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Minimally Invasive Surgery - a Zenith Forte in Periodontal Therapy

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Minimally Invasive Surgery - a Zenith Forte in Periodontal Therapy Imperial Journal of Interdisciplinary Research (IJIR) Vol-3, Issue-4, 2017 ISSN: 2454-1362, http://www.onlinejournal.in Minimally Invasive Surgery - A Zenith Forte In Periodontal Therapy P. Sudhakar1, Satish. M2, Ramoji Rao M.V.3 & Vidya Hiranmayi. K4 1(M.D.S ,STUDENT), Department of Periodontics, Drs.S&NR Siddhartha Institute Of Dental Sciences,Chinnaoutapalli, Gannavaram mandal ,Krishna District ,Andhra Pradesh, India. 2(M.D.S,READER) Department of Periodontics, Drs.S&NR Siddhartha Institute Of Dental Sciences, Chinnaoutapalli, Gannavaram mandal ,Krishna District ,Andhra Pradesh, India. 3(M.D.S,PRINCIPAL & HOD) Department of Periodontics, Drs.S&NR Siddhartha Institute Of Dental Sciences,Chinnaoutapalli, Gannavaram mandal ,Krishna District , Andhra Pradesh, India. 4(M.D.S ,STUDENT) Department of Periodontics, Drs.S&NR Siddhartha Institute Of Dental Sciences, Chinnaoutapalli, Gannavaram mandal ,Krishna District ,Andhra Pradesh, India. Abstract : Performing minimally invasive surgical approach for periodontal regeneration would be one procedure is enhanced by using microsurgical that allow access to the site to be regenerated techniques. Periodontal microsurgery is the without extending the surgical incision into refinement of basic surgical techniques made adjacent healthy areas1. In 1990, Wickham and possible by the improvement in visual acuity gained Fitzpatric described the technique of using smaller with the use of surgical microscope. In the last incisions as minimally invasive surgery3. The decade, a special emphasis has been focused on the concept of minimally invasive surgery further design and performance of surgical procedures for refined by Hunter and Sackier as the ability to periodontal regeneration.. Minimally invasive miniature the operator eyes and extend his hands to periodontal surgery can diminish the negative perform microscopic and macroscopic surgery4. outcomes while increasing the efficacy of therapy. The application of minimally invasive surgery for Minimally invasive periodontal surgery technique the treatment of periodontal attachment and bone allows for minimization of soft tissue trauma and loss was first described by Harrel and Ress in the removal of granulation tissue from periodontal 1995. Minimally invasive approach was later defects using a much smaller surgical incision than modified to Modified Minimally invasive that used in conventional surgical techniques. surgical technique (MMIST) in 2009 by Further in order to improve surgical effectiveness, Cortenelli and Tonetti9. Main objective of the the use of operating microscopes and minimal invasive treatment is minimizing trauma to microsurgical instruments has been suggested. the tissues and still achieve a satisfactory Future devices for performing minimally invasive therapeutic result. Microsurgery incorporates three periodontal surgical procedures need to be easier different principles, That include improvement of to use. motor skills to enhance the surgical ability of operator, to obtain passive wound closure with INTRODUCTION opposition of wound edges and reduce the tissue trauma by using microsurgical instruments and The aim of periodontal surgery has always been to suturing 5. The application of magnification to alleviate or eliminate the degeneration associated periodontics promises to change clinical concepts with progressive periodontal disease. In order to of periodontal surgical care. For these reasons accomplish this goal, the access to the periodontal minimally invasive surgical procedures are defect for debridement has been integral part of advantageous than conventional surgical surgical therapy. Traditional surgical techniques procedures.5 used extensive flap procedures to access diseased areas and treat the underlying bone damage1. With the advent of more predictable regenerative REVIEW therapy, the focus of periodontal surgery shifted The concept of minimally invasive surgery in the from the removal of pocket walls to the re growth field of dentistry was introduced by Hareel and and regeneration of lost tissue2. The ideal surgical Ress. Minimally invasive surgery (MIS) has been defined as the ability to perform a procedure Imperial Journal of Interdisciplinary Research (IJIR) Page 2149 Imperial Journal of Interdisciplinary Research (IJIR) Vol-3, Issue-4, 2017 ISSN: 2454-1362, http://www.onlinejournal.in through a substantially smaller surgical wound than eyesight can be achieved at a light density of 1000 had previously been necessary to accomplish the cd/m. At higher densities, visual acuity decreases. same surgical goals. Minimal invasive surgical This, in turn, means that claims for optimal lighting procedure is possible through the use of conditions have to be implemented. Visualization magnifying instruments such has surgical of fine details is enhanced by increasing the image microscope, surgical telescope, microsurgical size of the object. Image size can be increased in instruments and materials6. There are three two ways elements in microsurgery. These three elements 1. By getting closer to the objects collectively called as microsurgical triad. It consists 2. By magnification. To see small objects in of: operative field magnifying loupes can be used. Magnification, Periodontal microsurgery is commonly performed Illumination and at 10x to 20x magnification. In dentistry two basic Microsurgical instruments7. types of magnification systems are commonly used: 1.Loupes Magnification: The first element of 2.Surgical microscope microsurgical triad Loupes An optimal vision is a stringent necessity in The most common magnification system used in periodontal practice. Vision is a complex process dentistry is magnification loupes. Loupes are that involves the cooperation of multiple links fundamentally two monocular microscopes, with between the eye, the retina, the optic nerve and the side-by-side lenses, angled to focus on an object. brain. Another important factor influencing visual The magnified image that is formed, has acuity is the lighting. The relation between visual stereoscopic properties that are created by the use acuity and light density is well established: a low of convergent lens systems. A convergent lens light density decreases visual acuity. The best optical system is called as kaplerian optical system. MAGNIFICATION ILLUMINATION INSTRUMENTS MICROSURGICAL TRAID It includes working distance, working range, the use of convergent lens systems. A convergent convergence angle, field of view, Interpupillary lens optical system is called as kaplerian optical distance and viewing angle. system. Working distance Principal optical features of loupes. The working distance is the distance measured It includes working distance, working range, from the eye lense location to the object in vision. convergence angle, field of view, Interpupillary Working range distance and viewing angle. The working range (depth of field) is the range Principal optical features of loupes. within which the object remains in focus. Convergence angle Imperial Journal of Interdisciplinary Research (IJIR) Page 2150 Imperial Journal of Interdisciplinary Research (IJIR) Vol-3, Issue-4, 2017 ISSN: 2454-1362, http://www.onlinejournal.in The convergence angle is the pivotal angle aligning identical distance and angle. the two oculars, such that they are pointing at the Principal optical features of loupes spaces to gain additional refractory surfaces. This allows increased Field of view magnification with more favourable The field of view is the linear size or working distance and depth of field. angular extent of an object when viewed Magnification of compound loupes can be through the telescopic system. increased by lengthen the distance Interpupillary distance between lenses there by avoiding The interpupillary distance depends on the excessive size and weight. These loupes are based on Galilean optical system and position of the eyes of each individual and is a key adjustment that allows long-term, allow a magnification of about2.5x. routine use of loupes. Prism telescopic loupes Viewing angle Prism loupes are the most optically advanced type The viewing angle is the angular position of loupe magnification presently available. These of the optics allowing for comfortable loupes actually contain Schmidt or roof-top prisms working. that lengthen the light path through a series of Three types of loupes are commonly used: mirror reflections within the loupe.They are 1. Simple loupes. superior to other loupes in terms of better magnification, wider depths of field, longer 2. Compound loupes. 5 3. Prism telescopic loupes. working distances and larger fields of view . Loupe Magnification Simple loupes - Simple loupes consist of Wide ranges of magnifications are available in a pair of single, positive, side-by-side loupes, ranging from 1.5x to 10x. Loupes with less meniscus lenses. Each lens has two than 2x magnifications are usually inadequate for refracting surfaces, with one occurring as the visual acuity necessary for microsurgery. For light enters the lens and the other when it most periodontal procedures in which leaves. Their magnification can only magnification is needed, loupes of 4X to 5X provide an effective combination of magnification, increases by increasing lens diameter and 5 thickness. Its main advantage is that it is field size, and depth of focus . cost effective and light weight.5 Choice of Loupes Compound loupes Before choosing a magnification system, different Compound loupes use multiple loupes and appropriate time for a proper
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