Dr. Sapnil., MDS Reader

1. ADVANCES
IN
SURGICAL TECHNOLOGY
Presented by
Dr. Sapnil, MDS
Reader

2. MAGNIFICATION SYSTEMS
Requires an understanding of optical principles
that govern all magnification systems
Improves the accuracy of clinical & diagnostic skills

3. MAGNIFYING LOUPES
Loupes are fundamentally two monocular
telescopes with side-by-side lenses converged
to focus on the operative
field
The magnified image they form has stereoscopic
properties by virtue of their
convergence
A convergent lens optical system is also
called a “KEPLERIAN OPTICAL SYSTEM”

4. MAGNIFYING LOUPES
SIMPLE COMPOUND
PRISM TELESCOPIC
EYE GLASS - MOUNTED COAXIAL LIGHTED

5. PRISM TELESCOPIC
Produce better magnification
Wider depths of field
Longer working distances
Larger fields of view
Recent innovations in prism telescopic loupes
include coaxial fiber optic lighting incorporated
in the lens to improve illumination

6. MAGNIFICATION RANGE
Dental loupes provide a limited range of
magnification [ 1.5 x to 10 x ]
The surgical operating microscope provides
much higher magnification and superior
optical properties than any of the loupe
optical systems previously discussed

7. OPERATING MICROSCOPE
Superior magnification and better performance
compared to dental loupes
Designed for use in dentistry
Employ Galilean optical principles

8. Galilean optics allows stereoscopic viewing of
the operative field without eye Convergence
This positions the eye as if they were
focused on infinity to permit a relaxed
viewing of the operative field without eye strain
or fatigue
The operating microscope incorporates fully
coated optics with achromatic lenses to
provide the highest optical resolution with
the most efficient illumination

9. The greatest advantage of the surgical
operating microscope is its ability to allow the
dentist to easily change working magnification
to a level appropriate for the clinical task at
hand
Periodontal surgeon must establish adequate
working distance between the surgical field
and the microscope objective lens
This permits the surgical assistant to retract
tissues and to irrigate or evacuate the
surgical site
Such assistant aided control of surgical
access is essential for microsurgical visibility

10. Assistant eye piece attachments are available
for all surgical microscopes and can greatly
aid the progress of microsurgical procedures
Surgical microscopes are available with
objective lenses with various working distances
The useful range in dentistry is 250 to 350 mm
The surgeon can view perfectly the deepest
reaches of the oral cavity, including the
sub- gingival pockets and angular bony defects

11. Definitive visualization of root surface deposits
and irregularities is possible at magnification
levels provided by a surgical microscope
The surgical operating microscope is ideal
for documenting periodontal pathology
35-mm slides can easily be produced using
a beam splitter camera attachment
Excellent video documentation is also
available through the operating microscope
using a video beam splitter attachment

12. PERIODONTAL MICROSURGERY
ROOT PREPARATION
The importance of root debridement is
recognized universally as an essential
component of periodontal therapy
When debrided roots were examined with
the aid of a microscope, substantial deposits
remained
Primary aims of periodontal surgery is
visual access to the root surface for plaque
and calculus removal and for removing
pathologically altered tooth structure

13. Magnification permits preparation of both
hard and soft tissue wound surfaces so they
may not be joined together according to the
commonly held microsurgical principle of
butt – joint wound approximation
This encourages primary wound healing
and enhanced periodontal regeneration
Epithelial anastamosis of micro surgically
joined surgical wounds occur within 48 hours

14. SURGERY UNDER MAGNIFICATION
What appears to the unaided eye as gentle
handling is revealed under magnification as
gross crushing and tearing of delicate tissues
Periodontists have always attempted to treat
the surgical site atraumatically and to achieve
primary wound closure

15. Periodontal microsurgery is the natural
transition from conventional surgical principles
to a surgical ethic in which the microscope
is employed to permit more accurate and
atraumatic handling of tissues to enhance
wound healing

16. MICROSURGICAL INSTRUMENTS
Important characteristic is their ability to
create clean incisions that prepare wounds
for healing by primary intention
Microsurgical incisions are established at a
90-degree angle to the surface using
ophthalmic microsurgical scalpels

17. CASTROVIEJO MICROSURGICAL SCALPEL
MICROSURGICAL SUTURING

18. Microscopy permits easy identification of
ragged wound edges for trimming and
freshening primary wound closure , micro-
sutures in the range of 6-0 to 9-0 are
needed to approximate the wound edges
Microsurgical wound apposition minimizes
gaps or voids at the wound edges
This encourages rapid healing with less
post-operative inflammation and pain

19. ERGONOMICS
Motor coordination is greatly improved when
surgeons use microsurgical instruments,specifically
designed to employ a precision grip of the hand
Microsurgical instruments are circular in
cross section to permit precise rotational movements

20. They are manufactured of titanium
Because of its strength, lightness and
non- magnetizing characteristics the various
postural and ergonomic ways of reducing
unwanted hand movements results in more
precise
surgeries
This greatly reduces surgical fatigue and the
development of spinal and occupational pathology

21. EXTRACTION : PRESURGERY
MICROSURGICAL VIEW
1 WEEK POST SURGERY
PAPILLA RECONSTRUCTION
MICROSURGICAL VIEW
POST SURGERY

22. SUMMARY
MICROSURGERY
Benefits include :
improved cosmetics
rapid healing
minimal discomfort
enhanced patient acceptance
Periodontics of the future will see increasing
use of magnification in all areas of practice
including implantology