10 essential aspects for implementing magnification in your practice

1.Ergonomics

Ergonomics is the ideal position of the operator in relation to the patient. With a Microscope, the ergonomics position is excellent which improves the posture of the operator. This fact alone can add years to your career as a dentist, by reducing strain on your neck and back. Neutral Body Position with support to forearms is the key for great ergonomics.

2. Position of Operator

Magnification allows you to work with great comfort and relaxation between 9 o’ clock to 12 o’clock position. Shoulders should be relaxed and forearms supported for refined precise movements without trembling of hands with postural symmetry.

3. Position of Patient

Position of patient is always supine and chair position head rest should be below the elbows. When working on Maxillary posteriors, the maxilla should be perpendicular to the ground. Neck hypertension is required when neck has to be turned for working on posterior teeth in maxilla and mandible. Thus, the scope can be maneuvered depending on the area of work.

4. Position of DOM

The body of DOM should be perpendicular to the ground. An imaginary line drawn through both eyepieces should be parallel to ground.

5. Magnification Changer

There are different steps of magnification. According to the area of working and need for magnification these fields are negotiated during the routine workflow.

e.g. Higher magnification is needed for re-treatment Endodontics or for locating the elusive MB2, whereas, in cases of crown preps and periodontal treatment lower magnification will suffice. Steps of magnification varies according to the type of microscope and components used by the company.

6. Documentation

A dental surgeon can use magnification as an excellent communication tool as they can explain diagnosis to the patient, present their treatment plans and show the final layout of the treatment. Cracked tooth cases can be easily diagnosed and a live procedure can be shown to patients and dentists for education purposes by video recording. I do all my cases under Microscope and document each so I can compare them and become better than I was yesterday by doing this.

7. Indirect Vision

This is very important to apply for DOM in clinical practice. It takes time and practice to develop an understanding of the Indirect vision.

8. Integrated Camera / External Camera / Video for Magnification

In case of external camera attachments, it has to be decided prior, as the camera optics need to fit the microscope optics with adapters provided by the manufacturers . These cameras exert extra weight on the scope as compared to integrated cameras. Extra cables are required if live procedures are shown but Wi-Fi enabled cameras solves this problem. Integrated cameras provide ease of maneuverability, as there is no extra weight on the scope and no extra cables.

9. Excellent Light Source

In cases of Endodontic treatment, to get maximum advantage of the light source be it halogen, xenon or LED, Rubber Dam is a must. In addition to other advantages that are innumerable it allows amazing visibility and admission of light to the areas which are difficult to see and access. E.g. deep interproximal areas. A very good tip here is to first isolate the rubber dam and then go towards magnification as it will be a lot easier to implement microscope for all cases.

10. Challenges

Cost of the scope, training of the staff, steep learning curve, inconvenience to take it in the flow of practice, cannot charge accordingly, back is good- no need, eyes will be tired due to magnification, it will reduce my speed of work etc.. The reality is once you start using dental operating microscope and experience its benefits as I have done in my clinical practice, you will never want to go back to your old way of practice. My clinical world has changed totally once I have incorporated DOM into my practice.

Conclusion 

DOM has already started a revolution with regards to diagnosis, treatment and quality control in dentistry and it’s the need of the hour for a practitioner to implement magnification in day to day practice. You cannot treat what you cannot see. When you visualize the hidden detail, that is the moment where magnification works.