Enhanced Visualization in Periodontal Therapy: A Clear Picture of Better Patient Care
Magnification

Enhancement of visual acuity through the use of magnification loupes is common in medicine and dentistry.²⁷ Loupes can provide magnification of 2 to 8x magnification and are used extensively during dental therapies, including nonsurgical and surgical periodontal therapies.²⁸ There are two general types of loupes that are used in dentistry: Galilean loupes and Keplerian (or prismatic) loupes.²⁸ Galilean loupes are composed up a set of lenses—a convex objective lens and a concave eyepiece lens. Galilean lenses generally have a magnification of 2-3x and offer depth and width of visual field that cannot be achieved with a single lens (i.e., simple loupe).²⁸ Keplerian loupes feature two or more positive convex lenses and can achieve magnification up to 8x.²⁸ Due to the number of lenses, Keplerian loupes tend to be heavier and offer a limited width of field, but newer materials, including high index, lightweight glass, can remedy these issues.²⁸

Of the currently available enhanced visualization technologies, magnification loupes are the most used in dental practice. It has been reported that up to 66% of dentists utilize loupe magnification for some or all of the procedures that they perform, although a significantly lower percentage of dental hygienists reported loupe use.^29-31 The use of loupe magnification has demonstrated improved operator ergonomics, clinician comfort, and decreased incidence of musculoskeletal injury.^32-35 Furthermore, in novice dental and dental hygiene practitioners loupe use was associated with improved visual acuity.³⁶ It has also been suggested that loupe magnification may allow for enhanced visual acuity that can overcome age-related visual acuity loss associated with presbyopia in older dental practitioners.³⁷ Additionally, clinical outcomes after closed ScRP, including scanning electron tooth root surface roughness and inadvertent removal of cementum/root gouging were improved when 2.5x loupe magnification were used.³⁸ However, no such advantages to the use of loupe magnification were seen when they were used to improve visualization during supragingival scaling procedures.³⁹