Optimizing surgical visualization with the ZEISS EXTARO® 300

Dr. Jon Irelan discusses innovations in endodontic microsurgery

With advances in 3D-imaging techniques and the advent of microtomography, our understanding of root canal anatomy has evolved markedly over recent decades. Through this understanding comes the realization that root-end anatomy presents with profound complexity and variability. Further complicated by the intricate mechanism of periapical disease and biofilms, the challenge we face as clinicians is the necessity for diligent and accurate detection of etiologies associated with the pathoses we seek to resolve.

Historically, my practice has been largely centered on endodontic retreatment and microsurgery. With many microsurgeries involving the treatment of molar teeth, ideal visualization of the surgical site is a main concern. In addition to properly accessing the surgical site, great effort must be made to achieve proper positioning of the patient in order to remain comfortable throughout the procedure.  Furthermore, this must be done while also allowing the clinician to maintain ideal posture throughout the surgery. Thanks to features offered by the EXTARO^® 300 from ZEISS, these goals can be readily accomplished.

With the MORA Interface, eyepieces are kept level while the lens can be angled sharply to accommodate the patient’s position.  While the Foldable Tubes are a lesser-known feature of the EXTARO 300, they allow the clinician to remain a greater distance from the scope and can even allow the lens to be angled back toward the clinician. The Varioskop^® 230 from ZEISS allows for even greater flexibility with a focal length of 200 mm to 430 mm, which accommodates a wider in-focus range of distance between the scope and the patient than other endodontic microscopes.

While I regularly employ methylene blue dye for evaluation of root structure and apical anatomy, I have found Fluorescence Mode on the EXTARO 300 invaluable. Fluorescence Mode allows for the detection of cariogenic bacteria by exciting fluorophores, which give off an orange-red light, a technology that does not require the application of any additional substances. While its intended use allows for caries detection with high sensitivity and specificity, I have personally found it to act as an excellent contrasting tool during microsurgery. Using this augmented visualization mode, dentin and cementum fluoresce brilliantly relative to osseous and soft tissue. This distinction between tissues allows for ready identification and evaluation of the root structure, providing another important tool for locating critical root canal anatomy during microsurgical procedures.