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Chapter 112In 1934, George Christiansen introduced developments in the field of tooth removal in his paper on ‘Problems in Oral Surgery’ as follows: ‘The extraction of teeth, in spite of greatly improved technic and a multitude of new and strange instruments, remains and extremely difficult, delicate and important operation’. He reduce tooth removal procedures to a problem, which is ‘to remove a calcified substance, the root, from a bony socket lined by fibrous membrane’ [3]. In his paper, he described different techniques to perform standard tooth removal, mostly based on anatomic variability between the teeth. In a recent review, it was shown that the first study that tried to objectify forces exerted in tooth removal was published in 1973 [4,5]. Since then, only a few attempts were undertake to measure a variety of metrics during these procedures ranging from gripping force, forces exerted along different axes, muscle contraction of the surgeon and rotational forces (torques). A high degree of heterogeneity was found with regard to outcome measures and methodology was often described with insufficient detail. Most studies registered force data in a limited manner by measuring forces in only one or two directions, which seems to underestimate the complexity of these procedures. The study concluded that a large knowledge gap exists in our fundamental understanding of tooth extractions [5].Despite the successes of preventive dentistry and a concurrent decline in prevalence and incidence of tooth loss around the world, tooth removal procedures are still very common and should be considered as an essential skill for dentists [6,7]. The high frequency, in which these procedures are performed, makes the lack of scientific progress in this field remarkable [5]. The same forceps that were proposed 200 years ago are still used in everyday practice. Modern textbooks for dental students are still limited to ‘rotation’ or ‘rocking’ instructions, similar to textbooks written 2000 years ago [8]. In 2011, a questionnaire was distributed among students from 23 dental schools across Europe showing that up to 60% of students felt that their knowledge about forceps and elevators was insufficient. Moreover, preclinical training modalities were shown to be heterogeneous and not widely used, meaning that most students have to ‘practice’ their skill in a clinical setting. If preclinical training modalities were used, not all students considered them as useful. In Amsterdam, the mean score students gave for their satisfaction with extraction education was 2.5 ±1.0 on a 5-point Liker scale ranging from 1 (absolutely not) to 5 (absolutely) [9]. Tom van Riet.indd 12 26-10-2023 11:59