Endodontics and the use of the microscope

Following the latest article by my colleague Felixin which I talked about the optical microscope and its application in the field of dentistry, I would like to address a related topic that I think could be of interest: why is the microscope used precisely in endodontics?

During the article, in which the history of the light microscope was reviewed, reference was made to its introduction as a compulsory subject in postgraduate courses in endodontics in the United States, so I would like to explain why endodontics is the speciality, among all those that make up dentistry, that benefits the most from the use of the light microscope, or at least began to do so first.

Let's start with the basics and refresh concepts,

A endodontics is what is colloquially known as 'nerve killing', and you may know someone who has had it done, or perhaps even yourself. The term comes from the union of endo, which means inside, and doncia, which refers to the tooth.

When we have a very deep cavity, a fracture or a dental infection, in order to solve it, we must then access the inside of the tooth, literally. As you will understand, visibility in these conditions is very reduced, due to, among others, these reasons:

  • It is often performed in the back of the mouth.
  • The entrance to the roots is in a very small cavity.
  • The treatment is done through a hole of a couple of millimetres on the surface of the tooth.
  • Instruments for cleaning and disinfecting the roots of the tooth must be inserted through this hole.
  • These roots have a minuscule access, just a few tenths of a millimetre.
  • If there is an old crown on top of it, visibility is much lower.

For all these reasons, endodontics is the treatment that benefits the most from the use of the microscope, and not only because of the magnification...

The microscope allows us to work in a range from 2.5x to 25x, so we see better access to the roots, and therefore treat them much better. We can see things that would otherwise be invisible: small obstacles such as calcifications at the entrance of root canals, lesions inside the tooth or microscopic accessory canals.

It also helps us a lot because it illuminates better. The microscope has a confocal xenon light that allows us to have a three-dimensional image with depth. It is a very powerful light and it is oriented in the same direction as the lens, so it does not generate shadows.

Improve our working posture. Dentists have horrible ergonomics, if you notice we are almost always working with our backs bent so that we can look into our patients' mouths. With the microscope the working posture is straight, so we are more comfortable and we can concentrate on doing a proper treatment.

The microscope is an endodontist's best friend. It allows us to see where we could only guess before, and has greatly improved the success of our treatments.