roots C.E. - the international magazine of endodontology

I C.E. article_ microscopes The dental operating microscope in endodontics Author_Frank C. Setzer, DMD, PhD, MS _The practice of endodontics requires precision and great attention to detail. These depend on the training, skills and experience of the clinician. Most endodontic procedures are carried out in dark and confined places, and fractions of millimeters may decide the outcome of treatment. Over the past decades, endodontics has gained not only basic and clinical scientific knowledge, but also has taken technological quantum leaps. Due to the intricate nature of endodontic treatment, practitioners have always sought to improve their vision of the opera- tional field. _Advantages of dental microscopes Better vision requires enhanced magnification and illumination, and both microscopes and loupes have been widely adopted. Operating microscopes have a number of advantages compared with loupes. Loupes are worn on the head and may be used with or without external light sources. This necessitates weight limitations and restricts the oculars to the bare minimum of lenses needed for magnification. By contrast, the microscope is a self-supported unit; therefore, additional lenses or prisms are not a con- cern. This has meaningful implications with regard to ergonomics and visualization. The attachment of loupes to glasses dictates a design that angles the binoculars inward in order for the viewer to focus on the object. As a result, the practitioner’s eyes also rotate medially. This is similar to near object accommodation by the naked eye, which can lead to eye muscle strain and fatigue. By contrast, micro- scope binoculars are arranged in a parallel orienta- tion. This arrange- ment is facilitated by prisms that let the incoming light beams reach the eyes also in a parallel direction. This simulates the observation of a distant object: a straight, forward-looking gaze that causes less muscle stress and fatigue. In addition, from an ergo- nomic perspective, working correctly with a dental microscope improves overall body posture and may reduce neck and back pain. Commercially available microscopes provide ad- justable magnification ranging from approximately 4x-25x magnification, while most loupes provide fixed magnification between 2.5x-6x. Magnification can be divided in low magnification (~2x-8x), mid magnification (~8x-16x), and high magnification (~16x-25x). Low, mid and high magnification are applicable for different procedural steps throughout nonsurgical and surgical endodontic treatment. Low magnification is mainly applicable for an overview of the operating field. Mid magnification is used for the main procedural steps throughout root canal therapy and endodontic surgery. High magnification is used for the identifi- cation of minute structures and documentation of the finest details. Using a microscope significantly increases a practitioner’s accuracy.1 However, it must be mentioned that there is a learning curve and work- ing at both mid and high magnification will require the practitioner to slow down movements to avoid unintended actions on the smallest of anatomical structures. As a result of working in a small-scale environment, new types of micro-instruments also were introduced to the dental profession. _History of microscopes in endodontics The idea of using microscopes in dentistry is not new. Bowles suggested and used a dental microscope as early as 1907!2 In endodontics, dental operating microscopes were first introduced by individual clinicians3,4 and then adopted by endodontic spe- cialty programs throughout the United States. The American Association of Endodontists was an early proponent of training in microscopes for endodontic residents and successfully advocated for the Com- _c.e. credit This article qualifies for C.E. credit. To take the C.E. quiz, log on to www.dtstudyclub.com. Click on ‘C.E. articles’ and search for this edition (Roots C.E. Magazine — 1/2018). If you are not registered with the site, you will be asked to do so before taking the quiz. You may also access the quiz by using the QR code below. Fig. 1_High- magnification inspection of caries below crown margin. Courtesy of Dr. Francesco Maggiore, Aschaffenburg, Germany. (Photos/Provided by American Association of Endodontists) Fig. 1 06 I roots 1_ 2018

roots C.E. - the international magazine of endodontology

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