By Assad F. Mora, DDS, MSD, FACP
The operating microscope has been an essential instrument in my private practice since 1992. Once I became hooked on the visual advantage provided by the microscope in my daily practice, I became more aware of the ergonomic shortcomings that, occasionally, made the microscope a difficult instrument to use.
For the microscope user to be comfortable when using the microscope, it requires a posture in which muscle tension is minimized and equalized between the left and the right sides of the body and the arms. The ideal microscope position that can be conducive to assuming such posture must allow the operator to be seated in the 12 o’clock position and allow for adequate extension of the microscope between the objective lens and the eyepieces that is at least equal to the distance between the top of the head of the patient to the patient’s mouth, to prevent the operator from bending forward to reach the eyepieces and cause strain on the lower back. The MORA interface was developed in response to the challenges listed above.
Postural Problems Working under Microscope Magnification:
1. Restricted and posture-dependent access: Gaining visual access to the operating field with a microscope is a process totally dependent on the operator’s postural limits. The microscope cannot be positioned outside the envelope of postural extension of the back and neck of the operator if the eyes are to remain on the eyepieces. Any movement of the microscope will induce a change in the head & neck and upper & lower back positions. The most practical way to use a microscope has been with the operator sitting in the 10 o’clock position. Sitting in this position forces the operator to tilt the microscope by rotating it clockwise to gain visual access to the patient’s oral cavity, and subsequently tilting his/her head toward the right shoulder, resulting in an unfavorable and strained postural neck position (the Taco neck position).
2. Muscle tension and pain: Assuming strained postural positions for extended periods of time cannot be avoided when performing clinical dental procedures under microscope magnification. This will result in discomfort, muscle contraction, and pain. A strained visual postural position is further compounded by strenuous working positions resulting from the over extension of the arm holding the mouth mirror, and the forces required to stabilize it during use, either as a reflector, or as a retractor. This usually leads to shoulder and neck pain.
The Solution:
The MORA Interface provides a solution to the problems listed above, by creating a “posture-friendly” microscope system. To obtain the maximum benefits from the MORA Interface, the operator must be seated in the 12 o’clock position. A microscope with a MORA Interface and a beam splitter increases the horizontal distance between the eyepieces and the long axis of the body of the microscope. It provides a horizontal working distance that is compatible with the distance between the top of the head and the mouth of the patient.
Conclusion:
The MORA Interface can save your neck and upper back and can allow your assistant to use a co-observation tube. It makes working with a microscope more intuitive, more productive, and more enjoyable.
Reference:
An excerpt of Mora, A. (2007). Enhancing Ergonomics and Workflow in Microdentistry: OPMI pico with MORA Interface. The Microscope in Dentistry: An Editorial Forum for Dental Professionals.