By Dennis Brave, DDS & Kenneth Koch, DDS
Recently, we have been asked the same question by a number of participants at our "Real World Endo" courses. Due to the frequency of this question, we have decided to initially address it in this month's column. The question is, "Do I need a microscope to do quality endodontics?"
The answer is an unqualified "maybe." A fair number of root canals certainly can be performed without a microscope. However, if you desire to perform the best endodontics possible, you do need some form of enhanced magnification and illumination. The more complicated the cases you treat, the greater the likelihood that the microscope will be a necessary adjunct. The problem is, of course, that we seldom can predict which cases will require this technological advantage.
The simple premise for using a microscope is that light plus magnification equals excellence. This is the triad on which microdentistry is based. It certainly makes sense that if clinicians can see something more clearly, they can better evaluate and treat it. As some surgeons say, "If you see it, you can protect it." This adage also applies to endodontics and dentistry in general.
The initial awareness of the benefits of increased light during dental procedures came with the advent of fiber optic handpieces. For those of us doing dentistry before their acceptance, the introduction of fiber optics was remarkable. Fiber optics provided the ability to see into the posterior of the mouth and into access preparations. We were able to see things that previously "did not exist." The result of this improved visibility was better clinical dentistry.
The next step in the progression of light awareness was the external fiber optic light that attached to a headpiece. These units had an external power pack, and, when combined with magnifying loupes, were a significant advance in visualization. The light and the magnification were such that dentist felt they were in an operating room environment rather than dental treatment room.
Along with an increase in light, a corresponding increase in magnification is recommended for achieving endodontic excellence. The solution to this need came with the introduction of magnifying loupes. These loupes generally were in the power range of 2.5x or 3.5x power. However, some practitioners who performed a lot of surgery went higher in magnification. A drawback was that as the power of the loupes increased, the heavier and more uncomfortable they became. However, those who practiced with loupes and an external light source quickly realized that this was far superior to practicing in the dark. Although the magnification associated with loupes is helpful, it is indeed limited when compared to the typical microscope, which offers magnification on the order of 3x to 30x.
The logical progression of light and magnification awareness is what led to the use of the microscope. This is truly a quan-
tum leap forward in visualization. Practitioners can now see calcified canals and fracture lines that previously were impossible to see with the naked eye. Combine the previous lack of vision with the normal aging process and you realize why so many canals and root fractures were missed.
Endodontic microscopy and its implications for your practice involves:
• Diagnosis
• Nonsurgical endodontics
• Surgical procedures
• Documentation and patient education
• Marketing
&bull Revitalization of your career and yourself
As is evident, magnification affects almost every aspect of the endodontic practice, and it is virtually impossible to explore in one article. We will therefore dedicate a future article to enhanced visualization.
Dr. Dennis Brave is a diplomate of the American Board of Endodontics and was the senior managing partner of a group specialty practice for 27 years. Dr. Kenneth Koch is the founder and past director of the new program in postdoctoral endodontics at the Harvard School of Dental Medicine. Drs. Koch and Brave together are Real World Endo, an endodontic education company. They can be reached at (866) RWE-ENDO, or visit their Web site at RealWorldEndo.com.
