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  • 1. RECENT ADVANCES IN SURGICAL TECHNOLOGY
  • 2. 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.
  • 3. MAGNIFICATION SYSTEMS
  • 4.
    • 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.
  • 5. MAGNIFYING LOUPES
  • 6.
    • 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.
  • 7. Disadvantages
    • Clinician’s eyes must converge to view the operative field
    • May result in
    • eye strain
    • fatigue
    • pathological vision changes
  • 8. TYPES
    • SIMPLE COMPOUND PRISM
    • TELESCOPIC
  • 9. 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.
  • 10.  
  • 11. 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.
  • 12. b)COMPOUND LOUPES
    • STRUCTURE:-
    • Multielement lenses with intervening air space.
    • Gain additional refracting surfaces
  • 13.  
  • 14. Advantages
    • Allow increase magnification with more favourable working distance & depth of field.
    • Can be adjusted to some clinical needs without excessive increase in size or weight .
    • Can be achromatic.
    • Specific density of each lens counteracts the chromatic aberration
    • Produces color correct image.
  • 15. Disadvantage
    • They become optically inefficient at magnification above 3.0 diameter.
  • 16. 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.
  • 17.  
  • 18. Advantages
    • Produces better magnification.
    • Wider depth of field.
    • Longer working distance.
    • Larger field of view.
  • 19.
    • Recent innovation : -
    • Coaxial fiber-optic lighting is incorporated in the lens elements.
    • Improve illumination
  • 20.  
  • 21. 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.
  • 22. SURGICAL OPERATING MICROSCOPE
  • 23. 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.
  • 24.
    • Incorporate fully coated optics with achromatic lenses.
    • Provide highest optical resolution with the most efficient illuminations.
  • 25.  
  • 26. ADVANTAGES
    • Provide better magnification.
    • Better optical performance.
    • Durable.
    • Versatile.
    • Allow dentist to easily change working magnification.
    • Some microscopes incorporate electronic foot controlled focus & magnification for further convinience.
  • 27.
    • 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.
    7. Have a rotating variable magnification.
  • 28.
    • 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
  • 29. 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.
  • 30.  
  • 31. PERIODONTAL MICROSURGERY
  • 32. 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.
  • 33. 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.
  • 34.
    • 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.
  • 35. SURGERY UNDER MAGNIFICATION
  • 36.
    • 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
  • 37. MICROSURGICAL INSTRUMENTS
  • 38.
    • 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.
  • 39.
    • 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.
  • 40.  
  • 41.  
  • 42.  
  • 43.
    • 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.
  • 44.
    • 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.
  • 45. 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.