What does the future hold for high-level magnification in dentistry?

Magnification, illumination, and video magnification continue to evolve as technology changes and our thirst grows for complete visual information. More than 70% of endodontists now use microscopes routinely, and in a decade we will likely see enodondists’ numbers coming close to 100%. Using a microscope and loupes in combinations rapidly becoming standard in high-end restorative practices and increasingly common for “hometown restorative dentists” that aspire to greater accuracy and improved outcomes. New to the scene is digital magnification, which is essentially a high-quality video camera connected to an LCD screen with supporting peripheral hardware and software. These digital video systems promise the ability to do virtual dentistry while staring at a screen, not the patient. My experience with these video systems is that they lack depth perception (are not stereoscopic) and are too fuzzy as stand-alone replacements for glass optics (loupes and microscopes). Stereo video shot through a microscope projected on large screens and poloarized glasses for viewing holds more promise, but the cost of at least $60,000 is an issue. Microscopes continue to be the ultimate means of powerful magnification. You need one, you want one, here’s what to look for: Support, training, and continuing education are as important as any mechanical feature of the microscope. Articulating (inclinable/declinable) binoculars are a must-have. Without them, it is difficult to maintain proper posture. The good posture and healthy back and neck of the clinician are some of the most important advantages of the microscope. The objective lens decides how far the microscope will be from your patient. For example, a 200mm lens puts you very close with the advantages of brighter light and higher net magnification. The disadvantages are more potential splatter on the lens, and in my case, I periodically have problems with the distal end of the handpiece running into my microscopes; 225mm or 250mm is more practical. Restorative dentists and periodontists need a step magnification at the bottom end of 2.5x. The greater depth of field allows visualization of an entire quadrant without focusing problems. This way the clinician can minimize leaving the microscope to go to loupes. High-end magnification needs to go to 13x to 16x as a minimum. Diagnosis of early incomplete tooth fracture, finding calcified canal systems, microplastic periodontal surgeries, and elegant aesthetic dentistry, among other areas, demand it. These higher levels of 16x to 40x are more useful in the beginning for brief moments of observation; the bulk of operation is done at lower lower magnification. An orange filter that allows extended working time for light-sensitive materials such as composites has become a must have. Stiff, less expensive microscopes are reasonable in endo-only practices; however, for restorative dentistry, the microscope should glide effortlessly with the lightest brush of your hand or face, twisting and rotating on a neutral axis. I enjoy restoring a full quadrant or arch with my microscope, moving constantly and seeing the tooth from many angles. A beam splitter with a feed to a TV or monitor is a must. Unless the patients and staff see the benefits of microscope accuracy, the microscope will not have the same dramatic effect on the financial bottom line as it will on the level of clinical excellence. Quality of the microscope and careful installation to avoid drifting and vibration are key to utilization. Compromise here will make long-term, widespread use difficult and frustrating. An out-of-balance fan on the HVAC unit on the roof, for example, can create microtremors that are a macro problem for the microscope that is properly braced. If you are considering replacing your 3-power loupes with 4.5-power and a headlamp, get a microscope instead and keep your 3-power loupes for less detailed work. Loupes, while helpful, provide crude optics when compared to elegant microscope optics and coaxial shadowless light.