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Chapter 472DiscussionIn this study, a measurement setup is proposed that is the result of a strong collaboration between clinicians, mechanical and software engineers. It is capable of, for the first time, capturing the combination of high forces and subtle movements exerted during tooth removal procedures in high detail by using, amongst others, robot technology. First outcomes of experiments are used as a proof of the concept and show promising results. The dataset, which can be built with this setup, offers a unique insight in one of the oldest and most performed surgical procedures worldwide.It is remarkable how underdeveloped the scientific under- standing of tooth removal is. Only a few attempts have been undertaken in which moments were measured in an in vivo setting, in contrast to this study where an in vitro setup is proposed [1-5, 12]. The studies that have been performed thus far used either a strain gauge or manometer attached to, or integrated in, a dental forceps. They were therefor limited to measuring forces and moments, not the movements of the clinician. The outcomes are very limited and heterogeneous, which shows the difficulty of analyzing tooth removal in vivo conditions. For example, Cicciu et al. [1] found a 25 fold increase in forces used in upper premolar removal compared to lower premolar removal whilst Lehtinen [2] and Ojala [5] found the forces between upper and lower canines to be indifferent. This shows that a benchmark to compare our results to is unfortunately not available.The lack of technical possibilities to measure subtle (sub- millimeter) movements and high forces in all directions in an in vivo condition is the main reasons why an in vitro setup was chosen to study tooth removal. Its design for in vitro measurements is also one of the major drawbacks of this setup. It will be unsure how data can be translated into in vivo circumstances. This is even more true, since there is very limited in vivo data available to correlate the outcomes to. Next to that, the setup is limited to the use of dental forceps. The elevator is also frequently used in tooth removal procedures, but its usage is much more diverse (different positions relative to the tooth for example) and we would need to measure the movement of the teeth themselves, which made it unsuitable for a first proof of concept. Finally, the setup does not provide the possibility to measure clamping forces between the tooth and dental forceps. This would require mechanical changes to the dental forceps itself and might interfere with the normal usage of a dental forceps by the clinician. Despite its disadvantages, the authors Tom van Riet.indd 72 26-10-2023 11:59