Microscope enhanced dentistry / orthodontic course by indian dental academy

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Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.

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Microscope enhanced dentistry / orthodontic course by indian dental academy

  1. 1. Microscope Enhanced Dentistry is just starting to become available in India. It will soon become a standard feature in advanced dental clinics in the future here in India as well as around the world.Microscope Enhanced Dentistry is a new service which is spreading across the globe, slowly but surely. Teeth are normally small structures like the eyes, ear & nose. ENT surgeons, ophthalmic surgeons & neurosurgeons nowadays routinely use an operating microscope or magnifying loupes/spectacles to do surgeries of greater precision and accuracy. Cataract surgery is nowadays routinely done with a microscope nowadays. It is a stunning treat to watch teeth which are only 1 sq.cm in size magnified to fill a TV screen 14 or 21 inches cross!! And the joy of seeing a smile is all the more gorgeous to watch on a large TV screen. A big smile is made much bigger by the magnification provided by the microscope. And the highly improved quality of the fillings, RCT’s, crown and bridge preparations and various other procedures which can be done with the microscope make the patient smile even more! The patient’s confidence in his dentist is hugely increased as he can see the problems in his teeth very clearly under brilliant light and magnification. They co-operate better during the treatment as they are able to see on a TV screen the whole procedure being undertaken on their teeth, and it also ensures better compliance with advice given. The dentist who uses the microscope is much more comfortable and avoids un-due strain on his neck and back. The up-right posture can be maintained during almost all procedures, which is otherwise impossible. Occupational stress and strain on these 2 areas are very high and there are some incidences in the USA where some senior and experienced dentists have only been able to continue working after starting to use the microscope, thus enabling more patients to continue to benefit from their huge experience. The microscope can be used to magnify almost all the procedures which are done routinely by dentists. Since the eyes are not seeing the work area directly as before, a lot of training has to be under-taken to master the use of this new device effectively The use of the same operating microscope in the field of dentistry has just started recently in Western Europe and parts of America. The American Dental Association has made it mandatory and compulsory for higher post-graduate training in endo-dontics or the root canal treatment speciality to be trained in the use of the operating microscope. It is estimated that 75% of the endodontists in the USA now own or use a microscope at least part of the time. A select few dental colleges have started to introduce microscopes at under-graduate level. But many general dentists and other dental sub- specialists like periodontists, oral surgeons and prosthodontists have also pioneered and mastered the use of the microscope in their practices. This is a revolution in the dental world – the amount of improvement of care in dentistry done under magnification with the use of the microscope is very very high. Since microscopes have been used for endodontic RCT’s , extra canals called MB2’s and other minute accessory canals have been found and treated effectively which were not possible before. Thus, the chances of failure of RCT becomes much smaller. Doing complicated procedures like failed RCT and removal of broken files deep inside the roots of teeth are challenges which demand the use of a microscope. Teeth will failed RCT’s
  2. 2. can be re-treated with a second RCT and successfully saved, when done very carefully, and the chances of success are much higher when done under the microscope. Some teeth have decay which almost require a RCT if done with the naked eye. But with a microscope and a special caries detector dye, only the decay can be removed and a RCT avoided. No normal tissue is removed because it is possible to see the difference much better and clearer under magnification. Scaling or cleaning of the teeth done under the microscope affords better removal of tartar and stains and cleaner teeth at the end. Periodontal flap surgery when done under the microscope, is able to remove much more damaged tissue, with much less damage to nearby healthy tissue, and hence give a better result. Suturing of wounds done under the microscope is much finer and delicate, hence better scars, faster healing, less post-operative pain & discomfort is possible. Preparation of teeth to fit a metal or ceramic artificial crown is a routine procedure done in every dental clinic routinely. If a microscope is used for this while preparing the tooth, the margins of the teeth are much more neater and precise, thus allowing a much better fit of the artificial crown, better esthetics and longer life with less problems like leakage and failure. The crown can also be checked before fitting on to the tooth under the microscope to check for defects in shape, size and irregularities as well. Less tooth structure is removed as well if possible, because we can see more clearly. The fitting of crowns and bridges is made very precise and hence the longevity of these is hugely increased. Modern surgical practice in most areas of surgery are aimed to deliver a smaller incision, smaller scar, reduced pain, faster mobilization and a much better quality of outcome. To achieve this, advances like laparoscopy in general surgery, arthroscopy in orthopaedic surgery, endoscopy in urology have all played their part. Similarly, the use of the microscope in neurosurgery, ophthalmic surgery, plastic surgery etc is also helping in giving such benefits to the patient nowadays. The operating microscope is used in so many areas of surgery and medicine nowadays, it has almost become mandatory. The twin benefits of fantastic shadowless illumination and higher magnification make it un-beatable. At a meeting held recently in Coimbatore on Microscope Enhanced Dentistry, a well known plastic and microsurgical reconstructive hand surgeon remarked, “You can only treat what you can see well. You have to use the microscope to know how good and useful it is.”
  3. 3. Sun 9 Dec Microscope assisted precision dentistry articulatingmicroscope This article is about the use of microscope assisted precision dentistry, or the use of microscope in oral health treatment. Although microscopes have been used in medicine as early as 1921, it wasn’t until the early nineties that microscopes were to be used for dental applications. Shanelec, Tibbets, Feldman Ruddle, Friedman and others were able to publish a series of papers that documented the use of microscope n endodontics, termed “microscope assisted precision dentistry (MAP dentistry). And in 1998 the American Association of Endodontics (AAE) proposed all postgraduate students should have an experience in operating and handling of a microscope, in order to qualify for a license in endodontics. In Australia where advancement is pioneered, dental laboratories have been using microscopes as early as fifteen years ago for checking filling margins and castings. Some maxillofacial surgeons and other dentist have used microscopes for apicectomies. With MAP dentistry, it is now possible to remove decayed dental tissue (caries) to its interface without affecting the normal adjacent tissue. The quality and precision that MAP dentistry has brought raised the accuracy in removing decayed tissue without unnecessarily sacrificing normal intact dentin. With this success it prevents the occurrence of secondary caries. Dr. Peter Kotschy is a strong advocate of preventive, periodontology as well as minimal invasive dentistry, as such he has been using microscopes for preventive operations, periodontal and restorative procedures, endodontic, and prosthodotic work, enabling for a precise removal of secondary caries which was difficult before microscopes were introduced. What are the advantages of a microscope, first we have to look at the disadvantages. Conventionally, a decaying tooth is treated and filled with amalgam. This procedure is without certainty and complete caries control cannot be assured. It is a fact that a 100% caries control is impossible and a secondary caries will likely occur. In a secondary caries, it is actually a residual of primary caries, this are caries which were not completely removed. Although in the field of amalgam filling advancements have been made on the improvement of the type of amalgam filling, a tightly sealed amalgam cannot assure a secondary caries will not develop. Thus the article states, if we were able to completely remove primary caries will then be able to prevent further residual decay from spreading. Microscope assisted precision dentistry (MAP dentistry), is one of the field in medicine were an articulating microscope is needed. Considering that dentistry as the article states, is one of the medical specialty with the most demanding precision standards. Microscopes have evolved from fixed type to articulating microscope types. Articulating microscope has the advantage of mobility. With an articulating arm, the articulating microscope can shift from one position without moving the entire equipment. Like most microscope in the field of surgery, articulating microscopes have video attachment capability wherein videos or images can be seen from an
  4. 4. external monitor. The use of microscope assisted precision dentistry (MAP dentistry) is not only challenging but also time consuming, but considering the breakthrough in oral health surgery; in caries control, Dr. Peter Kotschy recommends the use for endodontic treatment and all other dental work in the fight to control caries. Article link • BLOG ITS ALL IN THE DETAILS-MICROSCOPE DENTISTRY DR. GLENN A. VAN AS HOW YOU VIEW THE PROFESSION THE D.O.M. AND POST CORONAL SEAL MONDAY, DECEMBER 3, 2007 One of the findings in endodontic literature is that the Coronal seal (Removing the ability of contamination of the obturation by saliva and oral bacteria) is a key in the ongoing success of endodontic treatment. Some studies have shown that exposure of the Gutta Purcha to bacteria can in as little as 28 days allow for bacteria to travel the entire length of the tooth, allowing for failure of the treatment to become a possibility.
  5. 5. J Endod. 2002 Nov;28(11):762-4.Click here to read Links An... READ MORE... 2 COMMENTS UNCOVERING MORE ANATOMY SATURDAY, DECEMBER 1, 2007 In today’s blog we look again at a couple of more cases focussing in on the role of the microscope in locating Portals Of Entry to the roots of the teeth. The cases below are my own of varying ages to show the photography possible and the ability if you know where to look to find canals. In the first case we see an upper first molar with 4 canals and see where the white line leads us to uncover the MB2 which as usual is located mesial to the line connecting MB1 and the Pal canals. The 2nd case is... READ MORE... NO COMMENTS TROUGHING FOR EXTRA PORTALS OF ENTRY (POE)- A LONG REVIEW. SATURDAY, DECEMBER 1, 2007 One of the confusing things when you get a microscope is what the heck you are looking at when you suddenly are getting the gift of actually standing inside the endodontic access ( it seems like that) and getting this huge magnified and illuminated view of the inside of the tooth. With time you begin to understand better what you are actually looking at, and understanding all the visual information that you have never seen before. Once the puzzle of whitelines, dentin maps, pulp stones, and... READ MORE... NO COMMENTS ACCESS WITH THE OPERATING MICROSCOPE- THE ELUSIVE MB2 THURSDAY, NOVEMBER 29, 2007 Many dentists purchase the operating microscope solely to be used in the early stages of endodontics to locate canals in molars with greater ease. The combination of magnification and illumination possible with the scope helps incredibly with the visual acuity possible in endodontic access. The most common tooth to fail after initial endodontic therapy is the upper first molar and the sobering study by John Stropko published in the JOE in 1999 which looked at 1732 maxillary molars and found... READ MORE... NO COMMENTS ENDO AND THE OPERATING MICROSCOPE - PART 2 TUESDAY, NOVEMBER 27, 2007
  6. 6. In yesterdays Blog entry, the topic of the microscope in the literature was broached (pun intended). There is a growing body of evidence in the literature on the role of the microscope in the discipline of endodontics. Much of the concentration of the literature has been focussed on the role of the higher levels of magnification for early access into the pulp. The published material has focussed on ability to discover 4th canals in molars, particularly the MB2 in maxillary first molars which are... READ MORE... NO COMMENTS ENDO AND THE OPERATING MICROSCOPE - SHOW ME THE LIT! MONDAY, NOVEMBER 26, 2007 Many people have asked during what parts of the endodontic treatment does the operating microscope help with. I guess the simple answer is all of them, particularly if you look at the value of the operating microscope for ergonomics, for its ease of documenting in video and still digital media and finally for the ability to show patients, staff and colleagues any portion of the entire procedure. In this first part of looking at the benefit of the microscope for endo, I will attempt to provide... READ MORE... NO COMMENTS PAIR OF CRACKS - A PREDICTOR OF INTERPROXIMAL DECAY SATURDAY, NOVEMBER 24, 2007 If you have never read Dr. David Clarks article on cracked teeth you owe it to yourself to get a copy of the article, read it, digest it, read it again. Its that important an article for those of us who use the operating microscope. I will occasionally cover a single type of cracks that David talks about in his landmark article. Today is one of those days.David was the founder of AMED and his enthusiasm and initiative were the driving force for the organization that acts as the primary annual... READ MORE... NO COMMENTS LOOK WHAT I FOUND! THURSDAY, NOVEMBER 22, 2007
  7. 7. When I started using the operating microscope, it quickly became evident that the tremendous improvement in visual acuity through both magnification and illumination allowed for much earlier diagnosis of decay. I still will bring over the diagnodent to help me quantify an occlusal lesion in terms of size and know whether it is possible to treat it without the dreaded needle. The “shadows” that the microscope illuminates is impressive. Far earlier than depending on cavitation and detection of an... READ MORE... NO COMMENTS USING THE FULL RANGE OF MAGNIFICATIONS WEDNESDAY, NOVEMBER 21, 2007 The answer to which magnification I use the most is ALL of them. To be honest when I look at the range of magnifications that I have, I break the 6 steps down to 3 groups. There is a LOW magnification range of 2.1 and 3.2X power. These are very useful magnifications for things like placing rubber dam, providing anesthetic, evaluating line of draw, looking at a smile from commissure to commissure, looking at a whole quadrant at once, placing orthodontic brackets, gross reduction of tooth... READ MORE... 3 COMMENTS OLD EYES, YOUNG EYES, ANY EYES. TUESDAY, NOVEMBER 20, 2007 The microscope offers all users regardless of their eyesight tremendous improvements in visual acuity through the increase in visual information it provides by magnification and illumination. Dr. Assad Mora at an early edition of AMED provided us with food for thought by the following table. The table shows us the tremendous improvement in visual acuity that is possible when we start to increase magnification compared to the naked eye and low level loupes. This amount of visual information is... READ MORE... NO COMMENTS The Dental Operating Microscope was brought to endodontics by pioneers like Carr, Arens, Ruddle, Castellucci, and Buchanan. It is now becoming more commonly used
  8. 8. by general dentists to help with treatment outcomes, ergonomics, and improving communication and documentation for all aspects of daily practice. Go to archive j.o. Endod. 2002 Nov;28(11):762-4.Click here to read Links An assessment of microbial coronal leakage of temporary filling materials in endodontically treated teeth. Balto H. King Saud University, College of Dentistry, Division of Endodontics, Riyadh, Kingdom of Saudi Arabia. This in vitro study evaluated the microbial leakage of Cavit, IRM, and Dyract when used as temporary filling materials after root canal treatment. The degree of coronal leakage was assessed by using a microbiological marker consisting of Streptococcus faecalis and Candida albicans. For each of the two organisms, a set of 15 maxillary premolars were prepared chemomechanically and obturated with thermoplasticized gutta-percha. A 3.5-mm thick layer of one of the three temporary filling materials was inserted in the access cavities of the teeth from each group (each group was compromised of five teeth). The control teeth (four positive and four negative) lacked any filling material over the gutta-percha, whereas the orifice and the apical foramen of the negative control were completely sealed with nail polish. Each tooth was placed in a well of a 24-well tissue culture plate and embedded in trypticase soy
  9. 9. broth and 0.5% Bactoagar. An organism suspension was inoculated in the access cavity, and microbial penetration was detected as an increase in turbidity of the broth. At the end of 30 days, the results showed that all positive control teeth leaked within 1 week, whereas those that served as negative control remained uncontaminated throughout the test period. With both organisms, IRM started to leak after 10 days, whereas Cavit and Dyract leaked after 2 weeks. Others have shown, the temporary restorations have far less ability to provide a coronal seal than a permanent restorative material on a completed endodontic procedure. J Endod. 1999 Mar;25(3):178-80.Links A comparative study of four coronal obturation materials in endodontic treatment. Uranga A, Blum JY, Esber S, Parahy E, Prado C. Faculty of Medicine and Odontology, University of Basque Country, Lejona, Spain. The aim of this study was to compare, in vitro, the ability of temporary versus permanent materials to seal the access cavity. Eighty human maxillary single-canal teeth were prepared biomechanically and obturated with gutta-percha and an endodontic cement AH Plus, using the warm vertical compaction technique. All access cavities were sealed with 1 of 4 materials (Cavit, Fermit, Tetric, or Dyract). Microleakage was assessed by methylene blue dye penetration. The teeth were submitted to 100 thermocycles, with temperature varying from 0 degree to 55 degrees C. The greatest degree of leakage was observed with the temporary materials (Cavit and Fermit). There was a significant difference (p < 0.05) in leakage between all materials except between Dyract and Tetric. This suggests that it may be more prudent to use a permanent restorative material for provisional restorations to prevent inadequate canal sealing and the resulting risk of fluid penetration. PMID: 10321182 [PubMed - indexed for MEDLINE] It is clear from the literature that the quality of the coronal seal can affect the longevity of the endodontic therapy. All of us have witnessed a seemingly successful endodontic case radiographicallly become reinfected and upon access into the tooth, discovered leakage and bacteria coronally that was responsible for the reinfection of the canals and for the reoccurrence of the periapical pathology.
  10. 10. In completing an endodontic case the micrsoscope can help with the ability to provide a nice clean and solid coronal seal. The technique is as follows: 1.Coronal seal is so important to preventing reoccurrence of periapical pathology. 2.Clean up of pulp chamber involves isopropyl alcohol in an Ultradent syringe. 3.Slowspeed round burs, or high speed diamonds to clean up Gutta Percha. 4.Flowable over the GP at the pulpal floors, corebuildup in composite afterwards. Some like Amalgam for seal The key in these cases is to see a nice void free interface leading from the endodontic therapy to the access of the tooth. This should be done at the completion of the treatment to give the greatest success to long term health for the tooth. The above procedural guide combined with the microscope which allows for easier viewing of the access of the tooth and careful placement of restorative materials provides for a nice radiographic flow of materials from the pulpal floor coronally. Stay tuned this week for further cases demonstrating the effectiveness of the microscope for endodontics. ACCESS AND THE OPERATING MICROSCOPE UNCOVERING MORE ANATOMY SATURDAY, DECEMBER 1, 2007 In today’s blog we look again at a couple of more cases focussing in on the role of the microscope in locating Portals Of Entry to the roots of the teeth. The cases below are my own of varying ages to show the photography possible and the ability if you know where to look to find canals. In the first case we see an upper first molar with 4 canals and see where the white line leads us to uncover the MB2 which as usual is located mesial to the line connecting MB1 and the Pal canals. The 2nd case is an upper 2nd molar and with the microscope you will soon become uncomfortable only finding one MB canal as well. There often as John Stropko shows in his study, 4 canals in upper 2nd molars as well.
  11. 11. TROUGHING FOR EXTRA PORTALS OF ENTRY (POE)- A LONG REVIEW. FRIDAY, NOVEMBER 30, 2007 One of the confusing things when you get a microscope is what the heck you are looking at when you suddenly are getting the gift of actually standing inside the endodontic access ( it seems like that) and getting this huge magnified and illuminated view of the inside of the tooth. With time you begin to understand better what you are actually looking at, and understanding all the visual information that you have never seen before. Once the puzzle of whitelines, dentin maps, pulp stones, and other oddities of the pulp chamber become better understood and more frequently seen then you know better where to search for the canals. John Khademi has shown repeatedly cases where extra canals are found. This first case is John’s taken from Dental Town. If you ever get a chance to see some of what John has to teach then I highly encourage you to listen to him lecture. He is a very bright man, with a great ability to teach.

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