The Conversion of a Scope Cynic
When this web site was first created in 2000, I originally had included a page that suggested that the use of a Surgical Operating Microscope (SOM) in endodontics was unnecessary and I questioned its routine use. I had been in specialty practice for 14 years, had a high degree of success and saw little need for this expensive piece of equipment. At the time I believed that the mandatory Postgraduate SOM certification was nothing more than a method to increase SOM sales. I also had some questions as to why this technology was so readily accepted without support from the literature. I also commented that the presence of a microscope could be used as leverage "against" the referring Generalist. The Endodontist could now say that optimal Endodontic treatment could only be delivered by using state of the art equipment, and that this included the SOM. I wrote that the subliminal message to "non SOM equipped dentists" was that they were second class, were ignorant, and that they just "didn't get it". It was a cynical attitude.
The reaction to this page was swift and dramatic. On the rxROOTS internet forum, several clinicians, (such as the father of Microscopic Endodontics Dr. Gary Carr) were very critical of the piece. They wrote that I could not treat what I could not see, that I had no concept of what a huge difference it made and that I could never reach my potential as an endodontist without one. There was much browbeating, name calling and at the same time very much encouragement from those on ROOTS. I finally saw the light, literally. After attending two scope courses at ROOTS Summits I and II, it became apparent to me that I was wrong. I made arrangements for immediate purchase of a Global SOM with upgraded Starlite light source and I haven't looked back.
Some initial impressions of a scope novice:
1. The light source is incredibly bright. My staff sometimes complain that they have difficulty seeing "away" from the field after they have been looking at the area for a few minutes. An assistant ocular would probably prevent this. Sunglasses are helpful if your assistants do not have their own ocular and work with the scope for long periods of time.
2. There is a tendency to go to "high power" immediately in order to "see better". This is a mistake. Skills must be developed at lower magnifications. In many instances it is better to observe the field at lower magnifications to gain "perspective". ( You also appear to have more light at lower magnifications). Then shift to higher magnification when close inspection of a specific area is required.
Staff have some major trepidation when confronted with this new technology. It requires a whole different set of assisting skills. Staff must be brought along slowly, as they regard the scope as a tool that will "slow us down" (i.e./ put more pressure on THEM) rather than as an augmentation to treatment.
3. Clinicians who are used to running multi-op practices (frequently filled with emergency toothaches) occasionally find themselves working alone while other ops are being prepared or patient's seated. This breeds a bit of "laziness" in staff because the dentist sometimes reaches for instruments while he is alone in the operatory. When using a scope, this is not possible. The clinician hands must be stationary in the operating field. Bur changes, file changes, suction and irrigation that may have been performed by the dentist alone in the past now cannot be done this way. Much greater staff discipline must be obtained and this takes time.
5. Scope Photography is a whole art by itself. I'm in the process of learning about this right now.
Although I have only been using the scope for a relatively short time, its advantages are obvious. Visibility is greatly enhanced and I now see much of what I missed earlier. For example, I am noticing how "wet" prepared canals remain, even after attempting to dry them with paper points. ( You need overproof alcohol and Stropko syringes for proper drying!) Additional canals (such as MB2) are easier to find. Most recently, I located a difficult second distal-lingual canal in a mandibular molar that I am sure I would have missed had I not had the SOM. The SOM offers the ability to see changes in dentin coloration ( as a clue to where orifices are), bubbling of NaOCl as it interacts with tissue, remove broken instruments etc.. With specialized micromirrors the SOM allows for close examination of retropreparations at angles impossible to view with the unaided eye or with loupes. The list goes on and on.
SOMs are the future of dentistry for those clinicians who truly want to see what they are doing. Back in the days where amalgam was our only option and margins where checked with a dull explorer, it was easy to neglect things that we could not see. In the era of bonded restorations, precise margins, and high quality dentistry this attitude IS passe. I believe that dentistry will be divided into those who can/want to see and those who don't.
One final question to ask yourself - Who would you rather have doing your restorations or Endo - someone who is or is not SOM equipped?
I owe much of my rethinking to the gang on rxROOTS.com and to Dr. Gary Carr, and for that I will always be grateful.
UPDATE - July 2003:
It's been almost a year since my first SOM was installed. I ran into a big problem: I realized that I couldn't see as well in my other non-SOM equipped operatories. The difference was dramatic and obvious. On the occasions that I had to work in this 2nd op, I found myself cursing the fact that I simply couldn't see what I needed to see to do a good job. That operatory was "handicapped" by the lack of the SOM. So on July 31st a second SOM (Seiler Revelation http://www.seilerinst.com/micro/dntsrg.asp ) will be installed in my second operatory. My conversion as a "scope cynic" appears to be complete.
Update May 2007 - NEW
I subsequently purchased a Global G6 which has gone into my #1 operatory. It is a fabulous scope and by far the best of the 3 that I now own. For more information about it please see click here to go to the SOM Product evaluation section of my site. I have also added a Carr II adapter for photography, using a Canon A95 with it. The G6 light source is much less yellow and the pictures have been very good. I am extremely happy with the G6 and wish I had one in each op! If you are considering an SOM, I strongly recommend that you do not "cheap out" and go with less expensive model. These instruments are your "eyes'" and if you want to do the best endodontics possible, you need to make an investement that will allow you the best visibility possible. It truly is the LAST place you shoudl be looking to save money. If you can't see it....you can't treat it.