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Good Reasons why to use a Dental Microscope – Interview with Endodontist Dr. Thorsten Wegner

“The microscope can turn the treatment plan upside down.“

With its high magnification and coaxial illumination, a dental microscope provides enhanced visualization that supports diagnosis and treatment. Its documentation capabilities also play a major role in a modern dental practice by supporting patient consultation.

We interviewed Dr. Thorsten Wegner, an endodontist based in Stadthagen, Germany, to find out why he uses the microscope in all aspects of his dental practice.

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How long have you been working with a dental microscope? Why did you decide to buy one?

Dr. Wegner: I’ve been working with the dental microscope Leica M320 for five years now. My decision to buy one resulted from a visit to a trade fair and conversations with a colleague, which convinced me of the benefits I would gain from using a dental microscope in my endodontic practice. I quickly appreciated the advantages of the ad hoc documentation. Instead of the complicated procedure of examining a patient, taking photographs of the findings with an intraoral camera and then discussing them with the patient, I can now look through the microscope from the beginning, taking photos during the examination and discussing them directly afterwards with the patient without having to get out a camera first.

Which treatment do you use the dental microscope for?

Dr. Wegner: Beginning with the examination and the diagnosis, I use the dental microscope in all aspects of my work, particularly in restorative and prosthetic dentistry and endodontics. The microscope is a real gain in many procedures: complicated extractions of root fragments, for instance, are much easier to do with a microscope.

In the case of root tip resections, we have focusing difficulties due to the restricted access to the retrograde portions with a loupe and a mirror.  The loupe magnification just isn’t high enough to see really well. Using a microscope, I can choose between an 8x, 16x or 20x magnification to see exactly what I want. It’s amazing the things you thought you could see before and the things you actually see today with the microscope! 

I can illustrate the advantages of the microscope in two really simple examples that I encounter in my practice every day: performing fillings involving an occlusal filling area and preparing a tooth for a crown. When we do a filling involving an occlusal filling area, we always encounter the problem of fissures in the tooth. These fissures may already be infected, i.e. carious. This is something you can’t generally tell with the naked eye. Even loupes don't provide a hundred per cent clarity. With a microscope, on the other hand, I can decide exactly how wide the filling has to be to ensure that all the decay has been removed from the fissure area as well.

The second example is a tooth for a crown and making a build-up filling. In these cases there are often micro-fractures at the bottom of cavities or at proximal wall surfaces, factors that may rule out the option of full or partial crowning. The extra visual information provided by the microscope may lead you to rethink your therapy plan, or realize that the tooth cannot be saved. For example, if you detect a fissure at 1/5 that extends from the interdental gaps to the bottom of the cavity, you have to extract the tooth rather than using a pin superstructure and replace it with an implant.

In such cases, the entire therapy plan is turned upside down by using a microscope. So the microscope can also help to avoid failures.

How do you use the documentation facilities provided by your dental microscope?

Dr. Wegner: The technical features of the Leica M320 are outstanding. The documentation facilities prove extremely useful for taking photos for prostheses, for example. I can send these to the lab and easily make arrangements with the team there.

Another great benefit of the documentation facilities is, of course, the opportunities they offer for communicating with the patient. I can photograph a tooth and show the patient why we don’t think it can be preserved, the photo makes it easier for the patient to understand. In that moment, the patient instantly realizes how useful the microscope is and appreciates the quality orientation of our practice.

We use a 40-inch display, and can show patients not only the images, but also, due to the capabilities of the camera – enlarged image details. Yet another reason why the integrated camera of the Leica M320 scores over that of other manufacturers is hygiene. The uniform surface and splash protection mean that the microscope can easily be wiped clean with disinfectant.

How do you rate the illumination concept of the Leica M320?

Dr. Wegner: In our practice we have six treatment rooms and an operating room, which previously meant a lot of light bulb changing. This is no longer a topic thanks to up to 60,000 hour lifetime of the LED illumination. I prefer the color of the LEDs to that of the halogen illumination, too. And there’s one thing you mustn’t forget: a microscope has to suit the needs of practitioners of all ages, so the ability to continuously adjust brightness is extremely important.

The older you are, the more illumination you need, and that’s why I’m glad I have the option of reducing the illumination. A 50-year-old needs twice as much illumination power as a 25-year-old to be able to see the same image equally sharply.

The Leica M320 offers so much light and such fine adjustment that I always feel adequately equipped, whatever the situation.