PROBLEMS OF ILLUMINATION
Getting enough light is a frequent challenge.It has been said that we treat what we see, and with greater light and magnification we see more. Here are some simple approaches and technology that elevate the prospects for excellent outcomes.
There is a battery-powered clone to the above that offer equivalent utility at a much lower price, less than half the cost, and with no unwanted heat..A good model is the ADDENT Microlux, (www.Addent.com)a LED, cordless illuminated mirror which does double duty with an included powerful transilluminator tip.
HANDPIECE FIBER OPTICS A fibre optic handpiece with the turbine locked and no water flow can be useful to inspect a dark and inaccessible prep.Sometimes an unrotating fiber optic handpiece head applied to the buccal surface will transilluminate cracks see Cracked teeth and decay at the mantle dentin interface, i.e., the DEJ, see also Caries detector to reveal caries
PAROTID SHIELDS — SILVERED DRI-ANGLES OR RICHMOND REFLECTIVE SHIELDS PLUS
These are an unobtrusive source of extra reflected light. Always specify the silvered products rather than the plain shields for this reason. Additionally, the silvered Dri-angles are stronger when soaking wet, because the silver backing reinforces the absorbent layers, protecting the cheek better and preventing sloughing of absorbent into the operating field..
Normally Dri-angles are used in the buccal vestibule. However they can also be placed in the lingual vestibule against the Hygoformic, see Hygoformic saliva ejector providing a thin, illuminating and absorbent source of isolation of the lingual vestibule.
Those who have them swear by them. In the early 2000s I steered clear of their expense, unwanted heat, short bulb life, a tangle of cords, and weight upon the bridge of glasses or a muss-your-hair-up- headband. Significant improvements have been made in the last decade since the adoption of LED light sources paired to lithium ion batteries. I still have a pair on hand for those special cases where something of importance cannot receive light with the above approaches.. If I were an oral surgeon, looking for root tips, I wouldn’t live without one.
In the meantime we have to use all of our other senses – the explorer with discriminating touch, manipulation of the operative lighting to reveal form indirectly through highlights, and caries detector painted on surfaces to reveal topography and test for defects. Vision alone is not our only sense.
In the last ten years loupes have become the standard for visual acuity in general dentistry. Now loupe use and the accompanying ergonomic and posture training are part of first year dental school training, beginning with Dentaform models.
This is a welcome trend and, as suggested above, direct composite resins are probably the biggest visual challenge among dental materials because of tooth-like shades and transparency of resins and bonding agents, so unlike the high contrast margins of gold or silver amalgam.
The operating microscope has begun to occupy a place in general dentistry. Of course it has its own built-in powerful halogen light source. Originally confined to endodontic and laboratory use, its applications are now expanding. The better microscopes retail at high prices but used ones can be found at a relative bargain. Practitioners who use them swear it is the appropriate realm in which to practice because our dental world is inherently so detailed. Elusive fourth canals in endodontic treatment of the upper first molar are said to be a breeze to locate under the scope. Loose crown abutments, faulty crown margins, sub gingival calculus in root furcations, cracked roots, and inspecting crown prep margins all become easier. Because it is furnished with its own powerful light source, it opens up new potential for visibility in composite resin dentistry, to:
- Assess cavity debridement prior to bonding
- Check band adaptation to gingival margins
- Check gingival margins for enamel integrity
- Assess margins post-operatively for flash
- Detect bond residues post-operatively
- Examine restorations with signs of failure
- Check for cracks in marginal ridges and other signs of failing enamel
Like most new tools in our profession, new and better applications develop once the tool becomes available. One unanswered question is whether it is much help in situations requiring indirect vision, because of the shallow depth of field inherent in super-magnification.
INTRAORAL DIGITAL CAMERA
High magnification and bright illumination from I/O cameras bring details into sharp relief. As well, because the CCD of these cameras is usually calibrated to exaggerate contrast, unwanted flash and other finishing irregularities virtually leap out at you.
In many offices, I see the I/O camera on its cart, in the hygienist’s room, gathering dust. In my office, I have taken pains to integrate it into my chairside set up. I disposed of the stock wand mount and instead hang it on the handpiece bar besides the turbines. The foot -operated capture pedal is ergonomicly placed so that it is effortless.It is ready to use at a moment’s notice to check small preps and any other restorative dilemma where loupes do not offer enough magnification. Some patients also like to be included in the restorative process.
Another process which has been an eye opener for this writer is digital photography of everyday procedures and magnification through computer cropping and projection. I would suggest this step for any practitioner wanting to become constructively objective about their quality of work.
It has been said that we treat what we see, and with high light and magnification we see more. I have worked under 5.25x loupes for the last ten years, and have used all the above modalities. These have provided welcome acuity, but there is no denying that perfect finishing of composite is one of dentistry’s more demanding challenges.Thankfully the many devices above can help us see better than in the past. See also Caries detector to identify flash, voids, bubbles and irregularities
The point of all this is to say that dental offices have many simple devices at their disposal to increase visibility in their composite procedures. The goal of this page is to encourage their use to full advantage. If the I/O camera is well-located chairside, it is a powerful tool. It can be recruited into the armamentarium of general restorative dentistry: to help locate root canal orifices, examine crown prep margins, look for caries in operative preps where access is limited, and in our context, to critically review any aspect of dentistry from prep to polish. Of course it will always be a powerful communicator for those patients that can handle seeing their teeth, which is not everyone by any means!