Microsurgery

Microscope- enhanced dentistry is a promising and inseparable aspect of modern day dentistry. It involves the uses of magnification systems starting from Simple Loupes(2-4x magnification) to Surgical Operating Microscope (upto 25-40x magnification).These enable the clinician to enjoy magnified vision, depth of focus of the treatment area and field of view characteristics, better illumination, and avail of an excellent tool in recording and documenting. Since there is magnified vision and the primary aim is minimal invasion, there is use of very fine light weight micro instruments, designed specially to work under the microscope. This ensures minimal trauma to tissues, more precise handling, , less pain, swelling, minimal scarring, significantly faster healing, far superior post-operative appearance compared to conventional procedures. A very remarkable example is that of Root Canal therapy , wherin the apex of the tooth, which is otherwise invisible can be seen directly under the microscope, thus helping in overcoming difficulties in treatment and achieving excellent outcomes.

The use of magnification systems and microsurgery are part of a broad movement in dentistry toward the use of minimally invasive procedures to replace the need for more extensive surgical procedures. A variety of magnification systems are available ranging from simple and prism telescopic loupes to more complex and advanced surgical operating microscopes. Each magnification system has its own advantages and limitations. Surgical operating microscopes are widely used in dentistry in all the specialities, but more commonly in endodontics, periodontics and implant dentistry. Microsurgery embraces the following values:

  • Enhancement of the surgeon’s motor skills to improve surgical ability. This is accomplished
    by increasing the precision of movements and decreasing involuntary tremor.
  • Reduction of tissue trauma at the surgical site through the use of small instruments and a smaller surgical field.
  • Application of microsurgical principles to achieve passive and primary wound closure.

In a broader sense, microsurgery implies an extension of surgical principles that encourage the paramount importance of gentle handling of the tissues and exceedingly accurate approximation of wound edges. This is not a conceptual revolution in dentistry, but merely improving the accuracy and gentleness of what is already being done in everyday practice.Microdentistry/Microsurgery offers an improvement in predictability, cosmetic results,and patient comfort level over conventional surgical procedures. This is especially true of procedures requiring the application of materials and techniques that are difficult to use successfully and predictably within the confines of normal vision. For example, using 20x magnifications, vascular microsurgeons routinely anastomose vessels with a diameter of 1 mm or less. Using 120x magnifications, cellular biologists routinely perform subcellular operations on chromosomes. Within the limitation of their motor skills, it is possible for dentists to learn to use magnification in the range of 10x–20x to achieve surgical tolerances from 1–2 mm to assmall as 10 microns.

minimally invasive surgical techniques

In periodontal and Endodontic surgery, the benefits of surgical microscope help in Minimally Invasive Surgical techniques.(MIST)
The primary objectives of the MIST include the following:

  • Reduced surgical trauma
  • Increased flap/wound stability
  • Creation of a stable primary closure of the wound.
    Reduced surgical chair time
  • Minimization of patient discomfort and side effects.

Microsurgical instruments and microsutures are specifically designed to minimize trauma. Since microsurgical instruments are made of titanium, they are strong, lightweight, and nonmagnetic.A variety of shapes and sizes of microsurgical scalpels and ophthalmic scalpels can be used for various procedures.

Applications

  • Root canal therapy
  • Retrieval of broken instruments
  • Removal of old Root canal fillings
  • Endodontic –periapical surgery( Apicoectomy)
  • Scaling and RootPlaning
  • Periodontal surgery
  • Peridontal plastic surgery (All Procedures)
  • Papilla reconstruction
  • Implant dentistry
  • Restorative dentistry.

All procedures in dentistry can be performed under magnifications.