Operating microscope in endodontics: A systematic review

doi:10.4236/ojst.2013.39A001

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Open Journal of Stomatology, 2013, 3, 1-5 OJST

http://dx.doi.org/10.4236/ojst.2013.39A001 Published Online December 2013 (http://www.scirp.org/journal/ojst/)

Operating microscope in endodontics: A systematic

review

Carla Cabral dos Santos Accioly Lins1*, Elma Mariana Verçosa de Melo Silva2,

Georgina Agnelo de Lima2, Silvio Emanuel Acioly Conrado de Menezes3,

Rosana Maria Coelho Travassos3

1Center for Biological Sciences, Department of Anatomy, Federal University of Pernambuco (UFPE), Recife, Brazil

2Department of Prosthetics and Oral and Facial Surgery, Faculty of Dentistry, Federal University of Pernambuco (UFPE), Recife,

Brazil

3Department of Endodontic, Faculty of Dentistry, University of Pernambuco (FOP/UPE), Recife, Brazil

Email: *[email protected]

Received 16 August 2013; revised 16 September 2013; accepted 2 October 2013

Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is

properly cited.

ABSTRACT

The objective of this study was to systematically re-

view the literature about the use of the operating mi-

croscope in endodontics. It used sources of biblio-

graphic cataloging electronically identified by MED-

LINE via PubMed, LILACS, BBO and Scopus, using

as descriptors: Endodontics, anatomy and micros-

copy. The selected articles were identified from the

titles and abstracts, taking into consideration the fol-

lowing criteria: publications ranging from January

2001 to November 2012, case reports, published in an

indexed journal, and publications in English language.

The search showed 167 articles related to this topic,

and these 21 articles met the inclusion criteria. These

indicated that a higher magnification helps coronary

access and the location of channels to identify and

interpret the complexities of the anatomy of root ca-

nals, the removal of nuclei and intracoronary frac-

tured instruments, to minimize trauma of surgeries in

soft and hard tissues, and detect fractures and mi-

crofractures. It was found that its use has provided

Endodontics with a significant improvement in vision

of the operative field, offering better quality jobs and

a higher success rate.

Keywords: Endodont i cs; Anatomy; Microscope;

Systematic Review

1. INTRODUCTION

The knowledge of dental morphology, location, cleanli-

ness and formatting of the root canal system (RCS) are

prerequisites for successful endodontic treatment. Varia-

tions in the number, morphology of roots and root canals

are constant challenges to obtain satisfactory results in

Endodontia [1].

Currently, in order to progress in the quality of treat-

ment, the endodontist has been seeking support for new

technologies to help you achieve success. The Operating

Microscope (OM) has been used to minimize the obscu-

rity of the operative field favoring better quality results

[2].

The OM Endodontics was introduced in the early

1990s by Gary Carr [3], and their study was the basis for

several other authors deepen research on its use in

Odontology [2]. Its incorporation in that specialty had

profound effects on how to work the endodontist; For

this reason, in 1998 the American Dental Association has

requested that all graduate programs in the United States

should teach the use of the microscope in nonsurgical

and surgical endodontics [4].

Considering this scenario, the OM emerges as a tool

that offers many benefits such as better lighting, magni-

fication and visualization of the operative field [5]. The

high magnification helps coronary access and the loca-

tion of channels to identify isthmuses, to interpret the

complexities of RCS anatomy, the removal of intracoro-

nary nuclei and fractured instruments, to minimize trau-

ma of surgeries in soft and hard tissues, and detect frac-

tures and microfractures [2,6]. In addition, their use gives

the dental surgeon a working position more comfortable

and ergonomic, reducing fatigue and stress, and cones-

quently, increasing work efficiency [7].

The aim of this study was to perform a systematic re-

*Corresponding a uthor.

OPEN ACCESS

C. C. dos Santos Accioly Lins et al. / Open Journal of Stomatology 3 (2013) 1-5

view of the literature on the use of OM in Endodontics,

trying to focus on how this new technology is being used

by experts during the execution of their treatments.

2. MATERIALS & METHODS

It were performed a literature review of the past decade

in scientific search engines described below: PubMed (a

service of the National Library of Medicine, USA),

available at electronics www.ncbi.nlm.nih.gov/pubmed,

Bireme (Virtual Health Library, a specialized service of

the Pan American Health Organization), specifically in

the databases Medline, Lilacs, available at the website

www.bireme.br and Scopus, available on the website

www. info.sciverse.com/Scopus, using as descriptors in

Portuguese: Endodontics, anatomy, microscopy, and as

descriptors in English: Endodontic, Anatomy, Micro-

scope.

The literature review performed was the systematic

type, being adopted the following inclusion criteria: 1)

publication in an indexed journal; 2) publications ranging

from January 2001 to November 2012; 3) articles in

English and 4) case reports. The exclusion criteria were:

1) in vitro studies; 2) works of literature review; 3)

paraendodontic surgery, and 4) articles in languages of

non-English origin. The articles related for the search

were selected by two independent reviewers, evaluating

the adopted criteria for inclusion and exclusion.

3. RESULTS

In databases consulted it was found in a total of 167 arti-

cles. The articles selected after methodological analysis

were twenty-one. Figure 1 illustrates the design process

of distribution of articles for the systematic review ac-

cording to the methodology employed.

The included studies that enabled the analysis of the

use of operating microscope in endodontic treatment are

described in Table 1. The selected articles were organ-

Figure 1. Distribution of articles for systematic review.

ized regarding: the author, year of publication, the tooth

in which was performed the endodontic treatment and

the treatment stage in which the OM was employed.

After analysis of twenty-one selected articles, it was

observed that in 2001 and 2009 it were not found publi-

cations which met the inclusion criteria proposed in this

research. In the years 2002, 2004, 2005, 2006, 2008, oc-

curred one publication per year, two in 2003, three in

2007 and 2010, occurring an increase in 2011 and 2012,

in which four publications dealt with the subject of this

study each year.

4. DISCUSSION

The knowledge of the complexity of the internal anat-

omy of the RCS is a permanent challenge to the endo-

dontist. Proper cleaning, shaping and obturation are the

requirements for successful endodontic treatment. Cur-

rently new features are available to the dental surgeon,

which adds the po ssibility to better understand th e details

of the pulp cavity [8,9].

The OM is a tool that has characteristics of stereo-

scopic vision and coaxial illumination, and those when

associated with magnification facilitate the achievement

of the clinical procedures [5]. The biggest impact of this

innovation is that it allow an increase of 8x to 16x, and

may even offer higher magnifications with 32x and 40x,

which are used to examine finer details [4,5,10]. Another

important aspect is that it can be adapted to a photo-

graphic camera, a video camera and a videoprinter,

which offers a best dental record and helps in patient

education [2].

After analyzing the twenty-one items selected, it was

observed that there was an increase in the number of

publications in 2011 and 2012, of four jobs each year.

This fact may be related to increased acquisition of this

equipment by specialists in endodontics, contributing to

a greater number of publications.

In the studies it was observed that there was no stan-

dardization in the step of the procedure or technique in

which the operating microscope was used, the same be-

ing used in different stages of treatment in access to the

pulp chamber [8,11-16], and the observation of the floor

and location of the root canals [8,9,13,17-26] in viewing

artifacts inside the root canal [8,16,27-29] in perforation

closure [29] and the placement of the intracanal medica-

tion [19] .

Regarding to the use alone or combined with other ins-

truments such as ultrasound tips, cone beam computed

tomography and optical fiber, among the authors it was

not observed a consensus associated with the use of OM.

In ten studies it was used only the microscope [12,13,

16,18,20-26] and in eleven the combination with other

tools [8-11,14-19,23,27-19]. Emphasizing in the articles

that its use was performed according to the clinical

C. C. dos Santos Accioly Lins et al. / Open Journal of Stomatology 3 (2013) 1-5

Table 1. Studies included in the study that allowed the analysis of the use of the operating microscope in endodontics.

Author/Year Dental element Treatment step for the use of operating microscope.

1.Sachdeva et al., 2012 41 Observation of the floor of pulp chamber and root canals location.

2. Silva; Zaia, 2012 22 Access to the pulp chamber.

3. Narayana; Wallace; Nair, 2012 12 Access to the pulp chamber; Placement of intracanal medication.

4. Nunes et al., 2012 12 Visualization of artifact inside the root canal; Perforation closure.

5. Kaneko et al., 2011 12 Access to the pulp chamber.

6. Karumaran; Gunaseelan;

Krithikadatta, 2011 24, 14 Access to the pulp chamber; Observation of the

floor of pulp cha mber and root canals location.

7. Kottoor; Velmurugan; Surendran, 2011 26 Observation of the floor of pu lp chamber a nd root canals location.

8. Ianes et al., 2011 46 Access to the pulp chamber; Observation of the floor of pulp chamber

and root canals location; Visualization of artifact inside the root canal .

9. Kottoor et al., 2010 16 Observation of the floor of pulp chamber and root canals location.

10. Karthikeyan; Mahalaxmi, 2010 26 Observation of the floor of pulp chamber and root canals location.

11. Kottor; Sudha ; Velmurugan, 2010 46 Observation of the floor of pulp chamber and root canals location.

12. Cunha et al., 2008 22 Access to the pulp chamber.

13. Kontakiotis; Tzanetakis, 2007 36 Observation of the floor of pulp chamber and root canals location.

14. Tzanetakis; Lagoudakos; Kontakiotis, 2007 25 Observation of the floor of pulp chamber and root canals location.

15. Sathorn; Parashos, 2007 13 Access to the pulp chamber.

16. Yilmaz et al., 2006 16 Observation of the floor of pulp chamber and root canals location.

17. Moor; Calberson, 2005 15 Observation of the floor of pulp chamber and root canals location.

18. Jung, 2004 12 Observation of the floo r of pulp chamber and root canals location.

19. Ward; Parashos; Messer, 2003 16, 36 Visualization of artifact inside the root canal.

20. Ward, 2003 16 Visualization of artifact inside the root canal.

21. Girsch; McClammy, 2002 11 Observation of the floor of pulp chamber and root canals location.

experience of the operator or the need for each treat-

ment.

When there is a deficiency in some stage of endodon-

tic treatment is required reintervention [1]. One of the

selected articles reported retreatment of upper and lower

first molars, describing that the microscopic analysis was

more effective in detecting and removing debris, but also

allowed the location of additional channels [8]. In two

other studies conducted in the upper anterior teeth the

operating microscope was used for retreatment of dens

invaginatus and perforation closure [16,29].

OPEN ACCESS

The main question regarding its use is due to high cost,

and the training time required for its handling, however,

the authors stated that once overcome the training time

and learning, there is an improvement in clinical proce-

dures allowing the solution of situations that would not

be possible without this tool [1 0].

Many researchers had the same opinion that OM is

helping much in Endodontics, for providing great light-

ing and better visualization of the operative field [12,

18,22]. Thus, with high magnification is possible to im-

prove the ability to communicate with th e patient and the

technical skill, thus seeing the tenuous boundaries re-

sponsible for the failure or success of the procedure [5].

5. CONCLUSION

The anatomical complexity of root canal system in the

context of en dodontic therapy is always a ch allenge. The

results from the present study reveal that the OM has

been increasingly used as an instrument of labor among

endodontists. It was found that its use has provided en-

dodontics with a significant improv ement in vision of the

operative field, offering better quality jobs and a higher

success rate.

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