The dental operating microscope is utilized during every single endodontic procedure in our office. Working at high magnification is a “game changer” as far being able to provide predictable, world-class, root canal treatment. Using the microscope, we find more and miss less. We are also able to treat the tooth with a minimum of tooth removal. It has been said that no tooth was made stronger by drilling. If these teeth are going to last a lifetime, as little tooth structure as possible should be removed during treatment. This philosophy is maximized with use of the dental operating microscope. Traditional endodontic access cavities with principles such as “straight line access” and “complete pulp chamber roof removal” are becoming obsolete with the use of the microscope. More dentin is conserved, which intuitively means, the tooth is “weakened” less by our treatment. It is the excessive removal of dentin combined with the patient’s occlusion habits that lead to root fracture.
Patient presented to our office with a chief complaint of temperature sensitivity and biting pain in the lower right quadrant. Tooth #30 had been recently prepared for a crown and provisionalized. The tooth was acutely painful to biting. The provisional crown was removed, the pulp chamber accessed through the existing buccal composite, and the canals medicated with calcium hydroxide. Her symptoms resolved in one week. At the second appointment, root canal treatment was completed and the access cavity was restored with a dual cure composite resin. The provisional crown was replaced and the patient sent for permanent crown cementation. A bare minimum of coronal tooth structure was removed due to increased visibility using the dental operating microscope and a conservative technique.