Using a dental operating microscope

Dr. Antony Esprey explains why he has integrated the dental operating microscope into his practice, the benefits it has provided, the learning process, and the decisions that influenced his choice

Dentistry has always been limited by the small field — the tooth — something that is further impeded by the mouth. This difficulty has made diagnosis and execution of treatment somewhat difficult.

To be able to see the field of vision unimpeded has long been the dream of all dentists. Unfortunately, even with 20/20 vision, this has in the past been a random affair with haphazard results.

Changed perspective

However, with the advent of loupes, this difficulty seemed to be overcome, and the restricted vision of a dentist was improved. Using loupes required some initial orientation stages, but once they were mastered, the tooth became something that was big enough. Dentists were now able to see things that previously were only guessed at.
The dentist could now make accurate assessments and diagnose more easily. It was now possible to see the fracture lines that could have been responsible for the patient’s discomfort. Guesswork was reduced, and the field opened up a myriad of options available to the patient. Loupes changed the perspective of dentistry.
As a general dental practitioner, loupes served me well, and once I started to use them, I was no longer able to work without them. It was a quantum leap from the days when I would be peering into a patient’s mouth trying to get the best view of the tooth that was causing problems.  

Under the microscope

This journey of discovery was further enhanced with the advent of the microscope and, once again, I was able to multiply my field of vision.

The microscope opened up an entirely different work environment. So much more is visible via the range of six different levels of magnification. This allows the dentist to detect dental problems when they are small, which in turn, lets the dentist diagnose more accurately, as well as advise and show the patients their options. This means that the small problems don’t escalate into problems that are difficult to treat, time-consuming, expensive, and invasive. This benefits both the dentist and the patient.

When microscopes were first introduced in dentistry, I thought that there would not be much use for them in general dentistry. I thought that they were the domain of the specialist endodontists. However, since purchasing one, I have been overwhelmingly convinced that there is great use for them in general dentistry as well.

Transitions

Once I made the decision to purchase a Global microscope, my mindset had to shift from using loupes to using a microscope. The transition from headband loupes to microscope was postural. Loupes can move around, whereas the microscope is relatively fixed. Overcoming this obstacle was relatively slow as it takes time to readjust to a different visual field. However, once achieved, the benefits of using a microscope are obvious, and working without it would now be im-
possible for me.

There are several adjustments that dentists need to make once they have taken the step to start using a microscope. I have enjoyed using it and adapted to it. Every time I used it, I became more confident and familiar with it. I now never work without it.  
Here are some of the factors that helped me to become more accomplished at using it.

Sitting comfortably

Adjusting the height of the microscope to suit my sitting position and then the patient chair allows for most situations to be visualized almost immediately with minimal adjustment. Smaller adjustments will be accomplished by moving the chair slightly, the microscope slightly, or adjusting the fine focus on the microscope.

If the swivel settings are loose, then it is easy to move with your hand, head, or nose. Posture and comfort for the dentist are enhanced with correct setup and use. Once the learning curve has passed, the postural benefits of microscope use become apparent (Figure 1).
Correct installation and positioning of the microscope in the surgery are vital to ensure easy access and regular use. I opted for a high wall-mounted Global unit, which eliminates any clash with existing equipment such as X-ray units (Figure 2).

Assistance please

Dental assistants also have to make a few changes to the way they assist the dentist. For example, they have to adjust to a slightly different aspirating technique so that they are not obstructing the dentist (Figure 3). They also have to develop a different technique for passing instruments. They must place instruments in the dentist’s hand with the tips of the instruments facing in the direction needed for the surface being worked on. Dental assistants also need to render the instruments nonstick while placing composites. They need to turn the amber microscope filter on and off when teeth are being restored with composites.

At times, it does help to have the light switched off to prolong the working time with composites and for the assistants to view textures on the screen via the camera. Endodontics lends itself especially well to the microscope, and here the skill of the dental assistants is of paramount importance. They need to be excellent at assisting with the sterilization, irrigation, and obturation of the canals.

A whole new world

Using a microscope improves the predictability of most procedures. Once using the microscope has been accomplished, a different world awaits. In this new world:

• Gingival health is clearly shown and crevicular status accurately determined.
• Enamel textures and dentin characteristics are more visible.  
• The marginal bevels and finish lines are very clear.
• Crown margins can be very precise, and preparations can be very exact.
• Pulpal health during procedures can be assessed and minute exposures detected.
• One can travel down root canals and never miss extra canals.

Once you start using the microscope, you can never go back to working without it; it opens up a new world of possibilities.

Going global

My Global microscope incorporates a fully adjustable, silent (no fan) LED light with composite filter, a digital stills/video camera for documentation, patient education, and nurse participation. Support from the manufacturer and supplier (for me that’s Global and DP Medical Systems) is important from the outset in choosing the correct specification to suit, gaining familiarization during the learning curve and the provision of long-term technical support. The modular concept of the Global microscope enables me to add new developments and upgrades as they become available with minimum cost implications. I chose Global for its reputation for quality and service provided through its UK distributor DP Medical Systems Ltd.

Improved outcomes

The microscope provides numerous benefits for dentists, nurses, and patients. Patients are impressed with the technology, the level of care offered by micro-dentistry, and the ability to view conditions that previously could only be described by the dentist. This enables the dentist to involve the patient in treatment decisions and the rationale for treatments. I consider investment in technology vital to maintain the practice ethos of quality care. I decided to introduce the microscope to my practice for all of these reasons and particularly to improve outcomes and predictability. Early signs indicate that these latter objectives are being fulfilled. My enthusiasm for precision dentistry has been further advanced.