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Treatment modalities addressing both biologic and aesthetic demands are most often expected from today’s dental practice. New technologies, instruments and less invasive surgical techniques are necessary to help clinician ensure the best results and satisfy the patient’s expectations. With increasing awareness and the desire to get the best treatment among patients, these magnificent magnifying tools come handy for an innovative dental surgeon!

            By definition: ‘Microsurgery’ implies to an extension of those universally accepted surgical principles by which gentle handling of soft & hard tissues and extremely accurate wound closure are made possible through magnification’.

The holy trio of microsurgery includes:

The main stay for enhancing the field of vision as well depth of field, in turn leading to maximum efficiency from a practitioner, is via magnification of surgical field.

Magnification can be carried out via the following two systems mainly:

LOUPES: Most commonly used tool of magnification in dentistry. The mechanism of action of a loupe is based on ‘Keplerian optics ’ i.e

There are three main types of loupes available, each having their own set of advantages and disadvantages.

The choice of loupes ultimately depends upon the operator’s requirements and ‘cost to effect ratio’ presented by that particular model. Certain practical factors that should be considered before purchasing loupes are:

However, the question remains… How do we choose the correct loupes???

The basic steps to be considered are:

Even though loupes are the most commonly used form of magnification widely in dentistry, there is major drawback to it: the clinician’s eyes must converge to view on the operate field, which can result in eye strain, fatigue and even vision changes when poorly designed loupes are used.

Fret not, the solution is to do thorough research on the design, illumination and the quality of lenses before purchasing the loupes, to ensure maximum efficiency!

An optical microscope specifically designed to be used in a surgical setting, typically to perform microsurgery, is THE MOST ERGONOMIC & EFFICIENT form of magnification and illumination in a dental practice !

The major advantages of a DOM include:

A. Versality due to an extended range of variable magnification from 2.5x to 20x

B.  Excellent shadow free ‘co-axial illumination‘

C. There are also numerous accessories for digital still and video image case documentation.

While the loupes work on simple ‘Keplerian’ optics, this one works on the Galilean optical mechanism, which sounds and looks complex but is easily understandable in terms of the end product i.e CO – AXIAL (parallel) ILLUMINATION.

The main features of any DOM are:

THE MAIN DIFFERENCES BETWEEN LOUPES AND DOM

Accurate operator, assistant and patient positioning can go a long way in the spinal health and hence, efficiency of any dentist in the future.

Inevitably, every dental student complains of some kind of neck or shoulder pain due to improper posture over the years.

Well, magnification is also the answer to our cries in this aspect!

Observe the various positions with which procedures are performed using these magnification aids and decide for yourself:

The last piece in the puzzle of microsurgery are these amazing, 10 fold smaller instruments that aid in better precision and much faster healing in all procedures invariably.

Rajachandrasekaran et al, 2018 classified the set of microsurgical instruments as follows:

Common features of microsurgical instruments are:

Gone are the days of ‘modified pen grasp’, with these instruments…

‘INTERNAL PRECISION OR PEN GRIP’ is used which keeps the ulnar border of hand, wrist and the hand well supported during movement.

Although loupes can be used to enhance visual acuity in any and every field of work in dentistry, there are certain procedures that really benefit from the use of microsurgical triad.

ENDODONTICS (Magnification – 2x and above):

The desire to eliminate disease at root end, the need to obtain a clearer understanding of the complexities of pulpal anatomy, and  the use of enhanced magnification and illumination in contemporary apical surgery, more accurately described as ‘apical microsurgery’.

The differences between traditional and endodontic microsurgery are as follows: (Ananad S, Soujanya E, Raju A, Swathi A. 2015)

PERIODONTAL AND ORAL SURGERY (Magnification – 4x and above)

Microsurgically treated areas achieved vascularization more rapidly than those who received macrosurgical care (Burkhadt and Lang P.)

To present a gist of the principle behind the above long blog you all patiently went through..

Finally, I want to urge each & every dental professional to try to get your curiosity running on microsurgical modalities of practice, for a better future of dentistry!

Thank you for your patient reading. Please feel free to enquire, in case any doubts arise! Wishing you safe and happy times ahead

Dr. Divya (MDS Periodontics & Implantology) Email id – drdivyadhingra@outlook.com

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Very well worded doctor, this will help a lot In the clinical practice

Very well written and compiled. Gives a lot of info and with such details!

Thank you for the positive feedback, Dr. Fatima ! 🙂

Very informative, micro dentistry is the future and this content would certainly inspire many dental professionals to learn and practise the the latest trends in dental procedures and techniques.

Thank you for the encouraging words, sir! i really wish people incorporate magnification in their practices as much as possible for they will see the difference themselves.

Very informative and crispy knowledge specially for the first time user dilemma…….could be more specified towards general dentistry…but overall a great content to clearify the vision😀😊

Thank you for the feedback, Dr. Anuj. I am going to definitely work on your advice for making it easier from the general dentist’s point of view nex time. However, you can reach me on the email id given above for any doubts/ queries that you have regarding the subject. take care!

Very concise and well articulated. A quick read will help general dentist revise and understand about microsurgery ✌️

Thanks, Dr. Kriti ! Appreciate the feedback 🙂

Very well written and detailed information given. Definitely a great read Dr Divya! Looking forward to more of such content from you.

Thank you for the feedback, Dr. Ankita ! Do give suggestions if there is any particular topic you want to read about, will try to keep up to that 🙂

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