Open Journal of Stomatology, 2013, 3, 1-5 OJST
http://dx.doi.org/10.4236/ojst.2013.39A001 Published Online December 2013 (http://www.scirp.org/journal/ojst/)
Operating microscope in endodontics: A systematic
review
Carla Cabral dos Santos Accioly Lins1*, Elma Mariana Verçosa de Melo Silva2,
Georgina Agnelo de Lima2, Silvio Emanuel Acioly Conrado de Menezes3,
Rosana Maria Coelho Travassos3
1Center for Biological Sciences, Department of Anatomy, Federal University of Pernambuco (UFPE), Recife, Brazil
2Department of Prosthetics and Oral and Facial Surgery, Faculty of Dentistry, Federal University of Pernambuco (UFPE), Recife,
Brazil
3Department of Endodontic, Faculty of Dentistry, University of Pernambuco (FOP/UPE), Recife, Brazil
Received 16 August 2013; revised 16 September 2013; accepted 2 October 2013
Copyright © 2013 Carla Cabral dos Santos Accioly Lins et al. This is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
ABSTRACT
The objective of this study was to systematically re-
view the literature about the use of the operating mi-
croscope in endodontics. It used sources of biblio-
graphic cataloging electronically identified by MED-
LINE via PubMed, LILACS, BBO and Scopus, using
as descriptors: Endodontics, anatomy and micros-
copy. The selected articles were identified from the
titles and abstracts, taking into consideration the fol-
lowing criteria: publications ranging from January
2001 to November 2012, case reports, published in an
indexed journal, and publications in English language.
The search showed 167 articles related to this topic,
and these 21 articles met the inclusion criteria. These
indicated that a higher magnification helps coronary
access and the location of channels to identify and
interpret the complexities of the anatomy of root ca-
nals, the removal of nuclei and intracoronary frac-
tured instruments, to minimize trauma of surgeries in
soft and hard tissues, and detect fractures and mi-
crofractures. It was found that its use has provided
Endodontics with a significant improvement in vision
of the operative field, offering better quality jobs and
a higher success rate.
Keywords: Endodont i cs; Anatomy; Microscope;
Systematic Review
1. INTRODUCTION
The knowledge of dental morphology, location, cleanli-
ness and formatting of the root canal system (RCS) are
prerequisites for successful endodontic treatment. Varia-
tions in the number, morphology of roots and root canals
are constant challenges to obtain satisfactory results in
Endodontia [1].
Currently, in order to progress in the quality of treat-
ment, the endodontist has been seeking support for new
technologies to help you achieve success. The Operating
Microscope (OM) has been used to minimize the obscu-
rity of the operative field favoring better quality results
[2].
The OM Endodontics was introduced in the early
1990s by Gary Carr [3], and their study was the basis for
several other authors deepen research on its use in
Odontology [2]. Its incorporation in that specialty had
profound effects on how to work the endodontist; For
this reason, in 1998 the American Dental Association has
requested that all graduate programs in the United States
should teach the use of the microscope in nonsurgical
and surgical endodontics [4].
Considering this scenario, the OM emerges as a tool
that offers many benefits such as better lighting, magni-
fication and visualization of the operative field [5]. The
high magnification helps coronary access and the loca-
tion of channels to identify isthmuses, to interpret the
complexities of RCS anatomy, the removal of intracoro-
nary nuclei and fractured instruments, to minimize trau-
ma of surgeries in soft and hard tissues, and detect frac-
tures and microfractures [2,6]. In addition, their use gives
the dental surgeon a working position more comfortable
and ergonomic, reducing fatigue and stress, and cones-
quently, increasing work efficiency [7].
The aim of this study was to perform a systematic re-
*Corresponding a uthor.

C. C. dos Santos Accioly Lins et al. / Open Journal of Stomatology 3 (2013) 1-5 2
view of the literature on the use of OM in Endodontics,
trying to focus on how this new technology is being used
by experts during the execution of their treatments.
2. MATERIALS & METHODS
It were performed a literature review of the past decade
in scientific search engines described below: PubMed (a
service of the National Library of Medicine, USA),
available at electronics www.ncbi.nlm.nih.gov/pubmed,
Bireme (Virtual Health Library, a specialized service of
the Pan American Health Organization), specifically in
the databases Medline, Lilacs, available at the website
www.bireme.br and Scopus, available on the website
www. info.sciverse.com/Scopus, using as descriptors in
Portuguese: Endodontics, anatomy, microscopy, and as
descriptors in English: Endodontic, Anatomy, Micro-
scope.
The literature review performed was the systematic
type, being adopted the following inclusion criteria: 1)
publication in an indexed journal; 2) publications ranging
from January 2001 to November 2012; 3) articles in
English and 4) case reports. The exclusion criteria were:
1) in vitro studies; 2) works of literature review; 3)
paraendodontic surgery, and 4) articles in languages of
non-English origin. The articles related for the search
were selected by two independent reviewers, evaluating
the adopted criteria for inclusion and exclusion.
3. RESULTS
In databases consulted it was found in a total of 167 arti-
cles. The articles selected after methodological analysis
were twenty-one. Figure 1 illustrates the design process
of distribution of articles for the systematic review ac-
cording to the methodology employed.
The included studies that enabled the analysis of the
use of operating microscope in endodontic treatment are
described in Table 1. The selected articles were organ-
Figure 1. Distribution of articles for systematic review.
ized regarding: the author, year of publication, the tooth
in which was performed the endodontic treatment and
the treatment stage in which the OM was employed.
After analysis of twenty-one selected articles, it was
observed that in 2001 and 2009 it were not found publi-
cations which met the inclusion criteria proposed in this
research. In the years 2002, 2004, 2005, 2006, 2008, oc-
curred one publication per year, two in 2003, three in
2007 and 2010, occurring an increase in 2011 and 2012,
in which four publications dealt with the subject of this
study each year.
4. DISCUSSION
The knowledge of the complexity of the internal anat-
omy of the RCS is a permanent challenge to the endo-
dontist. Proper cleaning, shaping and obturation are the
requirements for successful endodontic treatment. Cur-
rently new features are available to the dental surgeon,
which adds the po ssibility to better understand th e details
of the pulp cavity [8,9].
The OM is a tool that has characteristics of stereo-
scopic vision and coaxial illumination, and those when
associated with magnification facilitate the achievement
of the clinical procedures [5]. The biggest impact of this
innovation is that it allow an increase of 8x to 16x, and
may even offer higher magnifications with 32x and 40x,
which are used to examine finer details [4,5,10]. Another
important aspect is that it can be adapted to a photo-
graphic camera, a video camera and a videoprinter,
which offers a best dental record and helps in patient
education [2].
After analyzing the twenty-one items selected, it was
observed that there was an increase in the number of
publications in 2011 and 2012, of four jobs each year.
This fact may be related to increased acquisition of this
equipment by specialists in endodontics, contributing to
a greater number of publications.
In the studies it was observed that there was no stan-
dardization in the step of the procedure or technique in
which the operating microscope was used, the same be-
ing used in different stages of treatment in access to the
pulp chamber [8,11-16], and the observation of the floor
and location of the root canals [8,9,13,17-26] in viewing
artifacts inside the root canal [8,16,27-29] in perforation
closure [29] and the placement of the intracanal medica-
tion [19] .
Regarding to the use alone or combined with other ins-
truments such as ultrasound tips, cone beam computed
tomography and optical fiber, among the authors it was
not observed a consensus associated with the use of OM.
In ten studies it was used only the microscope [12,13,
16,18,20-26] and in eleven the combination with other
tools [8-11,14-19,23,27-19]. Emphasizing in the articles
that its use was performed according to the clinical

C. C. dos Santos Accioly Lins et al. / Open Journal of Stomatology 3 (2013) 1-5 3
Table 1. Studies included in the study that allowed the analysis of the use of the operating microscope in endodontics.
Author/Year Dental element Treatment step for the use of operating microscope.
1.Sachdeva et al., 2012 41 Observation of the floor of pulp chamber and root canals location.
2. Silva; Zaia, 2012 22 Access to the pulp chamber.
3. Narayana; Wallace; Nair, 2012 12 Access to the pulp chamber; Placement of intracanal medication.
4. Nunes et al., 2012 12 Visualization of artifact inside the root canal; Perforation closure.
5. Kaneko et al., 2011 12 Access to the pulp chamber.
6. Karumaran; Gunaseelan;
Krithikadatta, 2011 24, 14 Access to the pulp chamber; Observation of the floor of pulp cha mber and root canals location.
7. Kottoor; Velmurugan; Surendran, 2011 26 Observation of the floor of pu lp chamber a nd root canals location.
8. Ianes et al., 2011 46 Access to the pulp chamber; Observation of the floor of pulp chamber
and root canals location; Visualization of artifact inside the root canal .
9. Kottoor et al., 2010 16 Observation of the floor of pulp chamber and root canals location.
10. Karthikeyan; Mahalaxmi, 2010 26 Observation of the floor of pulp chamber and root canals location.
11. Kottor; Sudha ; Velmurugan, 2010 46 Observation of the floor of pulp chamber and root canals location.
12. Cunha et al., 2008 22 Access to the pulp chamber.
13. Kontakiotis; Tzanetakis, 2007 36 Observation of the floor of pulp chamber and root canals location.
14. Tzanetakis; Lagoudakos; Kontakiotis, 2007 25 Observation of the floor of pulp chamber and root canals location.
15. Sathorn; Parashos, 2007 13 Access to the pulp chamber.
16. Yilmaz et al., 2006 16 Observation of the floor of pulp chamber and root canals location.
17. Moor; Calberson, 2005 15 Observation of the floor of pulp chamber and root canals location.
18. Jung, 2004 12 Observation of the floo r of pulp chamber and root canals location.
19. Ward; Parashos; Messer, 2003 16, 36 Visualization of artifact inside the root canal.
20. Ward, 2003 16 Visualization of artifact inside the root canal.
21. Girsch; McClammy, 2002 11 Observation of the floor of pulp chamber and root canals location.
experience of the operator or the need for each treat-
ment.
When there is a deficiency in some stage of endodon-
tic treatment is required reintervention [1]. One of the
selected articles reported retreatment of upper and lower
first molars, describing that the microscopic analysis was
more effective in detecting and removing debris, but also
allowed the location of additional channels [8]. In two
other studies conducted in the upper anterior teeth the
operating microscope was used for retreatment of dens
invaginatus and perforation closure [16,29].
The main question regarding its use is due to high cost,
and the training time required for its handling, however,
the authors stated that once overcome the training time
and learning, there is an improvement in clinical proce-
dures allowing the solution of situations that would not
be possible without this tool [1 0].
Many researchers had the same opinion that OM is
helping much in Endodontics, for providing great light-
ing and better visualization of the operative field [12,
18,22]. Thus, with high magnification is possible to im-
prove the ability to communicate with th e patient and the
technical skill, thus seeing the tenuous boundaries re-
sponsible for the failure or success of the procedure [5].
5. CONCLUSION
The anatomical complexity of root canal system in the
context of en dodontic therapy is always a ch allenge. The
results from the present study reveal that the OM has
been increasingly used as an instrument of labor among
endodontists. It was found that its use has provided en-
dodontics with a significant improv ement in vision of the
operative field, offering better quality jobs and a higher
success rate.
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