this presentation includes different parts of SOM, How it is mounted on the wall or the floor, its advanatges and disadvantages and how a dentist should maintain the microscope for better results.
This topic has been introduced in the new edition of Bailey & Love - 26th. This topic covers the types, uses & special uses as well as complications of Diathermy.
This topic has been introduced in the new edition of Bailey & Love - 26th. This topic covers the types, uses & special uses as well as complications of Diathermy.
HARMONIC SYNERGY® Blades use high-frequency mechanical vibration to simultaneously cut and coagulate at the same time, sealing vessels at lower temperatures than electrosurgery:
Precise: Minimal lateral thermal tissue damage for safer dissection near vital structures
Reliable: Seals and divides vessels <= 2mm, as well as lymphatics
Versatile: Cuts, coagulates and dissects, reducing instrument exchanges
HARMONIC SYNERGY® Blades use high-frequency mechanical vibration to simultaneously cut and coagulate at the same time, sealing vessels at lower temperatures than electrosurgery:
Precise: Minimal lateral thermal tissue damage for safer dissection near vital structures
Reliable: Seals and divides vessels <= 2mm, as well as lymphatics
Versatile: Cuts, coagulates and dissects, reducing instrument exchanges
Microscopes and Endoscopes in Neurosurgery.pptxDr. Rahul Jain
history, working, optics and salient features of operating microscopes in neurosurgery and endoscope. role of endoscopes in various surgeries and newer prospects of both microscopes and endoscopes
Detailed description of the operating microscope in endodontics, its use and availability in the market. Appropriate review of literature added with case reports.
this presentation shows different watre soluble vitamins and their role in our daily life and what happens if they become deficient in our body and how we can overcome this deficiency of these vitamins.
In this presentation, we will see the different mishaps or errors that we can encounter during endodontic procedure and what can be the various treatment options for them.
this presenation includes definition, history, various components of smear layer, importance of smear layer, whether to remove it while doing root canal and restoration or not?
this presentation includes theories for the spread of infection, different portals of entry of microorganisms, fish theory, kronfield's theory and how the pulpal inflammation spreads.
this presentation includes various obturating materials, sealers which are used for binding the gutta percha points inside the root canals, what is difference between standard and non standardized gutta percha and various newer methods for obturation are also included.
this presentation include various types of matrices, retainers like tofflemire, ivory no 1, 8 ,compound retainer and wedges which include plastic as well as wooden.
presentation includes definition of immunity, its various types, cells of immunity in our body and their working and the various diseases associated immunity deficiency
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
2. CONTENTS
• Introduction
• History
• Optical principle
• Working of surgical microscope• Working of surgical microscope
• Parts of microscope
• Clinical applications
• Magnification ranges used for nonsurgical and
surgical endodontic procedures
• Advantages
• Disadvantages 2
3. CONTENTS
• Positioning of microscope
• Position statement of AAE on use of microscopes and
other magnification techniques
• Law of ergonomics
• Operatory design principle• Operatory design principle
• Misconception about surgical operating microscope
• How to care about the microscope.
• Conclusion
• References
3
4. INTRODUCTION
• With the development of clinical techniques that require high
levels of manual dexterity and fine details, there is increasing
interest in the use of magnification for dental procedures.
• Endodontic procedures were performed using tactile
sensation and only way to see inside root canal is radiographs.sensation and only way to see inside root canal is radiographs.
• Along with radiographs, various magnification systems-
loupes/telescopes have been used to perform conventional
endodontics.
4
5. • According to ZEISS company, microscope was introduced to
endodontics in early 1990s.
• Using Surgical microscope makes sense that if the clinician can
see something more clearly and magnified he or she can
better evaluate and treat.better evaluate and treat.
5
6. • Microscope also serves as a useful educational tool.
• The high magnification of microscope provides for a safer
procedure.
• Endodontics have frequently boasted they can do much of
their work blinfolded simply because there is nothing to see.
• The truth of the matter is that there is a great deal to see if• The truth of the matter is that there is a great deal to see if
only we had the right tools.
6
7. • The introduction of operating microscope has changed both
nonsurgical and surgical endodontics.
• The introduction of dental microscope and associated ability
to inspect the root canals- both orthograde and retrograde
have fundamentally changed our understanding of dentalhave fundamentally changed our understanding of dental
morphology and its complexity.
7
8. HISTORY
Dr. Apothekar, Dr. Jako Dental operating microscope-1981
(poorly configured,
ergonomically difficult to use,
Only 1 magnification-8x
Focal length too long-250 mm)
Chayes- Virginia (Evansville, IN)-
1st DOM. (Dentiscope)
8
Dr. Gary Carr-1992
Ergonomically configured operating
microscope
(galilean optics)
1950 Otolaryngology
1960 Neurology
9. OPTICAL PRINCIPLE
• All clinicians must construct 3-dimensional structures in a
patient’s mouth 3dimensional perception.
• Attempts have been made to use the magnifying endoscopes
used in Artroscopic procedures, but these devices require
viewing on a 2-dimensional (2D) monitor, and the limitationsviewing on a 2-dimensional (2D) monitor, and the limitations
of working in 2D space are too restrictive to be useful.
9
10. • Several elements are important for consideration in improving
clinical visualization.
• Included are factors such as
• (1)Stereopsis
• (2)Magnification range• (2)Magnification range
• (3)Depth of field
• (4)Resolving power
• (5)Working distance
• (6)Spherical and chromatic distortion (i.e., aberration)
• (7)Eyestrain
10
11. (1)Stereopsis:
• Stereopsis vision where in two separate images from two eyes
are successfully combined in to one image in the brain.
• Also called as 3-dimensional perception.
(2)Magnification range:
• Magnification is ability to produce enlarged images of object.
• The Maximum magnification of human eye is .068 cm also
called as 1X magnification .
• So the image size can be increased by using lenses for
magnification.
11
12. MAGNIFICATION RANGES
• •
• •
• •
Low
(X3 to X8)
• wide field of
view and high
focal depth
Midrange
(X10 to X16)
• moderate focal
depth, keeps
the field in
High
(X20 to X30)
• focal depth is
shallow, the
field moves out
12
view and high
focal depth
• orientation
within the
surgical field
depth, keeps
the field in
focus despite
small
movements
• “working
magnifications”
in endodontics
shallow, the
field moves out
of focus with
even slight
movements
• inspection for
fine detail
14. (3)Depth of field : It is the range of a depth that a specimen is acceptable in
focus.
• Depth of Field is basically how much of the object under the microscope
can actually be viewed.
(4)Resolving power:
• The resolving power of a microscope determines the degree of details that• The resolving power of a microscope determines the degree of details that
is visible.
• The resolving power of normal human eye is 200 micron. Object separated
by less then this distance appears as single Object.
• Dentists can increase their resolving ability without using any
supplemental device by simply moving closer to the object of observation.
• Resolving power also enhanced by using the shorter wavelength Light for
illumination.
14
15. (5)Working distance :
• The nearest point that the eye can accurately focus on exceeds
ideal working distance.
• Working distance of Microscope is inversely proportional to the
Magnification.
(6)Spherical and chromatic distortion (i.e., aberration) :
• Its type of Distortion in which there is failure of a lens to focus all
colors to same point.
(7)Eyestrain:
• One might think that working constantly with the microscope will
cause eyestrain and eye fatigue.
• But what is true is just the opposite.
15
16. Loupes
• Dental loupes have been the most common form of
magnification used in endodontics.
• Loupes are essentially two monocular microscopes with• Loupes are essentially two monocular microscopes with
lenses mounted side by side and angled inward (convergent
optics) to focus on an object.
• Magnifying telescopes sometimes are called "loupes."
16
17. • Loupes are classified by the optical method in which they
produce magnification.
• There are three types of binocular magnifying loupes:
• (1) a diopter, flat-plane, single-lens loupe,
• (2) a surgical telescope with a Galilean system configuration• (2) a surgical telescope with a Galilean system configuration
(two lens system),
• (3) a surgical telescope with a Keplarian system configuration
(prism roof design that folds the path of light).
17
18. Single lens loupes
• It consists of simple
magnifying lens.
• The only advantage of
the diopter system is
that is the most
inexpensive system, but
it is also the less
desirable because the
plastic lenses that uses
are not always optically
correct.
Galilean lens loupes
• The Galilean system
provides a magnification
range from 2X up to 4.5X
and is a small, light and
very compact system.
Prism loupes
• Prism loupes are the
most optically advanced
type of loupe
magnification available
today.
• They use refractive
prisms and they are
actually telescopes with
complicated light paths,
which provide
magnifications up to 6x.
18
correct.
• Furthermore, the
increased image size
depends on being closer
to the viewed object,
and this can compromise
posture and create
stresses and
abnormalities in the
musculoskeletal system.
magnifications up to 6x.
• Prism loupes also
provide larger fields of
view, wider depths of
field and longer working
distances than other
types of loupes.
20. PARTS OF MICROSCOPE
• The main parts can be divided into 3 groups.
1.supporting
structure
2.the body of
microscope
20
structure microscope
3.
accessories
22. 1. Supporting structure:
• Microscope must be stable while in operation.
• The supported structure can be mounted on the floor, ceiling
or wall.
• As distance between the fixation point and body is decreased,
stability increased.stability increased.
• In clinical settings with high ceilings or distant walls, floor
mount is preferable.
• The built in springs should be tightened according to the
weight of body of microscope.
22
24. 2. The body of microscope:
• Binoculars
• Eyepieces
• Magnification changers
• Objective lens
• Light source Illumination
Magnification
• Light source Illumination
24
25. 2. The body of microscope:
• I. MAGNIFICATION is determined by :
• a) Eye pieces which are available in powers of
• 6.3X, 10X, 12.5X, 16X, 20X.
25
26. • It consist of
• 1) A viewing side with rubber cup
• 2) Adjustable diopter setting (-5
to +5).to +5).
• 3) Binoculars which is used to
hold eye piece which may be
straight, inclined or inclinable and
again of shorter or longer focal
length.
26
28. • b) Magnification changer:
• which may be a 3-5 step manual
changer or power zoom charger.
• c) Objective lenses :• c) Objective lenses :
• whose focal length (which ranges from
100 mm to 400 mm) determines the
operating distance between lens and
surgical field.
28
29. • Most operating microscopes usually possess magnification
steps or increments that can be adjusted manually or with
motorized foot controls.
29
30. The total magnification provided by the
microscope can be computed using the formula
• TM = (FLB/FLOL)×EP×MV
• TM – Total magnification
• FLB – Focal length of binocular• FLB – Focal length of binocular
• FLOL-Focal length of objectives lengths
• EP-Eyepiece power
• MV-Magnification value
30
31. • The clinician should remember that most procedures are
made at minimum/medium magnification while maximum
magnification is used just to check what clinician is doing.
• By increasing magnification, illumination, depth of field, width
of operative field- decreased.of operative field- decreased.
• A typical microscope setup should have the following features
to be properly equipped for application in dentistry:
31
32. • 12.5 x eyepiece power
• 125 mm inclined binoculars
• 5 step changer ranging from 4x x 28x.
• 200 mm objective lens
• Galilean optics focus at infinity and send parallel beams of• Galilean optics focus at infinity and send parallel beams of
light to each eye.
• With parallel light, the operator’s eyes at rest, as though
looking off into the distance, permitting performance of time
consuming procedures without inducing eye fatigue.
32
33. • II. ILLUMINATION(light source) :
• Is mainly by means of a 100 watt Xenon halogen bulb, where
intensity is controlled by a rheostat and cooled by a fan.
• Illumination is mainly co-axial with line of sight, which means
that light is focussed between the eye pieces so that no
shadows will be visible.
• This is possible due to the usage of Galilean optics.• This is possible due to the usage of Galilean optics.
33
34. • The light source is one of the most important features of
microscope, as it is responsible for illumination of deepest
portions of root canals.
• The light passes through a condensing lens, a series of prisms
and then through the objective lens to the surgical site.
• The intensity of light is controlled by a rheostat.
34
35. • The traditional standard is still halogen (yellowish hue, peak
at 600-700 nm, ~3300K).
• the brightest option is xenon (like daylight, homogeneous
spectrum 400-700 nm, ~5500K), making it most useful for the
identification of fine details in deeper areas of the root canalidentification of fine details in deeper areas of the root canal
system and documentation.
• Recently LED lights (green part of emission spectrum, low at
450 nm and 550 nm, ~5700K) became available and offer a
significantly longer lifetime, however, at a reduced brightness
compared to xenon.
35
36. 3. Accessories:
• 1) Pistol or bicycle grips
• 2) Liquid crystal display (LCD) and high resolution monitors
which receives video signals from cameras.
• 3) Integrated video camera
• 4) Eye piece with rectile field: used for aligning during video• 4) Eye piece with rectile field: used for aligning during video
taping and 35 mm photography.
• 5) Auxiliary monocular or articulating binocular for dental
assistant.
36
38. • In order to deflect a certain percentage of light from the
eyepiece towards accessories, a beam splitter can be placed
between the binoculars and the magnification changer.
• The beam is generally split at a 50:50 ration (i.e. half of the
light is always available to the operator)light is always available to the operator)
• A photo or video adapter can be connected to the beam
splitter.
38
39. HOW DOES THE SURGICAL
MICROSCOPE WORK?
• There has always been a doubt as to how, a microscope differs
from a loupe.
The dental microscopes uses the parallel beam path better
known as “the Telescope system” which follows galilean optics
wherein focus is at infinity and parallel beams of light are send
39
wherein focus is at infinity and parallel beams of light are send
to each eye thereby reducing strain on clinicians eye.
illumination with operating microscope is co-
axial with line of sight.
40. From the light source light is reflected through condensing lens to an
array of prisms to the objective lens.
From the objective lens the light is
40
From the objective lens the light is
focused to the surgical field.
From the surgical site the light is reflected
back to the objective lens and then passes
through the magnification changers.
41. •
From magnification changers the light reaches the
binoculars wherein the beam is split and the surgical field
is seen through the eye piece.
41
The telescopic loupes follow the convergent beam
path that is the Greenough system.
43. CLINICAL APPLICATIONS
• I. In Conventional Endodontics :
• An operating microscope aids for better performance:
• 1) visualizing root canal system in finer detailcleaning and
shaping more efficiently.
• 2) It is important that the root canal system is dry before• 2) It is important that the root canal system is dry before
obturation is done.
• It is only by examining the root canal with microscope that it
is possible to determine if canal is dried sufficiently.
43
45. • 3) By means of adequate illumination and magnification
access is enhanced.
• 4) In cases where root end closure is to be undertaken, it is
possible to view tissues beyond apex of root canal.
45
46. • 5) Examination of root canal under magnification ensures that
air voids in canals are kept a minimum even for a base of
coronal access sealing.
• 6) In cases of re treatment like post removal.
• 7) Retrieval of broken instruments like file and reamers is• 7) Retrieval of broken instruments like file and reamers is
possible.
46
47. Modern Microscopic Endodontic Procedure
Sequence
1) The diagnosis indicates that endodontic treatment is needed and
tooth is anesthetized.
2) Following placement of the rubber dam, access is made. The
microscope is not needed for this step, although some clinicians
may prefer to use it.
3) Using the microscope at low to mid magnification, the pulp3) Using the microscope at low to mid magnification, the pulp
chamber is thoroughly prepared for inspection.
4) Under high magnification (16x-24x), the floor of the chamber is
examined for additional canals
5) After the canal entrance is identified, the microscope is not
needed until a later stage. The apex is negotiated with a size 10 K
file and is then enlarged with size 15 or 20 files.
47
48. 6) Gates –Glidden burs are used in
reverse order to enlarge the coronal
half or two thirds using the crown down
techniques
7) An apex locater is used to determine7) An apex locater is used to determine
the canal length at this stage.
8) NiTi rotary instruments now employed to prepare the
remaining one half or one third of the apical canal in the crown
down technique. The final apical preparation of the master
apical file is done by hand instruments and light Speed,
depending on the original canal width or estimate of working
width.
48
49. 9) The microscope is used to check the
preparation and to check again for additional
canals.
10) A master gutta percha cone is selected,the
canal length and solid “tug back” is assured.
11) After obturation microscope is used again
for final check. Finally, the canal is filled with
temporary or permanent cements.
49
50. • II. In Surgical Endodontics:
Magnification: at 3 different levels
• 1) 2.5 X to 8 X for orientation of operating field.
• 2) 10 X to 16 X - midrange magnification, are best for
performing root-end resections and root- end preparations.performing root-end resections and root- end preparations.
• 3) 18 X to 30 X to observe and evaluate fine details – micro
fractures, isthmus etc.
50
51. • Illumination, which is simultaneous and focused, is an added
benefit to magnification.
• Micro instruments such as ultrasonic instruments aid in root
end preparation with greater accuracy and conservation of
root.root.
51
52. Conservative and Co-axial root end preparation
Identification of apex in intact buccal plate
Inspection of resected root surface
Bevel angle
Retropreparation Retropreparation
Retrofilling
52
54. • III. In Restorative dentistry:
• 1) Removal of caries most conservatively.
• Since the tooth can be seen magnified it is easy to view the
extent of caries and thus there is no need to remove healthy
tooth structure blindly.
• 2) Identification of crack lines, microgaps between the tooth• 2) Identification of crack lines, microgaps between the tooth
and a filling becomes easier due to enlarged vision
54
55. • IV. In Dental Extractions:
• to determine if luxation forces applied using elevators result
in microscopic incremental improvements in tooth particle
luxation.
• perform dentoalveolar extractions with more conservative• perform dentoalveolar extractions with more conservative
removal of alveolar bone, potentially minimizing trauma to
the extraction site.
55
56. • V. In Periodontal Therapy:
• In periodontal procedures surgical
microscope can be used for,
• 1) Diagnostic procedures
• 2) Crown lengthening
• 3) Regenerative periodontal• 3) Regenerative periodontal
surgery
• 4) Root coverage procedures
• 5) Papilla reconstruction
• 6) Smile designing and
• 7) Implantology.
56
57. • VI. Use of fewer radiographs:
• For procedures like post space preparation etc, as its possible
to see at least till middle third with the magnification rather
than depend on radiograph.
57
58. • Ⅵ. Patient education through its integrated video.
• Ⅶ. Documentation for dental legal purposes
• Ⅷ. Management of procedural errors
• Ⅸ. Best cosmetic outcome
• . Contrast• Ⅹ. Contrast
• Ⅺ. Ergonomics
58
64. ADVANTAGES
• 1.increased visualization,
• 2.improved Quality and precision of treatment,
• 3.enhanced ergonomics,
• 4.ease of proper digital documentation and
• 5.increased communication ability through integrated video• 5.increased communication ability through integrated video
64
65. • 6.Better vision
• 7.the microscope is a self-supported unit; therefore,
additional lenses or prisms are not a concern.
• 8.microscope binoculars are arranged in a parallel
orientation. This arrangement is facilitated by prisms that letorientation. This arrangement is facilitated by prisms that let
the incoming light beams reach the eyes also in a parallel
direction.
65
66. • This simulates the observation of a distant object: a straight,
forward-looking gaze that causes less muscle stress and
fatigue.
• 9.Orthograde and retrograde endodontics
• 10.Periodontal therapy in visually barely accessible root• 10.Periodontal therapy in visually barely accessible root
sections
• 11.Precise control of prosthetic preparations and impressions
66
67. DISADVANTAGES
• 1) It’s expensive.
• 2) Its size which is difficult to fit in a small operatories.
• 3) It takes the operator some time to get used to the
equipment.
• 4) Need for expertise by auxiliary staff• 4) Need for expertise by auxiliary staff
• 5) Adaptation to indirect vision
• 6) Narrower field
• 7) Movement of the patient
67
68. • There are some disadvantages, especially at the initial stages,
most important one is the 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 ofinstruments, and they are used in delicate movements of
small amplitude.
68
69. POSITIONING OF MICROSCOPE
• The introduction of the microscope in the dental office is a big
revolution that involves many ergonomic changes.
• To reduce as much as possible any stress for the operator, the
clinician should maintain the traditional working position
previously used without the microscope.previously used without the microscope.
• It is also important for the clinician to maintain good posture
with proper scope orientation.
69
70. • In chronological order, the microscope should be prepared
and positioned as follows:
• Positioning of the operator
• Positioning of the patient
• Positioning of the microscope• Positioning of the microscope
• Adjusting the interpupillary distance
• Fine positioning of the patient.
• Parfocaling
• Fine focus
• Adjusting the assistant scope
70
71. • To position the operator, the microscope and the patient
correctly, the simplest rule to follow in nonsurgical
endodontics is that
• the back of the operator should be straight;
• the light of the scope should be perpendicular to the floor and
also perpendicular to the root canal where he/she is working.
71
72. in nonsurgical endodontics ( by
indirect vision); therefore the light of
the scope is directed to the mirror
and, from there, into the root canal.
In conclusion, the position of the
in nonsurgical endodontics ( by
indirect vision); therefore the light of
the scope is directed to the mirror
and, from there, into the root canal.
In conclusion, the position of the
In surgical endodontics,( in direct vision),
everything is easier.
In surgical endodontics,( in direct vision),
everything is easier.
72
In conclusion, the position of the
patient depends on the position of
the scope, and not vice versa.
In conclusion, the position of the
patient depends on the position of
the scope, and not vice versa.
everything is easier.
Nevertheless, in order to be able to check
the retroprep through a micro-mirror, the
light of the microscope should be
perpendicular to the axis of the root canal.
everything is easier.
Nevertheless, in order to be able to check
the retroprep through a micro-mirror, the
light of the microscope should be
perpendicular to the axis of the root canal.
73. Position Statement of AAE on Use of
Microscopes and Other Magnification
Techniques
• Position Statement of AAE on Use of Microscopes
and Other Magnification Techniques, published in
2012 recommends the following procedures in2012 recommends the following procedures in
Endodontics can be benefitted from the use of the
microscope:
73
74. •
•
•
•
locating hidden canals that
have been obstructed by
calcifications and reduced
in size;
removing materials such as
solid obturation materials
(silver points and carrier-
based materials), posts or
separated instruments;
removing canal
obstructions
assisting in access
preparation to avoid
unnecessary destruction of repairing biological and
locating cracks and
fractures that are neither
visible to the naked eye
74
unnecessary destruction of
mineralized tissue,
repairing biological and
iatrogenic perforations
fractures that are neither
visible to the naked eye
nor palpable with an
endodontic explorer
facilitating all aspects of
endodontic surgery,
particularly in root-end
resection and placement
of retrofilling material.
75. LAW OF ERGONOMICS
• An understanding of efficient workflow using an OM entails
knowledge of the basics of ergonomic motion. Ergonomic
motion is divided into 5 classes of motion:
Class I motion: moving only the fingers
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Class II motion: moving only the fingers and
wrists
Class III motion: movement originating from
the elbow
Class IV motion: movement originating from
the shoulder
Class V motion: movement that involves
twisting or bending at the waist
76. THE OPERATING MICROSCOPE: WHY IS IT
ESSENTIAL FOR MICROSURGERY?
• Microsurgery is defined as a surgical procedure on
exceptionally small and complex structures with an operating
microscope.
• The microscope enables the surgeon to assess pathological
changes more precisely and to remove pathological lesionschanges more precisely and to remove pathological lesions
with far greater precision, thus minimizing tissue damage
during the surgery.
76
77. • The operating microscope provides important benefits for
endodontic microsurgery in the following ways:
The surgical field can be inspected at high magnification so that small but important
anatomical details, e.g. the extra apex or lateral canals, can be identified and managed.
Furthermore, the integrity of the root can be examined with great precision for fractures,
perforations, or other signs of damage.
Removal of diseased tissues is precise and complete.
77
Distinction between the bone and root tip can easily be made at high magnification,
especially with methylene blue staining
At higher magnification the osteotomy can be made small (3-4 mm) and this results in
faster healing and less postoperative discomfort
Surgical techniques can be evaluated, e.g. whether the granulomatous tissue was
completely removed from the bone crypt.
78. The number of radiographs may be reduced or may be eliminated because the surgeon
can inspect the apex or apices directly and precisely.
Occupational and physical stress is reduced since using the microscope requires an erect
posture. More importantly, the clinical environment is less stressful when clinicians can
clearly see the operating field
78
Communication with the referring dentists is improved significantly
Video recordings or digital camera recordings of procedures can be used effectively for
education of patients and students.
79. MISCONCEPTIONS ABOUT THE OPERATING
MICROSCOPE
• Experience suggests that magnification above 30x is of little
value in the periapical surgery because slightest movement by
patient, sometimes even breathing moves the field out of
view and out of focus.
• Surgeon must repeatedly recentre and refocus microscope,• Surgeon must repeatedly recentre and refocus microscope,
wasting valuable time.
• Thus, the belief that “greater the magnification the better” is
a misconception.
79
80. • We do not believe that all surgical procedures have to be
performed at high magnification.
• For certain procedures, low magnification is better.
• Microscope does not improve access to the surgical field.
• If access is limited for traditional surgery, it will also be limited• If access is limited for traditional surgery, it will also be limited
when the microscope is placed between the surgeon and
surgical field.
80
81. ARE SPECIAL INSTRUMENTS REQUIRED FOR
WORKING WITH MICROSCOPE?
• Working with microscope requires instruments designed to
keep fingers from getting in the way.
• Use hand spreaders instead of finger spreaders.
• Rotary files instead of hand files.
• Microsurgical instruments for apex resection.• Microsurgical instruments for apex resection.
• Use drills with longer shanks.
81
82. POSTURAL PROBLEMS WITH
WORKING UNDER MICROSCOPE
MAGNIFICATION
• Restricted and posture dependent
access.
• Muscle tension and pain• Muscle tension and pain
• Assistant’s co-observation tube
moves.
82
83. Solution?
• MORA interface provides a solution by creating a
posture- friendly microscope system.
• The operator must be seated in 12 o clock position to
make following possible:
83
84. Swinging the microscope
body in panning motion to
right and left sides of
mouth, independent of
eyepieces.
Panning the microscope
body with ease due to
massive reduction in the
weight of moving parts
when compared to moving
the whole microscope.
Providing the assistant the
ability to sit in 3 o clock
position and utilize a co-
observation tube that can
stay level.
Allowing the operator to sit
in upright position with
upright neck and
eliminating the need to tilt
Allowing the operator to
equally extend the right
and left arms around the
patient’s head and thereby
Proper utilization of arm
and wrist supports
eliminating the need to tilt
the neck to the side.
patient’s head and thereby
work more comfortably.
and wrist supports
Giving the operator the
ability to stabilize and
control the patient’s head
movement
84
85. CARING FOR THE OPERATING
MICROSCOPE
• Keep in a dry, cool and well-ventilated place to prevent fungus
growth on lenses.
• Every week, clean optics.
• To protect it from dust drape a cover over it.
• Wipe down the external surfaces with a damp cloth soaked in hot,
soapy water.soapy water.
• Cover the foot pedal with a clear plastic bag to prevent surgical and
cleaning fluids from entering and damaging the electronics.
85
86. • Before using, test the controls of the foot pedal.
• Avoid kinking or bending the fiber optic cables.
• When replacing bulbs, avoid touching them with your fingers.
• The oil left as fingerprints on bulbs can shorten its its life.
• Do not move the microscope while bulb is still hot because• Do not move the microscope while bulb is still hot because
strong vibrations may damage the filament,
• Every six months, clean and oil the wheels and the brakes.
• Remove any surplus oil when done.
86
87. THE FUTURE
• The next stage in microscopic endodontics will involve the use
of even finer microscopic instruments and the development
of even more sophisticated techniques.
• Eventually, endodontists will be able to re-vascularize the pulp
and grow dentin.and grow dentin.
• These procedures will most certainly be microscopic in nature
and will be quickly embraced by a specialty already well
trained in microscopic procedures.
87
88. • In the meantime, microscopic procedures are being adopted
by the other specialties in dentistry with impressive results.
• Restorative dentists and periodontists will be the next
disciples to embrace a microscopic approach, and then it will
be only a matter of time before all of operative dentistry isbe only a matter of time before all of operative dentistry is
performed microscopically
88
89. CONCLUSION
• Endodontics has changed tremendously in the past two
decades in relation to the use of equipments and instruments.
• This new approach of involving enhanced magnification has
rectified all the shortcomings of traditional approach, thus
making the procedure much more predictable and resultmaking the procedure much more predictable and result
oriented.
• Those who perform endodontic procedures without the
microscope are still evaluating the benefits of its use.
89
90. • After the initial learning curve, endodontic procedures can be
done in less time because of the greater visibility of the root
canal anatomy and procedural errors can be reduced.
• The key to successful endodontic practice lies in the operator
and his or her commitment.and his or her commitment.
• If sincere effort is made , one can be rejuvenated and
endodontics will be more enjoyable.
90
91. REFERENCES
• Rahul Kumar. Surgical Operating Microscopes in Endodontics: Enlarged
Vision and Possibility.
• Sharma N.Magnification In Endodontics
• Bertrand khayat. The use of magnification in endodontics: the operating
microscope.
• Prof. (Dr.) Utpal Kumar. Recent Advances in Endodontic Visualization: A
ReviewReview
• Dr. Anil Dhingra. THE DENTAL OPERATING MICROSCOPE IN ENDODONTICS
• Eudes Gondim.Dental Operating Microscope in Endodontics-A Review
• Gary B. Carr .The Use of the Operating Microscope in Endodontics
• Arnaldo Castellucci. Magnification in endodontics: the use of the
operating microscope
• Syngcuk Kim.Microscope and endodontics.
• Syngcuk Kim. Modern Endodontic Surgery Concepts and Practice: A
Review
• The Dental Operating Microscope in Endodontics
• The microscope in dentistry. An editorial forum for dental professionals.
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