RECENT ADVANCES IN

SURGICAL TECHNOLOGY

Fourthmolar.c
 INTRODUCTION

It is a part of broader trend in medicine &

dentistry toward the application of
minimally invasive technique for procedures
that previously required extensive surgical
incision.
MAGNIFICATION
SYSTEMS
• A variety of simple & complex
• magnification system are available
ranging from simple loupes to prism
telescopic loupes & surgical microscopes.

• Each system has its advantages & limitations.

• Magnification system improves the accuracy

of clinical & diagnostic skills.
MAGNIFYING
LOUPES
 STRUCTURE:-

Two monocular telescopes with side by side

lenses converged to focus on the operative
field.

Magnified image has sterioscopic properties.

A convergent lens optical system also called a

KEPLERIAN optical system.
 Disadvantages
• Clinician’s eyes must converge to view the
operative field

• May result in
eye strain
fatigue
pathological vision changes
 TYPES

SIMPLE COMPOUND PRISM

TELESCOPIC
 a)SIMPLE LOUPES
• STRUCTURE:-

Consist of a pair of single meniscus lenses.

They are primitive magnifiers with limited

capabilities.

Each lens is limited to just two refracting

surfaces.
 Limitation
• Only increasing there lens diameter or
thickness can increase their
magnification.

• Highly affected by spherical &

chromatic aberration.

• Distort the shape & color of object

being viewed.
 b)COMPOUND LOUPES
• STRUCTURE:-

Multielement lenses with intervening air

space.

Gain additional refracting surfaces

 Advantages
1. Allow increase magnification with more favourable
working distance & depth of field.
2. Can be adjusted to some clinical needs without
excessive increase in size or weight.
3. Can be achromatic.
4. Specific density of each lens counteracts the
chromatic aberration

Produces color correct image.

 Disadvantage

They become optically inefficient at

magnification above 3.0 diameter.

 C) Prism-Telescopic
Loupes
Structure : -

Lengthens the light path through a series of

switchback mirror reflection within the lens
elements.

This arrangement folds light so that the barrel

of the telescopic loupes can be shortened.
 Advantages
1. Produces better magnification.
2. Wider depth of field.
3. Longer working distance.
4. Larger field of view.
Recent innovation : -

Coaxial fiber-optic lighting is

incorporated in the lens elements.

Improve illumination
 Magnification Range Of
Surgical Loupes

Limited range of magnification from 1.5x to 10x.

Less than 2.5x inadequate for visual

acuity necessary.

More that 4.5x provide adequate

combination of magnification,
field of view & depth of focus.
 SURGICAL
OPERATING
MICROSCOPE
 Structure

Have binocular eyepieces joined by offsetting

prisms with parallel optical axis.

Allow viewing of operating field without eye

convergence.

Permit relaxed viewing of operating field.

No eye strain or fatigue.

 Incorporate fully coated optics with
achromatic lenses.

Provide highest optical resolution with the

most efficient illuminations.
 ADVANTAGES
1. Provide better magnification.
2. Better optical performance.
3. Durable.
4. Versatile.
5. Allow dentist to easily change working
magnification.
6. Some microscopes incorporate electronic
foot controlled focus & magnification for
further convinience.
7. Have a rotating variable magnification.

8.The surgeon can view, perfectly the

deepest reaches of the oral cavity,
including into subgingival pockets & angular
bony defect.

9.Definitive visualization of root surface

deposits & irregularities is possible.
• Periodontal surgeon must establish
adequate working distance between the
surgical field & the microscope objective
lens.
• Consist of coaxial fiber-optic illumination

position the light source exactly parallel to the

microscope’s optical axis.
with coaxial lighting no shadow is produced
 Beam splitter camera
attachment
• 35mm slides can easily be produced.
• With a foot-operated shutter control, the surgeon
can compose the photographic field as the
procedure unfolds without interrupting the surgery.
• Excellent video documentation is also available.
• High resolution cameras with video & slide printers,
high resolution digital video cameras are currently
replacing 35mm camera.
PERIODONTAL
MICROSURGER
Y
 Definition
Microsurgery is defined as a refinement in
operative technique by which visual acuity
is enhanced through the use of surgical
operating microscope
It is a methodology, through which
surgical techniques are modified to
accommodate the improved motor
coordination made possible through
magnification.
 ROOT PREPRATION
• Studies demonstrate that root debridement,
performed without magnification, was incomplete.

• Magnification enhanced vision may permits more

definitive root debridement.

• Among the primary aim of periodontal surgery is

visual access to the root surface for plaque & calculus
removal & for removing pathologically altered tooth
structure.
• Magnification greatly improves the
• surgeon’s ability to create a clean, smooth
root surface.

• Magnification permits preparation of both hard &

soft tissue wound surfaces so they may joined
together according to the commonly held
microsurgical principle of butt-joint wound
preparation.

• This encourages primary wound healing &

enhances periodontal regeneration.
 SURGERY
UNDER
MAGNIFICATIO
N
• Periodontist have always attempted
to treat the surgical site atraumatically &
to achieve primary wound closure.

• Periodontal microsurgery is the natural

transition from conventional surgical
principles to a surgical ethic in which the
microscope is employed to permit more
accurate & atraumatic handling tissues to
enhance wound healing
MICROSURGI
CAL
INSTRUMENT
S
• Microsurgery entails the use of specially
constructed microsurgical instruments designed
specially to minimize trauma.
• An important characteristic of microsurgical
instruments is their ability to create clean incision
that prepare wounds for healing by primary
intention.
• Microsurgical incision are established at a 90
degree angle to the surface using opthalmic
microsurgical scalpels.
• Microscopy permits easy identification
• of ragged wound edges for trimming &
freshening.
• For primary wound closure, micro-sutures in
the range of 6-9 are needed to approximate
the wound edges.
• Microsurgical wound apposition minimizes
gapes or voids at the wound edges.

• Encourages rapid healing with less

postoperative inflammation & with less pain.
• Studies shows that motor coordination is
greatly improved when surgeons use
microsugical instruments specifically
designed to employ a precision grip of the
hand

• Microsurgical instruments are circular in

cross section to permit precise rotational
movements.
• They are made up of titanium because
of its strength, lightness & non-
magnetizing characteristics.

They reduces unwanted hand movements

results in more precise surgeries & greatly
reduces surgical fatigue & development of
spinal & occupational pathology.
 SUMMARY

The microsurgery offers new

possibilities for periodontal surgery can
improve therapeutic result for a variety of
procedures & gives benefits of improved
cosmetics, rapid healing, minimal discomfort
& enhanced pt. acceptance.