Decision-Making Factors Among Dentists for Using Dental Magnifying Loupes: A Cross-Sectional Study

Purpose

Dental magnifying loupes (DMLs) allow better visualization of the operative field and operator's seating postures. This study aimed to investigate factors influencing the usage and selection of DMLs among dentists and determine the self-reported musculoskeletal pain and perception regarding DMLs usage.

Methods

A validated self-reported questionnaire of 19 items assessing participant's characteristics and DMLs usage was distributed to individuals who fit the inclusion criteria: practicing general dentists/dental intern and resident/specialized dentist in various dental specialties. The data were collected and then statistically analyzed using comparisons tests (chi-square/Fisher's exact test) and logistic regression with significance level (p-value) below 0.05.

Results

The response rate for this study's questionnaire was 97.33%. There is a significant association between the use of DMLs and training using them in dental school (p < 0.002). Using DMLs in endodontic treatment is significantly associated with the general dentist professional classification. Specialized dentists are 1.94-times more likely to use DMLs than general dentists (p < 0.001). The majority (50%) of DML users believe that DMLs are best used during undergraduate training. Using DMLs for "better vision" was the most selected (63.64%) option by DMLs users, followed by "increased clinical efficacy" (61.36%), "improved patient care" (50%), and "better ergonomics" (47.73%). Of dentists who did not use DMLs, 66.90% reported that DMLs being expensive was a limitation to their usage. Almost 91% dentists who have neck and shoulder discomfort (n = 219) do not use DMLs.

Conclusion

DMLs are under-utilized by dentists. The major factors limiting their use are the high cost and lack of training regarding their use in dental school. Addressing these two factors may contribute to a positive shift in the utilization of DMLs by a larger number of dentists.

Practices and preferences in the use of magnification among endodontists and restorative dentists: A multicentre study

BACKGROUND AND OBJECTIVES

Aim of the current study was to assess the perception, preference, and practice of endodontists and restorative dentists at different locations around the world about dental magnification instruments.

MATERIALS AND METHODS

A multicenter, cross-sectional study was ethically approved from the local committee of bioethics. After thorough literature search, a questionnaire was designed and validated. Later, the questionnaire was distributed to 10% (53 participants) of the total planned participants to conduct a pilot study. Based on the feedback from these participants, any ambiguities or discrepancies observed in the items and content of the questionnaire was modified. The questionnaire was assessed for its internal consistency as part of validating the items with Cronbach's alpha of 0.80. The completed questionnaire with an informed consent form for the participant was administered to the endodontists and restorative dentists in three different geographical regions namely MENA (Middle East and Northern Africa), British-Isles, and Indian Sub-continent using WhatsApp through the snowball convenience sampling technique.

RESULTS

Majority of the participants were male (56.5%) and in the age group of 25-35 years (30.3%). About 68.9% were from Indian sub-continent, followed by the British-Isles (16.5%) and the least (14.6%) were from the MENA region. By large, the participants of the present study, strongly agreed that dental magnification devices improved ergonomics, quality of work, and should be considered as standard of care in modern endodontic. Flip-up magnifiers (51.1%) and medium (8x-16x) magnification were preferred by majority of the participants. About 46.3% of specialist reported that they always used devices for all operative and endodontic procedures, especially while locating hidden and canals and negotiating calcified canals. Participants practicing in British-Isles have 2.42 times (P<0.05) higher adequate perception with reference participants in Indian sub-continent. Additionally, participants with fellowship have 2.77 times more (P<0.01) adequate perception with reference to their counterparts with a master's degree.

CONCLUSIONS

Most of the participants believe that dental magnification devices enhance the prognosis and quality of treatment of possibly all operative and endodontics procedures. Thus, emphasized on the inclusion of devices in the postgraduate curriculum and signifies the role of continuing dental education for specialist and dental assistant handling devices. However, multicenter studies with larger sample is required for generalizing the results.

Current Endodontic Practices among Romanian Dental Practitioners: A Cross-Sectional Study

Root canal therapy (RCT) is usually performed in Romania by general dentists (GDPs) because they are more readily available and more reasonably priced than endodontists. Concerns have been raised about the quality of RCTs performed by GDPs, possibly due to insufficient equipment or knowledge; therefore, this study aims to investigate current endodontic practices in Romania. Materials and Methods: A cross-sectional study was conducted via a questionnaire distributed to 400 randomly selected Romanian dentists, with 285 fully validated completed responses (71.25% response rate). Respondents were grouped by speciality, and statistical analysis, including cross-tabulation and the χ2 (chi-square) test, was used, with a significance level set at p ≤ 0.05 for all tests. Results: Significant differences were found in the use of magnification, rubber dam, sodium hypochlorite concentration, and bioceramics (p < 0.001). No significant differences were observed in preferences for measuring working length (p = 0.166) or rotary instrument motion (p = 0.289). Approximately 6% of the respondents used laser technology with no significant difference across specialities (p = 0.571). Additionally, 77.9% preferred using sodium hypochlorite, with no significant difference between groups (p = 0.006) regarding concentration. Conclusions: Most participants, including GDPs, use modern equipment and techniques during RCT, indicating their awareness and competence in current endodontic practices.

The importance of visual acuity screening in dental education amongst undergraduate dental students: a straightforward method

Background

Visual acuity plays a pivotal role in a dental professional's daily performance and screening the students' field of vision in their early formative years ensures successful undergraduate programmes.

Aims

To compare near and distance visual acuity and stereopsis in first-year and final-year dental students and investigate students' perception of their vision.

Method

This was a cross-sectional study involving 100 KCL first- and final-year dental students who underwent assessment of their vision and completed a self-perception questionnaire. Near visual acuity was assessed using a standardised near vision test chart, distance visual acuity using COMPlog (Clinical Vision Measurement Systems Ltd, London, UK) computerised software and stereopsis using the Frisby Stereotest. Based on the Mann-Whitney test, no statistical differences were found between the first-year and final-year students' near and distance visual acuity, nor in stereopsis difference at a significance level of α = 0.05. The null hypothesis was accepted.

Results

84% of first-year students and 94% of final-year students attained the highest binocular near visual acuity score of 0.50M. Distance visual acuity scores showed a median ETDRS (Early Treatment Diabetic Retinopathy Study) Letters score 94 in the first-year group and 95 in the final-year group. 8% of students were found to have correctable refractive errors in distance visual acuity. The majority of students across both year groups were able to discern 20 s arc of the smallest disparity. The final-year students reported worrying about their eyesight significantly more than the first-year students.

Conclusions

No statistically significant differences were found in near and distance visual acuity, and stereopsis, between first-year and final-year dental students. However, 8% of students were identified with undiagnosed, correctable refractive errors. The importance of students' vision in clinical dentistry is highlighted, and regular eye examination is recommended.

Evaluation of five methods to identify composite restorations in human teeth on a forensic purpose-an ex vivo comparative study

The use of tooth-colored composite resin materials in dentistry is increasing. As composite restorations appear similar to the natural tooth structure, their detection is becoming more challenging. The aim of this study was to compare five diagnostic methods for detection of dental restorations and to create reliable postmortem dental records for forensic purposes. A conventional examination method without a direct light source (CONV), with a dental loupe light (DL), Galilean loupes with a direct light source (GDL), a fluorescence-inducing device (FIT), and intraoral radiographs (RX) were compared. Dentists specializing in conservative dentistry or oral surgery and dentistry students participated. Regarding sensitivity, specificity, positive predictive value, and negative predictive value, FIT and RX showed significantly higher results than CONV, DL, and GDL. RX and FIT showed comparable results in identifying composite restorations but depending on their location. The combination of both methods may lead to even better results. In conclusion fluorescence-inducing devices show good results in identifying composite restorations and therefore should be considered as a standard tool in forensic examinations. Another advantage is their small size, low cost, and mobility. Good illumination and magnification devices are recommended to enhance performance during conventional examinations. Involving dentists specialized in conservative dentistry could contribute to dental identification.

Effect of magnifying loupes on tooth preparation of complete coverage crown: A quantitative assessment using a digital approach

OBJECTIVE

The purpose of this study was to evaluate the use of magnifying loupes (×2.5) on the quality of tooth preparation for complete coverage crowns; performed by predoctoral students using an objective and quantitative digital method.

MATERIALS AND METHODS

Forty-two predoctoral students were randomly assigned into 2 groups to perform tooth preparation for a complete coverage crown on a mandibular first molar in a manikin, with and without the use of magnifying loupes. All preparations were digitally evaluated by PrepCheck 3.0 (Dentsply Sirona). Parameters including tooth reduction, total occlusal convergence (TOC), undercut, margin quality and surface quality were assessed. Continuous data were analysed using Paired t-tests or Wilcoxon Signed Ranks tests. Ordinal data were analysed by McNemer's tests. To further detect the majority pattern ( > 50%) in each group (with and without loupes), one-sample t-test or one-sample Wilcoxon Signed Rank test was performed. The level of significance was set at p = .001 after Bonferroni adjustments for multiple testing.

RESULTS

No significant differences in the measured outcomes were found between the groups with or without the use of magnifying loupes (p > .002). The majority (>50%) of both groups had no undercuts (99.3% and 99.4% both p < .001) and the preparation type was within tolerance (81.6% and 85.3%, both p < .001) with acceptable margin (86.4% and 86.3%, both p < .001) and acceptable surface quality (99.0% and 99.1%, both p < .001). However, the majority of both groups underprepared occlusally (96.0% and 95.4%, both p < .001) and axially (65.3% and 67%, both p < .001). Only 30.0%-42.1% of the participants achieved the TOC within 0-20°.

CONCLUSIONS

Within the limitations of this study, the use of magnification loupes does not appear to significantly improve the quality of tooth preparation for complete coverage crown. The TOC was also found to be overprepared and occlusally underprepared.

Value of including loupes in prosthodontic and endodontic components of dental degrees: a systematic review

Background It is crucial dental students graduate with sound knowledge of endodontics and prosthodontics. The use of loupes is important for these due to their intricate nature, but there is currently no standardisation of curricula.Objective This systematic review investigates the value of including loupes in completing dental degrees and their benefits to dental students.Methods Literature was searched from inception to February 2022 in PubMed, Embase and Scopus. Articles included were primary studies of dental students studying endodontics or prosthodontics, which had outcomes related to the value of utilising loupes in learning, clinical application and ergonomics.Results A total of 1,489 articles were retrieved, of which 14 relevant articles were identified. These articles discussed student perceptions and the impact on visual acuity, ergonomic practices and dental procedures. Overall, students perceived that loupes increased self-confidence and allowed a greater operative view but were initially difficult to use. Using loupes resulted in greater visual acuity than no magnification and improved ergonomic practices by reducing neck angulation and improving posture. Students also received better grades when using loupes during cavity access preparation or root canal therapy.Conclusion The use of loupes by dental students can be beneficial if there is initial teaching on their use.

Do magnification loupes affect the precision of cavity preparations made by undergraduates? A randomized crossover study

BACKGROUND

Evidence on the effect of magnification devices on procedure quality in restorative dentistry is scant. This study therefore aimed to assess, under simulated clinical conditions, if magnification loupes affect the quality of preparations carried out by undergraduate dental students.

METHODS

59 undergraduate dental students underwent two visual acuity tests, based on which they were divided into a "low visual acuity group" (visus < 1) and a "good visual acuity group" (visus ≥ 1). In a randomized crossover experiment, participants performed a two-dimensional S and a three-dimensional O figure preparation with a dental handpiece on standardized acrylic blocs designed for preclinical restorative training. Each participant carried out the preparation tasks twice, once with magnification loupes (2.5×) and once without. Two blinded investigators independently evaluated parameters of preparation precision. Data were analyzed using Spearman rank correlation coefficients, intra-class correlation coefficients, and Wilcoxon rank-sum tests (α = 0.05).

RESULTS

Participants from the "low visual acuity group" did not show a statistically significant improvement in accuracy when they used magnification loupes for the S figure preparation (p ≥ 0.0625). Participants from the "high visual acuity group" obtained a higher level of accuracy (p ≤ 0.0012) when they used magnification loupes for the S figure preparation. The use of magnification loupes had no statistically significant effect on the accuracy parameters of the O figure cavity preparations (p ≥ 0.1865). Participants with high visual acuity achieved only a marginally better accuracy than participants with a visus < 1.

CONCLUSIONS

This study suggests that loupes with 2.5× magnification increase the accuracy of two-dimensional preparations while they have no significant effect, favorable or otherwise, on the accuracy of complex, three-dimensional cavity preparations of untrained dental students.

Effect of magnification factor by Galilean loupes on working posture of dental students in simulated clinical procedures: associations between direct and observational measurements

Objectives

To determine the effect of different levels of Galilean loupe magnification on working posture as measured by compliance with ergonomic posture positions, angular deviation from the neutral position of the neck, and muscle activation in the neck and upper back region during simulated clinical conditions.

Methods

An experimental laboratory study was performed in which the dependent variables were compliance with ergonomic posture requirements while performing simulated restorative procedures in Restorative Dentistry, angular deviation from the neutral position of the neck, and muscle activation in the neck and upper back. The independent variable was the level of Galilean loupe magnification, which was tested at four levels (naked eye, 2.5× magnification, 3.0× magnification, and 3.5× magnification). The cavity preparations and Class I composite resin restorations were performed on artificial first molars on a mannequin in a dental chair. The Compliance Assessment of Dental Ergonomic Posture Requirements (CADEP) was used for the postural analysis; as was an analysis of the angular deviation from the neutral position of the neck and surface electromyography. Working posture was recorded on video over the course of the procedure. Participants were filmed from three different angles. The Compliance Assessment of Dental Ergonomic Posture Requirements (CADEP) assessed compliance with ergonomic posture requirements. A locally produced posture assessment software analyzed angular deviation. Surface electromyography bilaterally assessed activation of the sternocleidomastoid, descending trapezius and ascending trapezius muscles. Two-factor analysis of variance (ANOVA) and either Tukey's post-hoc test or the Games-Howell post-hoc test were performed (α = 0.05).

Results

During the cavity preparations and restorations, the use of Galilean loupes at all magnifications positively influenced working posture as measured by participants' compliance with ergonomic posture positions (p < 0.01) and neck angulation (p < 0.01); the use of these loupes did not affect muscle activation in the regions evaluated (p > 0.05).

Conclusion

The use of Galilean loupes had a positive effect on dental students' working posture during the restoration procedures performed.

Perception and practices of Operative and Endodontic specialists in Pakistan towards the use of dental magnification

BACKGROUND

The perceptions and trends of magnification use in dentistry need to be determined since magnification significantly enhances clinical practice.

OBJECTIVE

To assess perception and practices of Operative and Endodontic specialists currently working in Pakistan, regarding use of magnification.

METHODS

A structured questionnaire administered for this analytical cross-sectional study recorded demographics, trends of magnification devices used in practice and their perceived advantages and disadvantages by the specialists with close-ended questions and three-point Likert scale.

RESULTS

Out of 91 forms, 77 responses were received (response rate of 84%). Most participants had 1-4 years of practical experience, were employed at both faculty and clinical positions, were more interested in operative/restorative procedures and used TLL (through the lens loupes) at low magnification. Use of magnification devices was learnt mostly during post-graduate training and was used daily or weekly for complicated cases. Noteworthy perceptions included improved treatment quality and standard of care. However, they were also perceived as irritating, increasing treatment time, with adverse effect on eyesight with prolonged use. No statistically significant correlation was found between the variables recorded (p > 0.05).

CONCLUSIONS

Most specialists used magnification devices in some form and were abreast with their advantages. Proper training and continued dental education courses can help dispel any observed misapprehensions.

Magnification effect on fine motor skills of dental students

OBJECTIVES

This study observed the effect of different magnification systems on dental students' real and perceived fine motor skills.

METHODS

This was a laboratory-based experimental study. Students in the fifth year of an undergraduate dentistry program (N = 92) participated in this study. The dependent variables were real motor skills, perceived motor skills and time required to complete the fine motor skills test. The independent variable was the use of a magnification system under four conditions. For each condition, the Dental Manual Dexterity Assessment was performed, which consisted of inserting the #3195FF bur into targets positioned on a Styrofoam plate. The accuracy of each penetration of the targets was scored, using a point system with a maximum possible score of 246 points. Students' perceived fine motor skills were assessed using a visual analog scale (VAS) that ranged from zero for no skills to ten for maximum skills. A descriptive statistical analysis and the repeated measures ANOVA were performed (α = 0.05).

RESULTS

The Galilean and Keplerian loupes were found to positively affect students' real fine motor skills (p<0.01); however, perceived fine motor skills and time were significantly better (p<0.01) under the naked eye.

CONCLUSIONS

Dental students' real fine motor skills were better when Galilean and Keplerian loupes were used, but the perceived fine motor skills were not.

The Best Dentistry Professional Visual Acuity Measured under Simulated Clinical Conditions Provides Keplerian Magnification Loupe: A Cross-Sectional Study

Visual acuity plays an important role in dentists’ vision in their daily clinical routine. This study aimed to determine dental students’ visual acuity without optical aids and when using magnification devices in simulated clinical conditions. The participants were forty-six students at the School of Dental Medicine with a visual acuity of 1.0 in decimal values or 100% in percentage. The central visual acuity was tested using a miniature Snellen eye chart placed in the molar cavity of a dental phantom, in simulated clinical conditions under five different settings (natural visual acuity, by applying head magnifying glasses x1,5 and binocular magnifying devices using Galileo’s x2,5/350 mm, Keplerx3,3/450 mm and Keplerx4,5/350 mm optical system). The Wilcoxon Signed Rank test shows that the distribution of measurements of the visual acuity undertaken by the application of magnifying devices (VNL, VGA2,5, VKP3,3, VKP4,5) contained higher values of visual acuity than those received by the use of natural vision (VSC) (p < 0.001 for the comparison to the VNL, VGA2,5, VKP3,3 and VKP4,5 groups). The highest and statistically most significant increase in visual acuity is achieved using the Keplerian telescope x4.5/350 mm. The application of magnifying devices provided dentistry professionals with better visual acuity, improving detail detection in an oral cavity during dental procedures by magnifying the oral structure. The use of magnification devices means much more precise work, decreases the operating time, improves posture and reduces muscle pain in the shoulder during dental treatment.

Ergonomic working posture in simulated dental clinical conditions: effect of magnification on the operator's experience

Objectives

This study observed the effect of different magnification systems on working posture and neck angulation during cavity preparation procedures according to operator's experience.

Methods

This was a laboratory study. The response variables were the neck angulation and the working posture adopted during Class I cavity preparations (N = 640) that were performed under four conditions (unaided visualization, simple loupe, Galilean loupe and Keplerian loupe). Working postures were recorded and evaluated by the Compliance Assessment of Dental Ergonomic Posture Requirements (CADEP). The two-factor ANOVA and Games-Howell post-hoc test were performed (α = 0.05).

Results

For all treated teeth it was observed higher posture scores and lowest neck angulations while using the Galilean and Keplerian loupes (p < 0.01). No correlations were found between operator's experience and working posture (p = 0.71-0.88).

Conclusion

It can be concluded that Galilean and Keplerian loupes helped operators to maintain an ergonomic posture and lower neck angulations for all teeth and the operator's experience provided better ergonomic posture for the mandibular teeth.

The impact of the use of magnifying dental loupes on the performance of undergraduate dental students undertaking simulated dental procedures

OBJECTIVES

This study aimed to evaluate the impact of the use of magnification (2.5x dental loupes) for third-year dental students in simulated endodontics and fixed prosthodontics assessments compared to those using no magnification.

METHODS

Upon institutional review board exemption, third-year dental students were assessed during endodontics and fixed prosthodontics exams in the simulation laboratory. The endodontic group (n = 93) consisted of students who made an endodontic access preparation on a plastic lower left first molar (Nissan). The prosthodontic group (n = 86) consisted of students who made porcelain fused to metal preparation (PFM) on a plastic lower right first molar mounted on an acrylic lower jaw model (Columbia Dentoform). The impact of the use of dental loupes was evaluated. Assessment of the tasks was undertaken by experts-calibrated, blinded examiners-using a standardized marking rubric for each task. The statistical analysis included Chi-square test, one-way ANOVA, and Logistic regression. The level of significance adopted was 5%.

RESULTS

Students' preparations using magnification were better compared with those without magnification. Students using magnification had a significantly higher pass rate than those not using magnification in both endodontic and prosthodontic groups (P < 0.05).

CONCLUSIONS

In conclusion, third-year dental students who used loupes in the endodontics and prosthodontics simulation laboratory had significantly higher scores at the assessments.

Measuring tooth vibrations induced during cavity preparation with time-averaged holography and its influence on near vision acuity in dentists

The aim of this study was to quantify vibrations and their influence on visual acuity. The study consisted of two parts, laboratory and clinical. Time-averaged holographic interferometry (TAHI) method was used in laboratory for measuring the amplitude of tooth vibrations induced by dental handpiece. The amplitudes of tooth vibrations were measured for the three diameters and three speeds. The larger diameter coupled with increasing speed resulted in greater vibration amplitudes, whereby a maximum amplitude of less than one micrometer was detected. For quantifying the natural visual acuity for the corresponding tooth vibrations, we have used the clinical condition approach with miniaturized Snellen optotype as an assessing tool. Central visual acuity did not display variance in visual acuity at rest or under load. Results indicate that the vibrations induced during cavity preparation are not sufficient to negatively affect visual acuity of dentists.

Implementing magnification during pre-clinical training: Effects on procedure quality and working posture

OBJECTIVE

The objective of this study was to evaluate the effects of magnification on the quality of two pre-clinical procedures, class I cavity preparations and composite resin restorations, and to evaluate the working posture.

METHODS

This was an experimental laboratory study. The response variables were the quality of cavity preparations and Class I restorations as well as the working posture adopted during the execution of these procedures. The independent variables were the magnification system under four levels (unaided visualisation, the use of a simple loupe, the use of a Galilean loupe and the use of a Keplerian loupe) and the artificial teeth treated. Class I cavity preparations and restorations (N = 320) were performed using standardised procedures, and the quality achieved was evaluated using pre-established criteria. Working posture was recorded using digital video cameras and was evaluated using the Compliance Assessment of Dental Ergonomic Posture Requirements (CADEP). A two-factor analysis of variance (ANOVA) and multiple comparison test were performed (α = 0.05).

RESULTS

The quality of cavity preparation did not differ significantly amongst the different magnification systems (P = 0.082). Galilean and Keplerian systems had a positive impact on restoration quality only for the left mandibular first molar (P = 0.04). Higher posture scores were observed when Galilean and Keplerian loupes (P = 0.01) were used, regardless of the tooth being treated.

CONCLUSION

The use of Galilean and Keplerian magnification lenses did not affect the quality of the pre-clinical procedures performed whilst improved the scores of ergonomic posture.

Factors contributing to student satisfaction with dental loupes and headlights

PURPOSE

Surgical loupes and headlights are becoming standard equipment for dental professionals and students. Students often purchase these relatively expensive instruments with limited knowledge of which features will affect their satisfaction with use. The purpose of this study was to measure levels of satisfaction with loupes and headlights amongst dental and dental hygiene students after 1, 2 and 3 years of use, and use those findings to guide first-year students in making better purchasing decisions.

METHODS

An electronic survey was sent to all second, third and fourth year dental students as well as second-year dental hygiene students at the University of Nebraska Medical Center (UNMC) in October 2018. The survey asked students to respond to multiple questions with a 5-level Likert scale measurement of satisfaction and provide open-ended responses to questions about their loupes and headlights.

RESULTS

Ninety-three percent of eligible students responded. Overall, 68% of students were very satisfied with their loupes and 56% were very satisfied with their headlights. Sixty-seven percent of dental students chose 3.5× magnification or higher and 96% of dental hygiene students chose 2.5×.

CONCLUSIONS

Of all characteristics evaluated for loupes, customer service and sales representatives received the lowest satisfaction ratings. For headlights, battery-related factors (battery life in hours, rate of recharging, size or weight and on/off controls) received the lowest satisfaction scores. Information collected and reported in this way can help future students make better decisions when selecting products, vendors and features that will best meet their needs.

Effect of Magnification during Post Space Preparation on Root Cleanness and Fiber Post Bond Strength

The aim of this study was to evaluate the effect of magnification during post space preparation on root cleanness and on fiber post bond strength. Methods: Thirty human central upper incisors with similar root canal in size and shape were selected, decoronated to 15 mm and endodontically filled. The teeth were assigned into 3 groups (n=10), according to the method of magnification during post space preparation inspection: Control, using naked eye; loupe, using a dental surgical 3x magnifying glass; surgical microscope, using a 6x surgical microscope. The roots were scanned by using micro-CT before and after post space preparation for residue remnants evaluation. Fiber posts were cemented using self-adhesive resin cement (Rely X U200, 3M-ESPE). Two 1-mm-thick slices from the cervical, medium and apical thirds were submitted to a push-out test (PBS). Failures modes were classified. PBS data were analyzed by using two-way ANOVA with repeated measurement and the Tukey test. The significance level was set at 5%. The method of visualization had no effect on PBS (p=0.556). The cervical region had higher values than apical region irrespective of the inspection method (p=0.012). Adhesive failure between the resin cement and dentin was the prevalent failure mode for all groups. Micro-CT analysis showed no difference on root cleanness into the root canal after post space preparation. The use of magnification devices as loupe and microscope while performing post space do not improve the PBS and did not affect sealer remain of decoronated anterior teeth.

Minimal invasive microscopic tooth preparation in esthetic restoration: a specialist consensus

By removing a part of the structure, the tooth preparation provides restorative space, bonding surface, and finish line for various restorations on abutment. Preparation technique plays critical role in achieving the optimal result of tooth preparation. With successful application of microscope in endodontics for >30 years, there is a full expectation of microscopic dentistry. However, as relatively little progress has been made in the application of microscopic dentistry in prosthodontics, the following assumptions have been proposed: Is it suitable to choose the tooth preparation technique under the naked eye in the microscopic vision? Is there a more accurate preparation technology intended for the microscope? To obtain long-term stable therapeutic effects, is it much easier to achieve maximum tooth preservation and retinal protection and maintain periodontal tissue and oral function health under microscopic vision? Whether the microscopic prosthodontics is a gimmick or a breakthrough in obtaining an ideal tooth preparation should be resolved in microscopic tooth preparation. This article attempts to illustrate the concept, core elements, and indications of microscopic minimally invasive tooth preparation, physiological basis of dental pulp, periodontium and functions involved in tool preparation, position ergonomics and visual basis for dentists, comparison of tooth preparation by naked eyes and a microscope, and comparison of different designs of microscopic minimally invasive tooth preparation techniques. Furthermore, a clinical protocol for microscopic minimally invasive tooth preparation based on target restorative space guide plate has been put forward and new insights on the quantity and shape of microscopic minimally invasive tooth preparation has been provided.

Magnification in endodontics: A review of its application and acceptance among dental practitioners

The application of magnification devices in endodontics is mainly meant for visual enhancement and improved ergonomics. This is crucial especially when long hours are spent in a narrow operating space to treat obscure microanatomy. Nevertheless, application of magnification in endodontics has yet to be introduced into the mainstream practice due to various influences in behavioral patterns. By conducting an extensive literature search in the PubMed database, this narrative review paper depicts the present state of magnification devices, their applications within the endodontic practice, factors that influence their usage, the advantages, and shortcomings, as well as the significances of magnification in the field of endodontics. This review paper will encourage clinicians to employ magnification in their practice for improved outcome.

[Effects of loupes and microscope on laminate veneer preparation]

OBJECTIVE

To assess and compare the effects of loupes and microscope on laminate veneer preparation of the first practitioner from the aspects of efficiency, quality and accuracy of preparation, and preference.

METHODS

Twenty young prosthodontists from the Department of Prosthodontics, Peking University School and Hospital of Stomatology were recruited into this study, which was prospective, single blind, self-control trials. The participants had no experience of using dental magnification devices. They prepared laminate veneers in the artificial dental model, under routine visual field (control group), 2.5× headwear loupes (loupes group), and 8× operating microscope (microscopic group) by turning. The time for tooth preparation was recorded. Thereafter, subjective assessments of efficiency, quality of preparation and preference were performed by themselves using visual analogue score (VAS). Expert assessments of quality and accuracy of preparation were performed by two professors using stereomicroscope and digital technique respectively.

RESULTS

In terms of efficiency, the subjective scores for the control group, loupes group and microscopic group were 7.15±1.73, 8.10±0.91 and 5.40±2.04, respectively. There was significant difference between the loupes group and microscopic group (P<0.05). The time of tooth preparation for the control group, loupes group and microscopic group was (430.10±163.04) s, (393.90±157.27) s and (441.95±164.18) s, respectively. There was significant difference between the loupes group and microscopic group (P<0.05). The loupes group was more efficient than the microscopic group. In terms of the quality of preparations, the subjective scores for the control group, loupes group and microscopic group were 6.55±2.09, 7.85±0.99 and 6.25±1.77, respectively. There was significant difference between the loupes group and microscopic group (P<0.05). The expert evaluations for the control group, loupes group and microscopic group were 12.20±1.67, 12.50±1.70 and 11.35±2.60, respectively. There was significant difference between the loupes group and microscopic group (P<0.05). The loupes group had higher quality than the microscopic group. In terms of the accuracy of preparations, the control group, loupes group and microscopic group of incisal 1/3 were (0.107±0.097) mm, (0.142±0.118) mm and (0.123±0.087) mm, respectively, of middle 1/3 were (0.128±0.073) mm, (0.113±0.105) mm and (0.125±0.077) mm, respectively, and of cervical 1/3 were (0.075±0.054) mm, (0.068±0.044) mm and (0.058±0.047) mm, respectively. There was no significant difference among the three groups (P>0.05). In terms of the preference, the subjective scores for the control group, loupes group and microscopic group were 6.55±2.31, 8.60±1.10 and 5.80±2.07, respectively. There was significant difference between the loupes group and microscopic group (P<0.05). The participants had the highest preference for loupes.

CONCLUSION

For the first practitioners, loupes is better than microscope for laminate veneer preparation.

Effect of magnification devices on dental students' visual acuity

This study aimed to determine dental students’ visual acuity and neck angulation when using magnification devices and distances from the operating field. Forty students from each of the second through fifth years of the five-year program at the School of Dentistry of Araraquara were selected (N = 160). Visual acuity was tested using a miniature Snellen eye chart under five different settings (naked eye; simple loupe; Galilean loupe; Keplerian loupe and an operating microscope). Photographs were taken during the visual acuity exam in order to evaluate the angulation of the subjects’ necks in a neutral posture. The two-factor analysis of variance and the Games-Howell post-hoc test were performed (α = 0.05). A significant difference in visual acuity and neck angulation was found between the "magnification device" and "distance" factors in each of the graduating classes analyzed (p<0.05). At a standardized distance, the Keplerian loupe (535.93±133.69), the Galilean loupe (514.06±171.56), and the operating microscope (517.71±161.61) all provided greater visual acuity. At a subjectively comfortable distance, the Keplerian (521.35±157.99) and Galilean (515.00±156.32) loupes produced the best visual acuity. The angulation of the neck was greater when the simple loupes (56,59±10,88) and naked eye (56.51±13.55) were used at a subjectively comfortable distance. At both a standardized distance and a comfortable distance, the Galilean and Keplerian magnification systems provided the best visual acuity and the lowest angulation of the operator’s neck. At a standardized distance of 30 cm to 40 cm, the operating microscopes produced similar results.

Using motion capture technology to measure the effects of magnification loupes on dental operator posture: A pilot study

BACKGROUND

Motion analysis has great potential for quantitatively evaluating dental operator posture and the impact of interventions such as magnification loupes on posture and subsequent development of musculoskeletal disorders.

OBJECTIVE

This study sought to determine the feasibility of motion capture technology for measurement of dental operator posture and examine the impact that different styles of magnification loupes had on dental operator posture.

METHODS

Forward and lateral head flexion were measured for two different operators while completing a periodontal probing procedure. Each was measured while wearing magnification loupes (flip up-FL and through the lens-TTL) and basic safety lenses.

RESULTS

Operators both exhibited reduced forward flexion range of motion (ROM) when using loupes (TTL or FL) compared to a baseline lens (BL). In contrast to forward flexion, no consistent trends were observed for lateral flexion between subjects.

CONCLUSIONS

The researchers can report that it is possible to measure dental operator posture using motion capture technology. More study is needed to determine which type of magnification loupes (FL or TTL) are superior in improving dental operator posture. Some evidence was found supporting that the quality of operator posture may more likely be related to the use of magnification loupes, rather than the specific type of lenses worn.

Effect of Magnification on the Precision of Tooth Preparation in Dentistry

OBJECTIVES

  To evaluate the impact of magnification aids on the precision of tooth preparation under simulated clinical conditions.

METHODS AND MATERIALS

  Two plastic blocks marked with a geometric shape were fixed in a dental phantom head: a circle as the distal surface of tooth 16 (UNS 3) and a y-shaped figure as the occlusal surface of tooth 36 (UNS 19). Sixteen dentists (mean age: 39 years; range: 26-67 years) prepared the geometric shapes from the inside to the boundary line with a cylindrical bur and water-cooling. The boundary line had to be touched but not erased. Chair-side assistance was provided to simulate the clinical situation. Tooth 16 was prepared under indirect vision via a dental mirror. Tooth 36 was prepared under direct vision A) without magnification aids, B) with Galilean loupes, 2.5× and light-emitting diode light, and C) with a microscope, 6.4× and coaxial light. The preparation procedure was performed three times in different sequences of the magnification devices and with a break of at least 1 week between each procedure. The correctly prepared contour and the incorrectly prepared areas were evaluated in relation to the whole circumference of the geometric shapes.

RESULTS

  For both values the precision was significantly higher when a microscope was used, followed by preparation using loupes; precision was lowest without magnification aids ( p<0.0001). This was true for both indirect and direct vision ( p<0.05).

CONCLUSIONS

  Magnification devices improved the precision of tooth preparation under simulated clinical conditions.

Awareness, Attitude, and Prevalence of usage of magnification devices among the dental practitioners in the state of Andhra Pradesh - A questionnaire-based study

Background:

Dentistry, dealing with teeth and supporting tissues in the oral cavity is not only an ever-evolving science but also an art combined with good eye-hand coordination. It not only encompasses clinical and theoretical skills which play a crucial role in the success of therapy but also a lot of intrinsic work is accomplished in dentistry. In a journey to fulfill the above accomplishments and for facilitating early diagnosis of pathologies which usually go unnoticed, a clearer and magnified field of vision are also essential. The purpose of this study is to evaluate the awareness, attitude, and prevalence of the usage of magnification devices among the dental practitioners in the state of Andhra Pradesh.

Materials and Methods:

A questionnaire-based study was conducted to assess the awareness, attitude, and prevalence of magnification devices among the 370 dental practitioners in Andhra Pradesh. All the participants were provided with a prestructured questionnaire comprising of 24 questions and answering was completely self-based.

Results:

Among the participants, majority were aware about magnification in dentistry (91.1%), and also of the different types of magnification devices available (90.5%). On the other hand, when the reason for not using magnification devices was taken into consideration, 32.7% attributed that they have not experienced the devices and 32.4% felt that devices were too expensive. Moreover, when regarding the usage of devices was taken into account, only 23.8% of the total participants were exposed to the usage of magnification aids.

Conclusion:

Among the selected group of participants, even though majority were aware of magnification in dentistry its application in practice was very less.

A Near Visual Acuity Test for Dentists

Unimpaired near vision is crucial in dentistry, but appropriate visual tests at dental working distance are not publicly available. The aim of this study was to validate a novel visual triage test for dentists that is easy to use and freely available. The near visual acuity at 300 mm of 106 dental professionals (aged 21–65 years) was assessed with 1) a validated near visual test for scientific purposes miniaturized on a microfilm; 2) an experimental test using a US $5 bill, in which the first five words of each line in the Lincoln Memorial frieze had to be read under a dental operating light. The Spearman rank correlation coefficient of 0.784 revealed a strong correlation between the two tests (p&lt;0.0001). The ability to read six or more words in the memorial frieze meant there was a 94% chance of having a validated near visual acuity greater than or equal to the median score of the dentists tested. If none of the words could be read, the chance of having a near visual acuity below the median of the peer group was 89%. The influence of the dentists' age and experience on their visual performance reported in former studies was corroborated with this new test. The US $5 bill offers a simple and easily available near visual test to rank individuals' near vision relative to that of other dentists and to recognize the progression of presbyopia with increasing age.