18 The Dental Microscope in Endodontics

18 The Dental Microscope in Endodontics

Owing to the very small size and complex nature of the tooth root canal system, the naked eye cannot discern in
sufficient detail several factors that influence the outcome of endodontic treatment. Problems arising during
primary root canal treatment, such as narrow root canal orifices, detection and dealing with obstructions or
obliterated canals, and recognizing root canals type III or VVII (Vertucci, 1984), can severely limit the chances
for treatment success.
In addition, endodontic retreatment is usually associated with a myriad of problems that can be effectively
overcome only with combined application of the underpinning clinical knowledge and state-of-the-art
technology.
The introduction of the clinical dental microscope provided a new dimension in diagnosis and therapy in
dentistry. The combination of additional light, magnification, and ergonomic design makes the dental
microscope one of the most significant technological developments in endodontology. It permits the effective
use of both time-tested techniques and newer therapeutic procedures, and has thus expanded the boundaries of
endodontology to include successful maintenance of previously questionable teeth.
As early as 1921, Carl Olof Nylen used a monocular microscope during surgical therapy. In 1975, Baumann
described the first use of a microscope in dental practice. He recommended it as a diagnostic and therapeutic aid
during caries removal, root canal treatment, during the preparation of dental restorations, and calculus removal.
He drew attention to its ergonomic construction, which allows the dentist to adopt an upright seated position
during treatment. Following additional technical improvements during the early 1990s, the dental microscope is
increasingly used in specialist dental practices.
The dental microscope provides for an optimal clinical diagnosis (Zaugg, 2004). The clinical detection of
even the smallest root canal orifices is significantly improved using the dental microscope (Schwarze, 2003).
The newest minimally invasive therapeutic procedures for the removal of endodontic pins/posts, root canal
filling material, foreign bodies, and fragments in complex retreatment cases can be carried out successfully. In
addition, new frontiers in endodontology have been opened up by the ability to deal with intracanalicular
obstructions and ledges, and to close perforations successfully (Arnold, 2009).

Construction and Functions

Support Stands
There are three ways in which a dental microscope can be integrated into a dental operatory. In addition to the
classic floor mount, wall-mounted or bench-mounted supports are available. Besides the need for an adequately
strong supporting wall or countertop to support the device, key criteria for selection of the appropriate support
include the space available and the desired degree of mobility. An absolute requirement is a vibration-free area
when working at larger magnifications. Before finally purchasing, a technical inspection of the space by an
expert is recommended.

Balance
Of special importance for the day-to-day, continuous use of the dental microscope is ease of mobility combined
with a solid and stable support. The use of simpler, apparently cost-saving supports can lead to
vibration/oscillation, delaying clinical treatment. It must be possible to manipulate the device with one hand in
all planes of space, and so the mechanical or electromagnetic brakes must securely hold the microscope in the
desired position.
18.1 The dental microscope

ProErgo, Zeiss (Oberkochen, Germany and Thornwood, NY, USA)

1 Floor stand

2 Swing arm with integrated computer controls and display monitor

3 Swing arm with integrated light source

4 Connection with electromagnetic brake

5 Optical head including:

Eyepiece

Tiltable tube

Varioscope

Video camera
6 Hand grips for:

Light with brightness control

Zoom, brake

Documentation

Optics and Magnification

The optics of the dental microscope consist essentially of the Kepler tube (eyepiece and tube), the magnification
changer, and the objective itself. The binocular optics permit spatial perception. The range of the focusing lens
system varies according to manufacturer, especially at higher magnifications.

Light
The light originates from a separate source and travels through a fiberoptic to the optical parts of the device, and
via a prism, coaxial to the optical axis. The light source may be a halogen or xenon lamp. These lamps are
significantly different in terms of heat development, color of the light, temperature, and lifespan.
For endodontic practice, the xenon light source is used, with a daylight-like color, temperature of about 5800
K and a significantly higher light intensity of 420 klx in contrast with halogen lighting (which is about 100 klx).

Ergonomics
The use of a dental microscope permits the clinician to assume an upright posture that is less prone to cause
fatigue, at a distance of more than 50 cm from the patient. For the treatment of maxillary teeth, the operator
should be in the 12-oclock position and for the mandible at the 89-oclock position with respect to the
reclining patient. With the patients mouth wide open, treatment can proceed under indirect vision using a
rhodium-plated mirror. For lengthy procedures, the patients head should be stabilized using adjustable or
inflatable airline-type pillows.
For vibration-free clinical work at higher magnifications, use of an operator chair with arm supports is
absolutely necessary. Extended arm rests and a back support will guarantee a comfortable and relaxed position
for the back muscles of the clinician. At the same time the dental assistant can keep a check on the stage of the
clinical procedure on the monitor, and therefore provide optimum assistance. Other aids include microprobes,
microabrasive ultrasonic instruments, and microsuction. Procedures of more than 2 hours duration can be easily
carried out while continuing to maintain a high level of concentration.


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