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Invited Review Magnification‑enhanced contemporary dentistry:

Getting started
Rashmi Hegde, Vivek Hegde1
Departments of Periodontology and Oral Implantology and 1Conservative Dentistry and Endodontics,
M.A. Rangoonwala College of Dental Sciences and Research Centre, Pune, Maharashtra, India

Address for correspondence: Dr. Rashmi Hegde, E‑mail: rashmidr21@yahoo.com

ABSTRACT
Contemporary dental practice is undergoing a sea change; wherein the approach is an interdisciplinary one aimed to impart minimally
invasive, painless, and atraumatic treatments to patients. To enhance their vision for both clinical and laboratory procedures, an
increasing number of practitioners are opting for magnification systems such as loupes and microscopes in their practice. Due to
their benefits such as improved visual acuity due to coaxial lighting, unobstructed vision, illumination, smaller instruments, minimal
trauma, and ergonomic benefits, microscope‑assisted precision dentistry is becoming the order of the day. Many dental schools
are also making the use of these systems mandatory in their teaching curriculi. Even though the use of microscope initially started
in ophthalmology, it’s benefits in endodontic therapy which can best be performed under magnifications up to ×10–20 remains
unparalleled. These benefits also extend to all aspects of dentistry including periodontics, restorative, prosthetic dentistry, and
implant dentistry. Barring the disadvantages of steep learning curve, cost, and maneuverability of the equipment, magnifications
are definitely becoming an important aspect of modern‑day dentistry, owing to their numerous other benefits.

CLINICAL RELEVANCE TO INTERDISCIPLINARY DENTISTRY

Microscope-enhanced dentistry is actually a part of a broader movement of minimally invasive and holistic approach in
dentistry, aimed at development of newer techniques, and achieving esthetically superior outcomes , due to improved visual
acuity. Magnified vision leads to improvised treatment, thus diagnosis, and management of multiple interdisciplinary problem
areas can be achieved with utmost precision by incorporating magnification systems in day to day practice.

Key words: Ergonomics, loupes, magnification, minimally invasive, surgical microscope

INTRODUCTION tools which improves the accuracy of work by bringing

the object as near to the eyes as possible, using finer

C ontemporary dentistry is spearheaded by a

movement in technological advances which
help clinicians with adequate training to incorporate
the finest skills and equipment in day–to‑day practice,
thus enhancing their existing skills and knowledge
and delivering the most ideal outcomes with utmost
precision. The modern‑day patients envision and expect
treatments delivered to them in the most painless and
minimally invasive manner. It is understood that the
brain can perceive what the eyes can see; however,
there is much more than what the normal eyes can see.
What more than magnified vision using magnification
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instruments, smaller incisions, shorter healing time,
minimal pain and trauma, superior esthetic outcomes,
and higher patient acceptance. Optical magnifications
have really broadened the horizons of dentistry.
The concept of magnifications for microsurgery
was intr oduced to medicine during the late
19 th century. [1‑6] Carl Nylen, who is considered
the father of microsurgery, first used a binocular
microscope for ear surgery in 1921. The pioneers
in dentistry were Apotheker and Jako, who first
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DOI: How to cite this article: Hegde R, Hegde V. Magnification-enhanced

10.4103/2229-5194.197695 contemporary dentistry: Getting started. J Interdiscip Dentistry
2016;6:91-100.

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Hegde and Hegde: Magnifications in dentistry
introduced the use of microscope in dental procedures
in 1978.[7] Following this, Carr, in 1992, published an
article defining and emphasizing the role of the surgical
microscope in endodontic procedures.[8] In 1994, Shanelec
and Tibbetts presented a continuing education course
documenting the use of surgical microscope in dentistry
and called it “Microscope‑Assisted Precision Dentistry.”[9]
Most experienced microscope users comment with
amazement about the wonders of working through a
microscope. It is well said that a magnified, clear image
can speak more for itself than a thousand words put
together. Definitely considered as an eye opener to
many dental professionals, microsurgery is unfolding
to be an interesting concept. In 1979, Daniel defined
microsurgery in broad terms as surgery performed under
magnification by the microscope.[2] In 1980, microsurgery
was described by Serafin as a methodology ‑ a modification
and refinement of existing surgical techniques using
magnification to improve visualization, with applications to
all specialties.[3] As a treatment philosophy, microsurgery
incorporates three different principles:
1. Improvement of motor skills, thereby enhancing
surgical ability
2. An emphasis on passive wound closure with exact
primary apposition of the wound edge
3. The application of microsurgical instrumentation and
suturing to reduce tissue trauma.
Magnification, illumination, and instruments (Kim 2001)
together form the “Microsurgical Triad.” Without these,
microsurgery is impossible. Microscope‑enhanced practice
does not indicate conceptual revolutions in existing
techniques, however implies an improved accuracy, better
handling, and gentleness and thoroughness in the procedures,
with slight modification in the already practiced techniques.
TYPES AND PRINCIPLES OF
MAGNIFICATION SYSTEMS
Broadly, the concept of magnification‑enhanced dentistry
incorporates the use of two types of optical magnification
systems: (a) loupes and (b) surgical operating microscope.
Loupes
The most common magnification system used in dentistry
is the magnification loupes. Primarily, loupes consist of
two monocular microscopes, with side‑by‑side lenses,
angled to focus on an object to form magnified images
with stereoscopic properties that are created by the use of
convergent lens systems. Wide ranges of magnifications are
available in loupes, ranging from × 1.5 to × 10. It is always
ideal to adapt to magnified vision by initially using loupes,
which enable the operator to adjust to the eye training
exercise and changes in hand–eye coordination. Although
92
loupes are widely used, their major disadvantage is that the
eyes converge to view an image (Keplerian optics), which
can result in eye strain, fatigue, and even vision changes
with the prolonged use of poorly fitted loupes.[10] There are
three types of loupes commonly used in practice:
Simple loupes
Simple loupes consist of a pair of single, positive,
side‑by‑side meniscus lenses. Each lens has two refracting
surfaces, with one occurring as light enters the lens and
the other when it leaves. Its main advantage is that it is
cost effective. The disadvantages are it is primitive with
limited capabilities and are highly subjected to spherical and
chromatic aberrations, which distort the image of the object.
Compound loupes or telescopic loupes
Compound loupes or telescopic loupes consist of
multiple lenses with intervening air spaces, thus allowing
adjustment of magnification, working distance (WD), and
depth of field without increase in size or weight.
Prism loupes
Prism loupes are optically most advanced containing
Pechan or Schmidt prisms that lengthen the light path
through a series of mirror reflections within by virtually
folding the light so that the barrel of the loupe can be
shortened. They produce better magnification, larger
fields of view, wider depths of field, and longer WDs. This
is a feature that dentists should seek when selecting any
magnifying loupe because an achromatic lens consists
of two glass pieces, usually bonded together with clear
resin. The specific density of each piece counteracts the
chromatic aberration of the adjacent piece[11,12] [Figure 1].
Surgical operating microscope
In dentistry, operating microscopes are designed on
Galilean principles. They incorporate the use of magnifying
Figure 1: Compound Loupes
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Hegde and Hegde: Magnifications in dentistry
loupes in combination with a magnification changer and
a binocular viewing system so that it employs parallel
binoculars for protection against eye strain and fatigue. They
also incorporate fully coated optics and achromatic lenses,
with high resolution and good contrast stereoscopic vision.
Surgical microscopes use coaxial fiber‑optic illumination.
This type of light produces an adjustable, bright, uniformly
illuminated, circular spot of light that is parallel to the optical
viewing axis. Due to its shadow‑free light, visualization of
pathologies, documentation, motion videography, and
management of all dental and surgical procedures can be
effectively performed under unobstructed vision. Patients
can be counseled better as they can directly visualize the
magnified image on the screen due to the beam splitter
video camera attached to microscope.
PARTS OF MICROSCOPE
The surgical microscope is a complicated system of
lenses that allows stereoscopic vision at magnification of
approximately ×4–40 with an excellent illumination of the
working area. Light beam falls parallel into the retina of the
observer so that no convergence is necessary and demand
on eye muscles, especially the lateral rectus is minimal.
Parts of a microscope are broadly divided into:[12-14]
Optical components
Magnification changer or Galilean changer consists of
one cylinder, in which two Galilean telescope systems
with various magnification factors are built. A total of
four different magnification levels are available. Power of
magnification decided by a magnification factor.
Objective lens
after processing by magnification changer, the image is
projected by single objective. This simultaneously projects
light from its source twice for deflection by the prisms into
the operation area. The most frequently used objective is
250–300 mm in dentistry.
Binocular tubes
They can be straight or inclined depending on the use.
In dentistry, only inclined, swiveling tubes that permit
continuously adjustable viewing are used. Furthermore,
they improve the feasibility for improving ergonomics as
the operator can adjust the tubes without changing his
head, neck, or back posture.
Eyepieces
They magnify the images generated in the binocular tubes.
Varying magnifications can be achieved (×10, ×12.5,
and ×20 up to ×40) with the same. Most of the endodontic,
periodontic, and restorative procedures can be carried out
Journal of Interdisciplinary Dentistry / May-Aug 2016 / Vol-6 / Issue-2
under ×10 magnification. Certain endodontic procedures
such as instrument retrieval or working on the apical
foramen, may require magnification up to ×15–20.
Majority of the surgical microscopes are equipped with
attachments that include integrated video systems,
photographic adapters for cameras, units for image
storage, color printers, powerful lighting sources, beam
splitter cameras, powerful light‑emitting diode, and halide
lighting systems for unobstructed coaxial illumination.
Lighting unit
In surgical microscopes, incandescent, halogen, and
fiberoptic are the principal types of illumination. Halogen
lamps provide a whiter light than lamps using conventional
bulbs due to their higher color temperature. Other options
available are the xenon lamps, which function up to
10 times longer than halogen lamp. The light has daylight
characteristics with an even whiter color, which delivers
exceptionally bright images with sharper contrast.
Mounting system
Ceiling, wall, and floor mounting options are available
for surgical microscopes. The surgical microscope must
have both maneuverability and stability for practical
use in day–‑to‑day practices. Initially, the microscopes
were fixed type that were difficult to maneuver. Most
modern microscopes are articulating types that feature
an articulating arm that allows easy movement of the
scope without moving the entire unit [Figure 2]. The
ceiling and wall mount have fixed positions, thus cannot
be moved; however, they help in space management.
The floor mount can be transported easily but may
occupy more space. Thus, depending on the space
available in the operatory, the mounting system may
be selected.
STEPS IN USE OF MAGNIFICATIONS
With a steep learning curve associated with the use of
magnifications, it is imperative to every desiring clinician
to master the steps toward achieving complete harmony in
hand and eye movements while using these systems.[1,9,12]
Working distance
It is the distance measured from the eye lens to the
object in vision. There is a multitude of back, neck, and
eye problems that dentists suffer from, due to a need to
attain short WDs for increasing visual acuity. Depending
on the individual’s height and length of arms, the WD
with slightly bended arms using microscope increases and
ranges between 30 and 45 cm. At this distance, posture
is perfect, ergonomics is greatly improved, and there is
decreased eye strain due to less convergence.
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Hegde and Hegde: Magnifications in dentistry
Working range (depth of field)
Range within which the object remains in focus. The DOF
of normal vision ranges from WD to infinity.
Convergence angle
It is the pivotal angle aligning the two oculars, such that
they are pointing at the identical distance and angle varies
with interpupillary distance (IPD). Defines the position
of extraocular muscles that may result in tension of the
internal and external rectus muscles, which may be an
important source of eye fatigue.
Field of view
Linear size or angular extent of an object when viewed
through the telescopic system.
Interpupillary distance
It is the key adjustment for the use of any magnification
system. The ideal way to understand your IPD is to focus
both the binocular eyepieces to initially see two images
or circles and adjust it to the point, wherein they merge
and become one circle. That point would be identified as
the IPD and used as a permanent reference for the use of
magnifications. The IPD varies with each individual and
a
b
Figure 2: (a) Parts of a microscope, (b) Determination of Interpupillary
distance (IPD)
94
forms an important aspect in the learning curve of use of
magnifications.
Viewing angle
It is the position of the binocular optics angled in such a
way that it enables comfortable working position for the
operator. The shallower the angle, the greater the need
to tilt the neck to view the object.
LOUPES VERSUS OPERATING
MICROSCOPES
Advantages of loupes
Less expensive and initially easier to use since they are
head mounted, loupes tend to be less cumbersome in
the operating field.
Advantages of operating microscope
(a) Greater operator eye comfort because of the parallel
viewing optics of the Galilean system as well as the
range of variable magnification, excellent coaxial
fiber‑optic illumination. (b) Countless accessories such
as still and video single‑lens reflex cameras for case
documentation and DVD preparations, co‑observer
tubes for additional viewing by a third assistant,
etc., (c) Magnification allows the surgeon to compare
the conventional surgical procedure, which appears
as gross crushing and tearing of tissues. (d) Motor
coordination is greatly improved using precision grip
instruments, thus reducing tremor.
Ergonomics is one of the most beneficial aspects of
using magnifications, especially the surgical microscope.
[14]
It is the study of people’s ef ficiency in their
working environment. It is also the applied science of
equipment design for the workplace with the intent of
enhancing productivity by reducing operator fatigue
and discomfort. Musculoskeletal problems such as
a b
Figure 3: (a) Keplerian optics, (b) Galilean optics
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Hegde and Hegde: Magnifications in dentistry

herniated discs, spondylosis, rotator cuff impingement,

and neck, back, and shoulder problems are on the
rise in the dental fraternity due to various postural
variations, working at very close field, bending, or
inappropriately standing. Mechanisms related to muscle
balance and problems associated with the same can be
explored by understanding the differences between
“posture‑directed dentistry” and “image‑directed
dentistry.” “Image‑directed dentistry” is associated
with dental procedures performed using a direct vision.
“Posture‑directed dentistry” is associated with dental
procedures that are performed using an indirect line
of sight such as microscope. This position is directed
toward ergonomical well‑being of the operator. The
optics of a surgical microscope bend the path to almost
90° allowing the dentist to sit comfortably erect with Figure 4: Opthalmic blade at 16x magnification
the head, neck, and back arranged in a straight line
when viewing an object. During microsurgery, the Sutures
dentists’ seating zone is usually recommended for 11
Approximately, 6‑0–10‑0 resorbable or nonresorbable
o’clock and 12 o’clock positions. This prevents twisting
sutures are used in microsurgery. Layered technique
and turning movements during procedures, and verbal
for suturing butt joint incisions is preferred. Dark blue or
communication plays a greater role [Figure 3].
violet tinted sutures preferred as colorless sutures can
be invisible under the microscope. A 3/8 reverse cutting
needle preferably 5–13 mm in length, for papillary sutures,
INSTRUMENTS
needle lengths 1–15 mm are required. For anterior areas
Microsurgical instruments, especially designed to 10–12 mm and buccal‑releasing incisions 5–8 mm.[12,15]
inflict minimal trauma, are generally lightweight. They
are circular in cross section, as they are manipulated
between the thumb, index finger, and middle finger. MICROSURGICAL INDICATIONS IN
They should provide tactile perception for controlled PERIODONTAL SURGERY
rotating movements. Approximately, 18 cm long only
finger tips should move while using these instruments. Improved root visualization
They are held between the pad of the thumb and The critical determinant of the success of periodontal
index finger, allowing precision controlled movements therapy is the thoroughness of debridement of the root
of only finger tips. They are designed with colored surface (Lindhe et al. 1984). Accessibility and visibility in deep
coating surfaces or dull finish, to avoid reflection of subgingival pockets, furcation areas, and interdental areas can
light under the scope and minimize glare. Weight remarkably be improved using magnifications. It is clear that
should not exceed 15–20 g. Precise working lock magnification around ×4–10 greatly improves the surgeon’s
on needle holder with locking force 50 g. Basic set ability to create a clean, smooth root surface. It can help to
comprises needle holder, microscissors, micro scalpel detect islands of biofilm, calculus, or material alba clinging
holder, anatomic and surgical forceps, and various to the root surface and facilitate removal from areas which
elevators. Fine chisels, raspatories, elevators, hooks, were normally not visible to the naked eyes [Figure 5].[12‑17]
and suction. Micromirrors (furcation and interdental),
endodontic pluggers, root‑end preparation tips, and
Applications in mucogingival surgery
ultrasonics. An important characteristic of microsurgical
instruments is their ability to create clean butt joint All mucogingival surgical procedures are technique and
incisions that prepare wounds for healing by primary operator sensitive and therefore tend to have varying
intention. Several types of ophthalmic knives such as therapeutic results. Periodontal plastic microsurgery
the crescent, lamellar, blade breaker, sclera, and spoon has remarkably improved the predictability of root
knife can also be used. Ophthalmic knives offer the coverage procedures, frenectomy, vestibuloplasty, etc.,
dual advantages of extreme sharpness and minimal with less operative trauma and discomfort, excellent
size. This helps limit tissue trauma and promotes faster postoperative esthetics, and significantly faster healing.
healing [Figure 4 ‑ microinstruments].[12,14,15] For connective tissue and free gingival grafts, initial graft

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Hegde and Hegde: Magnifications in dentistry
a b
c d
Figure 5: Scaling and Root Planing. (a) Pre-operative view, (b)
Scaling at 8x magnification, (c) Root planing with Gracey Curette 8 x
magnification, (d) Post-operative view
a b
c
Figure 7: Microsurgical flap for Periodontal Regeneration. (a) Pre-
operative Raidiograph, (b) Microsurgical flap with bone graft placement
for Gr II furcation involvement, (c) Microsurgical 6-0 sutures
survival depends on early plasmatic diffusion. A minimally
traumatic approach ensures more precise recipient and
donor site preparation with minimal tissue and vessel
injury, more rapid and complete anastomosis of capillary
buds, and faster healing.[12,18‑23] This fact was emphasized
by several authors in their studies. Highly sensitive
techniques such as papilla reconstruction can also be
performed with higher predictability using a microscope
[Figure 6 ‑ free gingival graft and comparison].
Minimally invasive surgical technique
The minimally invasive surgical technique (MIST, Cortellini
and Tonetti, 2007) is a concept that was designed,
especially for isolated intrabony defects for periodontal
regeneration. It is based on minimal reflection of very
short buccal and lingual flaps with minimal mesiodistal
and coronoapical extensions, the aim being to expose
the coronal edge of the residual bone crest that include
96
a b
c d
e
Figure 6: Microsurgical Free Gingival Graft. (a) Pre-operative view:
Miller’s Class II Recession, (b) Microsurgical Free gingival Graft sutured
with 6-0 sutures, (c) Superior healing at 1 week, (d) Healing at 1 month,
(e) Comparison with Macrosurgical FGG with 3-0 sutures
a b
c d
Figure 8: Microsurgical implant exposure. (a) Pre-operative with
Opthalmic blade at 8x magnificatio, (b) Minimal crestal incision, (c)
Minimal flap reflection at 8x magnification, (d) Exposed implant with
healing abutment and 6-0 sutures
the defect‑associated interdental papilla. In narrow
interdental spaces, a diagonal incision is given closer
to the lingual side (simplified papilla preservation flap),
whereas a horizontal butt joint incision is performed at
the base of papilla in wide interdental spaces, modified
papilla preservation technique (MPPT), incorporating the
whole papilla into the palatal or lingual flaps. Scaling
and root planin is performed by means of mini‑curettes
and sonic/ultrasonic instruments. Modified minimally
invasive surgical technique (M‑MIST) has been proposed
by Cortellini and Tonetti, 2009, for use in combination
with enamel matrix derivatives (amelogenins). The overall
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Hegde and Hegde: Magnifications in dentistry

idea of the M‑MIST is to provide a very small interdental
access to the defect only from the buccal side, following
which the supracrestal interdental tissue is dissected
from the granulation tissue by means of a mini‑blade, and
regenerative material of choice applied. Passive closure
by internal mattress sutures is preferred.”[24‑28]
The clinical benefits of microsurgical approach for
periodontal regenerative surgery have further been
confirmed by various authors through case reports
(de Campos et   al ., 2006) and case‑cohort studies 
(Cortellini and Tonetti 1999, 2007 and Francetti et  al.
2004). All studies confirmed the beneficial effects of
microsurgical approach in terms of Clinical Attachment
Level (CAL) gains, reduction in pocket depth, regenerative
outcomes, etc.,[26‑31] [Figure 7 ‑ flap for regeneration].
Microsurgery in implant therapy
All stages of implants may be performed with higher
precision using a microscope. The microscope may be a
valuable tool in visualizing the last threads of the implant
for subcrestal placement, implant recovery with minimal
trauma to adjacent tissues, management of peri‑implantitis,
visualization of the sinus membrane during sinus lift
procedures, and minimizing the risk of perforations or
tears[15,32,33] [Figure 8a‑d ‑ implant exposure].
pulp can be excavated by distinguishing even the minutest
infected dentin areas due to the shadow‑free light.
This can help spare‑affected dentin and minimize pulp
exposures. Margin preparation and outline for a crown or
veneer preparation can also be perfected with thorough
precision under the scope [Figure 9 ‑ restorative margins,
Figure 10 ‑ veneer preparation, Figure 11 ‑ bonding brush].
Endodontics
The use of microscope has redefined the concept of
visualization in endodontics, to the extent that it can be
considered as an integral part of the armamentarium for
all endodontic procedures. The ability to inspect the root
canal both orthograde and retrograde have established
newer standards for outcomes of root canal therapy.
Diagnosis of fissure caries, microfractures, straight line
access to the apex of the canal, complete exposure of the
pulp chamber, removal of pulpal roof (deroofing), location
of canal orifices, especially MB2 in the maxillary first
molars, dentinal map, bent, split, oval canals, pulp stones/
calcifications, obturation techniques, perforation repairs
using mineral trioxide aggregate, fractures, instrument
retrieval, apical ramifications, retreatment, especially
gutta‑percha removal, and defects or kinks in rotary

Adhesive Dentistry
Bonded dentistry ideal restorative margins form the key of
successful restorations with longevity. Caries close to the

Figure 10: Tooth preparation for Veneer

a b
Figure 9: Adhesive dentistry. (a) Preparation of crown margins at 10x
magnification, (b) Comparison of macrosurgical no. 12 blade at 10x
magnification

Figure 12: Endodontic Access cavity 10x magnification showing

Figure 11: Applicator microbrush at 10x magnification dentinal map

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Hegde and Hegde: Magnifications in dentistry

a b
Figure 13: Post- Obturation. (a) Post-obturation at 16x magnification,
(b) Post-obturation showing MB2 canal at 16x magnification

Figure 14: Broken instrument in canal at 20x magnification

a b
Figure 15: Root Canal sterilization. (a) Laser & Microscope –assisted
Root Canal Sterilization, (b) Removal of pulp tissue

Figure 16: Vertical root fracture detected at 10x magnification with dye

Figure 17: Root end preparation in Apicoectomy 16x magnification

files, can be traced earlier, thus preventing instrument

fractures[34‑36] [Figure 12 ‑ access cavity with dentinal map,
Figure 13 ‑ obturation, Figure 14 ‑ instrument fracture
n retrieval, Figure 15 ‑ laser root canal sterilization,
Figure 16 ‑ root fracture, Figure 17 ‑ root end preparation,
Figure 18 ‑ periapical surgery].
ERRORS IN THE USE OF MICROSCOPE
Wrong power of magnification
Wrong power of magnification using too high magnification
can lead to narrower field of vision and smaller DOF, too
low magnification may not serve the purpose. Ideal
magnification should be that which allows the surgeon
to operate with ease without losing focus at all times.
In periodontal surgery, magnifications of up to ×5 for
98
Figure 18: Apical retropreparation with MTA placement
loupes and ×10–20 for microscopes appear to be ideal.
×10–15 for papilla preservation, ×12–15 for single‑tooth
root coverage, or guided tissue regeneration for intrabony
defect interdentally, ×6–8 for clinical inspection/diagnosis,
or flap surgery for quadrant, and ×15–25 for endodontics
appear to be the ideal range for magnifications.[12]
Inadequate coordination
Inadequate coor dination between surgeon and
assistant can lead to disruption of optimal workflow. In
microendodontics, there is straight line vision, minimum
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Hegde and Hegde: Magnifications in dentistry
movement of the object, and change of position in the
operating persons; however, during surgery, there may
be a wider field, constant movement, thus a second
assistant for arranging instruments may be required, and
co‑observer tubes for the assistant are of added benefit.
Improper training or lack of practice
Improper training or lack of practice may lead to
inadequate coordination between surgeon’s eyes and
hands, and reduction of tremor, achieving ergonomically
beneficial positions may get difficult to achieve. A learning
curve of minimum 6 months may be needed.
RECENT ADVANCES IN MICROSCOPES
Zeiss OPMI PROErgo
It has a feature of motorized/foot‑controlled adjustment
of focal length. This causes the least disturbance and
optimal ergonomic work even when treatment continues
for several hours.[37]
Mechanical optical rotating assembly
interface (MORA Interface)
It is a mechanical optical rotating assembly that connects
the binocular tube at a right angle to the body of the
operating microscope making it capable of a limited
independent rotation around the horizontal axis of
the binocular tube. This was devised to overcome the
drawbacks of conventional microscopes which were
designed to allow the clinician to sit at the 9–10 o’clock
position. This led to an inclined neck position toward the
right shoulder, leading to overextension of the left arm,
muscle tension, fatigue, and disability. This technology
enables the operator to be seated at 12 o’clock position,
providing a horizontal WD that is compatible with the
distance between the head and the mouth of the patient.[37]
Periodontal endoscope
It is a new procedure using a miniature dental endoscope
which allows subgingival visualization of the root surface
at magnifications of ×24 to ×48. This is accompanied
by a 99 mm fiber‑optic bundle that is a combination of
10,000 pixel capture bundle surrounded by multiple
illumination fibers. This fiber is delivered to the subgingival
margin coupled into an instrument called explorer. The
magnified images are immediately displayed on a chairside
video screen, following which any residual islands of
calculus or biofilms can be effectively debrided.[13]
Varioscope
Referred to as Augmented Reality, it is a lightweight
miniature head‑mounted operating microscope for
Journal of Interdisciplinary Dentistry / May-Aug 2016 / Vol-6 / Issue-2
surgical navigation; it features display of additional
computer‑generated sceneries. It has an integrated camera
for documentation. One of the greatest advantages of
the varioscope is mobility of the operator head, which
is contrary to the surgical microscopes which lack
maneuverability due to cumbersome equipment.[37]
The infrared 800, flow 800, and blue 400 fluorescence
tools allow surgeons to see vascular circulation at the
surgical site and determine the sequence and direction
of blood flow.
CONCLUSION
The use of magnifications, though associated with a steep
learning curve and added cost factor attached to them,
have proven beneficial as seen through a cursory review of
various therapeutic aspects of dentistry. The opponents of
microsurgery may mention the adverse effects of prolonged
duration of procedures carried out under microscope;
however, it is compensated by the minimally invasive nature
of the technique ultimately leading to superior outcomes.
Some areas in the mouth may be difficult to access using the
microscope; in such areas, loupes may be preferred. With
the advent of newer systems such as varioscope, procedure
scopes, these limitations may further be overcome. Above
all the microscope can be a valuable patient education,
practice enhancement, and self‑appraisal tool, for improving
the overall quality of work in day‑to‑day practice. In the
above‑mentioned clinical scenario, there appear to be
no obvious contraindications for the use of magnification
systems in dentistry, rather they could become an integral
aspect of the future of clinical dentistry.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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Journal of Interdisciplinary Dentistry / May-Aug 2016 / Vol-6 / Issue-2