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| Title |
Use of Physics Forceps May Result in Less Pain and Fewer Adverse Outcomes Than Conventional Forceps |
| Clinical Question |
In patients undergoing extractions, will the use of physics forceps, as opposed to conventional forceps, result in a more efficient method with less pain, tooth/bone fractures, and post-operative tissue loss? |
| Clinical Bottom Line |
In patients undergoing extractions, physics forceps seem to provide a safe and efficient method of treatment resulting in less pain, tooth/bone fractures, and post-operative tissue loss. Although more studies, especially with larger study sizes, should be completed for conclusive evidence, the evidence to this point seems to indicate several advantages to using physics forceps. |
| Best Evidence |
(you may view more info by clicking on the PubMed ID link) |
| PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
| #1) 26604469 | El-Kenawy/2015 | 200 adults requiring simple extractions (normal root morphology, no uncontrolled systemic disease, no wisdom teeth) | Randomized Controlled Trial | | Key results | The group using physics forceps resulted in 4% crown fractures, 8.5% root fractures, and 3% bone plate fractures. The group using conventional forceps resulted in 10% crown fractures, 16.6% root fractures, and 7% bone plate fractures. The difference in crown and root fractures was statistically significant (P = 0.04 and 0.027, respectively), while the there was no significant difference between the groups in bone plate fractures (P= 0.19). | | #2) 25015020 | Hariharan/2014 | 27 people (age 11-23 years) requiring extraction of upper premolars for orthodontic treatment | Randomized Controlled Trial | | Key results | The variables studied were operative fractures in the root or alveolar bone, inflammatory complications post-operatively, duration of the procedure, and VAS score at three separate intervals post-operatively. Although physics forceps scored equal to or comparatively better than the universal forceps in all these categories, the only statistically significant value came with the 10-point VAS pain score on the first post-operative day (0.6 with physics forceps and 1.04 with the universal) (P = 0.03). | | #3) 27630951 | Patel/2016 | 11 patients (age 14-23 years) requiring bilateral extractions of upper and lower premolars for orthodontics | Prospective Cohort Study | | Key results | The variables studied were extraction time, root and buccal cortical plate fractures, gingival and marginal bone loss, and pain score. Although the VAS pain scores were lower for the physics forceps, it was not clinically significant. Also, physics forceps yielded two root fractures, and the universals resulted in two alveolar bone fractures. However, all other categories were statistically significant, with physics forceps showing better results. In physics forceps compared to the universal forceps, respectively, extraction time was 58.8 seconds vs. 88.3 seconds (p= 0.019), mean gingival level loss was 0.57 mm vs. 1.01 mm (p=0.035), and mean difference in bone level was 1.26 mm vs. 1.87 mm (p=0.037). | |
| Evidence Search |
"physics forceps"[All Fields] |
Comments on
The Evidence |
Validity: The study by El-Kenawy involved a randomized control trial between two similar groups of people. There was no significant difference between the groups on the basis of age, the patients were randomly assigned, and all patients were similar at the start with equal inclusion and exclusion criteria for the total patient population. Although we do not know if the evaluators were blinded, there is no reason to believe there was any bias due to no conflicts of interest.
The study by Hariharan involved a split-mouth comparison of upper premolars with physics forceps being compared to universal forceps. The two different procedures were performed similarly by a common surgeon with common anesthesia and a blinded evaluator. Follow-up for post-operative values was taken after 1, 3, and 7 days. There were no competing interests or reason to assume bias in this study.
The study by Patel involved a split-mouth randomized control trial. The two forceps procedures were performed similarly in terms of pre-surgical preparation, local anesthesia, construction of template and measurement based on it, post-extraction examination, post-operative instructions and medications prescribed, and proper follow-up. There were no financial or other competing interests that would suggest bias.
Perspective: All three articles showed some advantages of physics forceps over the commonly used conventional forceps. These advantages included: less gingival and bone loss; less post-operative pain experienced by the patient; lower rates of crown, root and buccal plate fractures; and faster extraction times. These factors benefit the surgeon in regard to efficiency or the patient in regard to in pain and trauma, and thus allow for an increased likelihood in healing and successful future treatment. All three studies, however, had relatively small patient pools, and the effect of this can be seen, for example, by Harihan observing a clinically significant pain difference, while Patel not noting a significant difference. Although all the studies showed promising results for physics forceps, more studies with larger sample sizes will be needed to show conclusive benefits from using physics forceps.
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| Applicability |
The patients assessed in these studies were either younger patients requiring extractions for orthodontics treatment, or older patients with various reasons for extractions. As a general dentist or oral surgeon, a patient will commonly present with teeth that need to be extracted, and a choice will have to be made of which instruments to use to allow an efficient, safe, and beneficial treatment, which the patient in turn expects to receive. |
| Specialty/Discipline |
(General Dentistry) (Oral Surgery) |
| Keywords |
Physics forceps, extraction techniques, forceps
|
| ID# |
3190 |
| Date of submission: |
04/05/2017 |
| E-mail |
grady@livemail.uthscsa.edu |
| Author |
Patrick Grady |
| Co-author(s) |
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| Co-author(s) e-mail |
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| Faculty mentor/Co-author |
Daniel Perez, DDS |
| Faculty mentor/Co-author e-mail |
perezd5@uthscsa.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
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