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Use of Dental Operating Microscope in endodontic therapy In all areas, from exposure of the access cavity and preparation to three-dimensional obturation and post endodontic management, the microscope provides major advantages over working without appropriate magnification. As a result, the use of the microscope can be expressly recommended for the following specific indications and special aspects.
For an endodontic specialist include: increased visualization, improved Quality and precision of treatment, enhanced ergonomics, ease of proper digital documentation and increased communication ability through integrated video.
1} Examination, diagnosis, and treatment planning - With enhanced visualization, the clinician’s ability to diagnose problems in the earlier stages of a disease process is possible. High-powered magnification allows endodontists to identify a microscopic blemish,colour alteration, tiny amounts of plaque collecting within the grooves, microscopic amounts of chalky white demineralization around the grooves, and tiny amounts of flaking of darkened carious tooth structure within the crevices of these grooves. Treatments also can be performed with a greater level of precision, thereby reducing the occurrence of failures and the need of redos.
2} Diagnosis of cracked teeth Microfractures and longitudinal fractures which are often difficult to diagnoseclinically and represent signs of occlusal damages which include cracks in teeth orrestorations, craze lines, wear facets, cracks at slightly elevated marginal ridges, or areaswhere the enamel has been worn by opposing porcelain, exposing dentin and thus causingsensitivity and pain can be viewed more precisely with DOM
3} Better visualization of pulp chamber, canal orifices Magnification allows endodontists to better identify anatomical landmarks, within thepulp chamber—including the sides, overhanging remnants of the pulp chamber roof, initialperforations into the pulp, dentinal map, canal orifices and to differentiate between the pulphorns and the main body of pulp within the chamber
4} During instrumentation , the improved ability to see specific canals allowsendodontists to maneuver files into canal openings with greater efficiency, to distinguishbetween vital and necrotic canals, and to detect tiny amounts of purulence or blood drainingthrough specific canals or see any tiny amounts of necrotic pulp material that were notremoved during canal instrumentation. So it is possible for an endodontist to determine if allcanals are accessed and instrumented properly when a direc t view might be difficult withoutremoving excessive amounts of coronal tooth structure
5} Locating hidden canals/canal systems Anatomical variations are not as rare or exotic as is frequently assumed as described by Walter Hess as early as 1917. Many of these important structures cannot be readily detected or treated with traditional endodontic treatment methods. If the radiographic image is examined more closely, there are often signs of unusual root and/or canal shapes like those caused by changes in the course of canal anatomy or root surface.An off center exposure or three dimensional image can provide further valuable information. Three rooted premolars, for example, are encountered in 6% of all first maxillary premolars. However, anatomical variations also include other complex structures like middle mesial canal in mandibular first molar and C-shaped canals in mandibular second molar (7.6%) . Without a doubt, the second mesiobuccal canal in maxillary molars (16% and 78% in vivo), which is often difficult to localize and prepare, is the reason why the failure rate is highest in first maxillary molars . Virtually all studies point to distinct advantages in the localization and treatment of this highly complex anatomical variation when using a dental microscope. The introduction of the dental microscope and the associated ability to inspect the root canals – both orthograde and retrograde – have fundamentally changed our understanding of dental morphology and its complexity.
6} Identification and removing of Obliterations and calcifications - These signs occur to a greater or lesser extent in 50% of all teeth, impairing instrumentation considerably or essentially preventing treatment of the canal system
Identification and removal of Denticles This specific form of calcification is also encountered very frequently, can block the canal entranceor even obstruct further instrumentation. Denticles can be found and negotiate readily with the help of a DOM
In Open apex cases Modern apexification therapies call for special treatment techniques and materials, the manipulation of which is facilitated significantly under a dental microscope .
Perforation repair Treatment of iatrogenic problem such as pulpal floor perforation, lateral root perforation and prognosis chiefly involve visualization of the problem so the microscope certainly plays a major role in this contex.
7} Removal of fractured post and instruments The enhanced vision with magnification and illumination from a microscope allows endodontist to observe the most coronal aspects of fractured post and broken instruments andto remove them without any major loss of tooth structure and perforations, the prognosis forpreservation of the tooth is quite good.
Microsurgical apicoectomy Incorporating microscopic approach in surgical endodontics, Use of the smaller retro mirrors it is possible to carefully examine the apical segment of the root endand perform an atraumatic , more moderated bevel apical resection procedures and permit a coaxial ultrasonicpreparation into the root, better management of the bone structures thereby making minimally invasive class Iretrograde cavity preparation and retrograde filling of the canal system and all its branches along the longitudinal axis of the root easy to perform
Microscope reduces distance and improves the overall treatment quality and encourages endodontists to review and perfect their own treatment concepts resulting in a positive impact on the entire practice structure but also increases the enjoyment of providing treatment.