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

Microscope use in medicine was pioneered by Carl Nylen at the University of Stockholm who developed a monocular microscope for ear surgery in 1922 and the first commercial binocular operating microscope in 1953 by the Carl Zeiss Company in West Germany.^40,41 Dental operating microscopes were introduced in 1978 and commercially produced in 1981 by Dentiscope (Chayes-Virginia, Inc. Evansville, IN).^42,43 Since that time, incorporation of dental operating microscopes into practice has adopted in many disciplines of dentistry. Q4Generally, the surgical microscopes used in dentistry use Galilean optics.⁴⁴ They have binocular eyepieces joined by counteracting prisms creating a parallel optical axis.⁴⁴ The use of dental microscopy offers an ability to magnify areas that are extremely small and require precision to access and appropriately treat. Unlike loupe magnification, the dental microscope offers an ability to utilize different magnifications with the same instrument and can provide higher levels of magnification, generally up to 25x, although it has been reported that the ideal magnification for periodontal surgical procedures is generally reported to be 5-12x. While the use of dental microscopy is common in endodontic therapy, its adoption in periodontal therapies is less widespread.⁴⁵

While microscope magnification is more commonly used in dentistry during endodontic and surgical interventions, microscopy use has been evaluated as a potential adjunctive visualization technique for closed scaling and root planing. In studies evaluating the use of a surgical operating microscope at various magnification variables, it was demonstrated that probing depth reduction at 4 weeks was better for all variables than without magnification and that qualitative practitioner reports of improved ergonomics were best for 0.6 magnification variable (i.e. 3.5-5x magnification).⁴⁶ SEM analysis of extracted teeth that received no treatment, ScRP using loupe magnification, or ScRP with the use of a surgical operating microscope revealed that teeth treated with nonsurgical therapy with the use of the surgical operating microscope demonstrated less root gouging and more root surface nanohardness than those in other groups. Additionally, in vitro studies revealed improved attachment and proliferation of periodontal ligament cells and decreased pro-inflammatory cytokine production at the root surfaces treated with ScRP and microscope use.⁴⁶ This research indicates that the use of the surgical operating microscope may provide improved visualization leading to root surface biocompatibility and enhanced clinical outcomes.