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Microscopic Dentistry a Practical Guide Microscopic Dentistry a Practical Guide Microscopic Dentistry A Practical Guide Microscopic Dentistry A Practical Guide Publisher Editors Carl Zeiss Dr. Tony Druttman Dr. Greg Finn Authors Dr. José Aranguren Cangas Coordination Dr. Kristina Badalyan Slaven Sestic Dr. Rino Burkhardt Dr. Annett Burzlaff Dr. Maciej Goczewski Dr. Manor Haas Oscar Freiherr von Stetten Dr. Bijan Vahedi Dr. Maxim Stosek Dr. Claudia Cia Worschech Dr. Tony Druttman Foreword Dear Reader, Enhancing the visualization of medical The authors have succeeded in providing a most professionals is a core focal point for us at the valuable guide to using the surgical microscope in a Medical Technology Business of ZEISS. We strive range of dental applications. The articles were written to help our users across a broad range of medical with the idea in mind that they shall enable a step-by- disciplines see more. Seeing more can help step implementation that unlocks the full potential of clinicians to generate better outcomes, master even surgical microscopy in your daily practice: highly complex cases, to gain greater enjoyment and satisfaction from their work and finally - but How can the surgical microscope support an most importantly - improve patients’ lives. ergonomically correct, upright working position which is health promoting for the dentist over the long term? Since its inception in 1921, surgical microscopy has been crucial for the advancement of several surgical How can the surgical microscope broaden your clinical fields, such as brain tumour surgery, vascular scope and increase your efficiency - as key to the neurosurgery, cataract or retinal surgery. realization of a return on your investments? As Pioneer in Surgical Microscopes, we have constantly pushed the boundaries of visualization. How can the use of the surgical microscope add crucial Today, a large number of the mentioned surgical benefit to specific procedural steps in every major procedures would not be conceivable without the dental application? use of a surgical microscope. How can documentation with the surgical microscope In dental visualization we are at an earlier stage of increase patients’ involvement in the treatment and this journey. Even though the surgical microscope demonstrate your skills? has become the standard of care in endodontics, today only a single-digit percentage of all dentists I am confident that implementing some of the precious worldwide enjoy the benefits of working with insights of this book in your daily practice will change this tool. We firmly believe that this will change your professional life for the better. as the surgical microscope will pave the way to accelerated medical progress in many applications in dentistry by giving the clinician a greater degree Sincerely, of control in a range of delicate procedural steps. In endodontics, the surgical microscope is already an integral part of the postgraduate curriculum. For other dental applications, we are not there yet. Therefore many dentists are seeking guidance on how to integrate microscopy into their daily Dr. Christian Schwedes practice, beyond endodontics. To help fill this gap, Director Business Sector Dental & Office, we asked leading clinical specialists in different Carl Zeiss Meditec AG disciplines of micro-dentistry to contribute to this publication. Table of contents 1 2 3 4 5 6 7 The OPMI Ergonomics OPMI in Endodontics OPMI in Periodontology OPMI in Restorative Documentation Practice Management and Implantology and Prosthodontics 25 Why use a surgical 55 Definitions 73 Introduction 105 Do we need an OPMI 135 Why use the surgical 181 Why? 191 The benefits of the OPMI microscope? of ergonomics in periodontal and implant microscope in restorative and extend far beyond 26 Benefits 74 Magnification in endodontics therapy? prosthodontic dentistry? 182 How? the obvious and well-proven 27 How the OPMI differs from 56 Overloads Working magnification Photo/video clinical benefits. medical loupes and the 75 Uses of the OPMI in endodontics 106 What are the advantages 136 Prevention and diagnosis intra-oral camera 58 Minimizing overloads and disadvantages of 186 Practical advice 192 Integration into 60 Position of dentist 76 Microendodontic instruments the use of an OPMI 137 Bacterial plaque clinical practice 28 The human eye – how it 61 Operator range of 9-12 o’clock 77 Ultrasonics in periodontology and works and why it is limited working positions Ultrasonics tips implantology? 138 Caries 193 The OPMI Accommodation 62 Position of the patient Uses of ultrasonics in endodontics as a communication tool 29 Stereoscopy 64 OPMI position 78 Mirrors 110 What does the 142 Fractured line – “cracks” Dento-legal aspects Micro instruments Files with a handle “microsurgical concept” 30 The components of 66 Functional design Stropko syringe consist of? 148 Preparation control 194 Marketing an OPMI 79 Burs the OPMI 31 Objective lens 67 OPMI assistance Dyes 122 Which are the first steps to 150 Matrix adaptation 32 Varioscope getting used to working with 195 Health benefits to the dentist 34 Magnification changer 80 Examination of the external the OPMI? 153 Rubber dam applications in 35 Zoom system surface of the tooth anterior and posterior areas 196 Financials of the OPMI 36 Binocular tube 82 Identification of the floor 126 How can you acquire 37 Eyepieces of the pulp chamber expertise in periodontal 154 Cervical lesions 38 Set-up OPMI – Quick Guide 83 Removal of coronal restorations and peri-implant 40 Co-observation Preservation of tooth structure microsurgery? 156 Finishing and polishing 84 Assessement of canal cleanliness 41 Optics after preparation 128 Which are the common 160 Possibilities for analyzing Correction for chromatic 85 Identification of internal cracks errors in the use of the the surgical field at different aberration 86 Canal location OPMI in surgical practice? magnifications 42 High transmission of light 88 Calcified canals Depth of field 91 Evaluation and management 130 References 164 Replacements – avoiding wear 44 Field of view of perforations 45 How to calculate 92 Obturation of the canal 166 The Tunnel preparation technique end magnification Non-surgical retreatment 93 Uses of the OPMI 168 Indirect restorations 46 Ergonomics and workflow in non-surgical retreatment: Varioscope 95 Apical plug with MTA 172 Instruments 47 Looking around the corner – File evaluation MORA interface and angled 174 Excellence in operative optics 94 Endodontic root-end surgery and prosthetic dentistry with regard to communication 48 Light with patients Light sources 49 Filters and pinhole diaphragm 176 References 50 Free floating system – balanced system and magnetic brakes 51 Maintenance 6 OPMI and Varioskop are registered 7 trademarks of Carl Zeiss The moment you see a hidden detail reveal a visible success. This is the moment we work for. // DENTAL OPTICS MADE BY ZEISS Key benefit 1 // Magnification with OPMI* You can only treat what you can see… *OPMI – Operation Microscope Key benefit 1 // Magnification with OPMI INSTRUMENT REMOVAL RETREATMENT CALCIFIED CANALS CRACKS AND FRACTURES SOFT TISSUE MANAGEMENT TUNNEL PREPARATION TOOTH PRESERVATION CARIES 8.5X …or you see more and treat more 13.6X Key benefit 2 // Ergonomics 8 hours of spine strain… 14 15 Key benefit 2 // Ergonomics …or 8 hours of working in comfort 16 17 Key benefit 3 // Visualization and Documentation A picture is worth a thousand words… 18 19 Key benefit 3 // Visualization and documentation …for better communication 20 21 1 The OPMI 1 Author: Dr. Annett Burzlaff 25 Why use a surgical microscope? 26 Benefits 27 How the OPMI differs from medical loupes and intra-oral camera 28 The human eye – how it works and why it is limited Accommodation 29 Stereoscopy 30 The components of an OPMI 31 Objective lens 32 Varioscope 34 Magnification changer 35 Zoom system 36 Binocular tube 37 Eyepieces 38 Set-up OPMI – Quick Guide 40 Co-observation 41 Optics Correction for chromatic aberration 42 High transmission of light Depth of field 44 Field of view 45 How to calculate end magnification 46 Ergonomics and workflow Varioscope 47 Looking around the corner – MORA interface and angled optics 48 Light Light sources 49 Filters and pinhole diaphragm 50 Free floating system – balanced system and magnetic brakes 51 Maintenance 23 1 The OPMI Why use an OPMI? Can you still remember the first time you looked through a Beginning in 1990, many innovative dentists from numerous microscope or magnifying glass? Perhaps the first thing you countries pressed for the use of OPMIs in dentistry: this saw was a daisy which you thought you knew well, but which drive towards microdentistry was led by Dr. Syngcuk Kim then under the OPMI opened up a new world for you. We (Philadelphia, Pennsylvania) and Dr. Clifford Ruddle (Santa are not only drawn into the microcosm by our curiosity, but Barbara, California) in the USA, as well as Dr. Peter Velvart we also benefit from the insight we can gain into intricate (Zurich, Switzerland) in Europe, among others. While details and structures. Microscopy is an integral part of many endodontics is the main discipline in which OPMIs are surgical disciplines nowadays. Doctors first used the surgical used in dentistry, other disciplines such as periodontology, microscope for microsurgical operations in the ENT area in implantology or restorative dentistry are adopting the use 1921. Ophthalmologists then attached lighting technology to of magnification technology. The dentist benefits from the surgical microscope and used it to perform eye operations. several advantages of OPMIs, regardless of the discipline. In the mid-1960s, neurosurgeons recognized the advantages Magnification enhances the visual acuity and supports more of using OPMIs for operations. Neurosurgery is today no precise treatment. However, no light means no information. longer imaginable without documentation and navigation OPMIs are therefore designed in such a way that they combine systems. The OPMI had been undergoing development for the magnifying lens and the light source. No matter whether around 60 years before finding its way into the world of they are working with low or high magnification, the dentists dentistry.
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