A Less Stressful, Simplified Approach to Extraction
Extractions can be stressful for both patients and practitioners, especially when the presence of coronal breakdown is making a tooth difficult to grasp with traditional forceps. Furthermore, traditional forceps require the use of significant force to extract a tooth, which can potentially result in fracture of the surrounding socket walls.
To improve the process of extraction and reduce the accompanying risk of fracture, Directa Dental developed the Physics® Forceps-a set of four standard extraction instruments (Standard Series) and two supplemental extraction instruments for hard-to-reach second molars (Molar Series) that feature a beak on one of the terminal ends and a wide round tip (ie, bumper) on the other terminal end. During extraction, a soft bumper guard (green for the standard set and yellow for the molar set) cushions the soft tissue on the buccal aspect of the ridge. The standard series instruments consist of one for use in the maxillary anterior region (GMX 100UA), one for the maxillary right posterior region (GMX 100UR), one for the maxillary left posterior region (GMX 100UL), and a universal mandibular forceps (GMX 200LU).
Physics Forceps are designed to use fulcrum mechanics, taking advantage of the denser palatal/lingual bone rather than the buccal/facial bone, decreasing the force needed to extract a tooth. The beak of the forceps is positioned on the lingual aspect as apically as possible, and the bumper guard is positioned on the buccal soft tissue, creating a first-class lever. A rotational motion toward the buccal aspect is then used to expand the socket around the tooth atraumatically, displacing the tooth buccally while preserving the buccal bone. Via the fulcrum created, the rotational motion magnifies the force placed on the tooth while decreasing the force needed by the practitioner.
In practice, following the application of local anesthetic, the periodontal ligament is first detached circumferentially with a periotome. The appropriate Physics Forceps instrument is then positioned on the tooth to be extracted with the beak located on the lingual aspect as apically as possible while remaining supracrestal on the root. After the bumper guard is positioned on the buccal aspect of the ridge on the soft tissue, gentle pressure is exerted to close the forceps without squeezing the tooth. Next, the instrument is rotated a few millimeters buccally using the positioned bumper guard as the fulcrum point and held in this position for approximately 10 to 20 seconds. This motion is repeated under a constant, steady pressure in a buccal-only direction approximately two more times until the tooth moves 1 mm to 3 mm, expanding the socket surrounding the tooth. Once the tooth exhibits 1 mm to 3 mm of mobility, it should be delivered from the socket site with a conventional instrument (eg, 150, 151, hemostat). Remember, the Physics Forceps instruments are actually "lingual elevators" and not forceps in the traditional sense.
1. Design: an atraumatic extraction system with instruments to accommodate all regions of the mouth
2. Less patient trauma: by placing a constant, steady load on the tooth, it expands the socket around the tooth, decreasing the potential to fracture the crestal bone
3. Placement: the unique technique simplifies the extraction process while improving patient experience
4. Clinician comfort: Results in less hand fatigue for clinicians when compared with traditional instruments
Gregori M. Kurtzman, DDS
Academy of General Dentistry
International Congress of Oral Implantologists
Silver Spring, Maryland