|Year : 2015 | Volume
| Issue : 2 | Page : 134-137
The use of dental operating microscopes by endodontists in the Middle East: A report based on a questionnaire
Mansour Alrejaie1, Nada M Ibrahim2, Manjunath H Malur3, Khalid AlFouzan4
1 Department of Restorative Dental Science, Endodontics, College of Dentistry, Riyadh; Department of Restorative Dental Science, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
2 Department of Endodontics, Resident, Saudi Endodonic Board, Riyadh, Saudi Arabia
3 Department of Restorative Dental Science, Endodontics, College of Dentistry, Riyadh, Saudi Arabia
4 Department of Restorative Dental Science, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
|Date of Web Publication||20-Apr-2015|
Diplomate, American Board of Endodontics, Assistant Professor, KSAU-HS College of Dentistry, Division Head, NGHA-Endodontics, Riyadh
Source of Support: None, Conflict of Interest: None
Objectives: The purpose of this study was to determine how the Dental Operating Microscope (DOM) is currently being accepted for usage by endodontists in the Middle East. Materials and Methods: A one-page letter and auto-return upon completion computer-based questionnaires were e-mailed to most of the active members of the Middle Eastern endodontic associations. Results: Out of the 47% that are using the DOM, only 35% answered yes to using the DOM as much as anticipated. The reasons for not using the DOM as much as anticipated were positional difficulties (80%) and increased treatment time (75%). The majority of endodontists reported that they always use it during retrieval of separated instruments, negotiating calcified canals and surgical treatment. Conclusions: The findings revealed that endodontists in the younger age-groups are more accepting of the DOM. It was also found that the endodontists that are using the DOM in their practice are not using it as often as they anticipated.
Keywords: Dental operating microscope, osseous resection, root-end filling
|How to cite this article:|
Alrejaie M, Ibrahim NM, Malur MH, AlFouzan K. The use of dental operating microscopes by endodontists in the Middle East: A report based on a questionnaire. Saudi Endod J 2015;5:134-7
|How to cite this URL:|
Alrejaie M, Ibrahim NM, Malur MH, AlFouzan K. The use of dental operating microscopes by endodontists in the Middle East: A report based on a questionnaire. Saudi Endod J [serial online] 2015 [cited 2020 Jan 25];5:134-7. Available from: http://www.saudiendodj.com/text.asp?2015/5/2/134/155453
| Introduction|| |
The Dental Operating Microscope (DOM) has been recognized as being an important tool in surgical and non-surgical endodontic treatments. There are a lot of advantages in using the DOM which include: Increased visualization, improved quality of treatment, enhanced ergonomics, and the ease of documentation using either the camera for photographs or videotaping.  The DOM was introduced by Abotheker and Dr. Jako in 1978.  They worked together in 1981 and produced the first commercially available DOM (Dentiscope, Chayes-Virginia Inc., Evansville, IN). Unfortunately, the Dentiscope did not get the attention it needed and was stopped. Eleven years after the development of the Dentiscope, the first symposium on microscopic endodontic surgery was held at the University of Pennsylvania School of Dental Medicine.  This heralded the beginning of serious attention to the DOM. In 1997, the Commission on Dental Accreditation of the America Dental Association agreed on making the microscopy training mandatory in every advanced specialty education program in endodontics.  Published accounts , indicated that the DOM was not initially accepted but currently gaining popularity between endodontists trained from accredited programs in the USA after becoming a compulsory requirement for the program's accreditation. The use of the DOM by endodontists increased from 52% in 1999 to 90% in 2007. 
No previous published data available relative to the acceptance of the DOM by endodontists in the Middle East. Our previous published data in 2012 about the situation of the Middle Eastern advance educational endodontic programs was not convincing. Only five countries; Saudi Arabia, Lebanon, Iran, Palestine, and Jordan have advanced specialty programs with DOM training but not mandatory for the programs accreditation. 
The purpose of this study was to determine how the microscope is currently being accepted for usage by endodontists in the Middle East, the specific treatment procedures for its usage, amount of formal training of the DOM that the endodontists have received, and the most commonly reported difficulties with its use.
| Materials and methods|| |
A one-page letter and survey were e-mailed to all members of the Middle Eastern Associations of Endodontists. To encourage unbiased data, no identification of the participant's data was requested. The questionnaire was limited to one page to encourage further participation. The responses were then recorded, and data was analyzed.
The survey included these questions:
- Do you use a DOM in your practice? (Circle one) Yes/No
- Please circle your age-group
- Please circle the number of years since completing your endodontic training. <5 years/6-10 years/>10 years (If you answered no to question 1, please stop here and return the survey.)
- Please circle your primary practice setting. Private practice/Academia/Military/Resident
- How many days of formal training have you received with the DOM? 0 days/1 day/2-5 days/6-10 days/11-15 days/>15 days
- In what procedure do you use the DOM during your endodontic practice?
- Do you use the DOM as often as anticipated?
- If no, please check reasons: (mark one or more)-
- Restricted field
- Positional difficulties with the microscope
- Increased treatment time
- Lack of auxiliary support.
| Results|| |
A total of 318/523 (60.8%) proper responses were received from the mailed questionnaires. Due to incomplete data, 205 surveys were not used in the analysis. Only 47% of respondents used the DOM most of them are middle-aged [Figure 1]. About 60% of the endodontists who use the DOM have finished their endodontic program in less than 5 years [Figure 2], 42% of them were in private practice, and only 14% were residents [Figure 3]. The number of days of formal training was 0 days in about (55%), 27% said only one day of formal training, 12% said 2-5 days, and only 3% answered 6-10 days. Seventy percent (70%) of the respondents answered that they did not have any non-formal training (either self-taught or by the technician) and 30% answered that they had only 1 day of non-formal training. The procedures that were mostly used by the DOM are summarized in [Table 1].
|Figure 1: Association between the age of the respondent and Dental Operating Microscope (DOM) usage|
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|Figure 2: Association between number of years since completion of endodontic training and Dental Operating Microscope (DOM) usage|
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|Figure 3: Primary practice setting that used the Dental Operating Microscope (DOM)|
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Out of the 47% that are using the DOM, only 35% answered yes to using the DOM as much as anticipated. The reasons for not using the DOM as much as anticipated were positional difficulties (80%) and increased treatment time (75%).
|Table 1: Endodontic procedures that were mostly used by the Dental Operating Microscope (DOM) by the participants |
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| Discussion|| |
Although the microscope has been used for more than 100 years by medical specialists, its introduction into dentistry is very recent. In endodontics, use of the DOM has been reported by Baurnann  and Selden.  Its use enhanced the results of endodontic surgical and non-surgical procedures due to adequate illumination and magnification.  The results of this survey do not reveal a significant adoption of the technology by endodontists in the Middle East, with just less than 50% reporting that they have access to and use the DOM in their practice.
The results of this survey suggested a bad need for more emphasis of formal microendodontic training (Academic, Workshops, and seminars) in DOM, which should resulted in an increased frequency of its usage for all endodontic procedures. There was not a wide range of training experience across respondents. There also seemed to be little standardization in the method of training. The usage of DOM by recent graduates (<5 years) and those up to 10 years after residency training program as well as the age group (> 35 - < 50 years) are almost very similar. The reason for that could be due to the early international increase in emphasis of the DOM usage in the specialty of endodontics. Another reason is that higher percentage of this age group of endodontists are designing and opening new offices in which the DOM is an integral part of the daily endodontic practice. These results correlate with the previous studies  where dentists over 40 years of age were dependent on the microscope to inspect the root canal system. However, the present study is not promising in terms of the acceptance of this advance technology by endodontists as compared with previous survey done by Mines et al.,  which showed significantly higher acceptance of the dental operating microscope as well as increased daily usage in most of the endodontic treatment procedures.
Studies showed that the surgical loupes were relatively ineffective compared with the microscopic method for detecting orifices.  The role of a DOM has shown improved results with nonsurgical treatment of calcified canals  and in locating the two mesiobuccal canals in maxillary molars in both clinical,  and non-clinical  situations. Recently DOM is effectively used in reporting rare cases.  Around 90% of the treated cases with perforation repair done under the aid of DOM had a successful prognosis. 
In the present survey, the highest reported procedural usages were retrieval of separated instruments, root-end preparation, placing root-end fillings, negotiating calcified canals, and locating canal orifices. Long-term follow-up of cases considered healed 1 year after apical microsurgery. 
The most commonly reported reasons for not using the DOM as anticipated, were positional difficulties, inconvenience, and increased treatment time. Increased treatment time was a major factor in discouraging some operators from using it extensively. Although some practitioners feel that the learning curve may be steep when the DOM is first used, they believe procedures could be completed more efficiently once experience was gained.
| Conclusion|| |
The findings of the present study revealed that endodontists in the younger age-groups are more accepting of the DOM. It was also found that the endodontists that are using the DOM in their practice are not using it as often as they anticipated.
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[Figure 1], [Figure 2], [Figure 3]