good one

1. Dr. Jagadeesh K
Second yr p.g
Dept of Conservative Dentistry & Endodontics
MAGNIFICATION
IN ENDODONTICS

2. Contents
• Introduction
• History
• Optical definitions
• Loupes
• Dental operating microscope
• Rod lens endoscope
• Ora scope
• conclusion

3. INTRODUCTION
• Significant advances in the use of magnification and
illumination and supportive armamentarium in recent years have
benefited treatment protocols in non surgical and surgical
endodontics.
• Such that teeth, which might otherwise have been extracted,
now have a predictable chance for retention.

4. HISTORY
• Otologists - Introduced operating
microscope
• In 1922 Carl Nylen - Monocular microscope
• In 1953 Carl Zeiss - Binocular operating
microscope
• In 1960 - 1st surgical operating
microscope

5. • In 1978 Apothekar & Jako - DOM
• In 1981 - DOM (Dentiscope)
• In 1993 - Symposium on
microscopic Endodontic
surgery
• In 1995 - DOM by Endodontists
• In 1997 - Microscopy training

6. DENTISCOPE

7. Optical Definitions
• Working Distance: The distance measured from the
dentist’s eye to the treatment field being viewed.

8. • Depth of Field: Refers to the ability of the lens
system to focus on objects that are both near and far
without having to change the loupe position.

9. • Field of view : The area that is visible through
Optical magnification.
• Viewing angle: The angular position of the
optics allowing for a comfortable viewing
position for the operator.

10. Loupes
• Dental loupes are the most common magnification
system used in dentistry.
MULTI LENS OPTIC SYSTEM
• Galilean optical system. (ideal magnification 2.5X)
• Keplarian optical system. (ideal magnification 6X)

11. An example of a Galilean system
Prism loupes.
These loupes have sophisticated
optics, which rely on internal prisms
to bend the light.

12. • The disadvantage of this arrangement is that the eyes must
converge to view an image.
• This convergence over time will create eyestrain and fatigue.

13. • Prism loupes produce better magnification, larger fields of
view, wider depths of field, and longer working distances than
other types of loupes.
• Only the Dental Operating Microscope (DOM) provides better
magnification and optical characteristics than prism loupes.

16. fiberoptic headlamp system

17. Dental Operating Microscope (DOM)
• Most microscopes can be configured to
magnifications up to × 40 and beyond but
limitations in depth of field and field of view
make it impractical.

18. Classification
Based on use :
• Surgical microscope
• Examination microscope

19. Based on magnification:
• Lower magnification (2.5x to 8x)
• Midrange magnification (8x to 14x)
• Higher range magnifications (14x to 30x)
Grossman’s Endodontic Practice 12th ed

20. Based on installation
Ceiling mounted
Floor mounted
Wall mounted

21. THE ANATOMY OF THE
OPERATING MICROSCOPE
• 3 primary components:
• Supporting structure
• Body of the microscope
• Light source

22. Supporting structure
Distance between the fixation point and the body
of the microscope is stability

23. Body of the microscope
• Eyepieces
• Binoculars
• Magnification
changer
• Objective lens

24. Eyepieces
Eyepieces
- Rubber cups
- Diopter settings
from -5 to +5
Eyepieces
(6.3x, 10x, 12.5x, 16x, and 20x)

25. Binoculars
Adjustment of the inter pupillary
distance
Straight
Inclined
Inclinable tubes

26. Straight Inclined Inclinable tubes
Binoculars

27. • 3-, 5-, or 6-step manual changers
• Manual & Power-zoom changer.
• located within the head of the microscope
Magnification changer

29. Power zoom changer microscopes
have foot controls, which allow the
surgical field to be focused and
magnified hands-free.

30. Objective lens
Determines operating distance
Focal length ranges from 100 – 400 mm
Many endodontic surgeons use a
200mm lens, which focuses at about 8 in.

31. How surgical operating microscope works ???
Magnification
Illumination
Instrumentation
Documentation

32. Magnification
• Power of the eyepiece
• Focal length of the binoculars
• Magnification changer factor
• Focal length of the objective lens

33. • Total magnification of a microscope:
TM = (FLT/FLOL) × EP × MV
FLT: Focal length of binocular tube
FLOL: Focal length of objective lens
EP: Eyepiece Power
MV: Magnification Value

34. Power of the eyepieces
Focal length of the binoculars
Magnification factor
Magnification Field of view

35. Focal length of
the objective lens
Magnification
Illumination
Magnification
Depth of field
Illumination

36. • It is important to keep in mind that maximum
magnification is used to check, and most of the
procedures are made at minimum-medium
magnification.

37. Illumination
Xenon bulb (100watt)
Width of light field 45 mm
Separation of the light beams
Stereoscope effect
COAXIAL ILLUMINATION

38. Galilean optics. Parallel optics enables the observer to focus at
infinity, relieving eyestrain.

39. Accessories
Beam splitter
Separation of light beam
Function of beam splitter

40. • Assistant scope.
• Condenser
• Documentation tools: video camera
• Strobe on objective lens
• Eye piece with reticule

41. Documentation
Quality slides and video proportional to quality of
magnification & illumination
Advantages:
• Communicate with referring dentist
• To educate patients and students
• To maintain required legal documentation

42. • Postural: posture should be perfect.
avoids tiring of eyes.
no need of wearing prescription eye wear.
• Procedural: improves manual abilities.
collateral vision decreases.
Procedure recording can be done.
procedural errors can be assessed.

43. • Psychological: Decreases psychological, physical,
Postural stress.
Increases personal and professional
satisfaction.
• Educational: Easy for us to gather images to file.
Procedures can be recorded and can be
presented in symposia and conferences.

44. • Shanelec and Tibbets[1998]
– Working without magnification, can make
movements that were 1–2 mm at a time.
– At 20× magnification, the refinement in movement
s can be as little as 10–20 microns (10–20/1000 of
a mm) at a time.
Tibbets LS, Shanelec DA. Periodontal Microsurgery. Dent Clin North Am. 1998; 42:339–359.

45. • Leknius and Geissberger, [1995] and
Zaugg et al. (2004):
– As magnification is incorporated, procedural errors
decrease significantly.
– The inclusion of a microscope resulted in fewer
errors than when a set of loupes was used.
Zaugg B, Stassinakis A, Hotz P. Influence of Magnification Tools on the Recognition of Simulated Preparation and Filling Errors. Schweiz Mo
natsschr Zahnmed. 2004; 114(9):890–896.

46. Improved & Ideal treatment Ergonomics
• All stooping and
bending is eliminated
• Constant bending
collapses the diaphragm

47. THE LAWS OF ERGONOMICS
• Class I motion: moving only the fingers

48. • Class II motion: moving only the fingers and wrists

49. • Class III motion: movement originating from the elbow

50. Class IV motion: movement originating from the shoulder

51. Positioning the DOM
• Operator positioning
• Rough positioning of the patient
• Positioning of the OM and focusing
• Adjustment of the interpupillary distance
• Fine positioning of the patient
• Parfocal adjustment
• Fine focus adjustment
• Assistant scope adjustment.

52. Operator Positioning
• At the 11- or 12-o’clock position
• 9-o’clock position comfortable when first learning to
use an DOM
• The hips are 90˚ to the floor, the knees are 90˚ to the
hips, and the forearms are 90˚ to the upper arms
• The patient is moved to accommodate this position.

53. Once the ideal position is established
lower magnifications to locate the
working area
The image is focused and stepped up
to higher magnifications if desired.

54. Rough positioning of the patient
The patient is placed in the trendelenberg
position and the chair raised until the patient in focus

55. Positioning of the OM and focusing
• Knowing the focal length of the objective lens, the
operator moves the microscope up and down until the
working area comes into focus.

56. Fine positioning of the patient
• Little movements can be done for the
definitive position of the patient.
• Maxillary teeth - horizontal
• Mandibular teeth - trendelenberg position

57. Parfocal adjustment
• The focused view of the working area will stay
sharp as the magnification is changed.
• It is mandatory that working area in focus to
the operator, it is also in same focus to the
assistant, for the video camera.

58. Operatory Design Principles for using DOM
• The organizing design principle using the OM
- circle of influence.

59. Disadvantages
• Need for specific training: as a DOM has a restricted
working field, 11mm -55mm
• An operator using a DOM can see only the tip of the
instruments, and they are used in delicate movements
of small amplitude
• High initial cost of the equipment and instruments

60. Use of Dental Operating Microscope
• Conventional endodontics:
• Preserving tooth substance
• Localization & visualization
• Locating Calcified Canals
• Final examination
• Removal of fractured instruments
• Obturation with warm gutta-percha
• Recognition & location of fractures

61. • Surgical Endodontics:
• Soft tissue management
• Root end procedures (apicoectomy with retrograde filling)
• Intentional Replantation

62. • Preserving tooth substance:
• Trephination opening
eg. MB2 canal
• Localization & visualization:
• Ultra sonic
• Appropriate magnification

63. • Locating calcified canals
• Specially…..
• Root Dilacerations
• Mid root bifurcations / trifurcations / sharp
demarcations of curvature

64. Removing fractured instrument:
• Traditional methods – perforations
- Gross destruction
• Operating microscope / ultrasonic tips/
High magnification
Recognition & location of fractures:
• High magnification
• Fracture identified - Methylene Blue

65. Perforation repair:
• Pro root MTA
• Micro instruments & ultrasonic attachments
Other Applications
• Removal of posts
• Cleaning of canals
• Handling vital tissue

66. Rod–Lens Endoscope
Made up of rods of glass working in junction
with a camera, light source, and monitor
Greater magnification than that achieved with loupes
or a microscope, with optical resolution comparable
with that of microscopes and/or loupes.
The use of the endoscope is therefore recommended for visualization of
surgical endodontic treatment.

67. • 2.7 mm lens diameter, 70 deg angulation, 3 cm length
rod–lens, are recommended for surgical endodontic visualization
• 4 mm lens diameter , 30 deg angulation, and 4 cm length rod–le
ns for non-surgical visualization through an occlusal
access opening.
• Hemostasis of the surgical field must be obtained
• Eliminate the fogging effect

68. Orascope
0.8 mm tip diameter and 0 deg lens and
the working portion is 15 mm in length
A canal must be prepared to a minimum size
of a 90 file in the coronal 15 mm of the canal.
If the canal is under-instrumented, a wedging
of the orascope may damage some of the
fiber optic bundles within the scope.
allows the orascope to provide imaging
of the apical third

69. Microscope–Endoscope Combination

70. Magnification versus Differentiation

71. CONCLUSION
• Endodontic procedures can be done in less time
because of the greater visibility of the root canal
anatomy and procedural errors can be reduced
‘You can only treat what you can see’

72. REFERENCES
• Richard Rubinstein. Magnification and illumination in apical s
urgery. Endodontic Topics; 11 (1), pages 56–77, July 2005.
• Detsch S , Cunningham W , Langloss J. Endoscopy as an aid t
o endodontic diagnosis. J Endod 1979: 5: 60–62.
• Held S , Kao Y , Well D. Endoscope – an endodontic applicati
on. J Endod 1996: 22: 327–329
• Bahcall JK , Di Fiore PM , Poulakidas TK. An endoscopic tech
nique for endodontic surgery. J Endod 1999: 25: 132–135.

73. • Gary B. Carr, Carlos A.F. Murgel. The Use of the Operating M
icroscope in Endodontics. Dent Clin N Am 54 (2010) 191–214
• Grossman’s endodontic practice 12th ed
• Ingle text book of endodontics 6th ed
• Pathways of Pulp- cohen 10th ed