Contents. Section I WHY

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Maude Cummings
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1 Contents Section I WHY 1 Ergonomics and the Dental Microscope Surveys document significant ergonomic risk factors 8 Ergonomics and the Microscope 8 Positioning your Chair 9 Positioning the Patient Chair 11 Positioning the Microscope 12 Microscope Equipment and Ergonomics 12 Microscopes and work efficiency 13 Ergonomic Tips and Tricks 14 Loupes and Microscopes are not Ergonomic Equivalents 2 Endodontics and the Dental Microscope Endodontic Microscope History 23 Anatomic Discovery 24 Dr. Stropko s Observations on Endodontic Microscopy 26 Retreatment 27 Instrument Removal 27 Perforation Repair 27 Diminished need for Periapical Surgery 28 Overall Improved Quality 28 Access Opening 29 Better Overall Visualization 30 Access Debridement 30 Fractured Teeth 31 Enhanced Clinical Observation and Diagnosis 3 Periodontics and the Dental Microscope Better Overall Visualization with Light and Magnification 41 Micro Surgical Instrument Development 43 Atramatic Tissue Management 44 Accurate, Precise Incisions xi

2 44 Complete Debridement 44 Accurate Suture Placement 46 Better Primary Closure 46 Cosmetic Enhancement with Proven Better Overall Results 47 Refinement of Macrosurgery 48 Improved Motor Skills 48 More Rapid Healing 49 Decreased Post-Op Morbility 49 More Predictable Root Coverage 50 Papilla Reconstruction 52 Atraumatic Surgery Equals Superior Revascularization 53 Periodontal Micro Surgery The Studies 53 Study of Microsurgery and Mucogingival Procedures 54 Study of Microsurgery in Periodontal Regeneration 56 Revascularization Study 57 Dr. Belcher s Observations on the Surgical Microscope 4 Restorative Dentistry and the Microscope Better Overall Visualization with Light and Magnification 67 Enhanced Clinical Observation 68 Improved Direct Cavity Preparation 68 Complete Caries Removal 69 Cracked Tooth Diagnosis 71 Finishing Direct Restorations 72 Improved Indirect Preparations 72 Accurate and Gentle Cord Placement 73 Evaluation of Impressions 74 Easy Meticulous Provisional Fabrication 74 Evaluate Indirect Restorations 76 Evaluating Fit, Cementation Cement Removal 77 Precise Occlusal Adjustmen 77 Overall Improved Quality 78 Better Patient Acceptance 78 Restorative Technique for Papilla Regeneration 5 Exodontia and the Dental Microscope Undesirable Exodontia Sequelae 87 Exodontia is Less Traumatic with Microscope xii

3 88 Microscope-Aided Exodontia Case 1 Maxillary Molar 89 Crown removal and Initial Sectioning 89 Expanded Sectioning to allow for Root Displacement 90 Kerf is Deepened 91 Separating Ligament from Tooth 91 Beginning Root Displacement 92 Distal Root Displacement 92 Root Removal 92 Microscope aided Exodontia Case 2 Maxillary Bicuspid 93 Root Sectioning Begins 95 Microscope Aided Exodontia Case 3 Dilacerated Bicuspid 96 Intentional Fracturing of Tooth 97 Removing Palatal Fragment 100 Immediate Implant and Temporization 101 An Operating Microscope is Essential for These Procedures 6 The Lab and the Dental Microscope The Lab Technician 108 Early University Dental Lab Research 109 Impression Evaluation 111 Casting and Die Examination 111 Die Surveying 111 Die Trimming and Marking of Die Margins 112 Margin Waxing and Wax density 112 Evaluating the Casting for Defects 113 Sprue Attachment to the Wax Pattern 113 Precision Seating of Casting on Dies 114 Margin Finishing and Polishing 114 Clinical Seating of Castings 116 Final thoughts on Dental Microscope Lab Use 7 Advantage The Microscope s Specific Advantage over Loupes 121 Relative Sizes in Dentistry 121 Illumination is Critical to Visual Resolution 122 Typical Magnification used in Dentistry 122 Stereopsis is Essential 123 You Must See It to Believe It xiii

4 124 Microscope Benefits of Coaxial Lighting 124 Microscope s Superior Depth of Field and Field of View 125 Are Loupes Alone Adequate? 125 Multiple Operatories and Multiple Microscopes 126 Inter-oral Exam with a Patient Video Monitor 126 The Appointment Book and the Beginning Microscope User 127 Zen Benefits of the Microscope 127 Doing Away with Microscope Misconceptions 8 A Selection of Dental Photomicrographs Preparing for Learning - A Prelude to Training Dental Microscope Training in Just Five Exercises 148 Four Components of Dental Microscopy 149 Ergonomic Skills 149 Eye-Hand Motor Skills 150 Magnification Selection Skills 152 Mirror Skills 153 Two Primary Mirror Positions 158 First Four Training Exercises - Overview 158 Basic Armamentarium for Training Exercises 159 Microscope 161 Parfocal Procedure 10 Training Exercise One - Motor Skills No Mirror is used in this First Exercise 166 Required Burs for Exercises 166 Specific Gross Reduction Technique 167 Hand Piece Size Recommendations for Training 168 Training Exercise One Begins 168 Perform Crown Preparations While Hand-Holding Typodont 170 Compensating or Diminishing Fields of Video 170 Dealing with Depth of Field Issues xiv Section II How

5 11 Training Exercise Two-Maxillary Anterior Exercise Two Basic Mirror-Skill Training Begins 174 Mirror Tour of the Maxillary Arch 174 Maxillary Anteriors 175 Veneer Preparations under Magnification 175 Extending Veneer Preparations 175 Direct or Indirect Vision Getting the Proper View 176 Overcoming Psycho-Motor Challenges 176 Three Ways to Fine-Tune Focus 176 Higher Magnification Becomes Easier with Experience 12 Exercise Three-Maxillary Posterior Introducing the Mirror-Clock 180 Left Handed vs Right Handed Operators O clock and 11 O clock Mirror Positions for # O clock Mirror Position for # O clock Mirror Position for # O clock Mirror Position for # O clock Mirror Position for # O clock Mirror Position for # O clock Mirror Position for #3 204 What is the Best Magnification 204 Avoiding Iatrogenic Insult 205 Thoughts and Techniques for Early Mirror Use 13 Training Exercise Four-Mandibular Arch Cross Arch vs Parallel 211 Mandibular Arch Concepts O clock Mirror Position for # O clock Mirror Position for # O clock Mirror Position for # O clock Mirror Position for # O clock Mirror Position for # O clock Mirror Position for #30 xv

6 230 3 O clock Mirror Position for # O clock Mirror Position for # Elliptical Mirror Issue 236 Sequential Reduction 14 Mastering Efficiency A New Way of Thinking 243 Time Limits are Critical in this Exercise 243 Time Allocations Parameters: Micro vs Macro 243 Outline of Efficiency Exercise Procedures 244 Begin Crown Preparations in the lower Right Quadrant 244 Special Considerations for Micro Veneer Preparations 244 Final Thoughts Conclusion Summary of Benefits 248 One Explanation for Slow Acceptance 248 In Conclusion Index xvi

The Dental Microscope. Index. Acceptance of Microscope endodontic 17. Broken Instruments endodontic 26. Depth of Field managing 170

The Dental Microscope. Index. Acceptance of Microscope endodontic 17. Broken Instruments endodontic 26. Depth of Field managing 170 257 Acceptance of Microscope endodontic 17 Index Broken Instruments endodontic 26 Depth of Field managing 170 Efficiency maximizing 243-245 Endodontics access debridement 40 access opening 28 anatomic