Seeing IS believing

Routine use of magnification increases our ability to see decay.

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Routine use of magnification increases our ability to see decay.

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Dentistry is an exacting combination of art and science that is often performed under extreme environmental conditions. As we battle the cheeks, tongue, and tired mandible and work under water, we have technology on our side. Magnification and illumination are available to help us obtain accurate visual information. Having the ability to see in detail is a key ingredient in providing optimal dental care for our patients and reducing the physical side effects of years of leaning over dental chairs.

Early caries detection is a fundamental service we can provide for the people we serve. If this most common of dental diseases is found early enough, our ability to conserve natural tooth structure increases dramatically with the use of minimally invasive restorative techniques. Despite the advent of new technologies to detect incipient lesions and improved radiographic techniques, often the first evidence is found through visual examination. Staining in the pits and fissures, clouding, color, and density changes in the enamel can often be overlooked with the naked eye. These same visual parameters come into play as we evaluate the margins of existing restorations. Bringing the colors and quality of the tooth structure into clear focus allows us to diagnose recurrent decay before our ability to detect it tactilely with an instrument. Routine use of magnification during dental exams increases our ability to see the early evidence of decay.

In addition to decay detection, magnification and illumination bring into view craze lines and allow us the ability to differentiate between these and cracks that cross onto the incisal or occlusal table. The ability to diagnosis and differentiate between cracks based on their severity is a crucial step on the pathway to making the appropriate treatment recommendations. Once we move from diagnosis to treatment of cracked teeth, moving beyond the ability of our eyes, and using magnification provided by microscopes allows us to see when cracks extend into the canals and will compromise the success of endodontic therapy.

Restorative success is measured in extremely close tolerances when we discuss marginal integrity, yet for many years, we aimed at being more accurate than we could visualize. Between the treatment plan and the final restoration there are many steps where increasing our visual acuity is a key factor in reduced frustration and increased, long-lasting, predictable results. The first time I was in my ceramist’s lab and he showed me the margins on a die under a microscope, I knew I needed the same or better magnification available during the restorative procedure to accurately assess the preparations and the impressions.

Marginal smoothness and accuracy has become increasingly more important as we create porcelain restorative margins to reduce the incidence of chipping and fractures. Magnification allows us to see the irregular enamel rod patterns at the cut tooth surface and the inevitable ripples and sharp line angles created by high-speed cutting. In addition to preparation refinement, magnification during restorative treatment allows visual information to be combined with tactile information when determining adequate removal of diseased tooth structure, allowing for maximal conservation. In addition to the advantages during preparation, magnification increases our accuracy while seating restorations. When we are able to accurately visualize the margins, we can assess seating of the restoration and reduce the resin thickness on all porcelain restorations. Decreased marginal discrepancy through more accurate preparation, impression, laboratory fabrication, and improved seating, decreases the incidence of restoration failure due to leakage decreases.

Working chairside can often lead to stress on our necks, shoulders, and eyes and ultimately result in medical problems that compromise our ability to work. As the main producer in our businesses, being out of work can cause both mental and financial strain. Taking measures to ensure our own health and well-being is a responsibility we owe ourselves, our families, our teams, and our patients. Magnification allows practitioners improved visual acuity at a working distance designed to eliminate leaning over and reduce the strain on back and shoulder muscles. Asking our eyes to differentiate small objects at close working distances in poor lighting can lead to eye strain and headaches. Using illumination in combination with magnification can reduce these effects.

The use of loupes for dental magnification and illumination has increased dramatically during the past few years. It is estimated that more than 60 percent of dentists wear loupes. Lower-strength magnification is on the rise for added accuracy and ergonomics in hygiene operatories. Making a decision about the type and strength of magnification to use will be based on the parameters of your practice, personal comfort, and cost effectiveness. With traditional loupes, as the magnification power increases, both the field of view and depth of field will decrease. The next evolution of dental magnification is the routine use of microscopes during restorative dentistry. The microscope allows us the ability to have increased magnification power with less decrease in the field of view and without the weight of equipment as a comfort issue. Transitioning to loupes or a microscope will include an adjustment period during which you must learn to work with this different visual information.

Differentiating your practice is a key step in attracting patients with a commitment to health and high-level health care. Routinely using magnification whenever you sit down with patients demonstrates your commitment to excellence. Building trusting, engaged relationships with patients is key to helping them move forward with optimal care. Magnification hones our attention so tightly into a defined area that it can be easy to forget the rest of the person beyond your field of view. Create a balance between focusing on the technical details for excellence and creating personal connections with patients. When these two pieces work together, doing the dentistry you love on patients who value and appreciate you is the payoff.

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Lee Ann Brady, DMD Dr. Brady graduated from the University of Florida College of Dentistry in 1988. A mother to three, she is a full-time clinical instructor in residence at The Pankey Institute and is on the editorial review board of Dental Practice Report. Reach her at lbrady@pankey.org.

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