
The ‘PHYSICS FORCEPS’ are an innovative design that provides the simple
mechanical advantage by employing first class lever mechanics .
7.
MATERIAL AND METHODS:
7.1 SOURCE OF DATA:

200 patients referred for extraction reporting to department of Oral and
Maxillofacial Surgery, college of dental sciences, davangere will be selected
for the study with their informed consent.
7.2 METHODOLOGY:
i.
Two hundred patients will be categorised in two groups :
GROUP I: extraction in 100 patients using the conventional extraction technique
will be considered as control group for the study.
GROUP II: extraction in 100 patients using the PHYSICS FORCEPS.
ii.
In group 1 patients, extraction will be done using the conventional extraction
technique.
In group II patients, extraction will be done using the new extraction technique,
the physics forceps.
iii. Both the extraction defects in these groups will be assessed with the use of an
extraction defect sounding classification system.
The extraction defect sounding classification system describes the condition of the
hard as well as soft tissues immediately following tooth removal, prior to healing and
remodeling of the extraction socket. This classification only applies after the treatment
decision has been made to remove a tooth and an objective evaluation of the extraction
defect is made.
The time required during extraction of tooth with physics forceps and conventional
extraction technique will also be compared.
7.3 CRITERIA FOR THE SELECTION :
 INCLUSION CRITERIA

Firm tooth which are indicated for extraction.

Patients who requires immediate implant placement.

Grossly decayed tooth.

Tooth that requires intentional replantation.

Tooth that are indicated for open extraction.
 EXCLUSION CRITERIA
 Patients having systemic illness.
 Patients who have periodontally compromised tooth.
7.4 METHOD OF STATISTICAL ANALYSIS:

The data will be collected and statistically analyzed.
7.5
DOES
THE
STUDY
REQUIRE
ANY
INVESTIGATIONS
OR
INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS
OR ANIMALS? IF SO PLEASE DESCIBE BRIEFLY.
Yes, Intra oral periapical radiograph of concerned tooth need to be taken.
7.6
HAS
ETHICAL
INSTITUTION :
Yes
CLEARANCE
BEEN
OBTAINED
FROM
YOUR
8.
LIST OF REFERENCES:
1) Harry Dym, Adam Weiss. Exodontia: Tips and techniques for better outcomes.
Dental Clinics of North America. 2012; 56:245-266.
2) Adam Weiss, Avishai Stern. Technological Advances in Extraction Techniques and
Outpatient Oral Surgery. Dental Clinics of North America. 2011; 55:501-513.
3) Choi YH, Bae JH. Clinical evaluation of a new extraction method for intentional
replantation. Journal of Korean Academy of Conservative Dentistry. 2011; 36(3):211217.
4) Nicholas Caplanis, Jaime L Lozada, Joseph YK Kan. Extraction Defect:
Assessment, Classification and Management. International Journal of Clinical Implant
Dentistry, 2009; 1(1):1-11.
5) Carl E Misch, Helena M Perez. Atraumatic extractions: A Biomechanical Rationale.
Dentistry today, 2008; 27(8):100-1.
9.
SIGNATURE OF THE
CANDIDATE
10.
REMARKS OF THE GUIDE
11.
NAME AND DESIGNATION OF
11.1 GUIDE
DR. MANJUNATH S. M.D.S.
PROFESSOR ,
DEPARTMENT OF ORAL
ANDMAXILLOFACIAL SURGERY,
COLLEGE OF DENTAL SCIENCES,
DAVANGERE-577004
11.2 SIGNATURE
11.3 CO-GUIDE ( IF ANY)
11.4 SIGNATURE
11.5 HEAD OF THE
DEPARTMENT
11.6 SIGNATURE
12.
12.1 REMARKS OF THE
CHAIRMAN AND
PRINCIPAL
12.2 SIGNATURE
DR. K.S.N. SIVA BHARANI M.D.S.
PROFESSOR AND HOD,
DEPARTMENT OF ORAL AND
MAXILLOFACIAL SURGERY,
COLLEGE OF DENTAL SCIENCES,
DAVANGERE-577004