Uso del microscopio operatorio nell’implantologia minimamente invasiva

Uses of the operating microscope in minimally invasive implantology

Dr. Behnam Shakibaie-M. Microscope-guided external sinus floor elevation (MGES) – a new minimally invasive surgical technique. Quintessenz, vol.61, p.293-308, marzo 2010

Minimally invasive procedures are ubiquitous in medicine. They will also make an increasing mark in invasive disciplines of dentistry in the future. Therefore in implantology three-dimensional diagnostics, microsurgical instruments and suture materials, but especially optical magnification with axially aligned illumination are required. The operating microscope combines these last two requirements, which are essential for microsurgery, even at high magnification. Customised sterile draping sheets allow the operating microscope to be used even under the aseptic conditions of implant surgery.

The advantages of the operating microscope in implantology are numerous and are apparent especially in clinical assessment, diagnosis, management of the aesthetic zone, sinus lift, soft tissue management and photo and video documentation. Technical developments such as autofocus, xenon illumination, magnetic fixation, CCD and HD digital cameras enhance the precision of the operating microscope, and at the same time improve ergonomy.

The following overview article describes in detail the main indications for using the in minimally invasive implantology.

Since the development of the operating microscope by Dr. Littmann and Professor Wullstein in 1953, it is no longer possible to imagine surgery on fine anatomical structures without optical magnification.

The first clinical attempts to use the operating microscope intraorally go back to the 1970s. Microscopic magnification was used then for maxillofacial surgical nerve reconstruction³. Shortly afterwards, new applications in the early diagnosis of precancerous lesions of the oral mucosa and visualization of non-tight filling margins were described as useful².

A few years later, endodontologists recognized the advantages of the operating microscope. Since the 1990s, systematic use of the operating microscope in endodontics has been do and is now fully accepted scientifically^1,4,8.
Working with the operating microscope has become a requirement in postgraduate education in the USA since 1998.

Finally, microscopic magnification has also been described as promising in periodontology^5,6,7. The main indications were listed as mucogingival plastic surgery, papilla reconstruction and connective tissue and mucosal grafts. Fenestration of the sinus floor and implant exposure were also mentioned, but peripherally. …

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The optimal illumination and high magnification of the operating microscope take the dentist working in the field of implantology into entirely new visual dimensions, just as in endodontics or periodontics.

The identification of fine anatomical structures of relevance for the implantologist allows much greater precision in diagnosis and during surgery. While this method does require more time and expense and greater surgical skill, this is balanced by greater treatment safety and outcome predictability, depending on the indication. It diminishes surgical trauma, shortens the postoperative healing period and produces better aesthetic and functional results. Photo and video documentation benefits in an unsurpassed authentic manner from a transmission operating microscope.

However, this gradual improvement of the quality of implant outcome by means of an operating microscope is only part of a routinely observed minimally invasive microsurgical treatment concept with a specially trained team.