Digital Dental Photography

Digital Photography and Workflow for Dentists

Dental Microscopes

Since July of 2009, I have been using a dental operating microscope (DOM) for virtually all of my operative and surgical dentistry, and it has been an amazing experience.  Until early 2012, however, I was unable to incorporate photography into my microscope experience, because I was renting a scope without the needed adapters, etc.  In April 2012, however, I took the plunge and purchased 2 scopes of my own, and so I began my journey of dental microscope photography.

In this introduction, I’ll describe why you should consider a DOM for your practice and the major factors to consider when evaluating scopes.  Later on, I’ll discuss the accessories needed and techniques that make dental microscope photography practical and easier (it’s never easy, but it can be easier.)

Why Use a Dental Operating Microscope as a General Dentist?

In discussions with colleagues, it’s common to see puzzled looks when I talk about buying and using a scope in my practice, mostly because I’m a GP.  The most common questions is, “Do you use it for anything besides root canals?”  To which my answer is an emphatic, “YES – I use my scopes for EVERYTHING – fillings, crowns, root canals, LANAP, the works.”  It almost seems a silly question, as if they would only use their loupes for certain things but not others, but given that endodontists have been the first specialty to embrace scopes, it does make sense.  But when they ask “WHY do you use it for everything?” the answer gets a bit more complex.

Here are the 4 Key Benefits of a Scope for All Dentists:

  1. Ergonomics: improved posture for all procedures decreases strain on the neck and back
  2. A Range Of Magnification: from 2-20X, not just a set magnification
  3. Improved communication: with HD video and still photography, we can show patients what we see and communicate better with colleagues
  4. Improved Documentation

My Scope Journey

My personal journey into scopes started on DentalTown.com in the EndoFiles Forum while trying to improve my endo skills.  Several  of the truly phenomenal endodontists and GPs were showing their cases with photos taken through their scopes, and it was truly amazing the clarity and detail visible in those photos.  It also became obvious that  the ability to see at that level of magnification, with such bright lighting in all areas of the mouth, would be a real benefit for my patients.  But the even that made me take the leap had nothing to do with quality dentistry; it was back pain.

In July of 2009, after a very busy and hard week at work, I woke up on Saturday morning with the absolute worst back pain of my life.  Almost that entire day was spent lying on the floor with my legs elevated, as that was the only position that seemed to relieve the pain. I popped more ibuprofen in 24 hours than any other time in my life!  And on Monday, despite the many financial challenges we faced that year, I made the calls to schedule scope demos with Seiler, Zeiss, and Global.  Ultimately, I ended up renting a used Zeiss OMPI Pico 5-step scope with a halogen lamp.  After just a short period of time, that scope became an essential part of my daily practice, and it became impossible to imagine practicing without one, for all of the following reasons:

  1. Unbelievably clear vision in every part of the mouth, even distal of second molars or third molars.
  2. Brilliant and perfectly even coaxial shadow free lighting in every part of the mouth, even distal of second molars or third molars.
  3. Ideal posture, because you really have difficulty developing bad posture with a scope.
  4. Less neck strain when compared to loupes and a headlight.
  5. Ease of documentation with both still photography and video.
  6. Ability to diagnose and treat pathology earlier, more accurately, and more conservatively

One man in particular has been a tremendous promoter of the benefits of DOM’s for dentists: Dr. Glenn van As.  I’m going to go ahead and give him a plug for another reason: his DVD Training Videos for Microscope Users.  In my opinion, these DVDs should be included with every scope sold, regardless of brand.  Much of the information I’ll discuss in this series comes from Glenn.

SPECIAL OFFER: If you follow the link and purchase Glenn’s DVD set, use the code “PAYET” when ordering online to receive $20 off!

Factors in Choosing a Dental Microscope

FULL DISCLOSURE: To be crystal clear – in May 2012 I purchased 2 Leica M320 Dental Operating Microscopes for my office, and because I am extremely happy with my scopes, don’t be surprised if I mention them frequently.  HOWEVER, I have no financial ties to the company in any way and do not receive any compensation from them.  In this section on factors to consider in choosing scope, I will do my best to remain completely unbiased.  In future posts about microscope photography, I will probably be a little more biased due to only being experienced with the Leica, as well as the excellent results.

There are currently 4 primary scope manufacturers with models specifically for dentistry.  At the most basic level, all scopes made by these 4 companies are more than adequate for virtually all GP’s.

  1. Leica – Leica Microsystems Dental Microscopes
  2. Zeiss – Zeiss Dental Microscopes
  3. Global – Global Dental Microscopes
  4. Seiler – Seiler Dental Microscopes
When looking at these 4 brands, there are a number of terms and items about each to consider, which will be discussed here.
  • Steps and Levels of Magnification: most microscopes currently available are 5- or 6-step scopes, meaning that they offer either 5 or 6 different levels of magnification, ranging from 2.5 – 20x.  Global offers a 4-step scope, and Seiler offers a 3-step scope for the most budget conscious.
  • Type of Illumination/Light Source: There are currently several different types of light sources
    • LED – in my opinion, this is the wave of the future.  LED’s last virtually forever (40-60,000 hours, enough for an entire career), which means no replacement costs or maintenance, are very bright, and have good light “color”.  All 4 of the brands listed now offer LED illumination.
    • Xenon – currently the absolute brightest light available, no doubt about it.  Available with Zeiss and Global.  Only problem?  Very expensive, typically about $4-6,000 to replace every 5-6 years.  The purest white light, too.
    • Halogen – these are still available on Seiler and older Zeiss’ models.  Least expensive, but the most yellow light, and also the least bright.  Honestly – just avoid these, they’re rapidly going out of style.
    • Plasma – only available through Seiler, and it’s a new light source, so there isn’t a lot of experience with them out there.  About 1/2 the price of the Xenon or LED, supposedly they last 5,000 hours.
    • Metal Halide – brighter than halogen, but not as bright as any of the others, still kind of yellow.  Again….slowly going out-of-style.
  • Documentation Options: if you don’t care about taking videos or photos of your work through the scope, IMO you’re missing one of the biggest advantages scopes offer.  The good news is that you can add documentation capabilities later, but you’ll pay more.  Every manufacturer offers the needed accessories, but because all of them are a little different, I’ll just tell you what you need to ask about.
    • Beam-splitter – this splits the light, so part goes to the operator and part goes to either the video or still camera; it can be a 50/50 split, 70/30 split, 80/20 split, and apparently Global has a virtual beamsplitter for their medical grade cube camera that allows 95/5 split.
    • Dual-iris diaphragm – a filter that reduces incoming light and increases the depth of field.  This is very useful for documentation, as the FOV with scopes is narrow by necessity of the magnification and working distance.
    • Camera adapter – this is the part to which you actually attach the still or video camera
    • Note: Leica is the only manufacturer currently that offers a built-in camera/video.  To be quite honest – it’s not very good, and given the quality of the scope overall, I’m surprised they didn’t do a better job with it.  I did NOT buy this built-in option, but opted for the necessary adapters for a Canon DSLR.
  • Ceiling, Floor, or Wall-Mount:  again, all manufacturers offer all options, and this is really a matter of preference and your operatory design.  Wall- or ceiling-mounts are the most common and usually have an additional cost for installation, and you must be sure that your ceiling or floor are properly reinforced.
    • You may hear the suggestion to get a rolling floor mount so you can move your scope around as a way to save money buy buying just 1 scope.  My experience?  Fuhgeddabouti!  They are so heavy, it is highly inconvenient and too much work.
  • Inclinable Optics:  the optical part of the scope, i.e. the part you put your eyes up to, needs to be adjustable.
  • Filters: Zeiss has both a yellow resin filter for bonding and a green filter for surgery; AFAIK all the other brands offer a yellow resin filter as standard but not the green.