Page 89 - Demo

5Using robot technology to analyze forces and torques in tooth removal 87process influenced the biomechanical properties of tooth removal. In addition, the availability of only Caucasian cadavers for this study should be taken into account. There are some disadvantages to our measurement setup. Despite efforts in setting the correct stiffness and damper of each of the robots axis, it must be noted that minor resistance of the robot can be felt during the experiments. Especially when reaching a ‘joint limit’ the robot will actively move other joints to facilitate freedom of movement, which inevitably leads to some resistance. Another disadvantage of this setup is the limitation of using only a dental forceps, whilst elevators are important and frequently used tools. The constantly changing position of the elevators relative to the tooth make it a less appropriate tool to start building a reliable dataset. Since elevators are frequently used, it would be interesting to evaluate forces and movements exerted with these instruments in the near future. In opposite of previously mentioned studies, we did not measure clamping forces [17]. Lastly, since counteracting forces had to be prevented, the surgeon was allowed to only use one hand during the experiments, which make it slightly unnatural but, moreover, the second hand might give useful feedback in clinical practice. Regardless of these disadvantages, we believe that, with existing techniques, it would be very challenging to gather the same quality dataset in an in vivo setup. To the authors’ best knowledge this is the first time that forces and torques exerted during tooth removal have been measured, let alone in high detail and in all its dimensions. Using fresh-frozen cadavers, an extensive measurement setup, experienced surgeons and including all teeth from both lower and upper jaws, we are convinced to have gained important insights. The data show a reliable order of magnitude when considering forces and torques in tooth removal and can be used as benchmark for comparison with future projects. Data gained from plastic educational models and different kinds of conserved cadaver material can be compared to see what we can learn from their differences. Furthermore, the current database can be extended to see what influence certain clinical parameters have on extraction forces. Eventually, our goal is to improve our understanding of these complex procedures to the extent that evidence-based educational tools can be created to acquire preclinical skills, for example, through force-based learning [19-21].Tom van Riet.indd 87 26-10-2023 11:59