Are Physics Forceps Less Traumatic than Conventional Forceps for Tooth Extraction? A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Ashutosh Kumar Singh,Nisha Acharya,Takashi Saito,Md Riasat Hasan,Dinesh Rokaya,Nikita Khanal

doi:10.3390/dj10020021

Abstract

This systematic review and meta-analysis studied the clinical outcomes with physics forceps compared to those with conventional forceps for closed dental extraction. A systematic literature search was performed to identify all the published randomized clinical trials that compared the relevant clinical outcomes with physics forceps to those with conventional forceps for closed dental extraction. A total of 11 studies were included. The adverse events were significantly lower with physics forceps (n = 48) compared to with conventional forceps (n = 120), with an odds ratio of 0.42 [0.25, 0.70], Z = 3.78 (p = 0.0002), and I2 = 21%. There were statistically significant differences in the incidence of GL (p = 0.04), and tooth or root fracture (p = 0.0009). Operating time was significantly lower in physics forceps than that of conventional forceps, mean difference (−20.13 (−30.11, −10.15)), Z = 3.78 (p = 0.0001), I2 = 79%. The available evidence is limited by a high risk of bias and low evidence certainty. Based on the current evidence, physics forceps might be better than the conventional extraction forceps in terms of the extraction duration, pain after extraction, trauma to both hard and soft tissue, and complications. Physics forceps are newer instruments that have not yet been introduced in the teaching of dental graduates. The introduction of physics forceps can be time saving, less invasive and reduce post-extraction complications.

Highlights

Adverse events were statistically significantly lower with the physics forceps (n = 48) compared to with the conventional forceps (n = 120), with odds ratio 0.42 (0.25, 0.70), Z = 3.78 (p = 0.0002), and I2 = 21%
There was a significant reduction in adverse events (77 fewer per 1000) with the physics forceps compared to with the conventional forceps, which can be understood as 8 fewer adverse events per 100 extractions
The reduction in gingival loss (GL) and tooth/root fracture are statistically significant with the physics forceps, but the difference did not achieve statistical significance for BCPF

Summary

Introduction

Physics forceps are newer instruments that have not yet been introduced in the teaching of dental graduates. The introduction of physics forceps can be time saving, less invasive and reduce post-extraction complications. The lack of proper instrumentation and physics principles can result in a long duration of extraction and iatrogenic trauma to the patient, and fatigue and injury to the clinician [1,2,3]. Atraumatic extraction is always preferred, especially in the case of a planned immediate implant placement, predictable orthodontic tooth movement, or in patients with compromised bone quality and quantity [4]. Immediate implant placement requires fully intact osseous and soft tissue, which can be achieved by less-traumatic tooth extraction [5,6,7].

Results

Discussion

Conclusion