The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses
in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses. for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Título original
microspcope 3 / orthodontic courses by Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses
in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses. for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses
in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses. for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The simple premise for using the microscope is that
Light + Magnification = Ecellence! "s some surgeons sa#$ "if you see it, you can protect it." This a%age also applies to en%o%ontics! "long &ith an increase in 'rightness$ a correspon%ing increase in magnification is nee%e% for en%o%ontic ecellence! En%o%ontic microscop# an% its implication can 'e categori(e% into si areas: )! *iagnosis! +! ,onsurgical en%o%ontics! -! Surgical en%o%ontics! .! *ocumentation an% patient e%ucation! /! Mar0eting! 1! Re2itali(ation of #our career " num'er of fun%amental re3uirements must 'e met 'efore master# of the use of the microscope can 'e attaine%! 4ision$ 5in%irect 2ision6 "%e3uate illumination$ an% Patient compliance *iagnosis: )! 2isuali(e the root canal s#stem in fine %etail +! %etect the microfracture 5 fracture line in root 7 cro&n 6 -! %istinguish the floor an% %entin .! locate small canal orifice /! eamining %ental caries 1! eamining cro&n margins 8! o'ser2e su' 9 gingi2al %efects :! o'ser2e comple anatomical situation ,on surgical en%o%ontics: Access: ; larger 7 coronal more flare% ; eas# to appreciate the color change in the floor of pulp cham'er ; opening of the sclerose% canals 7 location of a'errant canal location ; allo&s more light $ thus enhance% 2ision Examine the floor, 1 9 for orientation purposes$ use% for ultrasonic tips )+ 9 to enhance &hat is seen in lo&er magnification +1 9 to confirm the opening 5 M< + 6 BMP: ; The root canal s#stem can 'e more thoroughl# 7 efficientl# cleane% 7 shape% ; Smooth glass# &alls of R!C! &alls$ criteria for root canal preparation can 'e easil# 2isuali(e%! Obturation: ; To assess the %r#ness of the canal 'efore o'turation! ; "ssess uniform %istri'ution of sealers on the &all of the root canal %uring o'turation ; =inal eamination of root canal preparation Other uses: ; Remo2al of pulp stones in the canal orifice facilitate% '# accurate placement of ultrasonic tip aroun% it 7 thus pre2enting unnecessar# remo2al of ra%icular %entin! ; =or %iagnosis 7 management of perforation ; Repair '# scaling of the %efect &ith or &ithout a matri ; Locating calcifie% canals ; Retrie2al of 'ro0en %o&n or separate% inst: Helps to see the instrument &ith in the canal 7 pin point precisel# &here to trough &ith the ultrasonic instrument! ; management of proce%ural errors ; also helps in post remo2al Thus increase% li0elihoo% of a successful outcome$ 'ecause it helps in locating etra canals an% anatom# of tooth is more rea%il# 2isuali(e%! Surgical En%o%ontics: )! Osteotom# 5 pr>cise% 7 small 9 /mm6 Earlier microsurger# +! Curettage -! "picectom# .! Inspection of the resecte% root surface /! *etect apical perforation 1! "pical preparation 8! Retro filling :! Eamination of surgical site ?! I%entif# 7 mange isthmus )@! post 9 operati2e healing 9 use of fine sutures &ith precision ; 3uic0 une2entful healing! "pical microsurger#: One of the most important a%2antages of using the operating microscope is in e2aluating the surgical techni3ue! The pioneers &ho 'egan using the microscope some t&o %eca%es ago o'ser2e% earl# on that most tra%itional surgical instruments &ere too large to 'e place% accuratel# in small places$ or that the# &ere too traumatic &hen use% to manage soft an% har% tissue! This le% to the %e2elopment of a microsurgical armamentarium an% the true practice of apical microsurger#! "pical microsurger# can 'e %i2i%e% into +@ stages or sections! These are flap %esign$ flap reflection$ flap retraction$ osteotom#$ periapical curettage$ 'iops#$ hemostasis$ apical resection$ resecte% ape e2aluation$ apical preparation$ apical preparation e2aluation$ %r#ing the apical preparation$ selecting retrofilling materials$ miing retrofilling materials$ placing retrofilling materials$ compacting retrofilling materials$ car2ing retrofilling materials$ finishing retrofilling materials$ %ocumenting the complete% retrofill$ an% tissue flap closure! Instruments use%: " 2ariet# of micro scalpels si(e% );/ use% for precise incision! Comparison of the small en%s of t&o mini;Molts an% a stan%ar% Molt +;. curette! <la%e an% contact surfaces of the Ru'instein Retractors );1! Impact "ir ./t an% surgical length 'ur in close proimit# to the mental ner2e! Mini curettes Micro apical placement s#stem! Comparison 'et&een micro an% macro pluggers! "%2antages of micro surger#: )! The remo2al of 'one o2erl#ing a root is minimi(e% +! The periape can 'e eamine% for canal eits$ etrusion of filling materials Pre2ious retro fills 7 a%%itional roots &ith meth#lene 'lue staining also root fractures can 'e 2isuali(e% -! "fter resection$ anatomical 2ariation li0e isthmus$ lateral canals &ith shape% canals or fin can 'e 2isuali(e% 7 retro prepare%! .! Retro preparation can 'e eecute% precisel# along the longitu%inal ais of canal space 7 eten%e% to proper <ucco 9 Lingual 'oun%ar# /! Retro filling is more precisel# %one 7 an# ecess retrofilling materials can 'e %etecte% for remo2al 1! The marginal a%aptation of the retrofilling to the canal &all can 'e chec0e% CL"SSI=IC"TIO, O= E,*O*O,TIC MICROSARBIC"L PROCE*ARES 5Richar% Ru'enstein an% Cim$ DOE$ +@@+$ +:6 CL"SS " CL"SS < CL"SS C
CL"SS * CL"SS E CL"SS =
Classification is 'ase% on assessment root form osseo integrate% implants treatment outcome E Class " ; "'sence of periapical lesion$ 'ut resolution s#mptoms after non surgical approaches ha2e 'een ehauste%! E Class < ; Presence of a small periapical lesion an% no perio%ontal poc0ets! E Class C ; Presence of a large periapical lesions progressing coronall# 'ut &ithout perio%ontal poc0et! E Class * ; Clinical picture similar to Class C &ith a perio%ontal poc0et! E Class E ; Periapical lesion &ith an en%o%ontic an% perio%ontal communication 'ut no root fracture! E Class = 9 Tooth &ith an apical lesion an% complete %enu%ement of the 'uccal plate =ocuses on preoperati2e presence a a'sence of pulpal pain an% perio%ontal %isease (Richard Rubenstein and Kim, JOE, 2(6 2!!26 Procedure Traditional Micro surgery I%entification of ape Sometimes %ifficult Precise Osteotom# Large 5=F)@ mm6 Small 5= G / mm6 Root surface inspection Imprecise Precise <e2el angle Large 5./o6 Small 5G )@o6 Isthmus i%entification ,earl# impossi'le Customar# Retro preparation "pproimate Precise Root en% filling Imprecise Precise! Summar#: Hithout a %ou't$ the greatest re2olution &ith microscopes &as in root;tip resection! To%a#$ using the trifecta of magnification ; illumination ; instrumentation$ an ecellent$ retrogra%e$ microsurgical root;tip resection$ can 'e carrie% out un%er a surgical microscope &ith optimal illumination an% '# using ultrasoun%;supporte% retrogra%e treatment an% a special micro;instrument! The success rate using this metho% &as ?1!: percent &ith a mean healing time of 8!+ months for the ?. cases o'ser2e% o2er one #ear! ,e& hori(ons &ere$ an% &ill still 'e opene% for surgical microscopes in en%o%ontics! Hithout a %ou't$ the 3ualit# of the results &ill increase! The goal of microscopes is to achie2e the highest possi'le precision &hile pro2i%ing maimum protection to health# tissue! The a%2antage lies in minimal trauma to the treate% tissue an% an increase% securit# in achie2ing the %esire% result! =or patients$ this means less pain$ shorter healing times$ greater pro'a'ilit# of reaching the %esire% result 5e!g! as regar%s aesthetics6 an% 'etter long;term results! References: )! S#ngcu0 Cim! Microscopes in En%o%ontics! *C," Iul# )??8$ 2ol .) +! Richar% Ru'enstein an% Cim$ Dournal of En%o%onticsJ +@@+$ +:5:6$/.);.?! -! Path&a#s of pulp! Stephen Cohen! : th e%ition .! Magnification an% illumination in apical surger#! Richar% Ru'instein! En%o%ontic Topics +@@/$ ))$ /1988 /! Cim S$ Pecora B$ Ru'instein R! Color "tlas of Microsurger# in En%o%ontics! Phila%elphia$ H< Saun%ers$ +@@): +)9++! 1! The %ental operating microscope an% its slo& acceptance! Ho&ar% S Sel%en!Dournal of En%o%ontics$ +@@+$2ol +: 5-6! 8! Ase of %ental operating microscope in en%o%ontic surger#! Ba'irele Pecora et al! Oral surg$ Oral Me%$ Oral Pathol )??-$ 8/$ 8/);:!