MICROSCOPE DENTISTRY
or
MICROSCOPE ASSISTED PRECISION DENTISTRY

THE END OF SECONDARY CARIES? REVOLUTION IN CARIES CONTROL?

For years optical systems have been available for chairside work in dentistry. The magnification by a factor of 3 to 5 they provided helped to enhance precision in dental work and thus tremendously improved its outcome. Although dentists had time and again urged the use of microscopes in dental work, microscopes available in the past were unwieldy and poorly adapted to the task. Thanks to Microscope dentistry (MD) it has now become possible to remove decayed dental tissue (caries) to its very interface with normal adjacent tissue. The quality and precision with which this can be done raises justified hopes to remove decayed tissue completely without unnecessarily sacrificing normal intact dentin. This successfully prevents the much dreaded occurrence of secondary caries, although the ultimate benefits are not appreciated for years!
In the past caries control inevitably implied that intact dentin had to be sacrificed because,as we have learned with the advent of MD, there was no way of drawing a line to normal healthy tissue.
What does this mean for the patient? A sound tooth decays because of poor hygiene. Caries develops, a filling is placed, hygiene is improved and the tooth will never again decay even deep to the filling. Provided the filling material is of high quality, the filling will last for a lifetime! Making full use of high-tech medicine thus ensures an improved quality of life.
Not so today with traditional dentistry: Depending on the material used fillings will normally last for 5 to 20 years at best given high-precision work. Longevity for a lifetime is, however,a matter of chance and good luck!
Patients have come to realize that each tooth is an "organ in its own right" just like any other organ of the body and, thanks to Microscope dentistry, dentists can now enjoy the rewards of microsurgical work.

Historical review

Microscopes began to be used in medicine in 1921, when Nylen (Sweden) modified a standard lab version for surgery of the ear. His example was followed by eye surgeons, who used microscopes routinely in the fourties and fifties. In 1953 the German manufacturer Zeiss began to make operating microscopes for professional use. In the sixties experimental studies in the lab paved the way for the development of microsurgical techniques with micro-instruments and suitable suture materials. These were used in plastic and reconstructive surgery and particularly in neurosurgery: Microsurgery - a small surgical revolution in the medical history of the 20th century. Haeseker B.,Literatur

In the early nineties Feldman, Friedman, Ruddle, Shanelec, Tibbetts,Velvart and others published a series of papers intended to document the use of the microscope in endodontics for what they called"microscope-assisted precision dentistry" (MAP dentistry).

In 1998 the American Association of Endodontics (AAE) postulated that all postgraduate students must have had experience with handling the operating microscope in order to qualify for a license in endodontics . A survey of AAE in November 1999 showed that one third of all active AAE members have access to a microscope in their offices.

In Austria microscopes have been used in some dental labs for checking filling margins, castings etc. for about 15 years. Some maxillofacial surgeons and motivated dentists have employed them for apicectomies. Meanwhile experience has shown that Microscope dentistry increases the success rate of root canaling and apicectomies with retrograde microsurgical canal filling dramatically.

Current state of the art

In 2000 Zeiss Corp. further perfected its microscope, which had recently been specifically adapted for dental work.I use it for preventive, periodontal, restaurative, endodontic and prosthodontic work.

As I have always been an advocate of preventive dentistry, periodontology and minimally invasive dentistry, it was logical for me to put the emphasis on the best achievable precision of chair-side work. This is why I found it most gratifying to see that the PRO Magis operating microscope by Zeiss Corp has added a new dimension to caries control: Decayed dental tissue can now be removed with a precision that is very likely to make secondary caries a thing of the past.

What does this mean? When decayed dental tissue is removed conventionally and the defect is filled with amalgam, plastic or gold castings, the risk of missing out on complete caries control is almost 100%. In fact, perfect caries control is impossible without a microscope so that the much dreaded occurrence of secondary caries deep to the filling is more than likely. But what appears to be secondary caries is, in reality, residual primary caries, which was incompletely removed and slowly but inexorably continues to wreak havoc. Depending on the type of filling inserted and the precision of the chair-side work it will have done its disastrous job within 5 to 15 years.

When old fillings (gold, amalgam, plastic) are removed, secondary caries is found to be present in 99% of cases. This is normally not seen unaided, unless the light probe by Lercher Co. (Germany) is used, and will even be missed on X-rays, except if very extensive. The consequences are disastrous: extremely large fillings, crowns or root canaling, i.e. a lot of trouble for the patient.

If we were able to completely remove primary caries and to prevent residual decayed tissue from spreading deep to the filling, we would do a tremendous service to public health.

To set the scene for the use of MD or microscope-assisted precision dentistry (MAP dentistry) in the office setting,I developed entirely new instruments for chairside work in collaboration with Hu-Friedy (USA ). At the same time I tabled suggestions for new hand pieces, angled hand pieces,ultrasonic and sonic units with several European and overseas manufacturers. Hopefully this will give dentistry a major development thrust.

Considering that dentistry is the one medical specialty with the most demanding precision standards (0 to 50 µm),it is more than amazing that we are just beginning to lay the ground for MD. After all, other specialties like ENT, ophthalmology, plastic surgery and neurosurgery have long enjoyed the benefits of high-precision work.

There is no denying that Microscope dentistry is time-consuming, challenging for the surgeon and the medical staff and dependent on an efficient teamwork in the office setting. But it can be expected to mark a major breakthroughin caries control. This is why I recommend microscope dentistry (MD) all dental work, most particularly for caries and periodontal control and treatment .

Your experience, ideas, suggestions, etc. on microscope dentistry or microscope-assisted precision dentistry (MAP dentistry) will be most welcome.Please contact me:peterkotschy@icloud.com
© MR. Prof. Dr. Peter Kotschy