Fig 1. Application of adhesive on enamel
Over the past 15 years, there have been a number of fundamental technical changes in restorative dentistry. Restorative dentistry nowadays is no longer restricted to primary prosthetics-oriented treatment of a patient by providing appropriate work made in the dental laboratory. For colleagues practicing restorative, holistic dentistry, it is now possible to provide patients with both aesthetic and functional restorations from the periodontal and endodontic foundation onward, after undergoing further training in certain specific disciplines and investing in those areas. These special fields include all aspects of periodontology: a systematic adhesive bonding technique, high-quality root canal therapy, periodontal plastic surgery, implant dentistry, and ultimately–after a lengthy period of treatment–permanent, functional, and aesthetic restoration techniques (Fig. 1).
Fig 2. Endodontic revision therapy
Reasons for turning to a dental microscope
Further development of adhesive bonding techniques, plus an increasing desire over the past 10 years to preserve teeth, has resulted in endodontics becoming highly important in restorative dentistry. In addition to the adhesive stabilization of teeth subjected to endodontic therapy, the introduction of the dental microscope significantly increased success rates in primary and revised endodontic therapy as well as retrograde, apicoectomy surgery (Fig. 2).
Conservative, adhesive restorations after systematic caries excavation
Fig 3. Caries excavation close to the pulp
In cases with extensive carious defects and deep cavities, and where caries excavation is performed systematically and followed by adhesive management with built-up resin fillings, onlays placed at a later date may function properly for many years.
If caries is to be excavated close to the pulp, I like to use the dental microscope. Due to its shadow-free light in conjunction with rhodium-plated mirrors, it is excellent for distinguishing even the tiniest of infected areas (Figs. 3. 4). The closer to the pulp the operator needs to work while removing caries, the more this type of optimal vision enables great care to be exercised.
Periodontal therapy in visually barely accessible (subgingival) root sections
In closed or open periodontitis therapy, based on the full mouth therapy concept, one often has the problem that the deep subgingival pockets or interdental recessions and furcations already affected by bone destruction are hardly accessible to the naked eye. Due to the optical benefits mentioned and the illumination of the surgical field, I like to use the dental microscope in these instances because it is possible to detect any clinging islands of biofilm and remove them precisely.
Fig 4. Canal visualization after excavating caries from tooth 36
Conclusion – the advantages of using a dental microscope
One advantage of using the dental microscope that should not be underestimated, especially in the physically and psychologically highly strenuous dental profession, is a healthy, namely upright, working posture. Due to its superior technological features, a convenient-to-use microscope can provide the dentist with considerable quality of life and good health.
As originally published in Sidekick Magazine
Reference:
An excerpt of Gänsler, W. (2007). The Advantages of Using a Dental Microscope in Restorative Dentistry – A Practically Oriented Report. The Microscope in Dentistry: An Editorial Forum for Dental Professionals, 11–15.
Images courtesy of Dr. Wolfgang Gänsler, Illertissen, Germany