This Is Where Things Get Interesting…

Sometimes in what I like to call the great invention curve, there is a calm before the announcement storm. We saw it with artificial intelligence (AI). As I wrote in February 2024, AI was making quiet inroads into society at large and then moved into the dental profession before anyone was really aware of it. As we all know, AI seemed to explode across the profession in 2023; however, it had been flying under the radar for almost a decade. We are now about to see some similar amazing things that are in development in the areas of magnification.

First things first, though. I refer to loupes as surgical telescopes or scopes because that is what they are. Personally, I feel the word loupes lessens how important these things are.

Flying Blind

I find it amazing how far the profession and our industry have come in this field. When I look back over the years of my career, I can say that I have seen the full spectrum of this. When I was being trained, no one used magnification. To many of you reading this, that probably seems hard to fathom, and I’ll admit that it is for me as well. I do remember one particular doctor in my clinical team who kept a very low-magnification pair of glasses in his pocket. Occasionally when he was looking at a crown on a model, he would pull out those antiquated glasses and look at a margin. I don’t ever recall him actually looking in a patient’s mouth while wearing them, though. Rumors were that he had been incredibly successful and was teaching just to give back, but I never made the connection that perhaps that incredible success could be, in part, due to magnification helping him achieve his clinical excellence.

The first 7 years I spent in private practice, I did so with just my naked eyes. One day a good friend from Phoenix called me to excitedly tell me about his new 2.5x glasses. By this point you could see booths at trade shows selling these “glasses,” but the crowds looking at them were sparse. My friend kept pushing me to make a purchase, but I was stubborn. I had been blessed with 20/15 vision, while my friend needed prescription eyewear to read the newspaper. I thought, “Of course you need that. You can’t see things right in front of you without help.” Ah, youth.

However, he kept after me and I am so grateful that he did. About 6 months later, I finally succumbed to his persuasion and bought a pair identical to his. They were 2.5x “flip-ups,” and they rocked my world. By this time he had purchased a light system, and he told me I needed to purchase the light system too. This time, I was all in. By this point I’d have bought clown shoes if he told me they would help me see better.

Back then the lighting systems were big boxes that had a high-intensity halogen bulb. The light traveled to the glasses via a fiber-optic cord that you plugged into the light box. The boxes were big and heavy, so you had to have one in every operatory, and the $125 halogen bulbs burned out every 3 months. The setup was expensive but so worth it. I quit using the track lights in the operatories, and I was amazed how much easier it was to work when I wasn’t reaching up to constantly reangle the track light every time a patient moved or I needed to change my angle of access. Everywhere I looked, the light followed. It was phenomenal.

Once I got used to working with 2.5x, I wanted to see even better. Before long I had reinvested by upgrading to 4.8x, and my world changed again. My posture got better, I was more efficient, and best of all, my dentistry got better.

The next big jump was to LED lights. I was no longer tethered to “the box,” and I no longer had to buy all those expensive halogen replacement bulbs every 90 days. I was much more mobile while still having all the advantages of the light on my scopes. When I built my new office, I helped buy scopes for the hygiene team because I wanted them to see what I was seeing. That also meant that I didn’t need to purchase track lights for 7 new operatories either. And for those of you who are wondering, there are several very low-cost options for assistants that can attach to regular safety glasses, so your auxiliaries don’t need you there to provide illumination when they are fabricating temporaries, etc.

The Improvement Curve

Of course, the only constant is change, which I love. The bright people doing research and development kept working at making vision better and better. One of those earlier changes was to prismatic lenses. These high-quality lenses gave doctors a more generous field of view with amazing definition and edge-to-edge clarity. Prismatic lenses allowed me to see even better while allowing me to see even more.

This is also a good point to mention: the improvements to LED lights and why lighting is so important. Many current LED systems are incredibly bright, but they are also very much needed. One of the laws of light physics is that when you increase the magnification, you also need to increase the length of the telescopes. The longer the scope becomes, the less light actually enters it. The result is that a bright illumination of the field is not only nice but also required. I honestly don’t even want to think about practicing without the light.

Further improvements came along in the form of telescopes that have variable magnification. These scopes allow me to work at 3.0x-4.0x-5.0x, depending on my needs. The level is adjusted by rotating the telescopes until they click into the next level up. I find that for my needs, I like to do hygiene exams at the lower magnification of 3.0x, which allows me to see about a single quadrant at a time. This gives me a better field of view to help visualize and get a big picture of what is going on. During the exam, if I see an area that perhaps needs a closer look, I can easily move to a higher magnification level by just rotating the barrels on the scopes to the right. For those of you thinking about infection control in this scenario, wiping the barrels (and anything else you’ve touched with gloves) can be accomplished with a CaviWipe or similar surface disinfectant.

The only drawback to variable magnification is that if you prefer to do most of your dentistry at 3.0x and use higher magnification only in certain situations, you have the weight of all 3 levels on your nose all the time. For those who would like to have higher magnification on less frequent occasions, I’ve got your answer. For that doctor, I’d recommend a frame that allows you to swap in and out individual telescopes to change your levels. The OmniOptic frame (Orascoptic) has a single frame that has interchangeable telescopes that snap into place and are held there with powerful magnets. The telescopes come in levels 2.5x, 3.5x, 4.5x, and 5.5x. The nice thing about these is that you can have all those levels of magnification but have the weight of only what you are currently using. You can also pick and choose which telescopes to purchase and buy only the ones you prefer. Of course, if you then decide to have another level, you simply purchase the level you’d like. All the personal correction (if you need an optometric prescription for your vision) is built into the lenses mounted into frame. This means you don’t need to buy anything else with the correction. The telescopes are off the shelf and readily available when you order.

Seeing Into the Future

The great news here is that progress continues. Recently we’ve seen the launch by several manufacturers of deflection or declination telescopes. These telescopes exit the lens of the glasses and have a bend or angle built into them. The idea behind this is to allow the operator to sit in more upright posture. As someone who has been using straight telescopes since the late 1990s, there was a bit of a learning curve as I used them, but that learning curve was short. If a doctor bought some as a first-ever step into magnification, I would anticipate that learning curve to be less. At this point, I can swap between standard and deflection systems without even thinking much about the change.

However, the next step in this product category is coming soon, and it is going to be game changing. That’s because this product space is soon going to be digital! When you think of how much the camera in your smartphone has improved over the last 3 to 5 years, imagine that being built into your surgical telescopes! That’s right. Digital magnification is about to hit it big in dentistry.

Going Digital

Few things in recent history have gotten me this fired up. We are talking about a head-mounted system that puts high-definition stereoscopic screens right in front of your eyes. This is going to be paired with either a single or a pair of high-resolution camera(s) and bright, true-color, adjustable lighting. These systems will offer a large viewing field that will enable the operator to zoom in to levels of magnification that will up to this point have been available only with a surgical microscope.

Some of the systems will be WiFi enabled, which will allow the operator to take still photos or full-motion video and save them on the office network. You will also be able to stream this video for live demonstrations or for those curious patients who have always wanted to see what’s going on. If your WiFi signal is weak, the system should also have a memory card slot so that the images and video can be stored for downloading later.

There may be foot pedal controls or even voice activation to simplify usage and decrease infection control concerns.

Of course, there are going to be bumps in the road as we, the end users and our patients, adapt to this. How will patients react to these systems? No matter how stylish manufacturers design these, they are going to look different. Some systems may prevent the patient from actually seeing our eyes. Will patients trust that we are seeing better than ever before?

There is also the issue of what is referred to as lag time. The digital processors are going to need to be superfast so that there is no time difference between what the camera sees and the moment it is rendered on the screens. We cannot have a system where something moves and there is even a fraction of a second before the doctor sees it.

Weight is a concern. How heavy will these be and how comfortable will they be to wear? Doctors suffer enough from neck and back issues. The weight of these must be kept to a minimum. Some systems will be worn with a head loop, while others will look more traditional, with the system secured with the snugging neck strap we are used to.

And of course there is the simple subject of need. I know that some doctors are going to say that we are seeing well enough already. Do we need to see any better? How high in magnification can we go before small head movements appear to be drastic? One other factor to consider is the resolution. How high can the magnification go before we see pixelation on our screens? These questions and others are all things that both manufacturers and the end user need to consider.

Wrapping Up

As regular readers know, I am always enthusiastic about progress in our profession, but I try to remain realistic in my expectations. “Underpromise and overdeliver” is normally my mantra. However, I feel in my gut that this is going to be a quantum leap forward over today’s systems. For years I’ve been saying that, at least for me, the more and better I see, the more and better I want to see.

As you read this, I will be knee-deep in a clinical evaluation of one of these systems that is being created by a major manufacturer. I am going to be bench testing the device and then after the learning curve, I’ll be going live with use during actual clinical procedures. As soon as I am able, you can expect a follow-up column on my experiences. I can’t wait to tell you more!

About the Author

John Flucke, DDS, is in private practice in Lee’s Summit, Mo. He also serves as chief clinical editor and technology editor for Dental Products Report ® and keeps an active blog filled with thoughts and tidbits on the world of technology at blog.denticle.com.