Dr. Manuele Mancini
DDS, PhD
• Graduated with honours in Dentistry and Dental Prosthetics from the University of Rome Tor Vergata
• PhD and Tutor of the Chair of Dental Materials at the same University
• Active Member of the Italian Society of Endodontics (SIE), the Italian Society of Conservative Dentistry (SIDOC) and the Italian Academy of Microscopic Dentistry (AIOM)
• Official trainer in endodontics and conservative dentistry for the Dentsply-Sirona group
• Author of more than 50 scientific, clinical and research titles published in national and international journals
• Peer Reviewer of international scientific journals Speaker at national and international congresses
introduction
introduction
Technological advances and increasing patient demand for prevention make the topic one of the most debated and analyzed in the literature.
Magnifications, from simple Galilean loupes to the best-performing operating microscope, can represent a valid primary (recognising a crack as a predictive sign of a possible fracture), secondary (treating a tooth earlier and with a minimally invasive approach), and tertiary (increasing the quality of therapies, thus reducing the risk of recurrence) prevention tool. The use of an operating microscope was first proposed in endodontics probably because it was practically impossible to see in the notoriously small and poorly lit root canals, and everything was traditionally done by tactile control, which was often misleading for the operator. Furthermore, the endodontist generally works on a single tooth, with a single axis of view, and only occasionally needs to move the patient or the microscope, greatly simplifying microscope use. Therefore, this magnification tool was relatively easily adopted in practices specialising in endodontic treatments.
Many research articles have shown the benefits of using a microscope during endodontic treatments, particularly when discovering and locating canals previously considered supernumerary (MB2), and it is now considered the norm [1–3] (Figs. 1 and 2).
the case
the case
Dental structures dentists work on, both teeth and periodontium, are extremely small, and the causal agents of the leading oral pathologies (caries and periodontal disease) are bacteria, only a few micrometres in size (thus invisible under any operating microscope). Considering the number of restorations a dentist will perform throughout their career, any improvement can be considered clinically meaningful. Consequently, if the diagnosis is made early and the operator uses the correct dental techniques, they can maintain a more conservative approach.
As our society is increasingly ‘social’, the documentation of diagnosis, dental treatment and procedures, performed directly in the optics of the operating microscope without the need to interrupt or leave the operating field, is important, both to explain to patients the necessary treatment, and to colleagues attending courses and master’s programmes.
Indeed, using a beamsplitter in the optics of a microscope allows for the attachment of digital and video cameras that can capture images during the procedures (Figs. 3 and 4).
Correctly diagnosing a root crack or fracture can dramatically influence the treatment choice [4]. In this case, vision is the primary tool used to evaluate the presence and extent of these defects, which, if underestimated, can lead to tooth loss. Therefore, it is reasonable to state that better vision would allow for more accurate diagnosis and improved control of sensitive procedures. Clinical examination and symptomatology have long been the accepted diagnostic practice for cracked teeth. The limitations inherent in the lack of visual confirmation can often lead to delayed treatments of these types of affected teeth (Figs. 5 and 6).
Locating caries on occlusal surfaces can be difficult due to the high prevalence of hidden caries in this position [5, 6, 8]. Unaided visual examination has been used extensively in dental offices to detect carious lesions on the occlusal surfaces of posterior teeth. Many studies have shown that this method has high specificity, especially for detecting dentinal lesions. In contrast, unaided visual examination is not quantitative and has low sensitivity and reproducibility [7, 9]. A promising non-invasive method of detecting caries involves using magnifying visual aids.
“As our society is increasingly ‘social’, the documentation of diagnosis, dental treatment and procedures, performed directly in the optics of the operating microscope without the need to interrupt or leave the operating field, is important.”
One such is the operating microscope, which offers various magnifications at high and low power. Surgical microscopes offer homogeneous illumination without shadows and a three-dimensional view, which enables clear and wide visualisation of the examination site [10]. Working with a microscope allows for more conservative cavity preparation, more precise placement of restorative materials, better finishing of restorations, and more accurate diagnosis of carious lesions and old, incongruous restorations that need to be replaced (Figs. 7 and 8).
conclusion
conclusion
Improving vision through the use of magnification tools indeed seems to improve both the diagnostics and execution of a procedure. Furthermore, in addition to improving vision, working under magnification increases the operator’s neuro-muscular control [11,12].
The rationale for needing magnification in dentistry now seems well understood by dentists. Magnification can improve ergonomics and diagnostics as well as provide the operator with an improved view, allowing them to use smaller instruments and much less invasive procedures, which translates into less morbidity and greater patient comfort.
Magnification even makes it possible to consider some treatment options that would otherwise be impossible. While loupes remain the most frequently used magnifying tool by dentists, the many benefits of the much more powerful and versatile microscope are well worth the time and energy needed to master the new technique involved.
“Magnification can improve ergonomics and diagnostics as well as provide the operator with an improved view, allowing them to use smaller instruments and much less invasive procedures.”
SOURCES
(1) Buhrley L J, Barrows M J, BeGole E A, Wenckus C S. Effect of magnification on locating the MB2 canal in maxillary molars. J Endod 2002; 28: 324–327.
(2) Hartwell G, Appelstein C M, Lyons W W, Guzek M E. The incidence of four canals in maxil-lary first molars: a clinical determination. J Am Dent Assoc 2007; 138: 1344–1346.
(3) Yoshioka T, Kikuchi I, Fukumoto Y, Kobayashi C, Suda H. Detection of the second mesi-obuccal canal in mesiobuccal roots of maxillary molar teeth ex vivo. Int Endod J 2005; 38: 124–128.
(4) Bader J D, Shugars D A, Martin J A. Risk indicators for posterior tooth fracture. J Am Dent Assoc 2004; 135: 883–892.
(5) Anttonen V, Seppä L, Hausen H. Clinical study of the use of the laser fluorescence device DIAGNOdent for detection of occlusal caries in children. Caries Res. 2003;37(1):17-23.
(6) Shi XQ, Welander U, Angmar-Månsson B. Occlusal caries detection with KaVo DIAGNOdent and radiography: an in vitro comparison. Caries Res. 2000;34(2):151-8.
(7) Lussi A, Francescut P. Performance of conventional and new methods for the detection of occlusal caries in deciduous teeth. Caries Res. 2003; 37(1):2-7.
(8) Tonioli MB, Bouschlicher MR, Hillis SL. Laser fluorescence detection of occlusal caries. Am J Dent. 2002;15(4):268-73.
(9) Pereira AC, Verdonschot EH, Huysmans MC. Caries detection methods: can they aid deci-sion making for invasive sealant treatment? Caries Res. 2001;35(2):83-9.
(10) Gester V. [The microscopy in dental medicine: gadget or necessity?] Rev Belge Med Dent. 2004;59(1):62-6. [Article in French]
(11) 51 Leknius C, Geissberger M. The effect of magnification on the performance of fixed prosthodontic procedures. J Calif Dent Assoc 1995; 23: 66–70.
(12) Strassler H E. Magnification systems improve quality and posture. J Esthet Dent 1990; 2: 183–184.