Microscope-assisted precision dentistry

To enhance their vision for both clinical and laboratory procedures, an increasing number of dental practitioners are introducing magnification into their practices. Most are using either simple or compound loupes mounted on glasses frames. And although magnification is not new to dentistry, it is a trend that is gaining a broader acceptance among both seasoned practitioners and recent graduates. Many dental schools are allowing their students to use loupes on a discretionary basis, so the notion that magnification is reserved only to compensate for deteriorating vision is rapidly disappearing. Dental professionals have also begun to recognize that the quantity and quality of light in the working field is just as important as magnification. Headlamps with focused, color-correct light sources in combination with loupes are becoming popular. It is highly unlikely that a practitioner using loupes would relinquish them and return to practicing without magnification. The newest addition to the vision enhancement arena in dentistry is the operating microscope. In some medical subspecialties--such as otolaryngology, ophthalmology, plastic surgery, and neurosurgery--extensive microsurgical training is required to perform procedures at acceptable standards of precision. In 1998, the American Association of Endodontists (AAE) elected to mandate that all endodontic postgraduate students demonstrate proficiency using an operating microscope before they receive their certificates. Microscope use has also been reported in periodontics. For several decades, many dental laboratory technicians have used stereomicroscopes for trimming dies, refining castings, and performing other procedures that require a high degree of precision. However, according to microscope manufacturers, most current instrument sales are to general practitioners, who are not limiting the use of their microscopes to endodontic therapy--they are using them for a wide variety of procedures. Microscopes have the potential to enhance a dental practitioner's vision to unprecedented levels, but there are some practical questions that need to be addressed. What kind of visual acuity do dentists really need to perform high-quality dentistry? If a dentist wants to improve his or her vision, do loupes provide an adequate level of magnification? Is using a microscope too complicated for restorative and prosthodontic procedures, and how long does it take to become proficient with a microscope? These are some of the questions I posed to two outstanding dentists who have had extensive clinical experience using surgical microscopes. I also share my own experience with a microscope.