■Operate Microscope

■The Dental surgical Microscope

■ Microscopes Knowledge

■Welcome to surgical microscope(operate microscope)

■Microscope Buying Guide — Simple Steps to Effective Microsurgery

■The influence of the  microscope in locating the mesiolingual canal orifice: a laboratory analysis

Model LZL-4D the Latest Light Multi-function Operation Microscope

(ENT surgical microscope,Otolaryngology,Operation,operating)

The influence of the surgical microscope in locating the mesiolingual canal orifice: a laboratory analysis

In need of a surgery microscope for an application such as Otolaryngology  microscope (operating,operation,ENT surgical microscope,surgical,otolaryngology),hand microsurgery , ophthalmic eye surgery,or general micrology use? We can provide the equipment you need.We have microscopes (surgical,Operating,Operation, Otolaryngology) for ophthalmology , ENT and general medical use with the angled binocular head or straight head. We can add optional accessories such a beam splitter to take the image to a ccd camera port, which in turn is mounted a ccd camera for output to a cctv display monitor. We can also provide higher end units that have  assistant heads, also known as teaching heads. These additional heads can be either binocular (with two eyepieces) or monocular with a single viewing eyepiece. Some specialized systems can have enough viewing stations for up to three or four physicians and assistants to simultaneously watch the micrology (operating,operation)  being performed. Please contact us today to discuss your specific needs.

ABSTRACT

The aim of this study was to evaluate the influence of using the surgery microscope (SOM)(ENT,surgical,operating,Operation,Otolaryngology,ENT surgical microscope) for detection of the mesiolingual (ML) canal orifice in extracted first maxillary permanent molars. One hundred and eight human first maxillary permanent molars were randomly selected and mounted onto a dental chair mannequin. Conventional access cavity was prepared and an attempt was made to locate the mesiolingual canal orifice using only a sharp explorer, a mirror and a #10 K-file. A mesiolingual canal orifice was either located or not located. If not located, the teeth were then evaluated by using a surgery microscope (Otolaryngology, ENT surgical microscope,surgical,operating,Operation) (SOM). The mesiobuccal roots of all teeth where the ML canal orifice had not been located were sectioned in an axial plane and the sections were explored with an adjunctive use of the SOM at a 25 X magnification. ML canal orifices were detected in 58 teeth using only a sharp explorer, a mirror and #10 K-file. In the remaining 50 teeth, 37 ML canal orifices were located by using the SOM and 3 ML canal orifices were located after root sectioning.In 10 teeth,ML canal orifices were not found.The results of this study showed a high incidence of a ML canal in the mesiobuccal roots of the first maxillary molars (90.7%) and demonstrated that the adjunctive use of the SOM increased the ability of the dental clinician to locate the ML canal orifice.

Descriptors: Incidence; Dental pulp cavity; Microscopy.(operating,operation)

INTRODUCTION (operating,ENT surgical microscope,surgical,Otolaryngology)

The goals of successful endodontics are the total obliteration of the canal space and the perfect sealing of the apical foramen with an inert filling material. For this, the location and negotiation, with subsequent cleaning and shaping, of the root canal system are necessary . Pécora et al.11 (1992) affirms that one of the main reasons for the failure of root canal therapy is the lack of sufficient knowledge concerning the anatomy of teeth, both internal and external. The first maxillary molar is the most bulky teeth in the mouth, and has many anatomical variations. Usually both the distobuccal root and the palatal root present only one canal. The mesiobuccal root presents more anatomical variations, such as the number and disposition of the canals. Bjorndal, Skidmore2 (1983) affirmed that the difficulty in locating the mesiolingual canal (ML) during the first maxillary permanent molar endodontic treatment may have implications for the long-term prognosis.

Clinically, the presence or absence of the mesiolingual canal is limited by the conditions in which locating of the orifice is carried out. The ability to locate the mesiolingual canal depends on the skill of the operator, the complexity of the anatomy and the use of high power illumination and magnification techniques, such as that performed with the  operation microscope(operating,Operation, ENT surgical microscope,surgical,Otolaryngology). A literature review has demonstrated wide variation in the prevalence of the ML canal mostly in in vitro researches. Hess6 (1925), in a classical study, reported finding 4 canals in 54% of first maxillary molars. Weine et al.16 (1969) evaluated first maxillary molars and located 4 canals in 62% of the teeth. Pineda, Kuttler12 (1972) evaluated the number of canals in first and second molars and found 4 canals in 51.5% of the teeth. Fogel et al.4 (1994) evaluated the use of 2.5 X magnification telescopes with fiberoptic headlamps for locating the mesiolingual canals in first maxillary molars in vivo. They found that 71.2% of the mesiobuccal roots had two canals. Stropko15 (1999) found 73% to 93% of mesiolingual canals in a recent clinical study. Baldassari-Cruz et al.1 (2002) evaluated the influence of the dental operating microscope(surgical,operating,Operation,ENT surgical microscope,  Otolaryngology,ENT) in locating the mesiolingual orifice. This study demonstrated that the adjunctive use of the dental operating microscope (surgical,operating,Otolaryngology, Operation) increased the ability of the clinician to locate a mesiolingual canal.

The purpose of this study was to evaluate whether the adjunctive use of the operating microscope (surgical,Otolaryngology,operating,Operation) would increase detection of the mesiolingual canal orifice in the mesiobuccal root of first maxillary permanent molars.

MATERIALS & METHODS

For this study, 108 human first maxillary left and right molars were selected randomly from the tooth bank of the Department of Endodontics, Rio de Janeiro State University.

The teeth were stored in 10% neutral formalin. The sex and race of the patients from whom these teeth were obtained were unknown. The teeth were mounted onto a dental chair mannequin (Columbia Dentoform, Long Island, NY, USA). No isolation of the teeth by rubber dam was done. Without using magnification or headlamps, a conventional access cavity was prepared using a #6 high-speed hand-piece spherical bur (Dentsply-Maillefer, Ballaigues, Switzerland), a sharp endodontic explorer, a mirror, a #10 K-file (Dentsply-Maillefer, Ballaigues, Switzerland) and water irrigation. After locating the mesiobuccal, distobuccal (surgical,operating,Operation,ENT surgical microscope,Otolaryngology)and palatal canals, an attempt was made to locate the mesiolingual canal orifice using only a sharp explorer, a mirror and a #10 K-file. If the mesiolingual canal orifice was not located, a #700l low-speed hand-piece bur (Dentsply-Maillefer, Ballaigues, Switzerland) was used 2 or 3 mm into the orifice of the mesiobuccal canal where a trench was prepared in a lingual and slightly mesial direction through the mesial dentinal shelf1. The root was again explored by using only a sharp endodontic explorer, a mirror and a #10 K-file in an attempt to locate a mesiolingual canal orifice.

A mesiolingual canal orifice was either located or not located. If not located the teeth were then evaluated by using a  operating microscope (Dental F. Vasconcelos, M900 –25 X, São Paulo,Brazil) (urgical,operating,Operation,Otolaryngology,ENT surgical microscope) at a magnification of 25 X. Again, an ML canal orifice was either located or not located. The mesiobuccal roots of all teeth where the ML canal orifice was not located were sectioned in an axial plane 6 mm below the cemento-enamel junction. The sections were explored using a sharp endodontic explorer, a mirror and a #10 K-file (Figure 1F) with the adjunctive use of the surgery microscope(surgical,operating,Otolaryngology,Operation)at a magnification of 25 X to determine the actual presence or absence of the orifice of the ML canal. In this methodology, each tooth served as its own control.

RESULTS

In the first phase of this methodology, with the use of only a sharp endodontic explorer, a mirror and a #10 K-file (unaided vision), a total of 58 ML canal orifices were detected out of 108 teeth (53.7%). The 50 teeth where the ML canal orifices could not be located with unaided vision were submitted to evaluation under a  microscope (SOM)(ENT surgical microscope,surgical,Otolaryngology,operating,Operation). After this evaluation, a total of 37 ML canal orifices were located (74%). Thus, 37 ML canal orifices could only be located with the use of the SOM. In the lab, after sectioning, 3 additional ML canal orifices were located in the remaining 13 teeth (23%). These 3 canals were located neither with the traditional methods nor with the SOM evaluation. A total of 98 ML canal orifices were identified out of 108 experimental teeth (90.7%). (Graph 1).

Figure 1A shows one of the first maxillary molars (operating,operation) used in this experiment and the presence of 4 distinct foramina (Figure 1B). Figure 1C shows an example of the difficulty in locating the ML canal orifice in the first maxillary molar, and Figure 1D summarizes the results of this work.

DISCUSSION

The results of the present study demonstrate that 53.7% of the ML canal orifices were detected by using a sharp endodontic explorer, a mirror and a #10 K-file. With the adjunctive use of the SOM, the incidence increased from 53.7% to 87.96%. This result showed the efficacy of this clinical procedure. Carr3 (1992) affirms that the operation microscope(surgical,operating,ENT surgical microscope,Otolaryngology, Operation) has greatly improved the ability of the endodontist to visualize and treat periapical pathology in endodontic . It has also enhanced the practice of non endodontics. The higher magnification and illumination can be useful for access cavity preparation, instrumentation and obturation. It can improve the clinician's view of the complexity of the root canal anatomy and aid in the location of additional canals, fins or ribbons. Thus, the use of the SOM to detect the ML canal orifice of first and second maxillary molars may enhance the success of endodontic procedures.


Conservative or small access cavity preparations are not recommended because some missed canals can lead to root canal therapy failure. Weller, Hartwell17 (1989) have stated that there is an increased probability of finding the mesiolingual canal if the initial access is changed from a classical triangular shape to a more rhomboidal shape. Modification of the access cavity (to a rhomboidal shape) to include a trench preparation from the mesiobuccal canal to a mesiopalatal (Operation,operating,Otolaryngology) direction, where the ML canal orifice may be typically found, increases the frequency of ML canal orifice detection. Once a rhomboidal access shape has been established and all major canals have been located, a careful examination of the pulpal floor should be conducted. Baldassari-Cruz et al.1 (2002) related that different access cavity shapes increase the frequency of locating the ML canal in the mesiobuccal root of the first maxillary molar.The surgical microscope(surgical,ent surgical microscope ,  Operation,operating,Otolaryngology) is very useful in performing this task. Combined with the knowledge about root canal system morphology and accessibility, enhanced vision to the area allows the operator to achieve maximum results. This is confirmed by the high prevalence of the ML canal orifice found in this study.

The negotiation as well as the cleaning and shaping of the ML in the mesiobuccal (surgical,operating,Operation,ENT surgical microscope,Otolaryngology)roots of first maxillary permanent molars was not part of this study. We believe that a great number of these canals are impossible to be treated by methods used in endodontics nowadays. This represents an interesting theme for future researches.

CONCLUSION

Our study showed a high incidence of the ML canal in the mesiobuccal(operating,operation) roots of first maxillary molars (92%) and demonstrated that the adjunctive use of the SOM increases the ability to detect an ML canal orifice.

Back To Top

(ENT surgical microscope, surgical,operating, Operation,Otolaryngology)

(operating,surgical, Otolaryngology,ENT surgical microscope,Operation)

Increased Visualization
In addition to having up to six levels of magnification ranging from 2x to 20x available at one’s fingertips, illumination is a critical component in increasing visualization. Most microscopes (ENT surgical microscope,surgical,operating,Operation,Otolaryngology) are equipped with an integrated coaxial light source that allows for unobstructed, shadow-free illumination of the OPS field. With coaxial illumination, the path of light is directed parallel to the microscope’s (surgical,operating,Operation) optical axis, which allows for significantly improved visualization of even the most difficult to access areas of the oral cavity.

With enhanced visualization, the clinician’s ability to diagnose problems in the earlier stages of a disease process is possible. Treatments also can be performed with a greater level of precision, thereby reducing the occurrence of failures and the need for redos. Enhanced visualization can also allow for treatment to be provided more comfortably to the patient because of lighter, more refined hand movements which occur naturally when one is accustomed to OPS (surgical,operating,Operation) in a well-illuminated magnified field. Increased visualization can ultimately result in greater efficiency and productivity because less time is wasted with tactile exploration and confirmation that all decay has been removed. When one can see all areas of the mouth or of a preparation perfectly,the level of efficiency and precision in diagnosis and treatment naturally increases.

Digital Documentation Capabilities
This is perhaps the most significant advantage that microscopes(ENT surgical microscope, surgical,operating,Otolaryngology,Operation)offer over loupes, and where a significant return on investment can potentially be realized provided that they are fully integrated and used to their fullest potential. With the optional addition of a beam-splitting device, one is able to integrate various types of digital recording devices, such as an SLR and/or video camera. Digital (Operation,surgical,operating,Otolaryngology) documentation capabilities enable the clinician to efficiently capture and share with patients what is seen during an examination preoperatively, intraoperatively, and postoperatively.

During treatment, images can be efficiently captured, shared, and stored in the patient’s chart. This is especially useful when unforeseen problems are encountered. This not only helps to increase a patient’s level of trust and confidence in the treating doctor (especially with newer patients), but can also aid in reducing one’s medical-legal risk.

Additionally, a live video source can be attached to the microscope (ENT surgical microscope,surgical, Otolaryngology,operating,Operation) and fed to a TV or computer monitor, strategically positioned so that it can be easily viewed by the dental assistant. When the assistant is able to see exactly what is being done during a procedure, not only does his or her level of efficiency increase, but the level of interest and motivation also rises dramatically since he or she tends to feel more involved during the procedure.

Once treatment is completed, a great way one can internally market one’s practice is by providing patients with preoperative, intraoperative, and postoperative color photographs of their treatment. This has the great potential of stimulating new patient referrals of friends and family members.

Improved Ergonomics
With dental microscopy(surgical,operating,ENT surgical microscope, otolaryngology, operation), improved ergonomics is realized on many levels, the most obvious being improved posture. By OPS in a more upright, comfortable posture, the operator is less likely to experience strain or fatigue of neck and back muscles and is, therefore, able to work comfortably for extended periods of time. This can enable the practitioner to provide more dentistry in fewer visits, increasing the clinician’s productivity and making for very happy patients. Ergonomics is also improved during digital documentation because intraoperative images can be captured very efficiently by the assistant so that the clinician does not have to stop treatment.

Integrating Dental Operating Microscopes (Otolaryngology,ENT surgical microscope, surgical, operating, Operation)
The successful integration of any technology usually requires a commitment of time and sometimes money. Motivation  (Operation,operating,Otolaryngology)and persistence are also key ingredients for successful integration of technology. As is the case with any new technology or procedure, formal hands-on training will significantly decrease the amount of time required to attain complete, successful integration. It is important to realize that when incorporating anything new to one’s practice that problems will arise along the way. To minimize the occurrence and frequency of potential problems and ensure that the integration process proceeds smoothly, an implementation plan is critical.

The procedural execution plan involves making a list of specific procedures organized by degree of difficulty with the simplest being performed first. In the case of dental  microscopes (ENT surgical microscope,surgical,operating,Operation,Otolaryngology), the arch and area of the mouth also needs to be taken under consideration. For instance, with microscopes, the maxillary arch and anterior segments of the oral cavity are the easiest to start with. A crown preparation on a lower second molar, for instance, may not be a desirable procedure or location of the mouth to start with.

An example of an acceptable procedural execution plan for a restorative dentist learning to integrate dental microscopy(ENT surgical microscope,surgical,operating,Operation, Otolaryngology) might include starting out with simple filling restorations in the facial anterior segments because this is the easiest area to visualize through direct vision. One should preferably start out using the lowest to low-medium powers of magnification before advancing to higher powers of magnification to allow sufficient time for one’s hand-eye coordination to adapt to OPS (Operation,operating,Otolaryngology) under a magnified field. Once a point is reached where one feels comfortable in working under various levels of magnification in the facial anterior segments of the oral cavity, he or she can then proceed to crown or veneer preparations on the maxillary anterior segments where the use of a mirror would be necessary. As the use of the mirror becomes integrated with the use of a microscope (ENT surgical microscope, surgical,operating,Operation,Otolaryngology) in the anterior maxillary region, one can then advance posteriorly on the maxillary arch only, until an adequate level of proficiency is reached. The posterior mandibular region is generally considered to be the most difficult area of the mouth for an inexperienced microscope (surgical,operating,Operation) user to operate in and should, therefore, be avoided during the very early stages of the integration process.

While OPS with a microscope(ENT surgical microscope,surgical,operation, Operating, Otolaryngology) does involve a bit of a learning curve, the author personally has not found it to be as difficult as some may perceive it to be; it only requires practice, persistence, and time. As mentioned earlier, formal training would help in significantly reducing the amount of time needed to fully integrate microscopes (ENT surgical microscope,surgical,Operating,Operation, Otolaryngology) into a practice and may be well worth the additional cost for many new users or existing owners who have not been able to successfully integrate microscopes fully. A formal training course may also be a very valuable learning experience for those just contemplating adding dental microscopy (ENT surgical microscope)to their practices before making an actual purchase. Dental microscopy (operating,operation,ENT surgical microscope,surgical,Otolaryngology)may not be suitable for everyone, but until one tries, one may never know what they have been missing.

Back To Top

Back To Top

The ENT microscope (ENT surgical microscope,surgical, Otolaryngology, Operating, Operation, )is normally with a straight (no angle) binocular head. Focal distances vary, so the bottom objective lens is typically different depending on if the application is for ophthalmic use or for  ENT surgical  microscope (surgical,Operating, Operation)/dental use. Dental physicians use the dental microscope for a variety of  operation procedures inside the mouth. Neurosurgeons, sometimes called brain surgeons, use a microscope generally similar to an ENT operation microscope (surgical,operating, Operation).

Various optional accessories and features can be ordered with an operation microscope(surgical,operating,ENT surgical microscope,Operation,Otolaryngology). Most higher end equipment will come standard with motorized foot controlled focusing for hands-free focusing. Some units have the ability to center the field of view with motorized controls, as well as tilt the angle of the head assembly via servo motors. Eyepieces are usually 10x but sometimes 12.5x. The typical objectives (bottom lens) are f200 and f250. For more special applications, most factories make the f300, f350, and f400 objective lens. These change the focal distance, and result in different magnifications and different working distances.

Some surgery microscopes (surgical,operating,ENT surgical microscope,Operation, Otolaryngology) microscope  have only a single binocular head, but more advanced units have the option for teaching heads, also called assistant heads. These additional heads allow multiple simultaneous viewing of the patient by several physicians. Most  operations (surgical,Operation,Operating) do need assistants who view the OPS  (Otolaryngology, operating,Operation)procedure. Also, physicians in training are allowed to use these “teaching heads”. Some assistant heads are binocular, viewing the same image at the same magnification as the master surgeon. They may also be monocular with only one ocular eyepiece. Some of the binocular teaching heads have ind ependent magnifications.

Video microscopy (Operating, Operation,Otolaryngology) is also an added feature in a surgery microscope (ENT surgical microscope,surgical,operating,Operation, Otolaryngology). Many of the models have optional beam splitters to split the image to an optional c-mount where a ccd camera can attach. These ccd cameras have NTSC or PAL video output signals to be taken to a CCTV viewing / display monitor. This video microscopy equipment makes an excellent options package as it allows multiple simultaneous viewing by all physicians and assistants in the room.

If the  operation microscope (surgical,operating,ENT surgical microscope,Operation, Otolaryngology) is to be used in a hospital located in USA , then it needs to be a US FDA certified model. Some of our models, but not all, have FDA certification. All of our models have at least the CE certification for Europe . Some countries don’t require any certification. But all customers demand a reasonable level of quality and a good discounted price. We can provide you what your hospital or clinic needs, and at a significant savings over other operating microscope (surgical,Operation,Operating)  dealers. Please contact us today for more details.

Back To Top

There are various types of  operation microscopes that are used for different applications. One common type of operation microscope

Our prices on these vary, but you can be assured our prices are competitive, and generally lower than anyone else selling identical  equipment. Please contact one of our sales agents today for more details on our microscopes. (surgical, operating, Operation, Otolaryngology, ENT surgical microscope, )

Back To Top

Back To Top