Comparison of optical performance among three dental operating microscopes: A pilot study

Introduction:

Two important aspects of the dental operating microscope (DOM) that factor into its overall effectiveness are resolution and depth of field. Therefore, the objective of this study was to evaluate and compare the resolution and depth of field of DOMs from three well-known manufacturers using standardized test targets.

Materials and Methods:

A resolution test, using the 1951 USAF Hi-Resolution Target (Edmund Optics, Barrington, NJ), and a depth of field test, using the Depth of Field Target 5-15 (Edmund Optics, Barrington, NJ), were performed by two calibrated observers. Three DOM systems such as Seiler IQ (Seiler Instrument Inc., St. Louis, USA), Global G-Series 6 step (Global Surgical Corp., St. Louis, USA), and Zeiss Extaro 300 (Carl Zeiss Meditec AG, Oberkochen, Germany) were used to compare the resolution and depth of field.

Results:

The Zeiss Extaro 300 showed the highest maximum resolution and maximum DOF (64 lp/mm and 17mm, respectively). The Seiler IQ showed the lowest maximum resolution and maximum DOF (35.9 lp/mm and 11 mm, respectively).

Conclusion:

Within the limitations of this study, the Zeiss Extaro 300 was superior in terms of resolution and depth of field as compared to the other two DOMs.

Knowledge, attitude and practice regarding the use of dental operating microscope in pediatric dentistry in India: An online survey

Background and aim

Literature search shows scarcity of information regarding the use of Dental Operating Microscope (DOM) in children. There are various factors that limit the use of this novel technology by Pediatric Dentists in their practice. The aim of this study is to assess the knowledge, attitude and practice of pediatric dentist regarding DOM use in children.

Method

The present study was a descriptive web based questionnaire study conducted among 363 Pediatric Dentists (PDs) of India. A close-ended questionnaire was prepared to test the KAP regarding microscope use among PDs. Results obtained were analyzed using descriptive analysis in SPSS software and correlation was studied using chi-square test where statistical significance was observed at p ​< ​0.05.

Results

A response rate of 82.1% was observed. Majority (88.9%) of the pediatric dentists were aware of Dental operating Microscope (DOM) usage in their field, however, only 61.4% were aware of its magnification levels. 76.5% participants responded 12^oclock position to be the ideal position. Majority (94.0%) agreed that DOM is helpful in locating canals in deciduous teeth. 70.5% think that DOM can increase apprehension of children. 85.2% believed that DOM can aid in behavior management of children through its live visual output. However, 84.2% of the pediatric dentists hadn't used DOM in their practice.

Conclusion

The knowledge, attitude and practice regarding dental operating microscope among pediatric dentists in India is limited. In the foreseeable future, the use of magnification is likely to become the standard of practice in dentistry.

Mandibular first premolar with five root canals: a case report

Background

Understanding the anatomical morphology of the root canal is key for successful root canal treatment. The aims of this case presentation are to report a unique case of root canal treatment involving five root canals in the mandibular first premolar and to highlight the importance of variation in root canals of mandibular first premolars in clinical practice.

Case presentation

A 25-year-old male with intermittent pain in relation to the lower right posterior teeth over 3 weeks was diagnosed with symptomatic pulpitis in tooth #44. Four root canals were found, including mesiobuccal, distobuccal-1, distobuccal-2, and distolingual roots, and the Mtwo rotary system was used for root canal preparation. The four root canals were filled after 2 weeks, when a fifth canal was found, located in the buccal cavity. The fifth canal was confirmed to be the mesiolingual root canal by cone beam computed tomography (CBCT) and was found to be curved. After completion of the root canal filling, CBCT was performed, and a three-dimensional root canal image was reconstructed. After 1 week of observation, the tooth was repaired using composite resin filling.

Conclusions

This is the first case presentation of a fifth canal of the mandibular first premolar and advances our understanding of variations in the anatomy of the mandibular first premolar. This case report provides a reference for the treatment of mandibular first premolars.

Endodontic management of the maxillary first molars with two root canals: A case report and review of the literature

BACKGROUND

The complex anatomy of the maxillary first molars has always been a major challenge for complete root canal treatment in endodontic therapy. Here, we present two cases of maxillary first molars, each with only two root canals, which have been rarely reported. We also perform a literature review of maxillary first molar anatomy.

CASE SUMMARY

The two patients were referred to the hospital after 1) finding a cavity in their tooth with a color change and, 2) a toothache during mastication, respectively. Both of these cases were diagnosed as apical periodontitis by X-ray imaging and cone beam computed tomography (CBCT). Non-surgical endodontic therapy was performed with the assistance of a dental operating microscope (DOM). CBCT showed rare but accurate images of both patients, each with two root canals and two roots in their maxillary first molars. Both roots were located in the buccal in the palatal direction, and each root had only one clear root canal. In addition, each maxillary first molar in both patients was symmetrical to that on the opposing side with only two separate root canals. Non-surgical endodontic therapy was performed with the assistance of a DOM. Finally, the teeth were restored using composite resin and the patients were satisfied with the results.

CONCLUSION

Making full use of CBCT and DOM would contribute to helping dentists make correct diagnoses and successfully treat teeth with rare root canal morphologies.

Non-surgical Removal of Dens Invaginatus in Maxillary Lateral Incisor Using CBCT: Two-year Follow-up Case Report

A 14-year female presented with an atypical looking tooth #7 with a sinus tract on tooth #8. A gutta-percha point inserted into the sinus tract confirmed the affected tooth #7. A radiographic examination of tooth showed a lateral radiolucency with respect to tooth #7. Cone-beam computed tomographic imaging was done for the three-dimensional reconstruction analysis. Dens invaginatus (Oehler's type III) with pulp necrosis and chronic apical periodontitis was the definitive diagnosis. Use of the dental operating microscope and ultrasonics helped in the removal of the invaginated structure. At the two year follow-up, no clinical and radiographic evidence of infection was observed.

Endodontic management of mandibular first molars with mid mesial canal: A case series

The purpose of this study is to demonstrate the importance of knowledge of the internal anatomy of root canals for the success of endodontic treatment. Lack of knowledge of anatomic variations and their characteristics in different teeth has been pointed out as one of the main cause of endodontic therapy failure. Dental operating microscope plays a key role in the identification of canal and success of endodontic treatment. This case series describes the endodontic treatment of mandibular first molars with extra root canals, evaluate the occurrence of this extra canal, and discuss the importance of their identification and treatment.

Maxillary Second Molar with Fused Root and Six Canals- A Case Report

One of the known aberrations in root canal morphology of maxillary second permanent molars is the presence of collateral mesiobuccal canals. This case report describes the endodontic management of a maxillary second molar that had a single fused root with six canals that was successfully managed with the aid of dental operating microscope. Six canal orifices were located namely MB1 (Mesiobuccal), MB2, MB3, DB1 (Distobuccal), DB2 and palatal. During the cleaning and shaping, instrument separation occurred at the apical third of the palatal canal which was removed with ultrasonics. After cleaning and shaping, the canals were obturated with resin sealer and laterally condensed gutta-percha. The patient was recalled for periodic review. After two years of follow up the patient remained asymptomatic. Cone Beam Computed Tomography (CBCT) evaluation revealed satisfactory periapical status.

Endodontic management of a maxillary first molar with three roots and seven root canals with the aid of cone-beam computed tomography

Variation in root canal morphology, especially in maxillary first molar presents a constant challenge for a clinician in their detection and management. This case report describes the successful root canal treatment of a three rooted right maxillary first molar presenting with three canals each in the mesiobuccal and distobuccal roots and one canal in the palatal root. The clinical detection of this morphologic aberration was made using a dental operating microscope, and the canal configuration was established after correlating and computing the clinical, radiographic and cone-beam computed tomography (CBCT) scan findings. CBCT images confirmed the configuration of the canals in the mesiobuccal and distobuccal roots to be Al-Qudah and Awawdeh type (3-2) and type (3-2-1), respectively, whereas the palatal root had a Vertucci type I canal pattern. This report reaffirms the importance of careful examination of the floor of the pulp chamber with a dental operating microscope and the use of multiangled preoperative radiographs along with advanced diagnostic aids such as CBCT in identification and successful management of aberrant canal morphologies.

Microscope magnification and ultrasonic precision guidance for location and negotiation of second mesiobuccal canal: An in vivo study

Objective:

The aim of this study was to evaluate the influence of using the dental operating microscope (DOM) and ultrasonics for the detection of second mesiobuccal (MB2) canal orifice in maxillary first molars.

Materials and Methods:

Sixty subjects seeking root canal therapy for maxillary first molar were assessed for the presence of MB2 canal using endodontic explorer without magnification. Teeth in which the MB2 canal orifice could not be located were examined under magnification using DOM. If the MB2 canal orifice could not be found even after using DOM, ultrasonic tips were used to prepare 3-mm-long trough from the mesiobuccal canal orifice toward the palatal canal and examined under DOM for location of the canal.

Results:

With naked eye, the MB2 canal was located in 12 teeth; with the use of the DOM, the MB2 canal was located in 21 additional teeth; and with the combined use of ultrasonic tip and DOM, the MB2 canal was located in 9 more teeth. Statistical comparisons between the tested techniques were done by analyzing the Receiver Operating Characteristic (ROC) curves; a statistically significant difference was found (P < 0.001).

Conclusion:

The results of this study indicate that the DOM and ultrasonics provide increased opportunity for the dentist to detect canal orifices.

Endodontic management of a two rooted, three canaled mandibular canine with a fractured instrument

It is important to assess the root canal morphology and its variations before initiating the endodontic procedure. This is because the inability to clean the complete root canal system forms the seat for the persistent infection which ultimately leads to endodontic treatment failure. This case reports the use of dental operating microscope for the successful endodontic management of a two rooted and three canaled mandibular canine with the fractured instrument in the middle canal of a 38-year-old healthy Asian woman. This case report highlights the need to use the dental operating microscope and ultrasonics in locating the elusive canal orifices. It is important to note the internal and external root canal morphological variations before starting the endodontic treatment without any pre-operative assumptions about the usual anatomy of the toot.

Management of pulpal floor perforation and grade II Furcation involvement using mineral trioxide aggregate and platelet rich fibrin: A clinical report

To report the management of an iatrogenic perforation of pulpal floor in the furcation of mandibular first molar, using Mineral Trioxide Aggregate (MTA) and platelet rich fibrin (PRF). Unpredictable endodontic root/pulp chamber floor perforations resulting in unacceptable high rate of clinical failure has now been a lesser threat with the advent of new technologies and biocompatible materials that utilize the applications of basic research along with tissue engineering concept in clinical practice. Present case report illustrates the use of MTA and platelet rich fibrin (PRF) for the repair of the perforation defect and regeneration of the lost periodontium in furcation area. Although, histologic events and reaction of MTA with PRF is not studied so far, however, the autologous and biocompatible nature of the components used for present treatment modalities seems to be beneficial for the long term clinical results obtained in our case.