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Magnification in Endodontics: a Review of Its Application and Acceptance Among Dental Practitioners

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Magnification in Endodontics: a Review of Its Application and Acceptance Among Dental Practitioners Published online: 2019-09-23 Review Article Magnification in endodontics: A review of its application and acceptance among dental practitioners Jun Fay Low1, Tuti Ningseh Mohd Dom2, Safura Anita Baharin1 1Centre for Restorative Dentistry, Faculty of Dentistry, Unit of Endodontology, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia, 2Centre for Family Oral Health, Faculty of Dentistry, Correspondence: Dr. Safura Anita Baharin Universiti Kebangsaan Malaysia, Jalan Raja Muda Email: [email protected] Abdul Aziz, 50300 Kuala Lumpur, Malaysia ABSTRACT The application of magnification devices in endodontics is mainly meant for visual enhancement and improved ergonomics. This is crucial especially when long hours are spent in a narrow operating space to treat obscure microanatomy. Nevertheless, application of magnification in endodontics has yet to be introduced into the mainstream practice due to various influences in behavioral patterns. By conducting an extensive literature search in the PubMed database, this narrative review paper depicts the present state of magnification devices, their applications within the endodontic practice, factors that influence their usage, the advantages, and shortcomings, as well as the significances of magnification in the field of endodontics. This review paper will encourage clinicians to employ magnification in their practice for improved outcome. Key words: Endodontics, lenses, magnification, optics, photonics, visual acuity, visual aids INTRODUCTION This review describes several common types of magnification devices applied in the discipline of Endodontics is confined to narrow operating space as endodontics, the factors that influence their adoption, it deals with miniscule anatomy. As a result, clinicians the advantages, and shortcomings, as well as the who manage intricate cases appear to demand higher importance of using magnification devices for visual acuity. endodontics. Over the years, many magnification devices have METHODOLOGY been introduced as bridging tools between the naked eyes and the microscope. In fact, tools, such as an An extensive literature search had been carried out by endoscope, magnifying glass, and intraoral camera, combing through the PubMed database. The MeSH have largely been superseded by contemporary keywords applied were “endodontics,” “visual devices that seem to be more practical and convenient for application, such as loupes and dental operating This is an open access journal, and articles are distributed under the terms of [1‑3] the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, microscope (DOM). which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under Access this article online the identical terms. Quick Response Code: For reprints contact: [email protected] Website: How to cite this article: Low JF, Mohd Dom TN, Baharin SA. www.eurjdent.com Magnification in endodontics: A review of its application and acceptance among dental practitioners. Eur J Dent 2018;12:610-6. DOI: 10.4103/ejd.ejd_248_18 610 © 2018 European Journal of Dentistry | Published by Wolters Kluwer - Medknow Low, et al.: Magnification in endodontics: A review aid,” “optics and photonics,” “lenses,” “surveys and PREVALENCE OF MAGNIFICATION questionnaires” and “visual acuity.” As a result, a total DEVICES USAGE of 670 articles were found. The title and the abstract of each article were then screened and only the relevant The reported data on the prevalence of use appeared papers were retrieved in full text. From these texts, to be limited. Nevertheless, an increasing trend was additional relevant articles were sought from the list noted in the United States and the United Kingdom.[9‑12] of references. The total number of articles accumulated This reflects the increasing demand for enhanced was 80. Breakdown of relevant articles according to visual details to achieve clinical excellence in the type of instruments is displayed in Table 1. endodontics. Besides, other studies that reported the prevalence of use of magnification devices are shown LIMITATION OF THE NAKED EYES AND in Table 2.[7,13‑19] SIGNIFICANCE OF MAGNIFICATION DEVICES (REARRANGED) TYPES OF MAGNIFICATION DEVICES Essentially, loupes are available in several forms as Unaided eyes can only see up to the level of canal noted in Table 3. In general, flip‑up loupe differs orifice.[4] Moreover, natural vision would begin to from through‑the‑lens (TTL) loupe in terms of barrel deteriorate at the age of 40.[5] This circumstance has mobility, weight and cost. been verified by using miniaturized eye charts placed in teeth.[6] Lack of awareness of this visual handicap is a [7] Some trendy TTL design may have a small frame problem within the dental profession. Nevertheless, rim that does not permit the loupe to sit lower for age‑related visual disability seems to minimize with a steeper declination angle. This may pose some the use of loupe and could be compensated by using ergonomic challenge requiring additional head [6,8] the DOM. tilt. Thus, clinicians must strike a balance between esthetics and ergonomics when selecting the frame Table 1: Breakdown of relevant articles according to design. This is contrary in flip‑up loupe as declination the type of magnification device angle can be freely adjusted. Number MeSH keywords Result (number On the other hand, DOM seems to offer better of articles) ergonomics and wider range of magnification. 1 Articles pertaining to loupes 15 Nonetheless, the two major shortcomings of DOM 2 Articles pertaining to operating microscopes 33 3 Articles pertaining to loupes and 15 are its high cost and lack of portability. operating microscopes 4 Articles pertaining to magnification in general 10 Table 4 presents a comparison between loupe and 5 Articles pertaining to others (endoscope, 7 DOM. Currently, the gold standard for the practice intraoral camera, magnifying glass, etc.) of endodontics necessitates the application of a 6 Total number of relevant articles reviewed 80 microscope.[22] Table 2: Articles that reported the prevalence of use of magnification devices Study Sample size, n Country Operator Prevalence (%) Loupe DOM Loupe and DOM Forgie et al. 1999 1280 UK GDP 9 - - Mines et al. 1999 2237 US Endodontists - 52 - Burke et al. 2005 701 UK GDP 26 - - Thomas and Thomas 2007 868 US Dental hygienist 60.5 - - Kersten et al. 2008 1091 US Endodontists - 90 - Farook et al. 2013 153 UK GDP 31 - - Savani et al. 2014 479 US GDP 75 2 - Neukermans et al. 2015 826 Belgium GDP and various specialists - - 47 Alrejaie et al. 2015 318 Saudi Arabia GDP and endodontists - 47 - Eichenberger et al. 2015 69 Swiss Private practitioners 64 - 19 Ferreira et al. 2017 279 Brazil Endodontists 23.66 35.48 8.24 Topkara et al. 2017 275 Turkey GDP and endodontists 12.4 1.8 - UK: The United Kingdom, US: The United States of America, GDP: General dental practitioner, DOM: Dental operating microscope European Journal of Dentistry, Volume 12 / Issue 4 / October-December 2018 611 Low, et al.: Magnification in endodontics: A review Table 3: Main differences between flip‑up loupe and through the lens loupe Features Types of loupes Flip-up TTL Barrel mobility Can be flipped out of sight when not in use Fixed. Barrels may hinder eye contact during communication Optics adjustment Interpupillary distance, convergence angle Not needed and declination angle can be changed Sharing among operators Permitted Not possible Weight Heavier due to the hinges Lighter Cost Relatively cheaper. More expensive Prescriptive eyewear May be worn with the loupe or incorporated into the frame Can be incorporated into the frame TTL: Through the lens Table 4: Main differences between loupe and dental operating microscope Loupe Dental operating microscope Cost Cheaper Significantly more expensive Portability Portable and light Floor standing microscopes are portable but Allows practice in multiple locations take up space and are very heavy to shift While, mounted microscopes are fixed to the ceiling or wall User adaptability Easier Steeper learning curve Ergonomics Slight head tilt may be required depending Perfectly neutral body posture on the degree of lens declination Level of magnification Reasonable but fixed and A higher level of magnification is available limited (2.5×‑8.0×) which can be adjusted (3×‑30×) The line of sight and The convergent line of sight leading to eye A parallel line of sight allowing more relaxed eye muscles[21] eye strain strain over a long duration of use[20] USES OF MAGNIFICATION DEVICES IN VARIABLES ASSOCIATED WITH THE ENDODONTICS DIFFERENT LEVELS OF MAGNIFICATION Many scenarios have greatly benefited from the The two variables directly associated with the levels use of magnification in endodontics. In fact, this of magnification are field of view and depth of field directly influences the decision‑making in saving (i.e., the range of working distance where an object stays previously thought non‑restorable tooth. The in focus). At higher magnification, the field of view seen [20] enhanced vision and illumination can facilitate is reduced and the depth of field is smaller. A clinician the following: who utilizes higher magnification loupe for endodontics • Diagnosing caries and minute crack[23‑25] may find it challenging to perform other procedures that require a wider field of view and depth of field. • Conservative access opening[26] [27,28] • Identifying obscure anatomy
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