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{ tooth & nail } 

Are Loupes Loopy? O

ne of the most touted advances in dental equip- ment has been the use of magnification. Younger

dentists may not know it is possible to cut a prep without magnification. The goals of magnification are to improve the qual- ity of dental work, reduce eye strain and improve operator positioning. The first two goals are met easily, but the third can be difficult.

I have been reviewing a 2013 Focus article entitled “Selecting dental loupes” in prep- aration to purchase a new pair of loupes¹. My current loupes do not position my neck in the optimal spot. The most important ergonomic factor in selecting loupes is declination angle, or the angle that your eyes are inclined downward to- ward the work area. This angle should put your head at less than 20 degrees from vertical¹. Most loupes, with the scopes fixed in the lenses (especially long-barrel, high-power), require the operator to tilt their head forward beyond an optimal head position, creating an over-curving of the neck (figure 1). If the patient or work area were elevated to the point where the head was in the best forward posture, elbows and hands would be raised up to a horrible ergonomic position (figure 2).

Fixed lens loupes are, by far, the most popular because the lens loupes have a wider field of vision, can be lighter and cannot be knocked out of alignment. Yet, they can be very stressful on the neck and shoulders. Flip-up loupes provide a better declination angle, but they are not without drawbacks. They can be knocked out of alignment, and until recently, were much heavier (but are getting lighter with new materials). Additionally, field of vi- sion is narrower. The operator has to look down through the scopes in a position

6 focus | SEP/OCT 2014 | ISSUE 5 figure 1

they are not used to placing their eyes. This requires some retraining of the eyes’ natural tendency to look straight ahead. As evident, both loupe options have pros and cons.

figure 2

Yet, are loupes your only “loopy” choice? No! The future of dental magnification may be changing. Some dentists, espe- cially endodontists, already have started using a great tool in the microscope. Microscopes often position the opera- tor so that their neck is up and they are looking straight ahead to see the field they are working in (figure 3, courtesy Dr. Steven Raphael). Users claim they can see things in their scope (extra canals) they could never see with their loupes. So, why doesn’t everyone have a scope? They are bulky: Often, microscopes require a special arm or some kind of rolling stand to move around. This can take up a large footprint. They are expensive: Rang- ing from around $13,000 up to more than $50,000, you can shell out a small fortune for the scope and accessories. There is a learning curve to scope use: The average operator takes several weeks to get used to finding all the correct angles to position the scope or patient. Some users report having to push their neck forward to engage the eye pieces, which can create neck strain. There is a limited field of view, so when the patient moves, you have to move them back or move the scope to adjust. Patients who cannot sit still are a challenge.

figure 3

What if the scope isn’t your thing or you don’t like looking through those little eye slots? An emerging technology known as “procedure scopes” use a small, high-def- inition camera mounted on the end of a LED light to project a video image of the operating field onto a monitor positioned so the operator’s head is looking up and

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