Appliance of science
Liam Ó Droma describes his voluntary work in Zambia and how he used the occasion to test out a new set of extraction forceps
Last August I had a fantastic opportunity to give a new range of uniquely designed extraction forceps a thorough testing during a working holiday to Zambia.
Physics Forceps were pioneered by world-renowned implantologist Carl Misch and his colleague Dr Richard Golden. The location of my maiden trial of these innovative instruments was the Neri Clinic in the Linda Community, a township of about 20,000 people 10 miles from Lusaka in Zambia. I had offered my services as part of my holiday to this amazingly beautiful country, replete with its magnificent national parks and of course Mosi O Tunya (Victoria Falls).
From previous experience, working in refugee camps near Capetown in 2008, I appreciated my main challenge would be extracting large numbers of long well rooted African teeth with little assistance from periodontal disease. Operating in a basic dental clinic, with no proper dental chair or operating light, meant that having to resort to elevators when a carious tooth fractured presented a daunting challenge – made even more onerous by the pressurised but grateful demand of the many patients seeking one’s clinical help.
Previous reports of the benefits to be gained when using the new Physics Forceps seemed to present a panacea to the anticipated challenge and also, of course, reduce the load of instruments I would have to transport on the plane. I therefore contacted the distributors of the forceps, General Medical, explained the challenge I faced and Managing Director John Lee most generously supplied a full set at cost price. This, I would emphasise, was a major contribution as these exclusive forceps, possibly due to patenting, are not cheap – one drawback!
At this point let me explain the rationale behind Physics Forceps, as explained by Misch himself. He compares tooth extraction to removing a bottle top; we can remove a top tediously and with difficulty by pulling it with pliers and risk fracturing the bottle or we can use the simple lever action of the lowly bottle opener to simply flip the cap off. There we have the basis behind the engineering of Physics Forceps – the ‘Beak and Bumper’ approach.
Basically we have a flat bladed lingual ‘beak’ that engages on the subgingival surface of the tooth (a little preparation with an elevator or fissure burr may be indicated to ensure a positive contact) and a buccal ‘bumper’ with silicone sheath to gently engage at the mucogingival junction, providing a pivot point and support to the buccal plate. Once the forceps are engaged, as described, a gentle wrist rotation of just a few degrees is made resulting in a mild lifting pressure as if removing a cap from a bottle.
Within a period of seconds there is a ‘pop’ and a visible movement as the tooth releases from its socket. A small rooted tooth may totally pop out at this stage, but to negate the very small risk of buccal wall fracture, particularly in the maxilla, it is better to put the Physics Forceps aside and complete the removal of the now dislocated tooth with a standard instrument.
Teeth can be removed with less effort and stress for the surgeon and less trauma for the patient. There was a short learning curve, during which I applied too much force and fractured one or two upper buccal plates. But, once I followed the advised protocol they were quite simply the most remarkable tools, making my clinical work in the very primitive conditions of the Neri Clinic highly effective, more efficient and therefore very rewarding, as I was able to cut a swathe through the huge demand of extremely grateful patients who queued quietly every morning for my ministrations.
During my second week I was fortunately joined (such was the demand) by Henry, a senior lecturer from Lusaka University Dental School, which runs a three-year programme to train dental therapists to help meet Zambia’s dental needs. These therapists are trained to tackle all aspects of general practitioner treatment including endodontics and orthodontics, but necessity dictates that simple extractions form the bulk of the treatment they provide in the outlying clinics.
As practice makes perfect, Henry was what could only be described as a ‘master extractor’ and what he couldn’t move with only the use of a straight Couplands isn’t worth talking about. However, he was astounded with the efficacy of the Physics Forceps and nearly ‘extracted’ them from me when my sojourn there was over. I consoled him with the promise that a set would soon be on the way to him.
We have all, from time to time, succumbed to marketing hype and purchased equipment that too often ends up in the cupboard not having lived up to the claims made for it. This includes my own all time great faux pas purchase of a laser handpiece sterilising unit, which appears now to be less effective than a few minutes under the sun – a wondrous waste of money! Incidentally, this cost about the same as the entire Physics Forceps range, which not only work exactly as claimed but even more besides.
Since qualifying from UC Cork in 1971 I have never taken out teeth so easily, atraumatically and cleanly as with these instruments. By clean, I mean the whole tooth is cleanly avulsed with no surrounding bone fracture including the palatal roots of upper molars, thus allowing one who like myself is into immediate implant insertion, to do so easily. In fact for those involved in implant dentistry I would deem these forceps to be the mandatory way to guarantee atraumatic extraction and a sound socket.
The other great plus, of course, is that your patient will be more than pleased with the ease with which the tooth was parted from him/her without any of the proverbial knee on the chest malarkey or hours fiddling around with the drawer of elevators of different shapes, angles and sizes – a great practice builder.
A word of experienced advice is appropriate here – it is important to ensure good positive lingual engagement sufficiently far enough down the tooth so as not to fracture a thin lingual wall. If subgingival exposure is required, a contact point can be quickly and easily achieved with a 557 tungsten carbide burr or flat diamond. I have found it helpful also, where there is inadequate tooth, to hold the lingual blade in position with finger pressure to stop it slipping while the dislocating lever pressure is applied.
It is also important to emphasise that the Physics Forceps extraction modality entails the application of steady gentle to moderate pressure for about 30 – 40 seconds, which builds up internal force or ‘creep’, allowing the bone to slowly expand and the periodontal ligament to release and the tooth to ‘pop’ occlusally 1-2mm from the socket. One can then easily pluck the dislocated tooth using orthodox forceps or sometimes just finger pressure.
Since my return from Zambia, I have hardly used any of the fifty or so conventional ‘pulling‘ forceps I have accumulated over the years, except for the odd few to pluck out the dislocated tooth effected by the Physics Forceps – a total change to my practice and no going back!
This was my second foray into Africa, combining the extraordinary rewards of giving of my clinical skills to a deprived and deserving community, while seeing some of the most beautiful sights this Earth has to offer. The good news from the Linda community is that my pioneering dental visit has initiated the setting up of a permanent dental clinic operating from the Neri Medical Centre itself, established as a result of an encounter between two young energetic newly qualified West of Ireland Doctors and a local Irish farmer keen to put something back into the country he now lives in. The Neri Clinic Project was launched in March 2009 and has as its patron the illustrious Dr Jack Kyle, a man who spent over 30 years as a doctor in Zambia.
If there are any colleagues out there who would like a bit of adventure, to visit a beautiful country and reaffirm their wonderful primary care skills and share them with a grateful community, then take yourself off to Linda in Zambia. I am more than happy to help and advise any would- be volunteers.
Liam can be contacted on firstname.lastname@example.org with any enquiries on either Physics Forceps or volunteering in Zambia.
The Physics Forceps set comes with a detailed handbook and an illustrative DVD. Further information is available at www.GoldenMisch.com
Physics Forceps are distributed in the UK and Ireland by General Medical. For further information telephone General Medical on 01380 734990, visit www.generalmedical.co.uk or email email@example.com