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Endo tips    Better Endo    Endo abstracts    Endo discussions

Microscope and quality - Courtesy ROOTS
The opinions within this web page are not ours. Authors have been credited
for the individual posts and images where they are.

From: Roy Bloom
Sent: Tuesday, February 27, 2007 9:25 PM
To: ROOTS
Subject: [roots] Scope and quality

Is there anyone out there that does excellent endo using only loupes? 
Is there anyone out there doing endo without any magnification?  
Is there anyone that just uses their zoom function on their intra
oral cameras? It is amazing how in just a few short years all the endo 
over the past decades are below standard of care.

		Sure.  I'm sure there are old guys out there doing excellent 
		stuff without a scope. 		I'm an old guy and it sure as hell 
		helped me tremendously.  - Guy

As an aside I found all those MB2ís recently with no magnification and 
no eye protection what so ever. I just used a mirror and a #2 round.

		But what did you miss? - Guy

I still think most endo cases are easy. Some are not. Sure would be 
cool if you could fill them with an expandable MTA material like that 
foam in a can.- Roy Bloom DDS

		All endo is hard until proven easy and only time post op will 
		prove how easy it was.  Guy

Roy,  I am not a dentist and I am sure that there are endodontists who 
do excellent endo using only loupes. 		The reality is that they 
would do even better with a scope. In almost every endo program in the 
country, 		the use of the scope is quickly becoming "standard of care"  
So if you are depending on referrals, 		I'm sure that most GPs would 
consider it a plus and would prefer to have their patients treated
by a scope using endodontist.

I can tell you that in Sao Paulo Brazil, we  have a dental school who 
provides a scope for every GP 		in the Dental Program. I actually have 
pictures of it. From what I understand, they don't even start with loupes, 
just the scope.

For the record, If you had a 3x set of loupes and you had your scope set 
on the 3x setting, the scope 		image would look similar to a >4x from
a pair of loupes. You talk about going to an 8x set of loupes. I have only 
heard the highest that any dentist ever used is a 6X. The dentists I work 
with on the scope, 		do most of their endo on  either 8 or 13x  I think 
you would agree that the larger the image, the better you can see and we 
all know that you have to see it to treat it.

Stefan Luger, Microscope Consultant and Trainer


DVF makes TTL 8x.the fiber optic will put a circle of bright white light 
at the end of a long hallway. 		I really want the scope to work. I will 
try more tomorrow. I had a good case with #4..just had too many surgery 
patients with IVís to participate in a learning curve. Thanks for the great 
tips today! 		It really is a great entry level scope! I will say I 
do not like having to roll it around.tomorrow I will lock the wheels once
I have it set up for me. - Roy Bloom DDS

		Use the loupes for surgery and the scope for endo.  - Guy

Roy, it is a challenge to conquer the learning curve with a scope so you have 
to ask yourself if you are willing to do so.  If this is the case then either.

1. Go to AMED and take a hands on course
2. Go to NCOFI (Newport Coast Oralfacial institute ) and take a hands on 
   course on a weekend    and if you buy a Global scope they will often include 
   this as part of your tuition.
3. I have a DVD that does help for sale
4. Have Stefan come out and do a one day training for you.

Microscopes help with 4 main areas:

1. They will improve the precision of the treatment you provide in all areas 
   of endo, there are lots of positive studies    comparing loupes or no mag 
   to the scope for finding canals.  All but one find the scope to be superior.
2. They will improve your ergonomics compared to loupes.
3. They will improve your documentation through video and or still photography.
4. They will improve  your ability to communicate with patients through the 
   video that you can attach.

You need to slow down though initially and this is tough for some people to do.  
In the end you will find that your speed will pick up but to conquer the learning 
curve you need to stick with it.

I hope that this helps you and scope really will change the way you view your 
profession (pun intended) - Glenn

From: "Dr. Glenn A. van As"
To: "ROOTS"
Sent: Thursday, March 01, 2007 9:57 AM
Subject: Re: [roots] Scope and quality

Here is some literature for you folks that I have compiled.  It is the lit on 
magnification and the scope primarily for endo.

I dont mind you using it but please for gosh sakes, put credit in your lectures 
for my industrious work. I hate seeing my slides uncredited in others lectures. 
Thanks - Glenn van As

Dr. Glenn A Van As I am not a dentist and I am sure that there are endodontists who do excellent endo using only loupes. The reality is that they would do even better with a scope. In almost every endo program in the country, the use of the scope is quickly becoming "standard of care" So if you are depending on referrals, I'm sure that most GPs would consider it a plus and would prefer to have their patients treated by a scope using endodontist. I can tell you that in Sao Paulo Brazil, we have a dental school who provides a scope for every GP in the Dental Program. I actually have pictures of it. From what I understand, they don't even start with loupes, just the scope. For the record, If you had a 3x set of loupes and you had your scope set on the 3x setting, the scope image would look similar to a >4x from a pair of loupes. You talk about going to an 8x set of loupes. I have only heard the highest that any dentist ever used is a 6X. The dentists I work with on the scope, do most of their endo on either 8 or 13x I think you would agree that the larger the image, the better you can see and we all know that you have to see it to treat it. Stefan Luger - Microscope Consultant and Trainer Good morning Stefan, I would like to clarify that the project that you are talking about was developed by me (when I was a scientific advisor for DFV many years ago ( year 2000) and unfortunately it is no longer active. This was the first undergrad clinics full equipped with microscopes in the world! The Professor that was active at the School was Professor Bramante (on my letf) the head of the endo department and we had 1 microscopes for every dental chair on the clinical floor. It was a beauty but the problem was that the Professors didn't like the microscopes.....- Carlos Murgel

Oh man, where have we heard that on ROOTS before! That was ME ! After 15 years of Endo practice, I had exactly the same attitude. I was BU guy, doing good work. I was using loupes. I thought I was pretty good. The scope was unnecessary. Overkill. Who needs it? I attended ROOTS Summit 1 and 2 demos and could no longer make excuses I simply could not avoid what my eyes were telling me. I got one, then a second and then a third. I couldn't believe the crap (literally) that I was missing. I couldn't believe how it helped diagnostically and clinically. The fact is: You can't treat what you can't see. and you may THINK that you're seeing well but you're really aren't. Just finished a chipped lower incisor this a.m. Old trauma, big canal, prior emergency access. . WL file 30+ close to RT at the start. I thought this was a slam dunk.. Cleaned and shaped it and was ready to pack. Checking it again, instead of a big apex I was looking straight down a 16 mm canal at 2 distinct formina and the PDL. Fit 2 cones and packed them. Loupes? Never would have seen that the one fat canal had two distinct foramina. Not enough light, not enough magnification. If you're not finding MB2 ( in one form or another) in 95%+ of maxillary first molars - you're missing em. I'm with Mark on this one. You can do good work w/o one.....but you do your BEST work with one. And I'll never work without one again. Damn Sure. (Glenn Van As....stop laughing at me ! :-)) - Rob K Rob: I mean this, I was talking to someone in Chicago at the Midwinter last week who was from Winnipeg, and I told him what a hero you are to me. You had practiced for 15 years and saw that you could improve. How many others would. You are one of my biggest mentors, you have improved unbelievably in your endo. I mean that. You are gifted with words, giving with your time( Roots summaries) and work so hard to be the best that you can be. My friend, I will never laugh at you, its case studies like yours that make it all worthwhile for me and one of the reasons I try to always think to keep an open mind. You did, I should! Cya and all the best buddy - Glenn Agreed Robby-bobby. Actually, 95% is a slightly low estimate. I wouldn'a believed it until I started troughing the triangle of dentin between the MB and the P canal. BTW, the point of the triangle extends MESIALLY, not the other way around. Without the scope, this is all talk, and possibly meaningless to you. And... it takes some acquired skill in addition to the scope and a good ultrasonic h.p., etc. And Roy, just because scope-assisted endo has raised the bar doesn't mean non-scoped endo is worthless; ... but it's plainly not worth as much as it could be. Like Rob said, until you are using the scope and finding 95% PLUS MB2's in max 1st molars and over 50% in max second molars, you probably won't believe it either. From your responses, it is clear that you don't believe it now. An MB2 that is visible on the unsculpted pulpal floor is a GIFT. They are not all that easy. ...? where have i heard that word before??? And BTW, it may be a year or 2 before you are using the scope well enough to experience this. I got my scope in 1995 and i b'lieve it was a few years after that before I was finding non-textbook numbers of canals with regularity. Of course, the regularity may have come from eating more prunes with my breakfast... You will also agree that the number is NOT predictable, but without a scope you will never know for sure whether it was there or not.- wes Rooters, I knew when I posted my comment about using loupes vs scope what I was up against on this list. :-) When I quoted the 60-80%, I was grouping 1st and 2nd molars and I am including those canals that I can fully instrument. (I'll have to track my exact numbers in the future.) One thing is finding them....another thing is getting into them fully and treating them. Here's my question to you guys-- What percentage of these MB2s are you fully treating?? How does the scope help you in this area?? Using 4.2x loupes, there are cases that I can 'see' but can't get in despite extensive use of ultrasonics, round burs, EDTA, etc. I have found that if I can't get a 'stick' with a 27 gauge sharp tuberculin needle as an explorer, I can't get in. (I use a tuberculin 1cc syringe with a very sharp 27 gauge needle from Henry Schein Medical to irrigate canals with EDTA and find/explore with the needle...works better than a DG-16 explorer for me. Check them out....a box of 100 with needles is $18.00) What tricks are there to getting into these 95% MB2s? Can 95% truly be instrumented? Your help at getting to my true best is appreciated.- Glenn

Nice curves in mesial canal

Apical periodontits

Type III dens case

5 canaled molar

necrosis periradicular..

Triple paste pulpectomy

Endo cases - Marcia

"C" shaped canal anatomy

Psycho molar

routine case

straight lingual

Doomed tooth

another molar

Tooth #36

Instrument removal

Tooth #27

Mark Dreyer cases

Troughing case

6 year recall

9 clinical cases

Flareup after best treatment

Fred Barnett cases

Cases by Marga Ree

Glenn Van As cases

Sashi Nallapati cases

Cases by Jorg

Terry Pannkuk cases

New dental products II

New dental products

Difficult retreatment

Canal anatomy 46

Freak case

huge lateral canal

Separate MB canal

Crown infraction

5 year recall

Palatal canals

TF retreatment

Fiber cone

Bio race cases