Enhanced Vision Enhances Success

George Grayson, BSc MSc DDS FAGD

Dr. Grayson has been practicing dentistry for over 40 years. He is a fellow in The Pierre Fauchard Academy, The Academy of Dentistry International, The International Congress of Oral Implantologists, and the Academy of General Dentistry.

The Detailed Work of Restoration

Dentists are trying to replicate the beauty of nature’s organization with our art by attaching inert substances to living tissue. We need to see definitively to be able to diagnose and treat.

What you can and cannot see is important to the final outcome of your art. Utilizing a greater magnification with a loupe and light allows easier and less time-consuming restorative placement (ie: the layering of composite) and finishing procedures. Restoration disappearance occurs. We create an illusion by making the restoration disappear into the body of the tooth.

Preparations of all teeth occur ever more often with electric handpieces, ultrasonic, and fine finishing diamonds less than 50 microns. We cannot lean physically into our patient’s mouth to see better. We require higher magnification to allow an ergonomic posture and to be able to see all the details of restorative procedures.

The Miniaturization of Dentistry

Over the past 10-20 years, with the advent of micro dentistry, conservative tooth preparations and fine margins finished with 20 μm diamonds are routine.

Magnification scales up to match the scaling down of tools. With higher magnification, you do not need a size 4 or 5 mirror. You need a size 3 mirror as it will be easier to maneuver within the oral cavity. As precision tooling becomes smaller, you need to see what you are evaluating with more detail. Magnification and co-axial loupe lighting augment your vision. With higher magnification we can do multiple restorations at the same time using a rubber dam to accomplish dentistry faster, safer, more accurately, and efficiently. All this adds up to better dentistry.

Magnifying Your Work

The visual assessment of cracked teeth enables us to diagnose the extent of the fractures which define our treatment, composite placement, endodontics and crown placement. These cracks occur due to shear and compressive forces that may be in excess of 100,000 lbs which fracture through the stressed broken down collagen fibers that make up dentin.

I use an 8.0x TTL with a mini-light that allows visualization to 30 μm or 0.03 mm. At this magnification, fractures are easily seen. Yes, there are times when the greater microscope power of 10-20x is needed to allow visualization of 0.01 mm or 10 μm (endodontics and very fine fractures). If you have 6.5x or 8.0x loupes you can visualize 0.05 mm or 50 μm in any environment naturally and comfortably in any operatory with loupes limiting the use of a microscope.

Lighting Your Work

It is now feasible to work in a small dark place with precise instruments that generate better results.

The Eclipse micro versus the more powerful mini light is a comparison that keeps coming up. It is a personal preference, I like the brighter (mini). You want to be able to see all depths of your preparations and their characteristics, especially in an endo tooth looking for the MB2 canal or the distal margins and their lateral borders in Cl2 and Cl3, inlay/onlay and crown preparations. A standard operatory light is not effective enough. You need an even, bright light during all your procedures.

You need more magnification and light than the standard operatory light in all your procedures to allow proper decisions especially with deeper small margins in posterior teeth.

Clinical Ergonomics

TTL loupes with increased declination angles enable better ergonomic postures. Well made, custom, ergonomic loupes result in comfort, accuracy, personal longevity, alleviation of neck and back issues, great dentistry and work satisfaction,

Ergonomically you want to limit motion. Unnecessary neck and arm movements negatively affect your neck and spine. This often occurs as you try to work with dental chair lights overhead or mounted, under low light conditions that don’t allow proper visualization. This results in using neck, shoulder and arm movements that are unbalanced postural movements which may negatively affect your neck and spine.

When changing from a lower magnification to a higher magnification, you may notice the depth of field will be tighter and you will stop leaning into your subject. The unintended benefit from this is sitting straighter in the chair with less movement. Be sure to work with the knowledgeable technical representative measuring you for loupes to get this working distance measured exactly. This measurement will assure comfort.

Clear vision with a good light ensures you sitting straighter with limited movement. Neck, shoulder and back issues may start to occur at any age in dentistry. They can generally be eliminated with an ergonomic dental posture created with a proper light loupe combination.

When comparing a 2.5x magnification loupe to an 8.0x magnification loupe, it is obvious the best tool is the one that allows for the greatest magnification and illumination. I recommend the brighter SurgiTel light as you can always turn a bright light down. I recommend moving up to a higher magnification as seeing well-defined items are most important. Ergonomic comfort is created with correctly customized loupes. Loupes are a professional tool, master the best tool.

Better Outcomes Through Better Visualization

Every day is a new learning experience. Some miss out. A great number of dentists do not want to wear their loupes or lights because they believe that are heavy, awkward, hard to get used to etc. Some believe that your handpiece produces enough light (only during tooth preparation), but this is only active <15% of the time. For those who have purchased a quality pair of loupes, had them custom fit, and work through the learning curve – they can testify the benefit of loupes far outweighs giving up on the idea. Unfortunately, some may have purchased poorly made loupes or lights with poor visualization. This is not a reason to declare that loupes as a whole don’t work. A well-made combination of the light/loupe TTL will give you a quicker, more precise diagnosis and complete accuracy to your tactile hand movements. The correct use of the specific tools will simply lead to quality outcomes ie: better dentistry.

You can create real value and mastership by using your loupes all the time, not just part of the time. Patients recognize loupe usage as it demonstrates the value you place on your work.

Foresee the end result you expect and then determine how your instruments are to be employed. You may foresee the following which is not possible without high-end magnification and lighting:

• Implant screws placed into the opening without dropping them
• Endo size 06, 08, 10 into the MB2 opening visualized and treated
• Margins on every tooth are seen clearly
• Removal of decay – not just some of it (decay may be left in place, treated and sealed for healing/repair without an exposure) – better visualized and accomplished under magnification.
• Proper placement layering of restorative materials limits waste and saves money and time
• Conservation of bone upon tooth removal with careful placement of allografts, membranes, PRF and sutures make for great end results
• Smaller preparation – conservative dentistry
• Finishings, closure of the margins, diastemas, Cl3 small chamfer shoulder finishing is easier when you can see the margin. Peg laterals – the illusion of making the restoration disappear. Feather margins polished microfills disappear.

At times, you may work without anesthesia or minimal anesthesia. Work done in fractions of a mm ie: half a millimeter or 50 microns will become commonplace.

With increased loupe magnification the ability to finish with minimal tissue abrasion/bleeding becomes routine. Margins can be finished with little or no bleeding utilizing proper cord techniques, astringents and fine diamond margin finishing. This results in less time spent, less blood products present on the impression and a cleaner margin for the lab to address. (See Figures 1 through 5)

You can see it all. There will be no searching with explorers anymore with all those movements wasting an enormous amount of time trying to guess what is present.

Results and benefits:

• Good declination angle means ergonomic comfort – you will have less back and neck issues
• Greater magnification can allow better posture and can cover an ergonomic working distance while achieving enhanced vision
• Greater magnification in a quality loupe simply means much greater visual acuity
• A light with adjustable intensity, an even achromatic beam, and a co-axial position will all enhance your visualization

Irrespective of the magnification or learning curve, you will find a comfort level with quality loupes/lights. You will eventually not be able to work without loupes and lights and as you upgrade in magnification power simply keep your previous loupes as backup.

Final notes:

• Redundancy, 2 sets of loupes lights and batteries are necessary
• You will limit questions if you have loupes and light
• If you can see it you can do it
• Loupes/lights enable you can see what was once impossible – we simplify complexity by seeing it
• Loupes enable you to see accurately, increasing precision and making you a better practitioner
• See it, diagnose it, treat it – use your loupes every time all the time for every single patient
• The system is there to benefit you and your patient
• Benefit from SurgiTel Loupes’ unique higher magnification powers
• Upgrade and be amazed at what is possible

George Grayson BSc MSc DDS FAGD
Windsor Ontario Canada