Endodontics is based on blindfolded cleaning and shaping of the root canal. Endodontists have the believe that they can do everything without seeing because they say that they have nothing to see. Endodontists always considered the microscope as a tool not a new approach or another way of practice. Until recently that was the general idea about endodontic therapy. Within the past 25 years, a huge advancement was made in the field of endodontics specially related to microscopes and laser aiding in achieving the best results. To give you a general idea to begin this re
port with, 1 micron contains a single bacterial cell and the average human eyes can see things more than 25 microns so 25 bacterial cells can’t be seen with naked eyes but can be seen using the microscope.
Many elements are accounted for enhancement of clinical visualization such as: Stereopsis, Magnification range, Field depth, Resolving power, Eyestrain and Working distance. One of solution of the limited clinical visualization is loups which help in the issues of proximity, field depth and eyestrain.
The dental microscope anatomy can be identified as the light source, the supporting structure and the body of microscope. The xenon light is way better as it provides a much more powerful and brighter light
The body components are the eyepiece, binoculars, magnification changer factors and the objective lens. The dental operating microscope was introduced by Apotheker in 1981 but it wasn’t a success and it was shortly cut from the market. It used to magnify up to 8x and had a stand in the floor and had a poor balance.
In 1991 another dental operating microscope was introduced to market and had better features such as better magnification range (3.5-30x) and a stand either from the wall or from the ceiling so it had a better balance.
The proper positioning of the microscope can be achieved by turning the light source on so the light circle is positioned on the working area, the clinician then moves the body of microscope approximately to the working distance and then moving the microscope up and down until the working area comes into focus.
Adjustment of interpupillary distance is done by taking the two halves of binocular head of microscope and moving them until the two circles are combined. The operating dental microscope can be helpful in many things such as diagnosis, locating the canal orifice and in retreatment cases. In diagnosis the microscope can help in recognizing the marginal integrity of the restoration, cracks and fractures.
It’s also helpful in repairing perforations, removal of fractured instruments, surgical endodontics and learning the curvatures of the canals. Laser is a device that amplifies the light by radiation emission. A photon is released from an atom and interacts with another photon released from a second atom. Pumping system is used to impart energy to the atoms of the laser medium to raise them into the exited state, this can be done by using electrical charges. Optical cavity provides the amplification required to select photons which are traveling in the desired direction.
Some of a advantages of laser that it works with a high working speed, processing without contacts and outstanding precision. Better results can be achieved by laser in cleaning the canal and removing smear layer and debris. Deferent types of laser are now used in dentistry such as: YAG, YSGG, Argon, Carbon dioxide, xenon fluoride and krypton fluoride.
The pulsed Nd:YAG laser is used in analgesia, to relieve tooth pain in endo, prepare the canal walls, removes smear layer, pulp remnants and debris at the apical foramen. Laser doppler can be used to check the pulp vitality. CO2 can be used in the treatment of vital tooth pulp amputation. Obturation of the root canal can also be done by vertical condensation using the laser. Periapical lesions can be removed using the laser and it fasten the healing of the wound. Apicectomy, retrograde cavity preparation. It stops haemorrhage so it will be bloodless and reduce or no post-surgical pain. It also reduce the number of bacteria present and doesn’t affect the sound tissues.
We can’t imagine the dental clinic without x-ray that helps us in most of the cases, the microscope and laser should have the same value in our minds because this modern technology can help us achieve the best result we can achieve.
Knowing that the microscope can give us a better visualization of the working field and the laser can provide more accurate and precise removal of bacteria and debris so a cleaner and more accurate shaping of the root canals will be the final outcome, our success rate will increase and the patients satisfaction will reach the roof.
This technology is a huge help in making the life easier for us and for the patients so we should utilize it as much as we can.
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