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The impact of the use of magnifying dental loupes on the performance of

undergraduate dental students undertaking simulated dental procedures

Article  in  Journal of Dental Education · September 2020

DOI: 10.1002/jdd.12437

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DOI: 10.1002/jdd.12437

ORIGINAL ARTICLE

The impact of the use of magnifying dental loupes on the

performance of undergraduate dental students undertaking
simulated dental procedures
Tiago Braga DDS1 Nigel Robb DDS, MSc, PhD1 Robert Matthew Love DDS, MSc,
1 1,2
PhD Rodrigo Rodrigues Amaral DDS, MSc Vandilson Pinheiro Rodrigues DDS,
MSc, PhD1,3 Jose Mauricio Paradella de Camargo DDS, MSc, PhD4
Marco Antonio Hungaro Duarte DDS, MSc, PhD 5

1School of Dentistry and Oral Health,

Griffith University, Gold Coast,
Queensland, Australia
2 Department of Dentistry, Pontificia
Universidade Catolica, Belo Horizonte,
Minas Gerais, Brazil
3 Dentistry Graduate Program, Federal
University of Maranhão, São Luis,
Maranhão, Brazil
4 School of Professional Development,
Campinas Association of Dental
Surgeons, Campinas, São Paulo, Brazil
5Department of Operative Dentistry,
Endodontics and Dental Materials,
University of São Paulo, Bauru School of
Dentistry, Bauru, São Paulo, Brazil
Correspondence
Tiago Braga, DDS, School of Dentistry and
Oral Health Griffith University, Corner
Olsen Avenue & Parklands Drive, Gold
Coast campus Southport, QLD 4215, Aus-
tralia.
Email: t.braga@griffith.edu.au
Funding information
Coordenação de Aperfeiçoamento de
Pessoal de Nível Superior; PROCAD,
Grant/Award Number: 88881.357834/2019-
01
Abstract
Objectives: This study aimed to evaluate the impact of the use of magnification
(2.5x dental loupes) for third-year dental students in simulated endodontics and
fixed prosthodontics assessments compared to those using no magnification.
Methods: Upon institutional review board exemption, third-year dental stu-
dents were assessed during endodontics and fixed prosthodontics exams in the
simulation laboratory. The endodontic group (n = 93) consisted of students
who made an endodontic access preparation on a plastic lower left first molar
(Nissan). The prosthodontic group (n = 86) consisted of students who made
porcelain fused to metal preparation (PFM) on a plastic lower right first molar
mounted on an acrylic lower jaw model (Columbia Dentoform). The impact of
the use of dental loupes was evaluated. Assessment of the tasks was undertaken
by experts—calibrated, blinded examiners—using a standardized marking
rubric for each task. The statistical analysis included Chi-square test, one-way
ANOVA, and Logistic regression. The level of significance adopted was 5%.
Results: Students’ preparations using magnification were better compared with
those without magnification. Students using magnification had a significantly
higher pass rate than those not using magnification in both endodontic and
prosthodontic groups (P < 0.05).
Conclusions: In conclusion, third-year dental students who used loupes in the
endodontics and prosthodontics simulation laboratory had significantly higher
scores at the assessments.

KEYWORDS
dentistry, endodontics, fixed prosthodontics, magnifying dental loupes, simulation laboratory

1 INTRODUCTION important tool in dentistry. The use of optical magnifi-

cation, associated with proper illumination is a safe and
Over recent decades, magnification devices such as den- effective way to improve the outcome of difficult endodon-
tal loupes and microscopes have become an increasingly tic procedures.1,2

J Dent Educ. 2020;1–9. wileyonlinelibrary.com/journal/jdd © 2020 American Dental Education Association 1

2 BRAGA et al.
Dentists are focusing on more conservative tooth prepa-
rations, resulting in better treatment of patients. In
addition to improving the accuracy of the operative
procedures, magnification may also improve diagnostic
capability, due to better visualization of the treatment
field.3–8
Enhanced magnification also helps to improve operator
ergonomics. Studies suggest that every dental professional
is at risk of an occupational musculoskeletal injury.9–15
Valachi and Valachi16,17 have highlighted the need for good
posture when carrying out dental procedures, as it has
been established that poor posture can contribute to the
development of back and neck pain. Many dentists experi-
ence chronic back and neck pain, with figures quoted rang-
ing from 60% to 80% affected individuals of various ages,
from different parts of the globe.18
While studies reported improved clinical perfor-
mance when a group of experienced clinicians used
magnification,19 Donaldson et al.20 could find no signif-
icant improvement when undergraduate students used
magnifying loupes for a trial period in clinical pedi-
atric and operative dentistry. Leknius and Geissberger21
reported that dental students performed fixed prosthodon-
tic procedures while using magnification produced half
as many errors as students who performed the same
preparation without the aid of magnification. Similarly,
Maggio et al.22 showed that dental magnification loupes
significantly enhanced student performance during pre-
clinical dental education and were considered an effective
adjunct by the students who used them.
The aim of this observational study was to evaluate the
impact of the use of magnification (2.5x dental loupes) for
third-year dental students in simulated endodontics and
fixed prosthodontics assessments compared to those using
no magnification.
2 MATERIALS AND METHODS
Upon institutional review board exemption, third-year
dental students were assessed during endodontics and
fixed prosthodontics exams in the simulation laboratory.
The dental students received essential learning regarding
magnifying dental loupes in the beginning of the second-
year curriculum. The main motivating factors for the stu-
dents were the information given concerning the bene-
fits of loupes and the subjective feeling of needing a bet-
ter vision to perform different tasks in dentistry special-
ties. The students that purchased loupes had their working
distance checked according to their height, and also inter-
pupillary distance by the manufacturers. They practiced in
the simulation laboratory for year and a half before these
assessments.
For the endodontics exam, an endodontic access
preparation on a plastic lower left first molar (Nissan)
(Figure 1A) mounted on an acrylic lower jaw model
(Columbia Dentoform) was assessed. Ninety-three stu-
dents were required to establish access using an endo
access bur set 2021 (Stoddard, UK), locate the root canals,
establish Glide Path and widen the canal orifice with an
X- Gates bur. The bur kit is shown in (Figure 1B).
The marking criteria were divided into 4 items and
a cumulative grade of <50% was considered a failure
(Table 1). There are criteria that are directly related, which
means if the student was graded 0 for 1 criterion, other cri-
teria’s would be compromised. Additionally, perforation of
the coronal pulp chamber or canals, more than 50% of the
roof of the pulp chamber not removed, separated instru-
ments left in a canal, or preparing the tooth outside the
mounted Columbia Dentoform were considered as a fail-
ure of the task.
For the prosthodontics exam, a different group of 86
students were required to prepare porcelain fused to metal
crown (PFM) on a plastic lower right first molar mounted
on an acrylic lower jaw model (Columbia Dentoform)
(Figure 2A). The prosthodontic bur kit can be seen in
(Figure 2B).
The marking criteria were divided into 11 items and
a cumulative grade of <50% was considered a failure
(Table 1). There are criteria that are directly related, which
means if the student was graded unacceptable for 1 crite-
rion, other criteria would be compromised. Additionally,
damage to 1 or both adjacent teeth requiring restoration
was deemed an automatic failure, as was working outside
the phantom head at any time, preparing the wrong tooth,
the use of wedges, clear bands, polishing cups, or matrix.
Each preparation was assessed by 2 experts, calibrated,
blinded examiners. If the preparation was borderline or
failed it would be reassessed by 2 different examiners. All
examiners used dental loupes (2.5x magnification) while
marking.
The examiners marked the entire cohort of prepara-
tions, blinded as to which were produced by students using
magnification. After the exam, the simulation laboratory
scientific officer collected the student’s models from the
phantom head and labeled each with a specific number
that corresponded with the student ID before handling
the models to the examiners. After marking, the grades
were returned to the simulation laboratory scientific offi-
cer, responsible for providing a report with the student
ID and marks. Using the attendance book, we could con-
firm which students were and were not using magnifi-
cation. The endodontic preparations were performed by
the third-year students in the academic year 2018, and the
prosthodontic by the third-year students in the academic
year 2019.
BRAGA et al. 3

F I G U R E 1 Endodontics exam (A) Periapical X-Ray of simulated tooth 19. (B) Endodontic access bur kit. (C) Endodontic access that failed
for removing less than 50% of the roof of the pulp chamber. (D) Preparation that failed due to overextension and floor of the pulp chamber has
been totally damaged but not perforated. (E-G)Best endodontic access preparation performed by a student using magnifying dental loupes

The grades were then grouped according to the use of
magnification: Group 1-Endodontic access preparation; no
magnification (54 students);—magnifying dental loupes
2.5x (39 students). Group 2- PFM preparation; no magni-
fication (36 students); magnifying dental loupes 2.5x (50
students).
(GPA) comparative analysis. Logistic regression analysis
was used to determine the odds ratio (OR) and 95%
confidence interval (95% CI) of association between loupe
use and practical exam performance adjusted for gender.
The level of significance adopted was 5%.

2.1 Statistical analysis
The data were analyzed by the statistical program SPSS
version 26.0 (IBM, Chicago, IL, USA). Descriptive statis-
tics of the variables were performed using measures of
frequency, mean, and standard deviation. Categorical
variables were analyzed using Chi-square test. One-way
ANOVA was used for the cumulative grade point average
3 RESULTS
The endodontic group included 93 students (57% women
and 43% men), the most frequent age group was 21–24
years (45.2%), international students were 54.8% of this
group, 43% of students used loupes, and the pass rate
was 82.8%. The prosthodontic group included 86 students
(45.3% women and 54.7% men), the most age group was
21–24 years (43%), international students were 65.1% of this
4 BRAGA et al.

TA B L E 1 Assessment rubric for simulated endodontic access and prosthodontic porcelain fused to metal preparation
Endodontics 5 marks 3 marks 1 mark 0 mark
External outline The placement of the access External outline over or under External outline over or under External outline
and location opening reflects the position of extended by 1 mm or less extended between 1 and 2 mm over or under
of the access the pulp chamber and should extended
opening allow for complete greater than
debridement of the pulp 3 mm, all
chamber or straight-line access walls
to the root canal system undermined
Internal outline: The access opening is of optimal The internal outline of the access The internal outline of the access The internal
Size and size and shape, allowing easy opening is over or under opening is over or under outline is
shape of identification of all canals and extended by 1 mm or less; the extended by 1–2 mm or overextended
access complete debridement of pulp shape of the access opening infringes on the marginal ridge up to 2 mm in
opening chamber without ledges only slightly reflects the shape leaving less than 1 mm of tooth all directions
of the pulp chamber structure internally
Internal outline: Opening with no ledges; all pulp Slight ledges; pulp horns are not Gouges are present that do not None of the
The internal horns are removed through the fully removed through the affect access to the canal walls are
form taper to access opening; internal walls access opening; preparation orifices; pulp horns are not smooth;
the canals are smooth; preparation allows dos not allow smooth flow of entered; preparation dos not preparation
uniform taper of pulp chamber pulp chamber into 1 of the allow for smooth flow of the does not allow
walls into the canals; floor of canals; floor of the pulp pulp chamber into 2 major for smooth
pulp chamber not damaged chamber has been slightly canals; floor of pulp chamber flow of pulp
damaged with moderate damage, which chamber into
evidence of groves and 3 or more
flattening canals; floor
of pulp
chamber has
been totally
damaged but
not perforated
Internal outline: All canals located and glide path All canals located and glide path Only 2 of the standard 3 canals Only 1 of the
canal location stablished; orifices of all canals stablished; orifices enlarged located; glide path not standard 3
opened adequately with with X-Gates but minor ledges stablished for >1 canal; orifices canals
X-Gates without any ledges present widened adequately with located; glide
X-Gates but not in all canals; path has not
large ledges present in 1 canal been
that prevents smooth insertion stablished in
of file all canals;
orifices are
over prepared
with X-Gates
(almost
perforated)
Acceptable preparation
Prosthodontics Ideal preparation 2 marks 1 mark Standards not met 0 mark
Buccal + lingual walls Parallel to slightly tapered 6–10 degree tapered (total) >10 degrees tapering and/or
(total 6 degrees) undercut
Mesial + distal walls Parallel to slightly tapered 6–10 degree tapered >10 degrees tapering and/or
(total 6 degrees) undercut
Occlusal reduction Functional cusp 2 mm ± 0.4 mm of ideal prep > ± 0.4 mm of ideal prep
non-functional cusp
1.5 mm
Preservation of tooth shape Well-shaped Acceptable result Preparation is out of shape
and anatomy, tooth
clearly recognisable
(Continues)
BRAGA et al. 5

TA B L E 1 (Continued)
Prosthodontics
Sufficient reduction of
buccal and lingual
margins and 2 planes on
functional cusp wall
Sufficient minimal
reduction of mesial +
distal margins
Correct and smooth margin
(shoulder
buccal/chamfer lingual)
Supragingival preparation
Overall smoothness of prep
No damage to adjacent
teeth
Ideal preparation 2 marks
1.2 mm buccal; 0.8 lingual
reduction and 2 planes
0.8 mm (chamfer) 1.2 mm
(shoulder)
Perfectly smooth, no
scratches and marks,
correct margins
0–0.5 mm and even
Perfectly smooth, no
scratches and marks
No damage
Acceptable preparation
1 mark
±0.2 mm of ideal prep and
no 2 planes
± 0.2 mm of ideal prep
Minor superficial scratches
but homogenous and
correct margin
0–1 mm and uneven
Minor scratches and marks
No damage
Standards not met 0 mark
>±0. 2 mm of ideal and no 2
planes
>0.2 mm of ideal
Major scratches and/or
margin not even, Breaks,
incorrect margin
>1 mm or subgingival
Major scratches and marks
Scratches/minimal damage: 0
Obvious damage: -2
points/tooth

F I G U R E 2 Prosthodontics exam (A) Tooth 30 before porcelain fused to metal preparation. B) Prosthodontic bur kit. (C) Over reduction
≥ 3 mm combined with preparation out of shape. (D) Over reduction ≥ 3 mm combined with preparation out of shape and damage of tooth 29.
(E, F) The top 2 porcelain fused to metal preparations performed by students using magnifying dental loupes
6 BRAGA et al.

TA B L E 2 Descriptive and comparative analysis of practical exam results according to general variables
Endodontic group Prosthodontic group
Practical exam Practical exam
Total Fail Pass Total Fail Pass
Variables n (%) n (%) n (%) P n (%) n (%) n (%) P
Gender 0.083 0.045
Female 53 (57.0) 6 (11.3) 47 (88.7) 39 (45.3) 18 (46.1) 21 (53.9)
Male 40 (43.0) 10 (25.0) 30 (75.0) 47 (54.7) 12 (25.5) 35 (74.5)
Age group 0.194 0.837
22–24 years 42 (45.2) 10 (23.8) 32 (76.2) 37 (43.0) 14 (37.8) 23 (62.2)
25–29 years 28 (30.1) 2 (7.1) 26 (92.9) 29 (33.7) 10 (34.5) 19 (65.5)
30 years and over 23 (24.7) 4 (17.4) 19 (82.6) 20 (23.3) 6 (30.0) 14 (70.0)
Australian nationality 1.000 0.486
Yes 42 (45.2) 7 (16.7) 35 (83.3) 30 (34.9) 9 (30.0) 21 (70.0)
No 51 (54.8) 9 (17.6) 42 (82.4) 56 (65.1) 21 (37.5) 35 (62.5)
Use of dental loupes 0.038 0.003
Yes 39 (41.9) 3 (7.7) 36 (92.3) 50 (58.1) 11 (22.0) 39 (78.0)
No 54 (58.1) 13 (24.1) 41 (75.9) 36 (41.9) 19 (52.8) 17 (47.2)
Chi–square test.

group, 58.1% of students used loupes and the pass rate was
65.1% (Table 2).
Table 2 also shows the comparative analysis of pass rate.
Men had a higher pass rate than women in prosthodontic
group (74.5% vs. 53.9%, P = 0.045). There were statistically
significant differences in pass rate between students that
were using magnifying dental loupes compared to those
without using no magnification. The pass rate was higher
for the students who used loupes in endodontic group
(92.3% vs. 75.9%, P = 0.038) and prosthodontic group (78%
vs. 47.2%, P = 0.003).
The most common failure for the endodontic group was
failing to remove >50% of the roof of the pulp chamber
(n = 7) (Figure 1C), followed by overextended outline and
damage to the floor of pulp chamber but not perforated
(n = 6) (Figure 1D) and blocked canals while using X-Gates
instruments (n = 3).
The top 5 endodontic preparations in grade were per-
formed by students that used magnifying dental loupes.
Figures 4E-G show the best endodontic preparation per-
formed by a student of this group.
The most common failure for the prosthodontic group
was over reduction ≥ 3 mm, which compromised too much
tooth structure (n = 15) (Figure 2C), followed by under
reduction ≤1 mm, which would not be enough reduction
for a PFM (n = 8), both combined with preparation being
out of shape and damage to 1 or more adjacent teeth that
would require restoration (n = 7) (Figure 2D).
The top 7 PFM preparations in grade were performed by
students that used magnifying dental loupes. Figures 2E, F
show the top 2 PFM preparations performed by students of
this group.
There were no statistically significant differences in
cumulative GPA according to the use of loupes and prac-
tical exam marks for both, endodontic and prosthodontic
groups (Table 3).
The logistic regression analysis showed that loupes
use was associated with increased odds of above average
performance in endodontic group (adjusted OR = 4.23,
95% CI = 1.08–16.5, P = 0.037) and prosthodontic group
(adjusted OR = 3.42, 95% CI = 1.30–8.96, P = 0.012), even
after adjustment for gender (Table 4).
In the academic year 2018 (the endodontic group) 39 of
the 93 (42%) students used magnification. In the academic
year 2019 (the prosthodontic group), this had risen to
50 out of 86 (58%).
4 DISCUSSION
Magnification is considered a great revolution in sci-
ence, and specifically in dentistry.8,23 Many dental schools
around the world now actively encourage their students
to use magnification while training.7,21,22 The advantages
include improving the quality of treatment, achieving bet-
ter posture during dental practice, reducing visual stress,
and decreasing musculoskeletal injury when implement-
ing them in dental practice. Though these advantages
occur only after going through the proper training and
after gaining the required skills.24–28
BRAGA et al.
TA B L E 3 Comparative analysis of cumulative grade point average (GPA) according to the use of dental loupes and practical exam results
Use of dental loupes
Fail Pass
Course Mean ± SD Mean ± SD
Endodontics 5.95 ± 1.11 6.16 ± 0.65
Prosthodontics 6.46 ± 0.58 6.45 ± 0.73
One-way ANOVA test.
T A B L E 4 Logistic regression analysis of association between
the use of dental loupes and the practical exam results adjusted for
gender
Adjusted
Models OR (95% CI) P that good vision is crucial in dentistry.
Endodontic group
Use of dental loupes 4.23 (1.08-16.50) 0.037*
Prosthodontic group
Use of dental loupes 3.42 (1.30-8.96) 0.012*
OR = Odds ratio. 95% CI = 95% confidence interval. Models adjusted for the
use of dental loupes and gender.
Custom-fitted quality magnification loupes have never
been inexpensive. They are made with oculars that have
high-quality optical glass, and frames that can be person-
ally adjusted to the user’s face.10 Other features then to
be considered include a choice of lens design, flip-up ver-
sus fixed-lens systems, working angle/distance, and head-
band versus glasses. Matching personal demands with the
options available will ensure a wiser investment and an
easier adaptation.29 However, in the present study, the use
of dental loupes was not compulsory, and 1 of the main rea-
sons for not all the students had loupes was due to the high
cost of quality loupes.
The result of this study showed there was a statisti-
cally significant difference (P < 0.05) between preparations
done by students who select to use magnification com-
pared to those without magnification. It is important to
highlight that all students received the same training for
the 2 disciplines during the academic year. The difference
in performance between the 2 groups is consistent with the
studies of Leknius and Geissberger21 and Maggio et al.,22
which concluded that dental magnification loupes signif-
icantly enhanced student performance during preclinical
dental education and were considered an effective adjunct
by the students who used them. Our results are also consis-
tent with the study of Brown et al.,30 which investigated the
use of magnification in undergraduate endodontics teach-
ing in the United Kingdom and Ireland. They concluded
that the use of dental loupes in nonsurgical endodontics
could be considered the minimum standard.
In contrast to scientific evidence supporting the low
impact of magnification on the dentist’s performance,20,31
7
No magnification
Fail Pass
Mean ± SD mean ± SD P
5.99 ± 0.78 6.25 ± 0.65 0.618
6.07 ± 0.79 6.43 ± 0.73 0.285
other studies indicate a direct influence of magnification
on the dental work. According to Eichemberger et al.,32
there is a lack of knowledge about the impact of magni-
fication on the performance of dentists. It seems evident
Even though some studies have shown high variabil-
ity in the near visual acuity of dentists,32–34 a standard-
ized visual test at a dental working distance was not per-
formed on the study participants. The acuity declines with
the increasing age of dentists older than 40 years as a result
of presbyopia.35–36 Eichemberger et al.37 showed a signifi-
cant improvement in the visual acuity with the use of den-
tal loupes independent of the dentist’s age. In the present
research, the most frequent age for both groups was 21–24
years.
The difference between the 2 groups was that 1 group
used magnification and the other did not. Table 2 shows
there were no statistically significant differences between
the groups in relation to age and nationality. Table 3 shows
there were no statistically significant differences in cumu-
lative GPA according to the use of dental loupes and prac-
tical exam marks for both endodontic and prosthodontic
groups. The logistic regression analysis results revealed
that the groups that used dental loupes were associated
with pass at practical exam in endodontic group (adjusted
OR = 4.23, 95% CI = 1.08–16.5, P = 0.037) and prosthodontic
group (adjusted OR = 3.42, 95% CI = 1.30–8.96), P = 0.012),
even after adjustment, for gender (Table 4).
The prediction of the number of failures assumes that,
apart from the use of loupes, there are no other significant
differences between the groups. There is little published
evidence on the motivation dental students to use magnifi-
cation, nor on any potential differences between the group
of students who regularly use magnification and those who
do not.
One suggestion from this paper is that all students
should use loupes both in the Simulated Clinical Environ-
ment as well as when treating patients. There is a signifi-
cant cost implication for students should the use of loupes
become mandatory. If students were required to purchase
loupes, then this should be made clear to potential students
during the application process.
It is still not clear in the literature when is the best time
to start using loupes in dental schools. We believe that in
8 BRAGA et al.
the simulation laboratory students have more time to get
used to dental loupes without stress; therefore, they feel
more confident working with this technology when they
get to the clinic.
Further research is required to identify the potential bar-
riers to students using loupes during the clinical years of
the program, and whether the change in the pattern of
use seen in these 2-year group’s precedents a trend. The
authors’ subjective experience backed up by the data in this
study is that those students who use magnification find it
beneficial. Thus, identifying potential barriers to the use of
magnification by clinical dental students will be an impor-
tant stage in promoting the use of loupes by clinical dental
students.
This study did not consider the financial circumstances
of the students. It is possible that those students who
used loupes experienced less of a financial burden dur-
ing the course, and thus had fewer distractions during
the program. Further study would be valuable in this
area.
The findings indicate that students using loupes appear
to have a significant advantage. If the use of loupes is to be
encouraged, then dental schools should consider advising
potential students of the advantages of purchasing loupes.
It would also be important to make potential students
aware of this additional expenditure.
5 CONCLUSION
In conclusion, third-year dental students who used den-
tal loupes in the endodontics and prosthodontics simula-
tion laboratory demonstrated significantly better scores at
their assessments. The undergraduate students who did
not use magnification were significantly more likely to fail
the assessments.
AC K N OW L E D G M E N T S
This study was supported in part by the Coordenação
de Aperfeiçoamento de Pessoal de Nível Superior
Brasil (CAPES) Finance Code 001 and PROCAD grant
88881.357834/2019-01.
CONFLICTS OF INTEREST
The authors deny any conflicts of interest.
REFERENCES
1. Buhrley LJ, Barrows MJ, BeGole EA, Wenckus CS. Effect of
magnification on locating the MB2 canal in maxillary molars.
J Endod. 2002;28(4):324-327.
2. Capelli A, Duarte MAH, Vivan R, et al. New resources to miti-
gate failure in root canal treatment and retreatment. Endodontic
Practice US. 2017;10:12-15.
3. Forgie AH, Pine CM, Pitts NB. Restoration removal with and
without the aid of magnification. J Oral Rehabil. 2001;28(4):309-
313.
4. Forgie AH, Pine CM, Pitts NB. The use of magnification in
a preventive approach to caries detection. Quintessence Int.
2002;33(1):13-16.
5. Eichenberger M, Perrin P, Sieber KR, Lussi A. Near visual acuity
of dental hygienists with and without magnification. Int J Dent
Hyg. 2018;16(3):357-361.
6. Lussi A, Kronenberg O, Megert B. The effect of magnification on
the iatrogenic damage to adjacent tooth surfaces during class II
preparation. J Dent. 2003;31(4):291-296.
7. Narula K, Kundabala M, Shetty N, Shenoy R. Evaluation of tooth
preparations for class II cavities using magnification loupes
among dental interns and final year BDS students in preclinical
laboratory. J Conserv Dent. 2015;18(4):284-287.
8. Alhazzazi TY, Alzebiani NA, Alotaibi SK, et al. Awareness and
attitude toward using dental magnification among dental stu-
dents and residents at King Abdulaziz University, Faculty of
Dentistry. BMC Oral Health. 2016;17(1):21.
9. Friedman MJ. Magnification in a restorative dental prac-
tice: from loupes to microscopes. Compend Contin Educ Dent.
2004;25(1):53-55. 48, 50.
10. James T, Gilmour AS. Magnifying loupes in modern dental prac-
tice: an update. Dent Update. 2010;37(9):633-636.
11. Hayes MJ, Cockrell D, Smith DR. A systematic review of muscu-
loskeletal disorders among dental professionals. Int J Dent Hyg.
2009;7(3):159-165.
12. Thornton LJ, Barr AE, Stuart-Buttle C, et al. Perceived muscu-
loskeletal symptoms among dental students in the clinic work
environment. Ergonomics. 2008;51(4):573-586.
13. Gupta A, Ankola AV, Hebbal M. Dental ergonomics to com-
bat musculoskeletal disorders: a review. Int J Occup Saf Ergon.
2013;19(4):561-571.
14. Zarra T, Lambrianidis T. Musculoskeletal disorders amongst
Greek endodontists: a national questionnaire survey. Int Endod
J. 2014;47(8):791-801.
15. Plessas A, Bernardes Delgado M. The role of ergonomic sad-
dle seats and magnification loupes in the prevention of mus-
culoskeletal disorders. A systematic review. Int J Dent Hyg.
2018;16(4):430-440.
16. Valachi B, Valachi K. Mechanisms leading to musculoskeletal
disorders in dentistry. J Am Dent Assoc. 2003;134(10):1344-1350.
17. Valachi B, Valachi K. Preventing musculoskeletal disorders
in clinical dentistry: strategies to address the mechanisms
leading to musculoskeletal disorders. J Am Dent Assoc.
2003;134(12):1604-1612.
18. Mangharam J, McGlothan JD. Ergonomics in the dental care
worker. In: Murphy D, ed. Ergonomics and the Dental Health
Care Professional. Washington, DC: American Public Health
Association; 1998:25-81.
19. Whitehead SA, Wilson NH. Restorative decision-making behav-
ior with magnification. Quintessence Int. 1992;23(10):667-671.
20. Donaldson ME, Knight GW, Guenzel PJ. The effect of magnifi-
cation on student performance in pediatric operative dentistry.
J Dent Educ. 1998;62(11):905-910.
21. Leknius C, Geissberger M. The effect of magnification on the
performance of fixed prosthodontic procedures. J Calif Dent
Assoc. 1995;23(12):66-70.
BRAGA et al.
22. Maggio MP, Villegas H, Blatz MB. The effect of magnifica-
tion loupes on the performance of preclinical dental students.
Quintessence Int. 2011;42(1):45-55.
23. Carr GB, Murgel CAF. The use of the operating microscope in
endodontics. Dent Clin North Am. 2010;54(2):191-214.
24. Del Fabbro M, Taschieri S, Lodi G, Banfi G, Weinstein RL. Mag-
nification devices for endodontic therapy. Cochrane Database
Syst Rev. 2009;3:CD005969.
25. Christensen GJ. Magnification in dentistry: useful tool or
another gimmick? J Am Dent Assoc. 2003;134(12):1647-1650.
26. Mallikarjun S, Devi P, Naik A, Tiwari S. Magnification in dental
practice: how useful is it? J Health Res Rev. 2015;2:39-44.
27. Maillet JP, Millar AM, Burke JM, Maillet MA, Maillet WA, Neish
NR et al. Effect of magnification loupes on dental hygiene stu-
dent posture. J Dent Educ. 2008;72(1):33-44.
28. Low JF, Mohd Dom TN, Baharin SA. Magnification in endodon-
tics: a review of its application and acceptance among dental
practitioners. Eur J Dent. 2018;12(4):610-616.
29. Baker JM, Meals RA. A practical guide to surgical loupes. J Hand
Surg Am. 1997;22(6):967-974.
30. Brown MG, Qualtrough AJE, McLean W. Magnification in
undergraduate endodontic teaching in the UK and Ireland:
a survey of teaching leads in endodontology. Int Endod J.
2020;53(4):553-561.
31. Neuhaus KW, Jost F, Perrin P, Lussi A. Impact of different mag-
nification levels on visual caries detection with ICDAS. J Dent.
2015;43(12):1559-1564.
View publication stats
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32. Eichenberger M, Perrin P, Ramseyer ST, Lussi A. Visual acuity
and experience with magnification devices in Swiss dental prac-
tices. Oper Dent. 2015;40(4):E142-E149.
33. Perrin P, Ramseyer ST, Eichenberger M, Lussi A. Visual acuity of
dentists in their respective clinical conditions. Clin Oral Investig.
2014;18(9):2055-2058.
34. Perrin P, Neuhaus KW, Lussi A. The impact of loupes and micro-
scopes on vision in endodontics. Int Endod J. 2014;47(5):425-
429.
35. Pointer JS. The presbyopic add. II. Age-related trend and a gen-
der difference. Ophthalmic Physiol Opt. 1995;15(4):241-248.
36. Gilbert JA. The dentist and the aging eye. J Mo Dent Assoc.
1980;60(3):22-24.
37. Eichenberger M, Perrin P, Neuhaus KW, Bringolf U, Lussi A.
Visual acuity of dentists under simulated clinical conditions.
Clin Oral Investig. 2013;17(3):725-729.
How to cite this article: Braga T, Robb N, Love
RM, et al. The impact of the use of magnifying
dental loupes on the performance of undergraduate
dental students undertaking simulated dental
procedures. J Dent Educ. 2020;1-9.
https://doi.org/10.1002/jdd.12437