MICR.........................OSCOPE.pptx

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1. OPERATING MICROSCOPE IN ENDODONTICS Presented by – Dr. NUPUR BAYAD mds 3 RD YEAR

2. INTRODUCTION HISTORY OPTICAL PRINCIPLE TYPES OF MAGNIFICATIONS DENTAL OPEARTING MICROSCOPE USES ADVANTAGES AND DISADVANTAGES ROD LENS ENDOSCOPE RECENT ADVANCES CONCLUSION REFRENCES CONTENTS:-

3. Human eye has inherent ability to distinguish two separate lines that are at least 0.2mm or 200microm apart. Most people can't refocus at distances closer than 10 to 12 cm. As the eye-subject distance decreases, the eyes must converge, creating eyestrain. Endodontic treatment was believed to be a blind procedure. It was purely based on tactile sensation & thus predictable outcome was less. INTRODUCTION

4. Human eye has inherent ability to distinguish two separate lines that are at least 0.2mm or 200microm apart. Most people can't refocus at distances closer than 10 to 12 cm. As the eye-subject distance decreases, the eyes must converge, creating eyestrain. Endodontic treatment was believed to be a blind procedure. It was purely based on tactile sensation & thus predictable outcome was less. INTRODUCTION

5. Due to complex nature of endodontic treatment, it was a demand to improve vision of the operating field. Introduction of magnification devices like loupes, dental operating microscope completely changed the way of practise

6. HISTORY 1611- Invention of Janssen Compound lens microscope by Hans and Janssen 1665- Hookes microscope was invented by Robert Hooke 1668- Antonie van Leeuwenhoek   the first person to see and describe bacteria 1876- Dr Edwin Saemich introduced simple binocular loupes to the surgery 1907- Bowles suggested and used a dental microscope. 1921 - Carl Nylen , father of microsurgery first used a binocular microscope for ear surgery. Introduction to magnification in endodontics donald e. Arens , dds , msd “

7. 1922- The Zeiss Company working with Dr Gunnar Holmgren of Sweden, introduced a binocular microscope for treating otosclerosis of the middle ear. 1940s- D r Jules Lempert , a leading mastoid surgeon from New York used loupes to perform his surgery. 1953- The formal introduction of the binocular operating microscope took place when Zeiss introduced Opton ear microscope. 1962- Dr Geza Jako , an otolaryngologist, used the SOM in oral surgical procedures.

8. 1975- Goss and Bosanquet reported that Ohnishi first used the endoscope in dentistry to perform an arthroscopicprocedure of the temporomandibular joint. 1977 - An otolaryngologist ( ENT Specialist) Dr.Robert Baumann , described the use of microscopes in dentistry. 1978- Dr Harvey Apotheker and Dr Geza Jako , began the development of a microscope specifically designed for dentistry 1979 -Detsch et al . first used the endoscope in endodontics to diagnose dental fractures. Magnification - an endodontic review journal of advanced clinical & research insights (2017), 1, 178–182

9. 1980- Dr Apotheker coined the term ‘ microdentistry ’ 1981- The first Dental Operating Microscope called Dentiscope was introduced by Chayes -Virginia Inc 25 th Sept 1982 - Harvard Dental School Boston, offered the first course in the clinical hands-on use of the dentiscope late 1980s- Prof S. Kim and Dr Gary Carr widespread use of microscopic techniques in endodontics.

10. 1986- Howard S Selden was the first endodontist to publish an article on the use of the DOM in endodontics. 1990- Dr Richard Rubinstein and Dr Gary Carr started using medical-grade microscopes for apical surgery. 1996- Held et al . and Shulman & Leung reported the first use of the endoscope in surgical and nonsurgical Endodontics. 1999- Gary Carr , introduced a DOM that had Galilean optics and that was ergonomically configured for dentistry. 1999- Bahcall et al. presented an endoscopic technique for endodontic surgery.

11. OPTICAL PRINCIPLE STEREOPSIS Definition- Depth perception (3D vision) provided by fusion of binocular images .

12. WORKING DISTANCE :- It is the distance measured from the eye lens to the object in vision.

13. FIELD OF VIEW :- Linear size or angular extent of an object when viewed through the telescopic system.

14. WORKING RANGE (DEPTH OF FIELD): Range within which the object remains in focus. DOF decreases with increase in magnification

15. INTERPUPILLARY DISTANCE: It is the key adjustment for the use of any magnification system.

16. CONVERGENCE ANGLE: It is the pivotal angle aligning the two oculars, such that they are pointing at the identical distance and angle varies with interpupillary distance (IPD).

17. TYPES OF MAGNIFICATION SYSTEMS LOUPES - Simple loupes - Compound loupes - Prism loupes B) SURGICAL OPERATING MICROSCOPE -Wall mounted -Floor mounted -Celling mounted

18. Dental operating microscope They are designed on galilean system (telescope system). It has wide range of magnification from x3 to x30. Endodntic microsurgery- E.Merino

19. PARTS OF DENTAL OPERATING MICROSCOPE Eyepiece Binocular tube Beam splitter Magnification changer Main objective lens Endodntic microsurgery- E.Merino

20. Eye piece: There are three types of eyepiece, depending on quality and optical aberration correction properties: • Huygens (H), the most simple and cheap • wide-field (WF), with good vision in all the field, edges included • PLÖSS! (PL), the most sophisticated and high quality with good correction of all optical aberrations They are available with 6.3, 10, 12.5, 16 and 20 magnification powers. Endodntic microsurgery- E.Merino

21. Binocular tube : The function of binoculars is to project an intermediate image into the focal plane of the eyepieces. They are set at the interpupillary distance. Inclinable binoculars are adjustable for positions up to and sometimes beyond 180° Endodntic microsurgery- E.Merino

22. Beam Splitter Digital picture camera is attached to a beam splitter through a picture adapter. A straight beam splitter or a C-code splitter can be inserted into the pathway of the light, as it returns to the operator's eye, between the binoculars and the magnification changer. Its function is to supply light to accessories. Endodntic microsurgery- E.Merino

23. Magnification Changer: Located in the microscope body, the changer holds the lenses that magnify the image in three or five steps manually or progressively if motorized. Binocular focal length = 125.mm Objective lens focal length = 250 mm Eyepiece magnification = 10x Magnification factor = 0.4 Total magnification = 125/250 x 10 x 0.4 = 2x Endodntic microsurgery- E.Merino

24. Objective Lens The focal length of the objective lens determines the distance between the lens and the surgical field. The closer the objective lens to the surgical field, the higher the final magnification at each step, and the smaller the diameter of the surgical field will be. A variety of objective lenses are available with focal lengths ranging from 100 mm to 400mm . Typical working distance are : 8 inches ( 20 cm) for a 200-mm lens; 10 inches ( 25 cm) for 250-mm lens; and 14 inches (35 cm) for a 300-mm lens. Endodntic microsurgery- E.Merino

25. Light Source Microscope provides a powerful coaxial illumination. At minimum magnification, the illuminated area is about 6 cm in diameter. Orange filter is used during composite restoration. Green filter is used during surgical cases.

26. Dioptre Steps for parfocaling Position the microscope above a flat, stationary surface & focus target and place it within the illumination field of the microscope. Set both the eyepiece diopter settings to “0”. Also set assistant’s eyepieces to “0”. Position the microscope vertically at a convenient view height, Set the microscope on its highest magnification setting and focus using the fine-focus control until a sharp image is obtained. Change the magnification setting to its lowest position & Focus left and right eyepieces, one at a time, by turning the diopter ring until the image is clear and sharp.

27. OPERATING POSITIONS FOR DENTAL OPERATING MICROSCOPE Surgeon’s stool position Dental chair position Surgeon position Microscope position Patient head & body position Assistant position Assistant observation devices.

28. Surgeon’s stool position The surgeon must feel comfortable. The best position is head and back straight and balanced. Thighs parallel or slighted elevated to the floor. Feet parallel to the floor Arms bent at the elbows (slightly extended) and properly supported Endodntic microsurgery- E.Merino

29. The surgeon must be able to move freely between the 10 o'clock and 2 o'clock positions Surgeon position Endodntic microsurgery- E.Merino

30. The patient is placed in the Trendelenberg position and the chair is raised until the patient is in focus. The dental chair is positioned slightly below the operator for ma x illary surgery and slightly above the operator for mandibular surger y. This allows the clinician to look down the axial plane of the root and across the beveled surface in maxillary teeth and up the axial plane of the root and across the beveled surface in mandibular teeth. Dental chair position The anatomy of the Surgical operating Microscope and operating Positions Richard rubinstein , DDS, MS

31. The patient is placed in the supine position and the chair is raised until the patient is in focus. The dental chair is positioned slightly below the operator for ma x illary surgery and slightly above the operator for mandibular surger y. Rough positioning of the patient The anatomy of the Surgical operating Microscope and operating Positions Richard rubinstein , DDS, MS

32. Fine positioning of the patient Little movements with the back of the dental chair, in order to position the patient in the definitive position. If the light beam is perpendicular to the floor and the mirror is at 45° to the light, the patient must be positioned in order to allow the light to enter the root canal to be treated. The root canal of the tooth to be treated must be positioned At 90° to the light beam, while the mirror is at 45° angle. FOR MAXILLARY ARCH The use of the operating microscope in Endodontics Gary B. Carr and arnaldo castellucci

33. FOR MANDIBULAR ARCH The use of the operating microscope in Endodontics Gary B. Carr and arnaldo castellucci The root canal of the tooth to be treated must be positioned at 90° to the light beam, while the mirror is at 45° angle.

34. Microscope position As per the focal length of the objective lens, the operator moves the body of the microscope approximately to the working distance. Looking through the eyepiece, moves the microscope up and down until the working area comes into focus. Fine focus device of the objective lens should be done in order to allow a wide range (20 mm) during the fine focusing of the operative field. Eyepiece is now adjusted so that the operator’s head and spine can maintain comfortable position with the working area in focus. Adjust the interpupillary distance. Endodntic microsurgery- E.Merino

35. PATIENT HEAD POSITION Patient should be in comfortable position Occlusal plane should be perpendicular to the floor while working mandibular arch and maxillary arch. With short surgery, the patient can move his or her head right to left and back and forth to permit better access to the surgical field. The patient's head is tilted to the opposite of the working side For long surgery tilt the whole of the patient's body instead of just the head, to the opposite working side

36. Assistant position A well-designed microsurgery may use three dental assistants first assistant is primarily responsible for suctioning. The second assistant passes instruments and usually stands. The third assistant functions as a charge nurse. He/she is also in charge of video and photographic functions The anatomy of the Surgical operating Microscope and operating Positions Richard rubinstein , DDS, MS

37. Assistant observation devices There are three types of assistant observation devices articulating assistant binoculars, LCD screens, and high resolution monitors. LCD screens can be placed in line with the video camera on the microscope and mounted on a swivel arm so that it can be positioned in front of the first assistant. The anatomy of the Surgical operating Microscope and operating Positions Richard rubinstein , DDS, MS

38. ERGONOMICS IN DENTISTRY Class I Motion: moving only the fingers 2. Class II Motion: Moving only the fingers and Wrists THE USE OF THE OPERATING MICROSCOPE IN ENDODONTICS GARY B. CARR AND ARNALDO CASTELLUCCI.

39. 3. Class III Motion: Movement originating from the elbow 4. Class IV Motion: Movement originating from the shoulder 5. Class V Motion: Movement that involve twisting or bending at the waist THE USE OF THE OPERATING MICROSCOPE IN ENDODONTICS GARY B. CARR AND ARNALDO CASTELLUCCI.

40. USES :- Diagnosis Visualizing the root canal system in fine detail 2. Detecting microfractures 3. Distinguish the floor and dentin 4. Examining crown margins The Dental Operating Microscope in Endodontics

41. For diagnosis and management of perforation. Locating calcified canals. Retrieval of broken down or separated instrument Microsuturing Also helps in post removal. The Dental Operating Microscope in Endodontics

42. Surgical Endodontics 1. Osteotomy (précised and small – 5 mm) 2. Curettage 3. Apicectomy 4. Inspection of the resected root surface 5. Detect apical perforation 6. Apical preparation 7. Retro filling 8. Examination of surgical site 9. Identify and manage isthmus The Dental Operating Microscope in Endodontics

43. Advantages of Dental Operating Microscope Increased Visualization Improved Quality and precision of treatment Improved & Ideal treatment Ergonomics Ease of Proper Digital Documentation Capabilities Increased Ability to Communicate through Integrated Video Dental operating microscope in endodontics-a review iosr journal of dental and medical sciences ( iosr-jdms 2013

44. Disadvantages of Microscopes DOM has a restricted working field, 11mm -55mm . The instrument occupies lot of space and is difficult to carry. The surgeon’s position is restricted. With higher magnification, the field of view and depth of focus is reduced. The equipment is very expensive and requires proper and regular maintenance. Dental operating microscope in endodontics-a review iosr journal of dental and medical sciences ( iosr-jdms 2013

45. Recent advances in magnification- Operating microscope with advanced features Endoscopes Orascope Endodontic Visualization System Head mounted microscope

46. Operating microscope with advanced features Zeiss EXTARO 300 Zumax OMS 2350 3D Zeiss OPMI PROErgo

47. Endoscopes The endoscope is flexible due to special nitinol coating The optical part which is 0.9 mm of diameter, is a piece of equipment that enables the practitioner a magnification of up to 20X RECENT ADVANCES IN ENDODONTIC VISUALIZATION: A REVIEW DR. ANIL DHINGRA1, DR. NIDHI NAGAR2 IOSR JOURNAL OF DENTAL AND MEDICAL SCIENCES (IOSR-JDMS) (JAN. 2014)

48. Orascope The recently introduced flexible fiberoptic orascope is recommended for intracanal visualization, has a 0.8mm tip diameter, 0º lens. Before inserting the coronal 15 mm of the canal must be prepared to a minimum size of a #90 file. MAGNIFICATION IN ENDODONTICS- RECENT ADVANCEMENTS- REVIEW RA JOURNAL OF APPLIED RESEARCH 06 JUNE -2018

49. Endodontic Visualization System This system incorporates both endoscopy and orascopy into one unit. the EVS II System is introduced. It also combines the fiber optic orascope and a rigid endoscope. RECENT ADVANCES IN ENDODONTIC VISUALIZATION: A REVIEW DR. ANIL DHINGRA1, DR. NIDHI NAGAR2 IOSR JOURNAL OF DENTAL AND MEDICAL SCIENCES (IOSR-JDMS) (JAN. 2014)

50. HEAD MOUNTED MICROSCOPE Specifications - WD-300-700mm (11.81 to 27.56 inches) Field of view-30-224mm with standard eyepiece Zoom- continuous foot controlled zoom magnification range- x2.9- x7 Vision correction- ±7 dioptre Colour temp- 5500-6000° Kelvin

51. MORA 3D vision Real-time Stereoscopic HD 3D-Video with up to 16x Magnification. Eliminates posture-dependent vision Expands viewing axis Reduces occupational injury Real-time Stereoscopic Video 1920 x 1080 Flat Panel 3D Display Uninterrupted Work-flow with Foot Controlled Zoom & Focus High Definition Optics with 10mm Depth of Field & 12x Zoom MoraVision™3D LiveView for the Patient

52. TECHNICAL SPECIFICATIONS FOR LABOMED PRIMA

53. CARE INSTRUCTIONS • Keep accessories away from dust when not in use, e.g. protect them from dust cover. • Remove dust with a pneumatic rubber bulb and soft rush. • Use special optics cleaning cloths and pure alcohol for cleaning lenses and eyepieces. • Protect your colposcope from moisture, fumes, acids and cosmetic materials. Do not store chemicals close to the instrument.

54. Protect it from improper handling. Never install other deviced sockets or unscrew optical system and mechanical parts unless explicitly instructed to do so in this manual. Protect the microscope from oil and grease. Never oil or grease the guide surfaces or mechanical parts.

55. CLEANING & SERVICING: Needed: water, detergent, spirit, microfiber cloth • Wipe the instrument and stand (non-optics) with a damp (not dripped wet) cloth regularly. Standard mild household detergents should be used at suitable dilution. Afterward wipe with a dry, non-fuzzing cloth. • Do not use harsh or corrosive cleaning agents, they can cause damage to painted printed and plastic parts. • Avoid splashing water, may cause device-as safety clause in IPXO. • Use 99% isopropyl alcohol to clean optical components. • Dry optical components using a microfiber cloth; dry the rest of the product using a paper towel. • For servicing as and when required, inform LABOMED after- sales service department.

56. CONCLUSION Magnification and coaxial illumination have enormously increased the possibility of saving teeth both non-surgically and surgically. The excellent visual information can help the doctor to create more precise, more healthful, and more esthetically pleasing dentistry This huge shift in clinical accuracy from low magnification tactile driven endodontics to vision based endodontics is bringing revolution to field of endodontics with higher success rate.

57. REFRENCES: THE USE OF THE OPERATING MICROSCOPE IN ENDODONTICS GARY B. CARR AND ARNALDO CASTELLUCCI. MAGNIFICATION IN DENTISTRY: A REVIEW INTERNATIONAL JOURNAL OF APPLIED DENTAL SCIENCES 2018; 4(2): 83-85 RAKESH J GOGIYA, MANOJ G CHANDAK, RICHA R MODI, PURVA BHUTDA, SNEHA KELA AND RAKHI M CHANDAK RECENT ADVANCES IN ENDODONTIC VISUALIZATION: A REVIEW DR. ANIL DHINGRA1, DR. NIDHI NAGAR2 IOSR JOURNAL OF DENTAL AND MEDICAL SCIENCES (IOSR-JDMS) (JAN. 2014) ERGONOMICS IN DENTAL PRACTICE ( INTERNATIONAL JOURNAL OF DENTAL AND HEALTH SCIENCES 2014) AASIM FAROOQ SHAH1, PRADEEP TANGADE2, MANU BATRA3, SOUMIK KABASI4 MAGNIFICATION IN ENDODONTICS- RECENT ADVANCEMENTS- REVIEW RA JOURNAL OF APPLIED RESEARCH 06 JUNE -2018

58. Magnification - an endodontic review journal of advanced clinical & research insights (2017), 1, 178–182 Dental operating microscope in endodontics-a review iosr journal of dental and medical sciences ( iosr-jdms ) e- issn : 2279-0853, p- issn : 2279-0861. Volume 5, issue 6 (mar.- Apr. 2013 Introduction to magnification in endodontics donald e. Arens , dds , msd “ The dentist’s operating posture – ergonomic aspects j med life . 2014 jun 15 Magnification and illumination in apical surgery richard rubinstein endodontic topics 2005 The anatomy of the Surgical operating Microscope and operating Positions Richard rubinstein , DDS, MS The Dental Operating Microscope in Endodontics

59. Microsurgery in Endodontics Syngcuk Kim, DDS, PhD, MD(Hon) Samuel Kratchman , DMD Endodntic microsurgery- E.Merino MAGNA User Manual Operating Microscope Dentistry