Microendodontics

The success of endodontics relies on the localization of the entire root canal system and its subsequent cleaning, shaping, and three-dimensional obturation. Several magnification systems have been advocated over the years. The most convenient and popular have been loupes with varying degrees of magnification.

The introduction of the surgical operating microscope (SOM) to Ferrari Dental Clinics has opened up entirely new vistas for the treatment of both non-surgical and surgical endodontics.

In several cases in which surgical endodontics is the treatment of choice, the increased magnification and illumination provided by the microscope allows enhanced visualization of the surgical field. This, in turn, allows for more efficient surgical technique and greater ability to achieve success in surgical endodontics.

Advantages of Micro- Endo:

• Procedural errors can be greatly reduced, if not eliminated, and complicated cases become less so under the microscope.
• Retreatment of endodontic cases that have failed due to separated instruments, separated posts, and repair of perforations can now be managed with greater efficiency and success. These cases, in the past, could be managed only by surgical approaches that had a lower success rate.
• Endodontic procedures can be done in less time because of the greater visibility of the root canal anatomy.
• Another benefit of the microscope is the flexibility with documentation. Compared with intraoral video cameras, microdental images can be captured on computer or digital camera. The information can then be shared with referring dentists or patients and the images are, of course, also required information for the patient record.

What is a Surgical Operating Microscope (SOM)?

The introduction of the SOM is relatively new concept that is revolutionizing the way procedures are performed.

The SOM has a video camera attached.

• The degree of magnification depends upon the combination of lenses that are utilized. Most microscopes come with three to fives steps of magnification ranging from 3x to 27x.
• The light source is usually 100 to 150 watt halogen bulb that is connected to the microscope via a high efficiency fiber optic cable.
• Many other options may be added to the microscope such as an assistant's viewing eyepiece, video, and 35mm cameras. These options provide a very powerful tool that can be used for teaching, patient education, and medical legal purposes.

For what procedures is the microscope really essential?

Diagnosis:

The microscope is an excellent instrument to detect microfractures that cannot be seen by the naked eye or by loupes. Under 16 to 24 magnification and focused light, any microfracture can be easily detected. Methylene blue staining of the microfracture area assists this effort greatly.

A persistently painful tooth after endodontic therapy may be due to an untreated missing canal (eg, MB2 in a maxillary molar). Re-examination of the chamber at high magnification under the microscope may locate the missing canal.

Locating hidden canals:

The most important utility of the microscope in nonsurgical endodontics is locating hidden canals. The canal anatomy is extremely complex. All endodontic textbooks have information on molar teeth with three canals, premolars with two canals, and anterior teeth with one canal. Often, dental anatomy is not that predictable. What was considered a rare exception in the past has become a routine finding when using the microscope. Considering this as the benefit of using the microscope for endodontic procedures is obvious.

Locating bifurcations: RADIO 3

There are teeth where the canal bifurcates at 3 to 5 mm into the canal and in the maxillary second molar, where the MB and DB are in very close proximity of each other; the microscope is an invaluable tool in clearly detecting the bifurcation and the two separate canals.

Management of calcified canals: RADIO 4

With normal vision or low-power loupes, calcified canal in the pulp chamber is not detectable. When the calcified canal is looked at through the microscope at high magnification, the difference in the color and texture between the calcified canal and the remaining dentin can be easily seen.

Perforation repair:

Perforation does occasionally occur no matter how carefully the tooth is accessed for endodontic therapy. When a perforation occurs, the microscope is the key instrument to identify and evaluate the damaged site. The results of a careful inspection will be the basis for which the preparation of the perforation repair will be made. Briefly, the microscopic procedure is to place a matrix precisely, just outside of the perforation site (ie, just exterior of the root substance). The matrix can be calcium sulfate or resorbable collagen. After the matrix is placed, mineral trioxide aggregate is packed against the matrix. This procedure requires delicate and careful handling of the materials so as not to extrude, overfill, or underfill. The microscope is essential for this procedure.

Retrieval of broken files: RADIO 1

With the more frequent use of nickel-titanium rotary files in general dentistry, the incidence of file separation within the canals has increased. When the file is broken at the apex, the microscope cannot be of help. If the file breaks within the coronal half of the canal, however, then the microscope is essential to guide the clinician to retrieve the broken files. In this manner, the broken file can be removed while minimizing the damage to the surrounding dentin.

Final examination of the canal preparation: RADIO 2

It takes a simple step to see whether a canal is completely cleaned. Under the microscope, a small amount of sodium hypochlorite, a popular irri- gation solution, is deposited into the canal and observed carefully at high magnification. If there are bubbles coming from the prepared canal, then there is still remnant pulp tissue in the canal. In short, the canal needs more cleaning.