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dental operating microscope.ppt

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dental operating microscope.ppt

  1. 1. DENTAL OPERATING MICROSCOPE Dr.Kishore Kumar Majety
  2. 2. Introduction History of the Dental Operating Microscope The Magnification Continuum Loupes Operating Microscope Advantages of the Operating Microscope Anatomy of the Operating Microscope & How it works magnification illumination Accessories Documentation Choosing the right one Optimum configurations
  3. 3. Operating Positions Dental chair position Surgeon’s position Patients position Jaw manipulation and access for posterior teeth Assistants position Specific Operating Positions USES of Operating Microscope Diagnosis Restorative Dentistry Endodontics conventional endodontics surgical endodontics Use of magnification in Dental technology Microscopic photography Patient education and Documentation Practice enhancement
  4. 4. Conclusion References
  5. 5. • 350 yrs ago Robert Hooke looked into a compound microscope and saw an image he called a cell • In the later part of the 20th century, physicians recognised the practicality and benefits of treating damaged and diseased tissues under higher magnification Robert hooke’s microsccope
  7. 7. MAGNIFYING LOUPES Are a vast improvement over unaided vision Offer magnification 2.5x to 6x But have major short comings
  8. 8. People who wear eyeglasses: the frame is glazed with protective, plano power lenses (0 D). Prescription lenses can easily be integrated by your own eye care provider. Ease of use: relaxed treatment with an ergonomically correct body posture and optimum working distance 1) Lightweight: titanium frame and soft bridge for maximum comfort. (2) Simple adjustment: height and tilt are easy to set with a Torx key. (3) PD: easy to set for each eye using the folding bridge.
  9. 9. 1) Lightweight: the headband system evenly distributes the minimal weight of the Prism Loupes over the entire head area. (2) Comfortable: the headband can be adapted to practically any head. Adjust the width using this button. (3) A neat solution: the removable textile pads are washable. (4) Height and depth: turn the button, adjust, finished. (5) Eye contact with the patient: the Prism Loupes can be easily swung out of your field of view with one simple movement. (6) Tilt angle: fast and precise setting with a single adjustment.
  10. 10. Shortcomings of Magnifying loupes • Limited range of magnification 2.5x to 6x • Individualised to the user • Limited depth of field , limited feld of view when compared to an operating microscope • Weight related fatigue
  11. 11. • Less than optimal ergonomics • Lack of real time guidance while operating
  12. 12. Advantages with the Operating Microscope • Mulitple magnifications 2.5x to 16x or greater • Multiuser capability • Accomplish co observation • Case documentation • Facilitate to have a digital database • Improved ergonomics
  13. 13. Types of Operating microscopes available Floor mounted Wall mounted Ceiling mounted Wall mounted
  15. 15. MAGNIFICATION Determined by the Me- power of the eyepiece , Ft - focal length of the binoculars, Mc - magnification changer factor, Fo- focal length of the objective lens , Total magnification Mt = Ft / Fo x Me x Mc
  16. 16. Eyepieces • play an important role in magnification • generally available in powers of x6.3, x10, x16, x20 • have an adjustable diopter settings from - 5 to + 5 • diopter settings also adjust for the refractive power • with a reticule field can aid for alignment during videotaping and photography
  17. 17. Binoculars • hold the eyepieces in position • project an intermediate image into the focal plane of the eyepieces • interpupillary distance is set by adjusting the two binocular tubes • come in different focal lengths • available with Straight , inclined or inclinable tubes
  18. 18. Magnification changer located on the side of the body of the microscope controlled either manually or by a foot control ( power zoom changer )
  19. 19. Magnification range with Operating Microscope Multiple steps of magnification Low power 2.5X to 4X viewing of multiple teeth in the field diagnosis periodontal surgery gross reduction of tooth structure during full coverage tooth preparation orientation of the surgical field alignment of surgical tips Medium power 6.4X to 16X diagnosis surgical procedures retro preparations Highest powers > 16X for spot checks during treatment digital photography
  20. 20. Focusing knob located on the side of the body of the microscope To focus the scope onto the field
  21. 21. Parfocalisation The process of setting the operator specific focus for the entire range of magnifications To parfocal a microscope, a flat object is placed under the microscope and focused at the highest magnification set when the object appears clear
  22. 22. Objective lens The focal length of the objective lens determines the operating distance between the lens and the surgical field Available focal lengths 100 to 400 mm a 175mm lens focuses at about 7 inches a 200mm 8 inches a 400mm 16 inches A 200mm objective lens is recommended Objective lens
  24. 24. Path of light from a light source
  25. 25. Light source systems Two light source systems commonly available 1. Xenon halogen bulb used in a fan cooled system 2. Quartz halogen bulb, found in fiberoptic light system
  26. 26. Beam splitter Supply light to an accessory such as a camera or an auxillary observation tube Can be inserted in the pathway of light as it returns to the operators eyes
  28. 28. A TV monitor or preferably an LCD screen
  29. 29. Optimum configurations 12.5X eyepieces 125mm straight or inclinable binoculars 200 to 250m objective lens A five step manual magnification changer or a power zoom magnification changer This package would allow the clinician to work comfortably about 8 inches from the patient in the magnification range of 3X to 26X the power zoom would allow a smooth zoom with an 8:1 ratio easy magnification and focus adjustments
  30. 30. Excellent optics Mechanical stability test for stability : gently tap the end of the arm of the microscope when it is fully extended In a good microscope, superior suspension and balance mechanisms prevent the arm from moving or bouncing in response to position adjustments Maneuverability The microscope should be light for almost effortless maneuverability Modularity/ adaptability
  31. 31. Operating positions The most appropriate operating position for a given surgeon is a combination of Patient’s head position Dental chair position Microscope position Assistant observation devices
  32. 32. Patient’s position View of a patient readied for surgery A travel pillow is an excellent support for the neck and head Keeping the head turned mote than slightly for a Prolonged period may cause torquing of the neck muscles. This position should be avoided For the patients and surgeon’s comfort,the patient lies on the side during posterior surgery
  33. 33. Jaw manipulation and access for Posterior teeth Lateral extrusion gains another1/2 to 1-inch of space for maxillary molar surgery Mandibular protrusion gives greater access for mandibular molar surgery
  34. 34. Dental chair position That ensures maximum comfort Manipulating the chair’s height and back position, allows sufficient space between the legs and space between the scope and the operating field The chair is adjusted twice 1. To create the necessary clearence between the objective lens and the patient’s mouth 2. Once the surgeon has assumed an ergonomically correct position and has determined the corresponding correct position, minor adjustments can be made in the patient’s chair position The patient is positioned, slightly below the microscope for maxillary surgery slightly above it for mandibular surgery
  35. 35. Surgeon’s position Use an adjustable stool Thighs parallel to the floor Arms should be relaxed and comfortable at sides Specially designed stools are available
  36. 36. Assistant’s position A well designed microsurgery may need three assistants FIRST ASSISTANT responsible for suctioning, usually seated SECOND ASSISTANT Passes instruments, positioned next to the surgeon’s dominant site if a front delivery system is used, positioned across the surgeon THIRD ASSISTANT incharge of the video and photographic functions
  37. 37. Specific operator positions operating positions for a RIGHT HANDED SURGEON Maxillary Left Posterior position * surgeon positioned to the right and to the rear of the patient * occlusal plane perpendicular to the floor * patient faces slightly to the right for premolar area and turns on to the right side for molar area * scope angled down the plane of the roots * dental chair position low in relation to the microscope
  38. 38. Maxillary Anterior position * surgeon positioned to the right and to the rear of the patient * occlusal plane perpendicular to the floor * patient looking straight ahead * scope angled down the plane of the roots * dental chair position low
  39. 39. Maxillary Right Posterior position * surgeon positioned to the right and to the rear of the patient * occlusal plane perpendicular to the floor * patient faces slightly to the left for premolar area and turns on to the left side for molar area * scope angled down the plane of the roots * dental chair position low in relation to the microscope
  40. 40. Mandibular Left Posterior position •surgeon positioned to the left and to the side of the patient * occlusal plane parallel to the floor * patient looking straight ahead or slightly to the right * scope angled up the plane of the roots * dental chair position low in relation to the microscope * First assistant stands or sits depending on comfort * instruments on the bracket tray behind the patient
  41. 41. Mandibular Anterior position * surgeon positioned to the right and toward the front of the patient * occlusal plane parallel to the floor * patient looking straight ahead * scope angled up the plane of the roots * dental chair position low in relation to the microscope * Second assistant moves to the left of the chair and makes room for the surgeon
  42. 42. •surgeon positioned to the right and to the side of the patient * occlusal plane parallel to the floor * patient looking straight ahead or slightly to the left * scope angled up the plane of the roots * dental chair position low in relation to the microscope Mandibular Right Posterior position
  43. 43. Uses of Operating Miscroscope
  44. 44. Uses in Diagnosis 1. Diagnosis of early enamel and dentine cracks at a range of 14X – 18X Type I:Little or no risk of underlying pathology include A. Craze lines that are usually linear or vertical and do not widen or become more pronounced as they extend from gingival to occlusal B. Vertical cracks not associated with restorations and without enamel stain penetration C. Cracks that follow natural anatomic grroves
  45. 45. D. Cracks with superficial environmental stain penetration E. Cracks that result from polymerisation of composite resin
  46. 46. 2. Cracked tooth syndrome 3. Marginal leakage of restorations 4. Soft tissue evaluation
  47. 47. Uses in Restorative dentistry Pulpal involvement Coronal preparation Impression quality examining the impression surface for imperfections, distortions and marginal inadequacies at the time of impression making eliminates laboratory guess work Evaluating the restoration under surface Restoration delivery and polish Bonded restorations
  48. 48. Use of magnification in Dental technology Six key areas of the fabrication of restorations where magnification is essential 1. Inspection of the impression the impression of tooth structure that extends apical to the preparation or just beyond the margin should be clearly visible to the unaided eye it should then be inspected for clarity under a minimum of 12X 2. Trimming and marking of the die and marking the terminal edgeof the die at 20X
  49. 49. 3. Waxing of the margin 4. Fitting of the initial casting 5. Final fitting of the restoration
  50. 50. 6. Final polishing of the restoration
  51. 51. Achieved with the global 6- step microscope
  52. 52. Patient Education and Documentation Digital data base Digital data base
  53. 53. In Endodontics 1. Conventional / Non-surgical endodontics 2. Surgical endodontics
  54. 54. Non surgical root canal treatment Rubber dam application aids in the vision CORONAL ACCESS Should be large The coronal part of the cavity can be flared for better vision Removing the roof of the pulp chamber is easier to achieve the microscope Use of ultrasonics is also suggested Once deroofing is done inspect the floor of the pulp chamber under high magnificatiom Orientation should be done at 6X , then increase the magnification to 12X to enhance what is seen at the lower magnification Magnification upto 26X can be used to confirm the openings
  55. 55. PREPARATION OF THE ROOTCANAL With the microscope the shape the preparation in the coronal part of each root canal can be examined and progress monitored easily. Prepare the root canal In straight root canal it is possible to see the full length of the root canal OBTURATION OF THE ROOT CANAL The distribution of the sealer coronal to any curve can be verified at 16X or 26X. After completion of the obturation to remove excess guttapercha
  56. 56. 1. Coronal access in obliterated pulp chambers 2. Locating orifices DG 16 Micro openers Ulltrasonics in pecking motion
  57. 57. 3. Locating missed canals available literature indicatec that the dtection of MB2 improved when an operating microscope is used 4. Negotiation of calcifed canals 5. Preparation of Post space 6. Removal of silver points 7. Retrevial of separated instrument
  58. 58. 8. Removal of Post during re treatment 9. Repair of perforations 10. Diagnosis of incomplete or complete radicular cracks
  59. 59. Endodontic microsurgery Triad of Endodontic microsurgery
  60. 60. Conventional surgery vs Microsurgery Procedure Identification of the apex difficult precise Osteotomy large small Bevel angle acute 45 degree shallow < 10 degree Isthmus identification impossible easy Retro preparation approximate coaxial to root Retrofilling imprecise precise
  61. 61. 1. Identification of the apex in the intact buccal plate at 10X to 16X 2. Osteotomy 3. Resected root surface stained with methylene blue examined carefully with a micro explorer under 12X to 25X identifies causes of treatment failure
  62. 62. 4. Isthmus identification 5. Retroprepararion
  63. 63. 6. Retrofilling
  64. 64. Conventional suturing vs microsuturing
  65. 65. Maintainence of the microscope Cover the scope with plastic covers Disinfect the parts handled Clean the eyepiece and the objective lens with lens cleaner
  67. 67. References Pathways of Pulp Cohen & Burnns Microscopes in endodontics Dental Clinics of North America , Vol. 41 no.3 July 1997 Color atlas of Microsurgery in endodontics Sungcuk kim with Gabriele Pecora and Richard A.Rubinstein The Dental Operating Microscope and its slow acceptance Journal of Endodontics vol.28 no.3 March 2003 Journal of Esthetic and Restorative Dentistry vol.15, no.7, November 2003 Personal video monitor as an accessory to dental operating microscopes Quintessence international 20044; 35: 151-154 The benefit of operating microscope for access cavity preparation by UG students Journal of Endodontics vol.30, no.12, 2004 Effect of magnification in locating the MB2 canal in maxillary molars Journal of Endodontics vol.28, no.4, 2002 Short term observation of the results of endodontic surgery with the use of surgical operating microscope and Super EBA as root filling material Journal of Endodontics vol.25, no.1, Jan 1999 Frequency of MB2 in maxillary molars as detected by an operating microscope – a clinical study Journal of Endodontics vol.26, no.11, Nov 2000 Operating microscope improves negotiation of MB2 in maxillary molars Journal of Endodontics vol.27, no.11, Nov 2001
  68. 68. Use of Microscope in Endodontics – a report based on a questionnaire Journal of Endodontics vol.25, no.11, Nov 1999 Use of DOM in endodontic surgery Oral Path , Oral Med, Oral Radiol, Endo1993; 75: 95 - 105
  69. 69. THANK YOU