Demystifying Dental Microscopes

Demystifying Dental Microscopes

Yes, they do belong in a general/esthetic practice.

Twenty-six years ago I graduated from dental school into a very different field than we see today. I had spent two years in the school’s clinics practicing without a mask, without gloves and without any sort of magnification. Only clinicians close to retirement used magnification.

A few years went by in private practice before I was convinced to try 2.5x loupes. Suddenly my dentistry didn’t look as good as before. Seeing was believing. I was happy with the higher level of care I felt I was delivering to my patients.

It was not until I was exposed to a surgical scope at an endodontics course given by Dr. Steve Buchanon that I realized my loupes were inadequate. I returned to my office, had a scope dropped off for two weeks and never saw dentistry the same.

Frequently I am asked by fellow clinicians, “If you moved your office, what piece of equipment would you take with you ?”. Without hesitation, it is my scope. Others are amazed at this. This has lead to a common group of myths I will address.

Myth 1

My loupes provide adequate magnification.

Working with 2.5X loupes provides the equivalent of 20/10 vision, a definite improvement; but a microscope than can go to 10X creates a resolution of 10x10. If you think of this as pixels, you are creating 100 times more information for you eyes to see. And by the way, there is a fiber-optic light source illuminating your working field only eight to 10 inches away. In addition, there is nothing heavy hanging on your head.

Myth 2

Microscopes are only used by endodontists to look inside teeth.

In addition to endodontics, where a microscope is considered the standard of care, periodontists, oral surgeons and G.P.’s who want to perform minimally invasive dentistry, or who want to take their quality to a higher level have instituted microscopes into their daily practice.

Myth 3

Using a microscope will slow my procedure time.

It is true that at the start you will be slower as there is a learning curve. With proper education on the proper positioning of the scope, following a prep sequence protocol, and using some ancillary mirrors along with rubber dam the learning curve is fast.
Taking a little more time at the preparation appointment will cut the time of your cementation appointment.

Myth 4

Microscopes are expensive, I can’t justify their cost.

If this is how you feel I have a few questions for you.

  • Have you found open margins after your explorer told you they were closed?
  • Which do you trust more, your vision or your touch?
  • Have you ever missed a fracture in a tooth?
  • Do you feel comfortable finishing the gingival margin on a Class V resin restoration?
  • Can you easily discern the marginal interface on you resin restorations so you are not polishing away enamel?
  • Do you use fissurotomy burs to open stained groove structures, only to find decalcification or decay?

Myth 5

Microscopes are difficult to use and take too long to learn to use properly.

AMED, the Academy of Microscope Enhanced Dentistry is a great forum to meet other practitioners from around the world practicing dentistry under a microscope. Their annual meeting is educational as well as practical. IDEA USA and other groups also offer excellent training classes on the use of microscopes

Myth 6

Does a microscope really help with ergonomics?

Use of the scope along with a dental operating stool with arm supports will create better posture, reduce shoulder fatigue and create a much steadier hand. The optics of a scope are also different than that of loupes, resulting in little to no eye strain. You are also further removed form the operating aerosols of your handpieces.

Myth 7

My dentistry is already fantastic!

That’s great, but you can now do fantastic-plus dentistry. Having better visual acuity will allow your motor skills to become more refined. Once you have developed these muscle engrams your work will be at a higher level even under reduced magnification.

Myth 8

A microscope is useful only for prepping teeth.

The microscope has endless uses. Here are just a few:

  • Patient’s initial exam;
  • Diagnosing fractures;
  • Checking for recurrent decay, open margins and loose crowns;
  • Visual confirmation of crown fit;
  • Refinement of preparations;
  • Sealing of Class 2 matrix bands at the gingival floor to prevent overfill;
  • Visual verification that your initial resin layer has actually reached the marginal interface;
  • Not violating the sulcus when packing cord;
  • When using an electrosurge or laser to only modify the intended tissue- with plenty of illumination so you can see; and
  • Verifying your impressions for marginal detail.

Myth 9

I’ll need to buy a lot of other equipment to work with a microscope.

You will need to buy some smaller burs, and smaller mirrors, but that’s about it.

Myth 10

I need one last reason to justify a microscope.

For me it is the self-satisfaction of knowing I am using the best technology available to provide the highest level of care to my patients.-

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