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Advanced Magnification for Improved Quality Control: Balancing the Art, Science, and Business of Dentistry

By Jeffrey C. Hoos, DMD, FAGD
As appeared in Collaborative Techniques

The use of a microscope helps the clinician and technician achieve the BALANCE between the ART, SCIENCE, and BUSINESS of dentistry. Having the opportunity to visualize the preparation, fabrication, and placement of restorations fulfills the art. Using science-based principles for design and cementation helps ensure longevity. Providing prosthetic replacements that offer aesthetics and longevity for our patients gives our practices the important business aspect for growth and profit.

Improved visualization results in an improvement in quality for the dentist. Being able to see greater detail when preparing teeth, inspecting impressions, and finishing the final restorations will result in greater doctor and patient satisfaction. The ability to "see what you are doing" will assure that the preparation and final insertion will be done to the maximum of the doctor's ability.

The microscope was traditionally used during endodontic procedures to allow clinicians to find canals that were previously difficult to find and that may have been committed to a surgical corrector (Figure 1). Use of microscopes for improved visualization of the operative field has increased the application of these devices within the general dental office. Improved vision increases the ability to provide improved dentistry. The following two cases demonstrate the use of the microscope in the preparation and insertion of anterior restorations. The images provided are not used to demonstrate the complete documentation of the cases, but to show how valuable the increased visual acuity is in the preparation and finishing of the cases.

Figure 1
FIGURE 1A. Magnified radiograph demonstrates instrumentation of the existing root canal space.
1B. Postoperative evaluation demonstrates complete root canal fill.

CASE PRESENTATIONS

Case 1

A 40-year-old male patient presented for restoration of the maxillary region (Figure 2). Since the patient desired a conservative preparation design in order to maintain as much natural tooth structure as possible, porcelain veneers with minimal reduction were selected. A diamond bur (856-020, SS White Burs, Lakewood, NJ) was used to complete the preparations without the removal of decay to gain the initial outline form (Figures 3 and 4). A caries detector solution was used to locate microleakage around the preexisting restorations and the decay was removed (Figure 5). The preparations were readdressed once the decay was removed and polished using finishing burs (OS1, FT9, Brassler USA, Savannah, GA) to develop smooth margins (Figures 6 and 7). Impressions were taken using the hydrophilic and hydrophobic (H&H) technique (J. Morita, Irvine, CA) without cord retraction (Figures 8 and 9). The microscope allowed the clinician to clearly observe the need to retake the impression as noted on the distal aspect of tooth #8(11). Magnification of the final restoration assured an excellent marginal finish (Figure 10).
Figure 2
Figure 2. CASE 1. Preoperative facial view upon presentation. The preexisting composite restorations were defective, and the patient desired a conservative restoration using porcelain veneers.
Figure 3
Figure 3. The veneer preparation was performed using rotary handpieces and diamond burs under increased magnification to ensure proper reduction.

Figure 4
Figure 4. Magnified view of the preparations. Note the precise ending of the finish line without wounding the gingiva as well as the distal anatomy of tooth #8(11).
Figure 5
Figure 5. The microscope was used to visualize decay removal and to ensure complete removal of the defective tooth anatomy.

Figure 6
Figure 6. The final tooth reduction was evaluated. Note the existence of striations in the preparations.
Figure 7
Figure 7. The preparations were polished under high magnification to allow for finishing without injury to the surrounding gingiva.

Figure 8
Figure 8. Magnified image of impression showing incomplete capture of the tissue margins.


Figure 9
Figure 9. Magnified view of the anterior veneer preparations.
Figure 10
Figure 10. Postoperative evaluation following delivery and cementation of the final restorations. Marginal integrity was evaluated at x30 magnification to ensure proper integration.



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