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Surgical Microscope

Magnification and fibre–optic illumination are invaluable tools that assist Dr. Kilislian in performing the technical aspects of endodontic treatment. Below are just a few applications that Dr. Kilislian utilizes the Global Surgical Microscope.

  • Improved lighting and magnification aid in locating additional canals.
  • Improves ability to thoroughly clean prepared canals.
  • Aids in retreatment of broken instruments.
  • Accurate depth of retro-prep extension can be more easily assessed.
  • Improves detection and evaluation of root fractures and abnormalities.
  • Allows Dr. Kilislian to minimize the size of the surgical site, reducing patient discomfort and healing time.
  • Improves accuracy of microsurgical incisions and suturing with 6–0 through 8–0 sutures, permitting precise tissue/tissue and tissue/tooth approximation for primary would healing.
  • Provides high-resolution video for patient education, enhanced training, and insurance/legal documentation.

Endodontists, the dental specialists who treat problems originating inside the tooth, began experimenting with microscopes in the early 1990's, using them to enhance surgical procedures they perform around the roots of teeth. The microscope helps not only by magnifying the surgical field but also by providing more light. In addition, tiny mirrors no more than one tenth the size of traditional dental mirrors help the endodontist see into places where the human eye alone never could.

When endodontists perform endodontic (or root canal) procedures, the goal is to remove pulp tissue comprised of nerves, blood vessels, and connective tissue from canals inside the teeth. The canals are then cleaned, shaped and filled with a special material, and the tooth restored, usually with a crown. This procedure saves teeth when their internal tissues have been damaged by serious decay or other trauma. Without a root canal, these teeth would have to be extracted and replaced with expensive bridgework, partials, or implants.

In most teeth, a canal containing nerves and blood vessels runs from the center of the crown (the part you can see above the gumline) of the tooth through the root and out into the jaw. Near the end of the root, the canal branches into many smaller canals, almost like a river delta. These smaller branches of the canal can be much easier to see with the microscope.

After initially using the microscope in surgery, many endodontists discovered that it can also help with diagnosis and nonsurgical endodontic procedures. Endodontists have used the microscope to find tiny fractures, which are often difficult to detect with traditional diagnostic methods. In addition, very small or unusually positioned canals become easier to see.

Sometimes new infection or injury will cause a tooth that has been treated before to need a second endodontic procedure. Endodontists call this "retreating" the tooth. To accomplish retreatment, all previous filling material and posts that may have been placed to support a crown must be removed from the tooth. The microscope can help with these procedures as well.

The Surgical Operating Microscope (S.OM.) was initially developed for medicine in the early 1920s, but was largely ignored, until it reappeared in the 1950s. Eventually, many of the medical disciplines began to realize that the enhanced magnification and illumination made possible by the microscope, improved the visual acuity of the operating field to such a degree that new procedures and new levels of precision during surgery were now possible. The inclusion of the S.O.M. as a part of the surgical armamentarium in neurology, otolaryngology, ophthalmology and for the reattachment of severed vessels and appendages provided for many new vistas in these microsurgical disciplines.

The progression of the operating microscope into dentistry has been slower, with only the discipline of endodontics fully embracing this technology. Although, Apotheker in 1981 postulated that the microscope might be advantageous to endodontics, it wasn't until Carr, Arens, Ruddle, Buchanan and others began expounding on the virtues of the microscope during the late 1980 and 1990s, that the microscope became part of the standard armamentarium.8-14 In 1998, it became mandatory for all post graduate endodontic students, enrolled in specialty programs in the United States, to show a proficiency in microscope usage in order to graduate from their accredited program. The usage of Dental Operating Microscopes (D.O.M.) within the field of endodontics has grown dramatically, to where some studies now point to as many as 80% of certified specialists using this technology in their practice.

Dr. Gary Carr, in his landmark article, reported that the unaided human eye has the ability to distinguish two separate entities that are separated by a minimum of 200 microns (0.2mm).23 The ability of the human eye to distinguish these two separate entities is called resolution. When the operator is able to magnify the field of view, the ability to resolve the two entities improves. For example 2X power telescopic loupes will drop the minimum resolvable distance to 100 microns or .1mm. In comparison, 4X magnifiers will improve the resolution of the eye to 50 microns or .05mm.

The team at Specialty Endodontics by Dr. Rita have trained at Dr. Gary Carr's San Diego, California office.



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