Procedure Scopes

(Extraoral Cameras)
Procedure scopes project the clinical site onto an LCD screen placed at eye level,
allowing the clinician to sit upright (Figure 8). They can be wall-or ceiling-mounted,
attached to a counter, or placed on a cart. The scopes reduce eye fatigue and offer
up to 23 times magnification (depending on the model), and the clinician can view the
whole mouth on the screen. The procedure scope is used in place of an examination
light and has a color-corrected LED light with three brightness levels. It enables
neutral spine alignment, reducing the risk of neck and back strain and injuries. The
scope does not generate heat and is safe for both patients and dental healthcare
workers. The learning curve is approximately two weeks long.
Figure 8. Procedure scope (Magnavu); Orascoptic Bodyguard chair
Photograph 2008 Posturedontics, LLC.

Prosedur scopes adalah situs klinis ke sebuah layar LCD yang diletakkan di tingkat mata agar
memungkinkan dokter untuk duduk tegak. Bisa dipasang di dinding atau di langit-langit, menempel pada
meja, atau diletakkan di troli. Scopes ini dapat mengurangi kelelahan mata dan dapat melakukan
pembesaran sampai 23 kali (tergantung pada model), dokter dapat melihat mulut secara keseluruhan di
layar. Prosedur scope digunakan di tempat dari lampu pemeriksaan dan memiliki koreksi warna cahaya
LED dengan tiga tingkat kecerahan. Hal ini memungkinkan tulang belakang dalam posisi netral,
mengurangi risiko nyeri dan cedera leher dan pinggang. Scope tidak menghasilkan panas dan aman bagi
pasien dan tenaga kesehatan gigi. Kurva pembelajaran selama sekitar dua minggu.
Gambar 8. Prosedur scope (Magnayu); kursi Orascoptic Bodyguard

Photograph 2008 Posturedontics, LLC

Dental Loupes (Telescopes)

Dental loupes atau teleskop paling sering digunakan untuk pembesaran. Dental loupes
dapat melakukan pembesaran dari 2 sampai 5 kali. Dengan pilihan yang tepat, loupes bisa
disesuaikan untuk menaikkan postur dan posisi selama prosedur, sehingga dapat
meningkatkan ergonomi. Postur kepala ke depan sebaiknya tidak lebih dari 25 derajat
selama digunakan. Maillet et al. menemukan bahwa penggunaan pembesaran loupes
mengakibatkan postur meningkat secara signifikan pada siswa dental hygiene selama
prosedur hand-scalling. Sebuah survei dari dental hygiene menemukan bahwa sekitar 60%
kadang-kadang menggunakan loupes, sementara hanya 21% telah digunakan loupes di
sekolah kesehatan gigi. Ada kesepakatan umum bahwa menggunakan loupes itu
menguntungkan. Dalam sebuah survei terhadap siswa kedokteran gigi senior dengan 128
responden, 85,3% telah membeli loupes, 30% dari pembeli memilih pembesar flip-down dan
70% memilih desain fix-lens. Mayoritas memilih perbesaran berdaya rendah (2 sampai 2
setengah kali). Menariknya, alasan ergonomi diberikan untuk oleh hanya 21% dari pembeli,
dan di antara responden yang tidak membeli loupes, setengah memberi alasan bahwa
masih bisa melihat cukup baik tanpa loupes.
There was general agreement that using loupes was advantageous.27 In a survey of
senior dental students with 128 respondents, 85.3% had purchased loupes, with 30% of
purchasers choosing a flip-down loupe and 70% a fixed-lens design. The majority chose
low-power magnification (two to two-and-a-half times). Interestingly, ergonomics was the
reason given for purchase by only 21% of purchasers, and among respondents who did not
purchase loupes, half gave the reason as being able to see well enough without them.28
Proper fitting of loupes is essential to optimize their influence on vision and posture.29 It is
crucial in selecting any magnification aid first to determine the optimal working
posture/position and second to choose a magnification aid based on this position that
has the appropriate declina- tion angle, field of vision and working distance It is
important to ensure that the loupes are appropriately designed to avoid increasing,
rather than diminishing, the risk of work-related injuries. Since first becoming available,
loupes have become lighter and now offer improved ergonomics due to superior
declination angles. Two basic designs of dental loupes are available: fixed mounts
(through- the-lens loupes) and front lens mounted (flip-up loupes) (Figures 10, 11).

Figure 10. Fixed (TTL) dental loupes

Figure 11. Flip-up dental loupes

Fixed loupes
Fixed loupes have a preset declination angle that is fixed, with the scope mounted into
the lens. Since they are fixed, the loupes do not get knocked out of alignment.
Compared to flip-up loupes, they are lighter and offer a wider field of vision the
scope is closer to the eyes. Prescription lenses can be included in the carrier lens of the
fixed loupes to enable distance viewing, and the actual scope itself can have a
prescription. If the clinician wears prescription lenses and the prescription changes,
the loupes will need to be modified by the loupes manufacturer.

Flip-up loupes
As their name suggests, flip-up loupes can be flipped-up during a procedure, with
the scope mounted in front of the lens. Advantages of flip-up compared to fixed loupes
include a better declination angle for head posture and the ability of the clinicians
regular optician to change prescriptions. On the other hand, flip-up loupes are typically
heavier than fixed loupes and can also be knocked out of alignment.

Ergonomics and loupes selection Syme et al. recommend binocular

surgical loupes with flip-up capability and two to 2.6 times magnification.31 However,
perfect head posture is not attained with either type of loupe, and the magnification
requirements differ by procedure (Table 4). Choosing which type of loupes to use is a
personal decision based on the types attributes, procedural requirements and comfort level
for the clinician. As with dental microscopes, the higher the magnification the shorter the field
of depth and narrower the field of vision. An accommodation period may be required
when first using loupes, and some eye fatigue may be experienced initially. When first
adopting loupes, wearing them for just two to three hours per day and extending the wearing
time over a couple of weeks helps the adjustment.

Table 4. Loupes magnification strength by procedures

Dental hygiene procedures 2 to 2.5
General dentistry 2.5 to 3.5
Endodontists 3.5 to 4.5 or more
Periodontists 3.5 to 4.5 or more

Declination angle, depth of field and working

distance
The working distance, depth of field and declina- tion angle must correspond to the
musculoskeletal needs of the individual clinician. 32 Frame size is an additional factor to
consider. The declination angle should enable adoption of an ergonomic and comfortable
working position, and should allow the clinician to avoid flexing the neck and posturing the
head forward more than 25 degrees.33 It is critical to ensure that an optimal declination angle
is possible with intended loupes (Figure 12). The same prin- ciple applies to dental loupes
as applies to dental stools one size does not fit all. The same pair of loupes will
have different declination angles in different individuals when worn. If the declination angle
is too small, the operator will be forced to flex the neck and position his or her head too far
forward, resulting in potential musculoskeletal injuries.34,35 Greater declination angles can
typically be obtained with flip-up loupes rather than with fixed loupes; if you choose fixed
loupes, then purchase them with the steepest declination angle offered.

Figure 12.
Dental loupes, appropriate chair, and good posture

Photograph
2008
Posture-
dontics, LLC.

The lower the scope is placed relative to your pupils, the better the operators head
posture. Large frames, while less elegant than small oval frames, are superior as they
sit low on the cheek, thereby enabling lower scope placement (Figure 13).

Figure 13. Large frames with low scope positioning

 Photograph 2008 Posturedontics, LLC.

Due to anthropometric differences, taller indi- viduals generally require a longer working
distance than shorter individuals. The difference in working distance requirements ranges
from less than 14 inch- es to greater than 20 inches. Select loupes that meet your
personal working distance requirements. Too short a working distance can lead to hunching,
and too long a working distance can result in stretching. Working distance is particularly
important to con- sider if you try loupes at a convention or trade show, as convention
booth equipment differs from your own in width, position and height (unless you can
adjust the stool and chair height before sitting down and trying the loupes). If you do decide
to purchase loupes at a convention, first measure your working distance in your operatory.
Working distance can be calculated with a standard tape measure, and is defined as the
distance between the front of the cli- nicians eye and the patients first incisor. To ensure
accuracy, it is important that both the clinician and the patient are properly seated in
their respective chairs during the measuring process. Ideally, your sales representative can
visit your office to help you determine the appropriate working distance while you have a
patient seated in your chair and you are in your regular operatory seating. He or she will
be able to help you with working distance, declination angles and other considerations.
Of the available magnification options spe- cifically designed for dentistry,
loupes are the least expensive, costing up to around $2,200. The options vary not
only in price, but in magnification, learning curve, accommodation period and
flexibility.
Other work-related injuries in the dental operatory include sharps injuries, hearing
loss, cross-infection and allergies. While it is important to consider prevention of these,
they do not involve musculoskeletal injuries due to poor ergonomics and thus are
beyond the scope of this article.