Microsurgery

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“It takes twenty years for anything new to really catch on, not because it takes long to convince the establishment, but because it takes that long for there to be a changeover to people who have grown up with the new idea as being accepted” Dr Peter Jannetta

The introduction of surgical operating microscope in dentistry was done as early as 1986 by selden, it was no until the early 1990’s that the DOM was introduced into the profession and graduate level endodontic programs. These revolutionary instruments have taken endodontic surgery to another level of sophistication “the microsurgical approach”. Microsurgery is limited to a surgical procedure on exceptionally small and complex structures with the aid of an operation microscope. The microscope allows the minimizing tissue damage during the surgery. In the traditional nonmicroscopic method, pathologic lesions were grossly curetted but the microscopic causes of the lesion were often missed furthermore, there was avoidable damage to healthy tissues during the surgery. The modern dental surgeons must have in depth knowledge, not only in surgical principles, but also in the use of the microscopic and microinstruments. Otologists were the first medical specialists to introduce the operating microscope. The simple premise for using the microscope is the light plus magnification equals excellence. The logical progression of light awareness has moved to the use of the microscope. Along with an increase in brightness, a corresponding increase in magnification is needed for endodontic excellence. The solution to this needed for magnification initially was solved with the introduction of magnifying loupes. These loupes, were generally in the power of the loupes, the heavier they became and hence somewhat uncomforatable. Although the magnification associated with loupes is helpful, it is ndeed limited when compared to the typecial microscope, which offers magnification on the order of 3x to 30x. The operating microscope has wider fields, variable magnification, better depth of focus and more importantly, the coaxial illumination. Advantages and uses of operating microscope

I. Visualization of surgical field
II. Evaluation of surgical technique
III. Use of fewer radiographs
IV. Patient education through video
V. Reports to referring dentists
VI. Reports to insurance companies
VII. Documentation for dental legal purposes
VIII. Video libraries for teaching purposes
IX. Marketing the dental practice
X. Less occupational stress
Implication of microsurgery in endodontics
In medicine, incorporation of the concept of microsurgery began in the late 1950’s.the surgical operating microscope was used for the first time in neurosurgery and ophthalmology in 1960.precision is a key element in endodontic microsurgery began in the late 1950’s. The surgical operating microscope was used for the first time in neurosurgery and ophthalmology in 1960. Precision is a key element in endodontic microsurgery because of the restricted access to the surgical field. The surgical operating microscope which has long been a standard instrument in medical surgery, provides the necessary illumination with a bright, focused light and magnification upto 32x. This enhanced visibility allows the surgeons to locate and treat anatomic variations such as partial or complete isthmus, multiple foramina, c-shaped canals and apical root fractures. These variation often cannot be treated by nonsurgical means Main advantages of microsurgical approach are osteotomies, shallow level; resected root surface under high magnification revels anatomic details such as isthmic, canal fins, and lateral canals. Together with microscope, ultrasonic instrument permit conservative coaxial root end preparations and precise retrofills. The microsurgery triad constitutes

1 Magnification
2 Illumination
3 Instruments
Magnification needed...
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