Treatment under the microscope 
The era of specialized microscopic treatment in endodontics emerged in practice not too long ago. The main advantage of the dental microscope is due to the enhanced magnification and illumination of the procedural field. It is of great benefit in identifying previous undiscovered structures, enables visualization of root canals, canal narrowing, perforations and obliterations. The functionality of the dental microscope is best illustrated by the pioneer of microscopic endodontics Professor Kim from Pennsylvania whom states “You can you only treat what you see.”
What is the course of root canal treatment using the dental microscope?
From the point of view of the patient, root canal treatment does not differ greatly from standard treatment. After securing the patient with a dental dam (a sheet of latex which isolates the tooth from the oral cavity), the dentist will open the tooth in order to gain access to the root canals. The microscope is secured to the wall on a swivel arm which is extended and closely positioned over the patients’ head thus facilitating an optimal view of the treated tooth. A magnification of 25X guarantees maximal precision and significantly increases success rates of the treatment.
Why does my tooth need specialized endodontic microscopic treatment?
Standard root canal treatment without the assistance of a dental microscope does not always end triumphantly. Complications may present such as atypical tooth anatomy, narrow, curved or calcified root canals. Furthermore, if you are endodontically treating your tooth for the second time, the procedure may also be very difficult due to broken metal files, perforations or undiscovered canals when the tooth was treated the first time. In all these cases a dental microscope greatly increases your chances of proper and successful treatment and in return your tooth which may have been deemed for extraction will be restored for many years to come.
Five root canal molar tooth
Four root canal molar filled with gutta-percha
Buccal separation of upper premolar
Root microfracture
Visualization of root-end opening
Root-end opening after closure using MTA cement
Visualization of broken metal file
Calcified canal orifices impairing entrance
C-shaped root canal
C-shaped root canal after filling with gutta-percha
Below you will find examples of successful root canal treatment conducted in our clinic under the microscope illustrating the various clinical scenarios mentioned above.
Lower incisor with broken file in root canal
After root canal treatment (broken file removed, canals filled)
Obliterated and 3 insufficiently filled
3 patent properly filled canals
Narrow and curved root ends of lower molar
3 patent properly filled canals
Prior to treatment
3 canals found and treated
Lower molar with large caries
3 root canals filled
Lower molar previously restored with
Metal post removed and canals filled
Lower molar with inflamed pulp
Canal patency increased and 4 canals filled
Upper molar with 2 broken metal files
2 metal files removed
Upper premolar with improper filling
Canal patency increased and filled
Upper molar with 3 partially filled canals
Additional 4th canal found and filled
Lower molar partially filled with cement
Canal patency increased and filled
Obliterated medial canals of lower molar
X-ray with metal files after achieving proper patency
Upper premolar with obliterated canals
Canal patency increased and 2 canals filled
Upper molar prior to retreatment
Canals treated and filled
Broken metal file in lower incisor
Metal file removed
Upper molar prior to treatment
Canals treated and filled
Lower molar with broken metal file
Patency increased in 3 canals (metal file bypassed)
Lower molar with insufficiently filled canals
3 canals retreated and filled
Tooth prior to retreatment
After retreatment
Tooth prior to retreatment
After retreatment and discovery of additional canal
Tooth after resection
Tooth after resection
Upper premolar with broken metal file
Metal file removed
Lower premolar root with broken metal file
Metal file removed and root end filled
Lower molar with large changes in bone
Anatomically atypical canal discovered and matter in the vicinity of the root end canals filled
Lower premolar prior to treatment
Canals filled with visible atypical horizontal
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