INTRODUCTION

Endodontics has progressed a long way from the old toothworm theory prevalent in 16th theory
which propagated that worms !rrowing in the decayed tooth was the reason for dental pain"
Treatment of diseased p!lp !sing leech and red hot wire were the modalities followed those days"
Introd!ction of anesthesia has radically changed the management of pain in the medical field"
Development of antiseptics r!er dam# g!tta percha# radiographs and rotary systems were
other landmar$s in the progression of endodontics" %dvances in the art and science of endodontics
have facilitated etter !nderstanding of disease processes and have led to development of treatment
modalities aimed at restoring health to the p!lp and periradic!lar tiss!es" Technological
discoveries in instr!ments and materials have made it possile to achieve treatment o&ectives that
once were considered !nattainale"
The state of art incl!des s!rgical operating microscope# which f!nctions as the third eye for
the endodontist" The introd!ction of microscopes into endodontics in the early nineties ro!ght on
a renaissance in endodontics that led to new and e'citing discoveries and the lossoming of new
ideas and techni(!es" )hen the s!rgical operating microscope was introd!ced in endodontics in
U*%# it was a historical landmar$ for advances in the filed of dentistry" The microscope proved to
e an inval!ale instr!ment# allowing endodontists to render treatment for prolems which were
previo!sly tho!ght to e impossile to treat"
+,odern man is seldom ama-ed" .!t there are still fascinating moments in dentistry" /or
me# loo$ing thro!gh a s!rgical microscope is among these" The root canal# once r!led y dar$ness#
is s!ddenly ill!minated and reflects in right light# opening its anatomical wonder of side canals#
ranches# notches# f!rrows# colored shadows and secret passages" In many cases# the omino!s
/oramen physiologic!m ecomes visile and can almost e to!ched# allowing the periape' to e
anticipated"0 1 2rof" Dr" ,ichael %" .a!mann
HISTORY:
%ltho!gh the first acc!rate lenses were not made !ntil ao!t the year 1344# credit for the first
microscope is !s!ally given to 5ans and 6acharias 7ansen# a father and son who operated a D!tch
lens1grinding !siness# aro!nd 1898 :11;" They prod!ced oth simple :single lens; and compo!nd
:two lenses; microscopes"
1
Using a compo!nd microscope# in 1668# Roert 5oo$e coined the word cell while descriing
feat!res of plant tiss!e :11;" %nother pioneer of microscopy %nton van <ee!wenhoe$ prod!ced
single lenses powerf!l eno!gh to enale him to oserve acteria =>3 mm in diameter in 16?@"
<ittle was done to improve the microscope !ntil the middle of the 19th cent!ry when Carl
6eiss# Ernst %e# and Otto *chott devoted significant time to develop the microscope# as we
$now it today" )hile 6eiss concentrated on the man!fact!ring process# %e and *choot devoted
their time to the theoretical st!dy of optical principles and cond!cting research on glass :1=;" Their
prod!ct was the genesis of the s!rgical operating microscope :*O,; that !ltimately fo!nd its way
into the practice of medicine"
Evolution of magnification and illumination in medicine:
In 19=1# Dr Carl Nylen :13; of Aermany reported the !se of a monoc!lar microscope for
operations to correct chronic otitis of the ear" The !nit had two magnifications of ' 14 and
' 18 and a 14mm diameter view of the field" This microscope had no ill!mination"
In 19==# the 6eiss Company :Aermany; wor$ing with Dr A!nnar 5olmgren of *weden#
introd!ced a inoc!lar microscope for treating otosclerosis of the middle ear" This !nit had
magnifications of ' B > ' =8 with field1of1view diameters of 6>1=mm"
1983 1 Carl 6eiss Company of )est Aermany mar$eted the first commercial inoc!lar
operating microscope mar$ed the eginning of micros!rgery to literally all the s!rgical
disciplines" :Opton ear microscope";
The Opton had a 81step magnification changer# which co!ld prod!ce magnifications
in five steps from ' 1"= to ' @4 and field1of1view diameters from @"B to 18@ mm" )or$ing
distances were a remar$ale =44>@44 mm" The Opton had !ilt1in coa'ial ill!mination#
which added immensely to vis!al ac!ity
Evolution of magnification and illumination in dentistry:
19?? 1 Dr Roert .a!mann# an otolaryngologist %nd practicing
dentist# descried the !se of the otologic microscope in dentistry"
19?B > %pothe$er and 7a$o pooled their efforts to prod!ce a Dental
operating ,icroscope :DO,; first commercially availale DO, in
19B1# Dentiscope, Chayes Virginia Inc. The Dentiscope had a single
magnification of B and d!al fieroptic lights# which were directed
=
toward the s!rgical field" The !nit co!ld e mo!nted on a moile stand or co!ld e
permanently mo!nted to a wall"
19B=# *ep =8th > offered the first co!rse in the clinical hands on !se of the Dentiscope at
harvard dental *chool# .oston" 1 disheartening response
19B6 1 Chayes Virginia Inc. stopped selling the Dentiscope
1993 # ,arch > the first symposi!m on microscopic endodontic s!rgery was held at
!niversity of 2ennsylvania *chool of Dental ,edicine
1 heralded the eginning of serio!s attention to the DO,
1994s > n!mero!s commercially availale microscopes were availale
.y 1998 > There was an ovio!s increase in DO, !se y endodontists"
1996 7an!ary the proposal that Cmicroscopy training e incl!ded in the new %ccreditation
*tandards for %dvanced *pecialty Ed!cation 2rograms in EndodonticsD was accepted"
One of the most important developments in conventional and s!rgical endodontics has een the
introd!ction of the s!rgical operating microscope"
The new standard of care in Endodontics re(!iresE
1. Magnification
2. Illumination
. !rmamentarium
"ou#es:
5istorically# dental lo!pes have een the most common form of magnification !sed in
apical s!rgery" <o!pes are essentially two monoc!lar microscopes with lenses mo!nted side y
side and angled inward :convergent optics; to foc!s on an o&ect" The disadvantage of this
arrangement is that the eyes m!st converge to view an image" This convergence over time will
create eyestrain and fatig!e and# as s!ch# lo!pes were never intended for lengthy proced!res" ,ost
dental lo!pes !sed today are compo!nd in design and contain m!ltiple lenses with intervening air
spaces" This is a significant improvement over simple magnification eyeglasses !t falls short of
the more e'pensive prism lo!pe design" 2rism lo!pes are the most optically advanced type of
lo!pe magnification availale today" They are act!ally low1power telescopes that !se refractive
prisms" 2rism lo!pes prod!ce etter magnification# larger fields of view# wider depths of field# and
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longer wor$ing distances than other types of lo!pes" Only the *O, provides etter magnification
and optical characteristics than prism lo!pes" Initially# lo!pes seemed ade(!ate# and emphasis was
placed on developing etter lo!pes" Clinicians who have !sed s!rgical telescopes and s!rgical
headlamps have enefited from the e'panded !se of magnification and ill!mination"
,agnification range of =F to 6F
Ill!mination > /ireoptic headlamp system
Gis!al ac!ity is heavily infl!enced y ill!mination" %n
improvement to !sing dental lo!pes is otained when a fieroptic
headlamp system is added to the vis!al armamentari!m" *!rgical
headlamps can increase light levels as m!ch as fo!r times that of
traditional dental operatory lights" %nother advantage of the
s!rgical headlamp is that since the fieroptic light is mo!nted in
the center of the forehead# the light path is always in the center of the vis!al field
DisadvantageE
The disadvantage of lo!pes is that ' 3"8> ' @"8 is the
ma'im!m practical magnification limit" ,oderate movements
of the head res!lted in total dislocation and loss of the vis!al
field# especially in higher magnifications" <o!pes with higher
magnification are availale !t they are (!ite heavy and if
worn for a long period of time can prod!ce significant head#
nec$# and ac$ strain" In addition# as magnification is
increased# oth the field of view and depth of field decrease#
which limits vis!al opport!nity"
@
,icroscopes have the capaility to go to magnifications of !pto @4 F and eyond"
The main advantage of the s!rgical microscope compared to all lo!pe systems is
that it is aided y coa'ial ill!mination
<imitations in depth of field and ill!mination# however# ma$e s!ch magnifications impractical"
,agnifications in the range of ="8 F to 34 F are recommended"
The lower magnifications :="8 F to B '; are !sed for orientation to the s!rgical
field and allow a wide field of view"
,idrange magnifications :14F to 16 '; are !sed for operating"
5igher range magnifications :=4F to 34 '; are !sed for oserving fine detail"
,any clinicians elieved the operating microscope wo!ld ma$e highly s!ccessf!l operations
complicated and drawn o!t" Event!ally# they recogni-ed advantages s!ch as wider fields# variale
magnification# etter depth of foc!s# and coa'ial ill!mination when !sing the microscope instead
of lo!pes"
In conventional endodontics the operating microscope is an inval!ale tool that aids the
endodontist" The aility to vis!ali-e the root canal system in fine detail provides the opport!nity to
investigate that system more thoro!ghly and clean and shape it more efficiently"
It also allows an assessment to e made of the dryness of the canal efore ot!ration and of the
distri!tion of sealer on the wall of the root canal d!ring ot!ration"
The microscope enhances the clinicians capaility to diagnose fract!re line in the root and crown#
locate small canal orifices in the p!lpal floor# remove p!lp stones in the canal orifice facilitated y
acc!rate placement of !ltrasonic tip aro!nd it and th!s preventing !nnecessary removal of
radic!lar dentin
It also ma$es the diagnosis and management of perforation and patient ed!cation easy"
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The introd!ction of dental microscope in conventional and s!rgical endodontics offers a n!mer of
advantages for improved patient care"
%reas where the s!rgical microscope can have great impact and conse(!ence in clinical practice
incl!de#
:1; Gis!ali-ation the s!rgical field#
:=; Eval!ation of s!rgical techni(!e#
:3; Use of fewer radiographs#
:@; 2atient ed!cation thro!gh video#
:8; Reports to referring dentists#
:6; Reports to ins!rance companies#
:?; Doc!mentation for dental legal p!rposes#
:B; Gideo liraries for teaching programs#
:9; ,ar$eting the dental practice# and
:14; <ess occ!pational stress
The fo!r areas to e disc!ssed in a *!rgical operating microscope areE
1" ,agnification
=" Ill!mination
3" Doc!mentation
@" %ccessories
M!$%I&I'!TIO%:
Determined yE
1" 2ower of the eyepiece#
=" The focal length of the inoc!lars#
3" The magnification changer factor#
@" The focal length of the o&ective lens"
T5E %N%TO,H O/ T5E *URAIC%< O2ER%TINA ,ICRO*CO2E
Eye#iece:
%vailale in powers of 6"3 F# 14 F# 1="8 F# 16 F and =4 F"
6
5ave ad&!stale diopter settings"
Diopter settings range from 1 8 to I 8 and are !sed to ad&!st for
accommodation# which is the aility to foc!s the lens of the eyes" It
also ad&!st for refractive error# which is the degree to which a
person needs to wear corrective eyeglasses"
(inoculars:
/UNCTIONE
To pro&ect an intermediate image into the focal plane of the eyepiece"
5old the eyepieces"
the interp!pillary distance is set y ad&!sting the distance etween the two inoc!lar t!es
Once the diopter setting and interp!pillary distance ad&!stments are made# they need not e
changed !nless the microscope is !sed y an other s!rgeon with different optical re(!irements"
Often come in different focal lengths"
<onger the focal length# the greater the magnification and the narrower the field of view"
availale with straight# inclined# or inclinale t!es
*traight t!e inoc!lars are orientated so that the t!es are parallel to the head of the
microscope" It allows the operator to loo$ thro!gh the microscope directly at the s!rgical field"
This system is !sed y ear# nose# and throat :ENT; s!rgeons" The dental chair is placed elow the
operator for ma'illary s!rgery and slightly aove the operator for mandi!lar s!rgery" This allows
the clinician to loo$ down the a'ial plane of the root in ma'illary teeth and !p the a'ial plane of
the root in mandi!lar teeth" *traight t!e inoc!lars gain even more versatility when a 1381degree
inclined co!pler or variale inclined co!pler is placed etween the mo!nting arm and the
microscope" This co!pler provides additional a'is of rotation and aligns the microscope so that
straight t!e inoc!lars provide direct vision whether the patient is sitting !p or lying down"
Inclined inoc!lars are orientated so that the t!es are offset at @8
degrees to the head of the microscope" Inclined inoc!lar t!es are !sed
for ma'illary s!rgery# !t the operator wo!ld have to !se indirect vision
?
thro!gh a mirror or position the patientJs head sharply to the side while performing mandi!lar
s!rgery"
Inclinale t!es are ad&!stale etween the straight t!e and
slightly eyond the inclined t!e positions !p to and sometimes
eyond 1B4 degrees" Inclinale t!e inoc!lars allow the s!rgeon to
loo$ directly at the ma'illary arches and mandi!lar arches and have
the advantage of the other inoc!lars# th!s providing the operator with
additional post!ral comfort and fle'iility d!ring long proced!res"
,ost !sef!l for endodontic s!rgery"
The only disadvantage of inclinale t!e inoc!lars is that they are diffic!lt to engineer and as
s!ch can e (!ite costly"
Magnification c)angersE
%vailale in 3 or 8 step man!al changers or 2ower -oom changers
<ocated within the head of the microscope
,an!al step changers consist of lenses that are mo!nted on a t!rret" The
t!rret is connected to a dial that is located on the side of the microscope
ho!sing" The dial positions one lens in front of the other within the changer
to prod!ce a fi'ed magnification factor or val!e" Rotating the dial reverses
the lens positions and prod!ces a second magnification factor" % conventional three1step changer
has one set of lenses and a lan$ space on the t!rret witho!t a lens" )hen the power of the
eyepiece# the focal length of the inoc!lars# and the focal length of the o&ective lens with the
magnification changer lenses are factored in# three fi'ed powers of magnification are otainedE two
from each lens pair comination and one from the lan$ space" The lan$ space prod!ces
magnification y factoring only the eyepiece# the focal length of the inoc!lars# and the focal
length of the o&ective lens"
% five1stepman!al changer has a second set of lenses mo!nted on the t!rret and prod!ces five
fi'ed powers of magnification" % power -oom changer is merely a series of lenses that move ac$
and forth on a foc!sing ring to give a wide range of magnification factors"J 2ower -oom changers
avoid the momentary vis!al disr!ption or &!mp that occ!rs with three1 or five1step man!al
changers as the clinician rotates the t!rret and progresses !p or down in magnification"
B
,agnification changer f!nctions in power -oom microscopes are controlled y either a foot control
or a man!al override control $no located on the head of the microscope"
O*+ective lens :
The focal length of the o&ective lens determines the operating distance etween the lens and the
s!rgical field" )ith the o&ective lens removed# the microscope foc!ses at infinity and performs as
a pair of field inoc!lars" % variety of o&ective lenses are availale
with focal lengths ranging from 144 to @44 mm"
1?81mm lens foc!ses at ao!t ? inches#
=441mm lens foc!ses at ao!t B inches# and
@441mm lens foc!ses at ao!t 16 inches"
% =441mm o&ective lens is recommended eca!se there is ade(!ate
room to place s!rgical instr!ments and still e close to the patient"
TOT!" M!$%I&I'!TIO%:
,
T
K f
t
L f
o
' ,
e
' ,
c
,
T
K Total ,agnification
f
t
K /ocal length of inoc!lar lens
f
o
K /ocal length of o&ective lens
,
e
K ,agnification of the eyepiece
,
c
K ,agnification factor
Charts are availale that e'plain magnification as it relates to eyepiece power# inoc!lar focal
lengths# magnification factors# and o&ective lenses" These charts contain val!ale information that
helps the clinician select the appropriate optical components to satisfy his or her re(!irements" The
information can e s!mmari-ed as followsE
1" %s yo! increase the focal length of the o&ective lens# yo! decrease the magnification and
increase the field of view" In addition#yo! decrease the ill!mination eca!se yo! are f!rther away
from the s!rgical field"
9
=" %s yo! increase the focal length of the inoc!lars# yo! increase the magnification and decrease
the field of view"
3" %s yo! increase the magnification factor# yo! increase the magnification and decrease the field
of view"
@" %s yo! increase the power of the eyepiece# yo! increase the magnification and decrease the field
of view"
8" %s yo! increase the magnification# yo! decrease the depth of field"
PARFOCALIZATION:
1 *etting the operator specific foc!s thro!gho!t the entire range of magnification"
1 *ho!ld e parfocalled once a month to $eep it properly foc!ssed even for s!tly changing
eye sight"
1 prevents !nnecessary eye fatig!e and pain"
In addition# when the microscope is parfoc!sed# accessories s!ch as cameras and a!'iliary
inoc!lars are also in foc!s"
To parfocal a microscope# a flat o&ect# s!ch as a d!ll copper penny is placed !nder the microscope
and foc!sed at the highest magnification"
The left L right eye diopter settings are !ni(!e to each person and sho!ld e written especially if
the microscope is shared"
O2TI,U, CON/IAUR%TION /OR ENDODONTIC ,ICRO*URAERH
M 1="8 ' eye pieces with a retic!le
M =44 > =84 mm o&ective lens
M 1B4o inclinale inoc!lars
M 8 step man!al magnification changer or power -oom magnification changer
M )or$ing range ao!t B inches from patient
M ,agnification range of 3 F> =6 F
Illumination:
It is important to !nderstand the path light ta$es when it travels thro!gh the microscope" The light
so!rce is a 1441watt 'enon halogen !l" The light intensity is controlled y a rheostat and cooled
y a fan" :The light is then reflected thro!gh a condensing lens to a series of prisms and then
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thro!gh the o&ective lens to the s!rgical field"; %fter the light
reaches the s!rgical field# it is reflected ac$ thro!gh the o&ective
lens# thro!gh the magnification changer lenses# and thro!gh the
inoc!lars and then e'its to the eyes as two separate eams of
light" The separation of the light eams is what prod!ces the
stereoscopic effect that allows the clinician to see depth of field"
144 ) Fenon halogen !l in a fan cooled system
/ire optic light :N!art- halogen !l is foc!sed onto the
end of the fireoptic cale;
Fenon !l 1 .righter :comparale to day light;
1 Color temp of 86444 O
1 2rod!ces a tr!e color pict!re
N!art- 5alogen light 1 Color temp of 3=444 O
1 2rod!ces a yellow pict!re
% fan1cooled 'enon halogen light system is recommended eca!se fieroptic cales asor light
and have a tendency to e light deficient" In addition# 'enon halogen is righter and warmer than
(!art- halogen and therefore pro&ects a righter and warmer light against one and soft tiss!es"
Ill!mination of the s!rgical microscope is coa'ial with the line of sight" This means that
light is foc!sed etween the eyepieces in s!ch a fashion that the clinician can loo$ into the s!rgical
site witho!t seeing any shadows" This is made possile eca!se the operating microscope !ses
Aalilean optics" Aalilean optics are those optics that foc!s at infinity" This is mar$edly different
from Areeno!gh optics :convergent optics;# which are fo!nd in dissecting or laoratory
microscopes" Areeno!gh1type microscopes necessitate oservation with convergent eyes# res!lting
in accommodation of the oserver and eye fatig!e" The advantage of Aalilean optics is that the
light eams going to each eye are parallel" )ith parallel light instead of converging light# the
operatorDs eyes are at rest as if he were loo$ing off into the distance" Therefore# operations that !se
the *O, and ta$e several ho!rs can e performed witho!t eye fatig!e"
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(eam s#litter:
% eam splitter can e inserted in the optical pathway of the microscope as
it ret!rns to the operatorJs eyes" The f!nction of a eam splitter is to s!pply
light to an accessory s!ch as a camera or an a!'iliary oservation t!e"
.eca!se the eam splitter divides each path of light separately# !p to two
accessories can e added" 5alf of the light is always availale for the operator" In addition to 84E84
eam splitters# other config!rations are also availale"
,ocumentation:
Doc!mentation is an important enefit of !sing the s!rgical microscope
1 Gideo adapter
1 Gideo camera
1 Gideo printer
2!rpose of doc!mentationE
1" To comm!nicate with the referring dentist
=" To ed!cate patients and st!dents
3" To maintain the re(!ired legal doc!mentation of each case
The aility to prod!ce (!ality slides and videos is proportional to the (!ality of the magnification
and ill!mination systems within the microscope" The eam splitter# which provides the
ill!mination for photographic and video doc!mentation# can e connected to photo and cine
adapters"
!ccessories:
,any accessories are made for the operating microscope"
2istol grips or icycle style handles can e attached to the ottom of
the head of the microscope to facilitate movement d!ring s!rgery"
%!'iliary monoc!lar or artic!lating inoc!lars can also e added
and !sed y a dental assistant
%nother accessory !sed to facilitate an assistantJs viewing is the
li(!id crystal display :<CD; screen" The <CD screen receives its
video signal from the video camera" )hen viewing the <CD
1=
screen# the assistant sees e'actly what the s!rgeon sees witho!t having to ta$e his or her
eyes away from the s!rgical field"
The feat!res of an endodontic microscope sho!ld incl!deE
1" E'cellent optics
=" ,echanical staility
3" ,ane!veraility
@" ,od!larity
The most important aspect# the (!ality of the optics# is very diffic!lt
to assess" /ort!nately# most microscopes on the mar$et have e'cellent optics" C!rrently
microscopic optics are made in .ra-il *eiler;# Aermany :Oaps# <eica# ,oller# and 6eiss;# 7apan
:Ni$on# Olymp!s;# and the United *tates :Aloal;"
,echanical staility is the second most important criterion in selecting a microscope" .eca!se
the microscope m!st e repositioned many times d!ring a proced!re to accommodate changes in
the patientJs head position# it is important that the microscope stop moving immediately after eing
repositioned" The staility of microscopes varies greatly" The microscope sho!ld not drift# and the
arm sho!ld not Po!nceP after eing moved" To test for mechanical staility# the dentist can gently
tap the end of the arm of the microscope when it is f!lly e'tended" In a good microscope# s!perior
s!spension and alance mechanisms prevent the arm from moving or o!ncing in response to
position ad&!stments"
,ane!veraility of the microscope is essential eca!se a patientJs head moves fre(!ently#
either to ad&!st position or eca!se of invol!ntary m!scle activity" The microscope head has to e
light for almost effortless mane!veraility" /or this reason it is not advisale to add an assistant
scope or any other large or heavy accessories"
.eca!se a microscope is a life1time investment# mod!larity# or adaptaility# is an important
factor" The re(!irements for the microscope will change with the !serJs needs# and other
sophisticated feat!res can e added as e'perience dictates" /or instance# man!al magnification can
e changed to an a!tomatic -oom f!nction" *ome microscopes are f!lly mod!lar# whereas others
13
-E,ME, series
are limited in this respect" It therefore is important to chec$ with the man!fact!rers ao!t the
mod!larity of the microscope efore it is p!rchased"

MIS'O%'E.TIO%S !(O/T S/R$I'!" O.ER!TI%$ MI'ROS'O.ES:
1" ,agnificationE
C5ow powerf!l is a partic!lar microscopeQD
Usale power is the ma'im!m o&ect magnification that can e !sed in a given clinical
sit!ation relative to depth of field and field of view" %s the magnification is increased# the depth of
field is decreased# and the field of view is narrowed"
C5ow !sale is the ma'im!m powerQD
,agnification in e'cess of 34 F# altho!gh attainale# is of little val!e in periapical s!rgery"
)or$ing at1 higher magnification is e'tremely diffic!lt eca!se slight movements y the patient
contin!ally throw the field o!t of view and o!t of foc!s" The s!rgeon is then constantly recentering
and refoc!sing the microscope" This wastes a lot of time and creates !nnecessary eye fatig!e"
=" Ill!minationE
There is a limit to the amo!nt of ill!mination a s!rgical microscope can provide" %s magnification
is increased# the effective apert!re of the microscope is decreased# and therefore the amo!nt of
light that can reach the s!rgeonJs eyes is limited" This means that as higher magnifications are
selected# the s!rgical field appears dar$er"
1@
6eiss Aloal *eiler
3" Depth 2erceptionE
.efore s!rgery can e performed with an operating microscope# the clinician m!st feel
comfortale receiving an instr!ment from the assistant and placing it etween the microscope and
the s!rgical field" <earning depth perception and orientation to the microscope ta$es time and
patience" Coordination and m!scle memory are easily forgotten if the microscope is !sed
infre(!ently" %s a general r!le# the clinician sho!ld reorient himself or herself to the microscope
efore eginning each s!rgery"
@" %ccessE
The s!rgical microscope does not improve access to the s!rgical field" If access is limited for
conventional s!rgery# it is even more limited when the microscope is placed etween the s!rgeon
and the s!rgical field" Use of the microscope# however# creates a m!ch etter view of the s!rgical
field" .eca!se vision is enhanced so dramatically# cases can now e treated with a higher degree of
confidence"
8" /lap Design and *!t!ringE
Reflecting soft tiss!e flaps and s!t!ring them ac$ in place are not high magnification proced!res"
%ltho!gh the microscope co!ld e !sed at low magnification# little is gained from its !se in these
applications" The operating microscope is recommended predominately for osteotomy# c!rettage#
apicectomy# apical preparation# retrofilling# and doc!mentation"
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