The introduction of magnification into dentistry has followed decades behind the medical surgical fields.
Apotheker et al first reported the introduction of a single level magnification microscope into dentistry in 1981. The fields of endodontics and periodontics pioneered the introduction of dental operating microscopes (DOMs) in the late 1980s, reporting the increase in surgical outcomes. Surgical loupes with additional illuminating headlights were introduced to the dental profession as a norm in the 1990s.
The benefits of magnification include:
- Improved visual acuity
- Improved precision of treatment
- Enhanced ergonomics
- Improved patient care
The amount of visual information provided by magnification is the product of horizontal times the vertical number of pixels. Table 1 summarises a comparison of unaided vision to magnification.
|Unaided eye||1 x|
|2x loupes||4 x|
|3x loupes||9 x|
|4x loupes||16 x|
|5x microscope||25 x|
|10x microsope||100 x|
|20x microscope||400 x|
Table 1. Comparison of unaided eye and levels of magnification
The unaided eye with 20/20 vision is able to resolve two lines at 0.2mm apart. Magnification of 4x (medium power loupes) allows a resolution of 0.05mm and at 10x magnification (Dental operating microscope DOM), the resolution is closer to 0.01 mm. Magnification beyond 6x allows a clinician to utilise their visual rather than tactile sense for examination, keeping in step with contemporary examination protocols. Medical studies have demonstrated surgeons working with the unaided eye typically make movements of 1-2mm at a time. At magnification levels of 20x (available in DOMs), there is a refinement in movement to 0.01 to 0.02mm allowing significantly increased surgical precision.
The DOM also allows the clinician to sit in an upright neutral and balanced posture, decreasing the onset, degree and symptoms of back-related mucoskeletal problems common in dentistry.
Magnification by either loupes or a DOM provides benefit for the patient and clinician. The advantages include improved visibility and the potential for improved examination and surgical precision. The ability to sit with an ergonomic posture is a significant advantage to the clinician.
- Magnification for dental procedures including examination and invasive clinical procedures is recommended. This is in recognition of the benefit to the patient from the potential increased visuality and surgical precision of the operator.
- Magnification is recommended for the clinician to reduce the potential of back-related mucoskeletal dysfunction that could affect their professional health and well being.
van As GA. Use of the dental operating microscope in laser dentistry: Seeing the light. L Laser Dent 2007;15(3)122-29
Apotheker H et al: A microscope for use in dentistry. J Microsurg 1981
Baldissari P et al: Reliability of tactile perception using sharp and dull explorers in marginal opening identification. Int J Prosthodont 1998;11(6):591-4
Tibbetts et al: Current status of periodontal microsurgery. Curr Opin Periodontol 1996;3:118-25
Valachi B et al: Preventing mucoskeletal disorders in clinical dentistry: Strategies to address the mechanisms leading to mucoskeletal disorders. J Am Den Assoc 2003;134(12):1604-12
Tim Johnston, Paediatric Dentist, Perth. BDSc MDSc FRACDS FADI