What is Microscope Enhanced Dentistry? |
Teeth are normally small structures like the eyes, ear & nose. ENT surgeons, ophthalmic surgeons & neurosurgeons nowadays routinely use an operating microscope or magnifying loupes/spectacles to do surgeries of greater precision and accuracy. Cataract surgery is nowadays routinely done with a microscope nowadays. It is a stunning treat to watch teeth which are only 1 sq.cm in size magnified to fill a TV screen 14 or 21 inches cross!! And the joy of seeing a smile is all the more gorgeous to watch on a large TV screen. A big smile is made much bigger by the magnification provided by the microscope. And the highly improved quality of the fillings, RCT’s, crown and bridge preparations and various other procedures which can be done with the microscope make the patient smile even more! The patient’s confidence in his dentist is hugely increased as he can see the problems in his teeth very clearly under brilliant light and magnification. They co-operate better during the treatment as they are able to see on a TV screen the whole procedure being undertaken on their teeth, and it also ensures better compliance with advice given. The dentist who uses the microscope is much more comfortable and avoids un-due strain on his neck and back. The up-right posture can be maintained during almost all procedures, which is otherwise impossible. Occupational stress and strain on these 2 areas are very high and there are some incidences in the USA where some senior and experienced dentists have only been able to continue working after starting to use the microscope, thus enabling more patients to continue to benefit from their huge experience. The microscope can be used to magnify almost all the procedures which are done routinely by dentists. Since the eyes are not seeing the work area directly as before, a lot of training has to be under-taken to master the use of this new device effectively The use of the same operating microscope in the field of dentistry has just started recently in Western Europe and parts of America. The American Dental Association has made it mandatory and compulsory for higher post-graduate training in endo-dontics or the root canal treatment speciality to be trained in the use of the operating microscope. It is estimated that 75% of the endodontists in the USA now own or use a microscope at least part of the time. A select few dental colleges have started to introduce microscopes at under-graduate level. But many general dentists and other dental sub-specialists like periodontists, oral surgeons and prosthodontists have also pioneered and mastered the use of the microscope in their practices. This is a revolution in the dental world – the amount of improvement of care in dentistry done under magnification with the use of the microscope is very very high. Since microscopes have been used for endodontic RCT’s , extra canals called MB2’s and other minute accessory canals have been found and treated effectively which were not possible before. Thus, the chances of failure of RCT becomes much smaller. Doing complicated procedures like failed RCT and removal of broken files deep inside the roots of teeth are challenges which demand the use of a microscope. Teeth will failed RCT’s can be re-treated with a second RCT and successfully saved, when done very carefully, and the chances of success are much higher when done under the microscope. Some teeth have decay which almost require a RCT if done with the naked eye. But with a microscope and a special caries detector dye, only the decay can be removed and a RCT avoided. No normal tissue is removed because it is possible to see the difference much better and clearer under magnification. Scaling or cleaning of the teeth done under the microscope affords better removal of tartar and stains and cleaner teeth at the end. Periodontal flap surgery when done under the microscope, is able to remove much more damaged tissue, with much less damage to nearby healthy tissue, and hence give a better result. Suturing of wounds done under the microscope is much finer and delicate, hence better scars, faster healing, less post-operative pain & discomfort is possible. Preparation of teeth to fit a metal or ceramic artificial crown is a routine procedure done in every dental clinic routinely. If a microscope is used for this while preparing the tooth, the margins of the teeth are much more neater and precise, thus allowing a much better fit of the artificial crown, better esthetics and longer life with less problems like leakage and failure. The crown can also be checked before fitting on to the tooth under the microscope to check for defects in shape, size and irregularities as well. Less tooth structure is removed as well if possible, because we can see more clearly. The fitting of crowns and bridges is made very precise and hence the longevity of these is hugely increased. Modern surgical practice in most areas of surgery are aimed to deliver a smaller incision, smaller scar, reduced pain, faster mobilization and a much better quality of outcome. To achieve this, advances like laparoscopy in general surgery, arthroscopy in orthopaedic surgery, endoscopy in urology have all played their part. Similarly, the use of the microscope in neurosurgery, ophthalmic surgery, plastic surgery etc is also helping in giving such benefits to the patient nowadays. The operating microscope is used in so many areas of surgery and medicine nowadays, it has almost become mandatory. The twin benefits of fantastic shadowless illumination and higher magnification make it un-beatable. At a meeting held recently in Coimbatore on Microscope Enhanced Dentistry, a well known plastic and microsurgical reconstructive hand surgeon remarked, “You can only treat what you can see well. You have to use the microscope to know how good and useful it is.”
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