Wonders of the video scope

Seeing better has always been the underpinning of doing better dentistry. As with many others, I had gone the route of such products as the removable headband, the 2.5X loupes, parallel lighting, and the more powerful 4.5X loupes. I even experimented with using binocular operating microscopes.

The view was often exquisite, but I found the learning curve long as did other members of my study group. Scopes were big, got in the way, and we had great difficulty aiming at many of the teeth we were trying to work on. This was particularly true if we were working in multiple quadrants.

So I was excited to find a different kind of microscope at the California Dental Meeting - a video scope.

No more pretzels

This system helps eliminate many of the difficulties encountered with the fancy, fixed microscopes. The concept is pretty straightforward: Mount a high-resolution zoom color video camera on a flexible arm, add a handle and parallel light, then send the signal to a high-quality monitor.

The operator sits up straight and gazes into the screen instead of turning into a pretzel to look down into the mouth. A second monitor is positioned opposite the assistant so this person can see exactly what the dentist is seeing. This allows the assistant to stay out of the dentist’s view path, and helps with the entire operation.

Just as you would aim an operative light, you can take the scope and point it upward from the patient’s chest, downward from over the nose, or left or right with ease.

You don’t even have to position yourself so that your eyes match up with the microscope oculars. You just sit upright and look at your screen.

This is, of course, a monocular system. I was concerned that we would be handicapped by not seeing in 3D. Well, it took about 10 minutes to dispel that worry. I don’t understand the entire neurophysiology, but the eye and brain are able to “see” the 3D as soon as your bur or other tool comes into view.

In fact, I know a dentist with sight in just one eye who has been practicing for many years and has not encountered any problems. 3D is not an issue.

Shorter learning curve

In general, I found the learning curve with the video-based scope very short. By comparison, some people take a year to get up to speed with conventional glass optics microscopes.

There are times, however, when the scope may be positioned in such a way that your hand seems to move opposite from what your brain is expecting. The manufacturers of my unit took this into consideration and built a picture-reversal switch into the camera to alleviate this difficulty.

Oddly, though, my office has been using the system for less than a year, and it is rare when we actually use the flip switch. In dental school, we learned that looking into a mirror was an automatic part of operating. The same seems to be the case with the video scope.

Sit comfortably

At my office we sit in whatever comfortable position we prefer and do our work. Most of the time we work without mirrors. Perhaps 10 to 15 percent of surfaces can be problematic, like the distals of upper molars. The rest of the time, especially when working with a rubber dam or cheek retraction, we can work without mirrors thanks to the scope’s versatile positioning capabilities.

In the past, we have done development work on using the intraoral camera in the left hand instead of the mirror. We found the image was a good quality for operative dentistry or endodontics. But we also observed that, far too often, the view was obscured by water spray so we were stopping constantly to clean the optics. The camera’s zoom lens keeps the unit far enough away from the work zone that the lens cover rarely must be cleaned.

But here’s the wildest part of using the scope. Originally, I thought we would purchase a scope that would improve our vision in closeups, even beyond what our loupes could provide.

The more profound effect, however, has been the savings physically on my body, giving me the potential to practice dentistry longer than I thought would be possible.

Prior to using the scope, I started each afternoon feeling a burning sensation around the right scapula region that sometimes reached into the shoulder area.

I had been using loupes religiously so I could sit more upright. But I still found myself contorted into strange shapes that were taking a toll on the vertebrae in my back.

Now, I am consistently making it through afternoons with little or no pain in my back and shoulder. The ergonomic effects of practicing with the operating camera might just overshadow the excellence in viewing.

Also, don’t forget about the operator’s chair. Together with the scope, it’s an integral part of doing microdentistry.

There is a variety of systems on the market. Each system differs widely in comfort and rapid positionability so operators can be seated and start work immediately.

In addition, take a look at whether your system will have a frame grabber system so you can do separate freeze frames. Then you can save these frames to your computer or show them to the patient. You might find that you pick up the intraoral camera on fewer occasions.

Our monitors also can show educational videos or double as computer screens. It’s easy to extend the computer desktop so you can look at digital X-rays on one screen and management software on another.

Great for teaching

For teaching purposes, our system has proved more than excellent. Another not-so-subtle effect: the patient can hear me talking with staff about what we are seeing. This can be quite instructional for everyone. Plus, the staff can appreciate some of the delicate and intricate procedures that they had been seeing only from a distance in the past.

We set the screens so that patients do not see any prepping. Only when we stop and let patients turn their heads to a frame-grabbed image are they able to get a look.

It’s also easy to route the camera output through a recorder for teaching, or to give to a patient.

There are now several manufacturers joining the video scope scene. Each differs significantly in ergonomics and cost. The scope our office uses has proven to be a cost-effective investment. We have enjoyed our scope so much that we are having another installed in a second operatory.

Dr. Bill Domb is a general dentist with a practice in Upland, Calif. He is the founding director of the Inland Institute of Aesthetic Dentistry, and serves on the faculty of his local dental and medical schools. His favorite lecture subject is “The Techno-Maven’s Back Closet.” You can reach Dr. Domb via e-mail at [email protected].