Use of Microscopes and Other Magnification Techniques – AAE Position Statement

Access additional resources at www.aae.org proficiency standard (4.9.j) to the CODA educational standards for endodontic programs in 1998. Standard 4.9.j was revised by CODA in 2005 by ubstituting “use of magnification techniques” for the previously phrased “use of microscopes,” and adding an intent statement that the standard is designed “to ensure that residents are trained in use of instruments that provide magnification and illumination of the operative field beyond that of magnifying eyewear, including operating microscope, orascope or other developing technologies.” The standard also raised the “level of knowledge” that a program must provide in magnification from “understanding” to “in-depth” which is the highest of
the three levels of knowledge.

Outcomes studies: magnification techniques. There is not a large body of clinical research comparing endodontic outcomes based on magnification techniques, and the research that exists involves relatively small sample sizes. The challenge of designing such studies lies in the many variables encountered in performing non-surgical endodontic procedures. These variables include the skill
of the practitioner, the morphology of the tooth, the type of irrigant used, the size of the lesion present, various anatomical aberrancies that may exist within the tooth, and many other complicating factors. Recall examinations arealso a problem with these studies.

Use of Microscopes in Endodontics:
General
The following procedures benefit from the use of the microscope:
• locating hidden canals that have been obstructed by calcifications and reduced in size;
• removing materials such as solid obturation materials (silver points and carrier-based materials), posts or separated instruments;
• removing canal obstructions;
• assisting in access preparation to avoid unnecessary destruction of mineralized tissue,
• repairing biological and iatrogenic perforations;
• locating cracks and fractures that are neither visible to the naked eye nor palpable with an endodontic explorer; and
• facilitating all aspects of endodontic surgery, particularly in root-end resection and placement of retrofilling material.
Additional benefits of the OM include the facilitation of enhanced photographic documentation and improved positioning ergonomics for the operator Conclusion
The OM is an important addition to the armamentarium of modern endodontics. It helps set the bar of excellence at the highest level. The AAE mission statement encourages its members to pursue professional advancement through “the implementation of technological advancements into clinical practice as they are introduced to and accepted by the specialty.”
The introduction of new technologies into any area of health care involves a transition period where individual practitioners evaluate the cost and benefit of integrating the new technology into their practices. For endodontists who were trained without microscopes, this varies based on a number of factors, including stage of career and time required for training in the new technology.

Current
graduates of endodontic residency programs immediately employ the use of OM’s upon their transition from educationto clinical practice. Recognizing these differences, the AAE encourages all
practicing AAE members to learn about the benefits of microscopes in patient care and pursue training if they determine it will benefit their practice. The AAE anticipates that over the next 10 years, as endodontists trained without microscopes retire, the percent of endodontists using microscopes in private practice will approach 100 percent. Universal adoption of the OM is a function of time.

Advances in endodontics over the past 20 years have been widespread and far-reaching. Endodontists now help patients retain teeth that would have been extracted in the past. The AAE expects that advances in magnification technologies and other treatment modalities will continue to improve endodontic outcomes in the years to come. The position of the AAE is that the microscope is an integral and important part of the performance of modern endodontic techniques.

References