Sunandan Mittal, Tarun Kumar, Jyotika Sharma, Shifali Mittal
Department of Conservative Dentistry and Endodontics, Dasmesh Institute of Research and Dental Sciences, Faridkot, Punjab, India
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|Date of Submission||10-Aug-2013|
|Date of Decision||16-Jan-2014|
|Date of Acceptance||30-Jan-2014|
|Date of Web Publication||2-May-2014|
| Abstract|| |
The introduction of the dental operating microscope was a turning point in the history of dentistry. It triggered a rapid transition from the conventional world of macro-dentistry to the precise, detailed world of micro-dentistry. However, working at these higher-power magnifications brings the clinician into the realm where even slight hand movements are disruptive. Physiologic hand tremor is a problem resulting in difficulty in mouth mirror placement. Hence, in this paper, a new instrument was designed to overcome the drawback of hand tremors during microscopic endodontics.
Keywords: Microscope, mouth mirror, rubber dam clamp, trembling effect
|How to cite this article:|
Mittal S, Kumar T, Sharma J, Mittal S. An innovative approach in microscopic endodontics. J Conserv Dent 2014;17:297-8
| Introduction|| |
Excellence in treatment requires a high level of precision, minimally invasive procedures, and exquisite clinical skills. These are traits that increasingly are possible only through the use of enhanced vision and the technical skills required to perform microscopic work. In nonsurgical endodontics, most procedures are made using indirect vision via a mirror. From the mirror, the light is reflected to enter inside the root canal. Despite numerous advantages use of microscope is still limited to small number of dentists as majority of people find it cumbersome with the major hurdle been stable focus. Working under operating microscope brings the clinician into the realm where even slight hand movements are disruptive and physiologic hand tremor is a problem.  The present instrument was designed primarily with an aim to minimize the movement of mouth mirror so that repeated refocusing could be avoided thus rendering a view which was stable, comfortable, vibration free and less problematic for the operator.
| Materials and methods|| |
In this instrument round mirrors of different sizes were used [Figure 1]a. A small ball was welded to the back of the mirror [Figure 1]b, c. A corresponding socket was welded to the bow of the rubber dam clamp [Figure 1]d. After rubber dam placement this mirror was attached to the clamp via ball and socket joint as described above [Figure 1]e. This type of instrument allowed movement from 0 degree to 120 degree. Anti-fogging spray was used to avoid the fogging of the mirror. According to the operator's convenience the mirror could be adjusted to different angulations [Figure 1]f, g.
| Discussion|| |
Optical magnification has expanded the horizons of endodontics. The improvement of visual acuity through optical magnification is becoming a part of modern dental practice. The most important benefits when using an operating microscope are excellent visualization of operating field, greater illumination and magnification, less iatrogenic occurrences, relaxed upright ergonomics and improved documentation of each treatment case. ,,
When a dentist first starts to use a surgical microscope, he/she will immediately recognize that one of the major hindrances is mouth mirror placement. After placing the rubber dam, the mirror has to be placed away from the tooth but within the confines of the rubber dam at an angle of 45°.  If the mirror is placed too close to the tooth it hinders instrumentation requiring readjustment of the mirror. This readjustment in turn requires refocusing of the microscope which makes the entire procedure frustrating and time consuming for the dentist.
Another problem encountered is the trembling of the operator's or the assistant's hand holding the mirror, causing movement of the mouth mirror. Although the trembling could be in terms of tenths of a millimeter, albeit it could lead to the loss of high definition and clarity of the image effecting the quality of the treatment.
New horizons are still to be opened in microscopic endodontics to overcome such problems. We have tried an innovative approach by designing a static and stable mirror to avoid repeated refocusing and trembling effect. The other benefits of this design are less fatigue to the operator and improved and stable vision. Further modifications via attaching a LED light source near the mirror surface are being looked into.
| Conclusion|| |
Excellence in endodontics is both a choice and a journey, and magnification can be a powerful asset for those who seek absolute clinical accuracy. The simplification of using microscopic technique is the need of the hour so that each and everyone can make use of it. Hence, the present instrument was designed to minimize the mouth mirror movement rendering a view which was stable, comfortable, vibration free and less problematic for the operator.
| References|| |
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|4.||Sempira, HN, Hartwell GR. Frequency of Second Mesiobuccal Canals in Maxillary Molars as Determined by Use of an Operating Microscope: A Clinical Study. J Endod 2000;26:673-4. |
|5.||Kim S, Beak S. The microscopic and endodontics. Dent Clin N Am 2004;48:11-18. |
Department of Conservative Dentistry and Endodontics, Dasmesh Institute of Research and Dental Sciences, Faridkot, Punjab
Source of Support: None, Conflict of Interest: None