All our offices are equipped with Operating Microscopes, digital radiography and cone beam computed tomography (CBCT) units.
All treatment rooms are equipped with operating microscopes. Magnification and halogen fiber optic illumination are invaluable in aiding the doctor in performing all technical aspects of endodontic procedures. Many of our operating microscopes are equipped with miniature high-resolution video cameras or digital still cameras to help document cases for enhanced communication.
The typical OM (Operating Microscope) head has three main parts — body tube optics, an eyepiece and an objective lens. Working together, these pieces magnify small objects in the surgical area by powers of approximately 5, 8, 12 and 16.
Illumination is a key feature of the OM. Procedures are viewed with a higher level of clarity and depth of focus. Fiberoptic or integral halogen and xenon light sources on our OMs deliver approximately 20,000 -50,000 candle power to the operating field.
Video cameras and/or 35mm photographic cameras are attached for high resolution imaging.
Uses of the Operating Microscope in Dentistry
The OM has revolutionized both nonsurgical and surgical endodontics, and is likely to have a significant impact in other fields of dentistry in coming years. Applications of the OM in endodontics are outlined below.
The Operating Microscope is an asset in examining the pulp chamber and root canal system. It helps assess the completeness of cleansing and the existence of fractures. Enhanced visualization through the OM also reduces fatigue and eye strain, and facilitates more efficient biomechanical instrumentation. Eyeglass type loops available for improved magnification help in this regard as well, but are limited by lack of focused lighting, restricted depth of focus, and the availability of only one power of magnification per pair.
Difficult endodontic cases may involve calcified root canal and/or chamber systems; internal resorptive lesions with or without external complications; crown and root fractures; caries; and cases with limited or restricted access. These cases are more successfully treated when using the OM.
This condition poses difficult challenges because the coronal and radicular pulp canals are obliterated by hard tooth structure. Although calcifications do occur in healthy uninflammed pulp, they tend to increase in dimension and frequency with irritation and age. The OM allows the operator to discern differences in the color of primary and other dentin types, which facilitates location of root canal orifices. The OM allows the user safely to explore the dentin visually rather than invasively. Removal of overlying dentin can be accomplished safely and precisely with direct vision through the OM, using high speed instrumentation or ultrasonic tips.
Resorptive Lesions and Defects:
Among the most difficult endodontic lesions to treat are pathologic external root resorption and the rarer progressive type of internal resorption. When the resorptive lesion is in the middle or coronal third of the root canal system, it often is possible to view using the OM and better gauge the prognosis of these teeth without relying solely on radiographic interpretation. Medicaments can be applied directly to the defect, and prognosis for other treatment modalities such as root extrusion can be assessed with the aid of the OM.
Crown and Root Fractures:
Fractured amalgams and tooth structure can be viewed and documented with excellent quality results using both 35mm and video OM technology. The video images can be displayed to the patient instantly via the freeze frame mode, or saved as a video print either on disk or on any computer equipped with a video capture board. This level of documentation is a valuable tool. In addition, the images, once transcribed to hard copy, can be used to communicate the exact location and extent of the fractures to your treating dentist.
Ordinarily, the size and extent of a fracture determines the prognosis for a tooth. The use of methylene blue dye is a superb marker of fractures and aids visualization.
Especially under full crown restorations, caries removal is more accurate and complete using the OM because the carious defect can be viewed while the dental handpiece is being used. The OM is helpful in sealing a carious perforation because it makes the site visible and illuminates the application of appropriate filling material.
Limited or Restricted Access:
Locating canals and examining the chamber and root canal system for fractures in difficult access situations also is easier with the OM. For instance, third molars and distally (backwardly) tipped second molars present fewer visibility problems with the intense light of the OM. Minor color changes in the dentin are more easily discernible, providing clues for locating calcified canals and facilitating caries removal.
Endodontic retreatments pose some of the most difficult challenges to the clinician. The nonsurgical retreatment of endodontic failures is the preferred treatment when feasible.
When retreatment is necessary, whether due to radiographic periapical pathosis, discomfort or prosthetic problems, the OM again enhances visualization. Inadequate cleansing, missed canals, and poor sealing are principal contributors to endodontic failure. The enhanced visibility afforded by the illumination and magnification of the OM aid in the accurate removal of debris, as well as cements, amalgam and cast metallic cores. Canal orifices can be identified more accurately and removal of contaminated canal filling material can be accomplished using a solvent (or heat) for gutta-percha and ultrasonics for non-soluble cements, silver cones and broken instruments.
Ultrasonic instrumentation is valuable in removing the cements frequently used in endodontic therapy performed overseas. Ultrasonic retroprep tips and files often can remove non-soluble cements quickly and accurately, thereby greatly reducing the chances of perforation associated with high and low speed dental handpiece burs. This procedure can be monitored with the OM at critical intervals to enhance control of the removal process.
Separated (broken) endodontic instruments in the root canal system may result in endodontic failure. The OM is helpful in illuminating the handling of these problems.
Similarly, the OM is useful in removing silver cones (“points”, “wires”). Post removal has been a difficult treatment issue for anyone attempting nonsurgical retreatment of an endodontic failure or post fracture. Ultrasonics, high magnification and brighter lighting play a significant role in post removal. With the OM, placement of special ultrasonic tips on non-cast and cast posts is more precise, and the vibratory forces are better directed until the post loosens in its preparation. Removal of the cement and/or composite or glass ionomer resins in the chamber around the post is also more efficient.
A micro-surgical approach may be necessary when orthograde (conventional) endodontic treatment is impossible or ineffective in resolving an endodontic problem. The OM is especially well suited to endodontic root end surgery because of its superior ability to magnify and illuminate the surgical site. Atraumatic flap management is best accomplished under magnification. The magnification can be increased for assessment of the osseous tissue and removal of the root end infection can then be accomplished.
Preparation of the root apex or large lateral canals then can be performed using ultrasonic retroprep tips. The OM allows detailed examination of the apical micro-preparation during the entire procedure. After the apical retroprep is performed, a thorough examination can be made using the extremely high quality reflective surfaces of small sapphire mirrors.
The spectacular clarity of the OM provides a definite benefit in the placement of bone augmentation material, guided tissue regeneration procedures, and routine suturing. Because suturing is critical to the success of these membrane placements and routine surgery, the OM is an invaluable device. Even in routine endodontic surgery, where accuracy of needle placement and tissue edge approximation for primary wound healing are critical, the OM is extremely effective.
High definition images can be captured through the Operating Microscope through either a 35mm camera or a mini lipstick camera.
Radiographs (x-rays) are an essential part of quality endodontic therapy. Our offices utilize an advanced non-film dental imaging system known as CDR (computed dental radiography). The already low radiation required for dental radiographs is further reduced by over 80% compared to conventional film. Using this system, an electronic sensor produces computerized radiographs which appear instantly on a chairside computer screen. These images can then be optimized, printed, archived indefinitely and sent to your dentist.
Our office employs the use of CCD/CID/CMOS sensors to produce direct digital images. Direct digital radiography has many advantages over silver halide film, such as speed, reduced radiation, environmental waste reduction, elimination of darkroom costs, and lossless e-mail image transfer and documentation.
The quality of many film-based images may be compromised by operational problems such as chemical and film freshness, developing inconsistencies, light leaks, and shipment handling. Detection of gross and moderate caries can be performed with both conventional film and digital imaging systems with a great degree of surety. For incipient caries detection, film sharpness and detail are still helpful adjuncts to digital systems. Unfortunately, the presence of caries are always more extensive than depicted by either digital or film systems.
Digital imaging requires less radiation than film based systems and are virtually instantaneous.
While film based images can easily be produced in duplicate, each subsequent rendition of the image will be reduced in quality. Digital images, on the other hand, can be reproduced in unlimited quantity because the images are stored and produced without loss of any detail. Furthermore, digital images can be stored on and off site, on many types of media, thereby helping to mitigate theft, fire or other damage to records.
Our offices utilize cone beam computed tomography (or CBCT), which offers extensive information in the assessment, diagnosis, and treatment planning of conventional and surgical endodontic therapy. In comparison to two-dimensional radiography, a three-dimensional rendition offers the clinician an undistorted view of the affected tooth that can be used to accurately visualize tooth orientations and anamalous structures, in addition to providing greater insight into complex radicular configurations and root canal systems. The CBCT is invaluable in diagnosis, locating missed and calcified canals, and identifying root fractures.
- Root Apex Locators
- System B
- Electronic Handpiece