Loupe Magnification Research Articles

Standard views do not suffice in assessing distal scaphoid articular cannulated screw penetration

BackgroundArticular screw penetration is one of the most common hardware-related problems after scaphoid fracture fixation, occurring in up to two-thirds of patients, in particular into the scaphotrapezotrapezoidal (STT) joint. The aim of this study was to investigate whether this clinically important issue could be detected using standard anteroposterior (AP) and lateral, as well as additional nonstandard fluoroscopic views using direct open visualization with magnifying loupes as reference standard.Materials and methodsTen fresh cadaver wrists were used for this imaging study. A 2.2 mm cannulated compression screws with a length of 24 mm was placed in the scaphoid and incrementally left to protrude at the STT joint up to 2 mm. Eight fluoroscopic views of the wrist were then obtained by rotating the forearm using goniometric measurements, keeping the image beam parallel to the floor: (1) anteroposterior with the wrist in neutral rotation, (2) anteroposterior with the wrist in ulnar deviation, (3) supinated oblique 60° from neutral (60° supinated oblique), (4) supinated oblique 45° from neutral (45° supinated oblique), (5) a true lateral, (6) a true lateral with the wrist in radial deviation, (7) pronated oblique 45° from neutral (45° pronated oblique), and (8) a pronated oblique 60° from neutral (60° pronated oblique).ResultsStandard anteroposterior and lateral fluoroscopy views (radiographically calibrated) of a percutaneous cannulated screw fixation of a scaphoid fracture were insufficient to detect distal articular penetration, missing half the amount of screw penetrations in the current study. The 45° pronated oblique view was found as the most sensitive in detecting STT penetration (p < 0.0001).ConclusionsStandard anteroposterior and lateral fluoroscopy views of a percutaneous cannulated screw fixation of a scaphoid waist fracture are insufficient to detect STT screw penetration. According to the current study, standard views would have missed half the amount of screw penetrations, which seems to reflect the high incidence of this problem in current practice. The most sensitive view was the 45° pronated oblique view, which detected STT screw penetration in all cases.Level of Evidence Not applicable.

Facts and Benefits of Using Dental Magnifying Loupes

Facts and Benefits of Using Dental Magnifying Loupes

Prevalence Of Second Mesiobuccal Canal In Maxillary Second Molars On The Basis Of Clinical And Radiographic Parameters.

The objective of this study was to determine the prevalence of the second mesiobuccal canal in permanent maxillary second molar in patients presenting to Peshawar Dental College and Hospital. One hundred and twenty patients advised for root canal treatment in the maxillary second molars participated in the study. Two detection procedures, clinical and radio graphical examination were used. Two pre-operative radiographs with different angulations and one post-operative radiograph were taken to examine roots and root canals. Access cavities were prepared and the second mesiobuccal canal was explored using magnifying dental loupes (3.5 x), endodontic explorer (DG16) and size 10 K-file. Descriptive statistics were recorded as percentages, frequencies and mean. The chi-square test was used for gender, age-wise comparison and right and left side of the maxillary jaw. One hundred and twenty patients were recruited in the study. There were 65 (54.2%) males and 55 (45.8%) females. The second mesiobuccal canal was more common in males compared to females (p-value=0.434). The second mesiobuccal canal was most commonly found in 3rd decade with mean age, of 40.5±12.31, (p-value =0.51). The frequencies and percentages of the second mesiobuccal canal in maxillary second molars on the right and left side of the jaw were 70 (58.3%) and 50 (41.7%) respectively (p-value =0.310). The second mesiobuccal canal was found in less than half of the second molars. The most successful method of detection in this study was both clinical and radiographic.

Optical Diagnostics in Periodontology

In terms of clinical performance, the conventional methods for diagnosing periodontitis fall short of ideal. By adding optical techniques to ocular inspection and periodontal probing, these procedures can be made better. The minor changes in periodontal tissues that cannot be visually inspected can be identified and measured constantly over a period of time with the help of optical diagnostic techniques. The removal of subgingival microbial biofilms and dental calculus deposits during debridement of teeth and dental implants can be made more efficient by using magnifying loupes, operating microscopes, and cutting-edge methods based on how light interacts with bacterial deposits, such as differential reflectometry and light-induced fluorescence. The absence of ionizing radiation from optical devices, which enables frequent usage on the same patient in clinical practice, is one of the greatest reasons in favor of their use as diagnostic adjuncts. The periodontium’s soft tissues can be examined using three-dimensional scanning, fluorescence spectroscopy, and optical coherence tomography to see how they relate to natural teeth and dental implants. By limiting the under- and overuse of treatment alternatives, an accurate prognosis-determining system would enable a more targeted deployment of finances, enhancing the appropriateness and quality of dental care. The clinical management of people with periodontal disease may be enhanced by a novel approach to periodontal diagnostics.

Evaluation of Second Canals in Mandibular Incisors using Magnification: A Cross-Sectional Study

Background: It is essential to have a thorough understanding of the typical anatomy of the root canal system, as well as the various common and uncommon anatomical variations, in order to achieve successful treatment outcomes.Objective: To determine the frequency and pattern of two canals in mandibular incisors using magnifying loupe Material and Methods: This study at Saidu College of Dentistry in Swat included 385 participants selected consecutively. Inclusion criteria were males and females aged 20-60 years with mandibular incisor-related dental conditions. Exclusion criteria were local anesthesia allergies, internal root resorption, calcified canals, and pregnancy. The number of canals was recorded radiographically using the SLOBE technique. Canals were classified using Vertucci's system. Canal frequencies were analyzed by gender and tooth types using chi-square tests (p&lt;0.05).Results: The mean age was 33.97±11.10 years. Of the participants, 215 (55.84%) were males. The highest numbers of tooth types were found among the left lateral incisors (n=148, 38.44%) and left central incisors (n=122, 31.69%). Second canal was found 139 participants (36.10%). Among these, Type I (n=84, 21.82%) was the most common two-canal pattern, followed by Type III (n=36, 9.35%). When analyzing the canal types within the single canal group, Type I was the most prevalent in both males (23.26%) and females (20.00%). The frequencies of Types II, III, and IV were similar between genders and did not exhibit significant differences (p=0.865). The distribution of canal types varied across tooth types, with Type I being the most common, but not statistically significant (p=0.652).Conclusion: The presence of a second canal in the mandibular incisors is quite common. The most common pattern of two canals, according to the Vertucci classification, was Type I, followed by Type III.Keywords: Magnification, Mandibular incisors, Second canals, Vertucci classification

Demystifying Giant Cell Tumours of Tendon Sheath (GCTTS): A Case Series of 18 Cases with Review of Literature.

The giant cell tumour of the tendon sheath (GCTTS) is the second most frequent soft tissue tumour affecting the hand. No consensus exists on the etiology, prognostic factors, or recurrence rate of GCTTS. This article presents a series of 18 cases supplemented by a literature review that examines the epidemiology, presentation, gross and microscopic characteristics, and recurrence rate of GCTTS. A total of 18 patients with a histo-pathological diagnosis of a GCTTS of the hand or finger were reviewed. The location for the tumour was limited to the wrist and hand. All cases were operated under Wide Awake Local anaesthesia (WALANT), and using a magnifying loupe. A total of 18 patients presented at our institution with a diagnosis of GCTTS from 2016 to 2018. Of the 18 patients, 11 were female and 7 were male. The mean age of included patients was 43.6years (31-59years). The most common site for the lesion was the middle finger (4/18), followed by the index finger, wrist, and thumb (3/18 each). The little and ring finger were least commonly affected with one case each. The mean size of the tumour was 2.4cm (0.5-5cm). None of the patients reported recurrence of the lesion on an average follow-up of 18.8months. GCTTS is a benign, slowly growing lesion of the hand that typically does not cause any symptoms and is treated with surgical resection. Meticulous excision of the GCTTS using magnification loupes to ensure appropriate wide excision of the tumour is the treatment of choice to prevent a recurrence. In addition, a radiographic and histopathological examination must be performed on the tumour to rule out other diagnoses. Finally, the function of the hand should be reconstructed to minimize the loss of any functional unit.

Role of Loupes Magnification in Tracheal Resection and Anastomosis.

The online version contains supplementary material available at 10.1007/s12070-023-04115-3.

High Magnification in Dentistry; Postural Benefits using Magnification Loupes to Improve Dental Work Performance

Stress, pain, injuries, and errors in dental procedures are situations highly linked to dentistry derived from multiple factors making this profession a profession with high physical and mental demand to achieve quality treatment without deteriorating the health of those who perform it, in this case, the dentist, the assistant, and hygienist. The effects of wrong postures, but above all, the lack of knowledge of the proper postures, the modeling of bad habits acquired during the training stage in dental school, and the lack of work guidelines that not only take into account the dentist but also to all the work staff and the methodological organization of dental tasks can be found in the scientific literature. Magnification devices are known to improve vision, precision, and ergonomics in dentistry; advances in the area of ​​high magnification in dentistry are taking place by leaps and bounds. In recent years, a new magnification loupes design has appeared on the market, called ergonomic magnification loupes appeared that stands out from conventional Galilean and Keplerian through the lens (TTL) Flip-up loupes in terms of their postural benefits and is part of the arsenal of magnification loupes to consider in the market. The postural approach of high magnification equipment is necessary for professional practice, where the design of Ergonomic magnification loupes with consideration not only for magnification but also for the operator’s postural health which can have a significant impact on the performance and overall health of the dentist and hygienist, more if incorporated from the beginning of dental school education and training.

Deep Inferior Epigastric Perforators Topography for "Island Transverse Rectus Abdominis Musculocutaneous Flap" in Breast Reconstruction.

Background The Island transverse rectus abdominis musculocutaneous (TRAM) flap is well vascularized with very reliable blood flow, because all perforators of the zone I are included when it is harvested. The number of perforators, topographic mapping, and their relationship with reconstructed outcomes were investigated. Methods Fifty patients with Island TRAM breast reconstruction from September 2021 to August 2022 were investigated. The zone I was divided into a total of eight sections. Under the loupe magnification, all perforators larger than 0.5 mm in zone I were counted with fine dissection, and photographs were taken in background of vessel loops. Complications like flap necrosis, seroma, and hematoma were also investigated. Result There are 12 ideal perforators on average in zone I such as one perforator in section I, II, IV, V, VI, VIII, and three perforators in section III and VII. However, two perforators (M6 and L6) below arcuate line were sacrificed in the time of flap harvest to prevent hernia. Island TRAM included 10 perforators on average (5 perforators in each side) above arcuate line to be transferred to the recipient site. Only minor complications were identified. Conclusion The Island TRAM flap includes 10 perforators to get the vigorous blood flow. The periumbilical to upper medial perforators become more dominant in the perfusion of the flap after deep inferior epigastric artery division. Well preserved perforators will guarantee the satisfactory breast reconstruction with the least complication.

A new portable Fresnel magnifying loupe for nystagmus observation: a clinical education and clinical practice setting study

BackgroundDizziness is a common complaint of patients treated by primary care physicians. It is predominantly caused by peripheral vestibular disorders; however, central nervous system disorders should be excluded. Examination of the eye movements and nystagmus can help differentiate the disorders of the central nervous system from the peripheral vestibular disorders; however, it is often not performed appropriately. In medical education practice, nystagmus observation may facilitate an understanding of vestibular function and nystagmus characteristics. Thus, we proposed a medical education practice to master nystagmus observation using a recently developed portable Fresnel magnifying loupe that could be shielded by one eye.MethodsThirty-three students from the Department of Physical Therapy and the Department of Speech, Language, and Hearing Therapy of the Mejiro University participated in this study. Postrotatory nystagmus was measured and compared using the new loupe and control methods, namely the naked eye and Frenzel goggles; we rated the ease of visibility using a five-point scale.ResultsThe number of detected cases of nystagmus was significantly higher with the new loupe than with the naked eye (p = 0.001). In addition, there were no significant differences in the nystagmus counts between the observations using the new loupe and Frenzel goggles (p = 0.087). No significant difference was observed in the visibility of eye movements between the loupe and naked eye (p = 1.00). The Frenzel goggles provided better visibility compared to that by the loupe (p = 0.034); however, none of the participants reported poor visibility using any of these methods.ConclusionsOur newly developed Fresnel loupe allows for the observation of nystagmus counts a level of reduction in fixation suppression similar to that of Frenzel goggles in an educational practice setting. Furthermore, it enables the detection of significantly more nystagmus counts compared to that by the naked eye. It offers several advantages over Frenzel goggles, including its lightweight, thin, durable, and portable design. Additionally, the loupe does not rely on a power source and can be used under normal room lighting conditions.Trial registrationThis study was approved by the Medical Research Ethics Committee of Mejiro University (approval number: 21medicine-021).

(130) Marsupialization of the Bartholin Duct Cyst and Recanalization for Symptomatic Recurrent Bartholin Cysts

Abstract Introduction Bartholin glands (BGs) are located posteriorly on each side of the vaginal introitus. During sexual arousal, BGs release mucinous secretions into the vestibule at the 5:00 and 7:00 positions via a 2.5 cm Bartholin duct (BD). The BD may become obstructed from trauma, inflammation, infection, vestibular or vulvar surgery, or idiopathic factors. Despite BD obstruction, the glands may continue to produce mucinous secretion causing cystic dilation of the duct. Thus, a Bartholin duct cyst (BC) is formed and can result in pain during sexual arousal. Treatment strategies include sitz baths, hot compresses, aspiration, Word catheter placement, or BC marsupialization. Objective This chart review was performed to assess the safety and efficacy of a new technique for BD marsupialization in patients with symptomatic BC. Methods This is a chart review of patients with symptomatic BC who underwent BD marsupialization using a new technique. This new strategy involves marsupialization of the anterior wall of the BC, identification of the BD lumen on the posterior wall of the BC under surgical Loupes magnification and advancement of the BD lumen directly to the surface of the introitus at 5:00 and/or 7:00 locations. The BD neo-ostium was secured with interrupted 4.0 chromic sutures. Results 14 patients (mean age 28 ± 9 years) between 2015 - 2022 diagnosed with recurrent BC-induced pain during sexual arousal were treated by marsupialization of the BC and advancement of the BD directly to the mucosal surface of the introitus. Each patient averaged 3 prior BC treatments (range 0- 6). Symptoms included pain with sexual arousal or walking/sitting (100%) and an introitus mass interfering with penetration (50%). The mean BC size on ultrasound was 2.7 ± 1.6 cm x 2.4 ± 1.7 cm. All BD marsupialization surgeries were performed as outpatient procedures. Sexual arousal was encouraged early post-operatively and mucinous secretion documented by vestibular photography post-arousal. With an average follow-up of 14 months, 11/14 (79%) symptomatic BCs have resolved. Conclusions A new surgical strategy is described for patients with symptomatic BCs involving BD anastomosis directly to the introital mucosa at the 5:00 or 7:00 locations, resolution of BD obstruction, and excellent restoration of BG lubrication. Disclosure No

Yoga Can Help You Practice and Teach Cardiothoracic Surgery.

Those who practice, and teach, thoracic and cardiovascular surgery and those who are training in this realm, as well as in many other disciplines, often endure debilitating physical stress and strain as a result of their practices. [Bishop, 2023] Despite the attention paid to issues such as proper adjustments for loupe magnification, optimal footwear, attention to 'micro-breaks', and paying attention to the ergonomics of performing long and intense operations, many surgeons still suffer discomfort and debility, and, even, disability. [Dalagher, 2019, Epstein, 2018, Alleblas, 2017, Giagio, 2019, Norasi, 2021] Dealing with those challenges should include what those practitioners can do outside of the operating room to increase their comfort and resilience, as well as what can be done in the operating room. One approach to dealing with these issues is to utilize the lessons and benefits of yoga. [Tribble, 2016].

Prevalence and Pattern of Visual Impairment among Adult Population in Mangu Local Government Area of Plateau State, Nigeria

Aim: Visual impairment is a public health problem globally. This study aimed to determine the prevalence and pattern of visual impairment among adult population in Mangu Local Government Area (L.G.A), Plateau State, Nigeria.&#x0D; Study Design: A population-based descriptive cross-sectional survey of 802 adult population aged 18 years and above was conducted in Mangu L.G.A, Plateau State, Nigeria using a multi-stage cluster random sampling design.&#x0D; Methodology: Subjects were evaluated using a magnifying loupe, Snellen E chart, direct ophthalmoscope and torchlight. Vision status was defined using World Health Organization categories of visual impairment based on presenting visual acuity (VA).&#x0D; Results: Out of a total of 960 respondents enumerated for the study, 802 (83.5%) adults participated. Prevalence of blindness (presenting VA of less than 3/60 in the better eye) was 8.1%; prevalence of low vision (presenting VA of at least 3/60 but less than 6/18 in the better eye) was 27.6%; prevalence of overall visual impairment (presenting VA less than 6/18 in the better eye) was 35.7%. Prevalence of visual impairment was higher in males (40.8%) than in females (34.9%), although not statistically significant (p=0.098). Prevalence of blindness and impaired vision increased significantly with increasing age, from 21.7% at 20 - 39 years to 83.6% among those aged ≥80 years (P &lt; 0.001).&#x0D; Conclusion: Much can be done by individuals, governments and non-governmental organizations to reduce so much blindness and vision loss through cost-effective interventions such as wears of sunglasses and other preventive measures to prevent ultraviolet radiation effect on their eyes.

Comparison of Enamel Surface Roughness after Bracket Debonding and Adhesive Resin Removal Using Different Burs with and without the Aid of a Magnifying Loupe.

This study aimed to evaluate the impact of using a magnifying dental loupe on enamel surface roughness during adhesive resin removal by different burs. Ninety-six extracted premolar teeth were randomly divided according to the bur used with or without the aid of a magnifying loupe into four equal groups (N = 24): group I: naked eye tungsten carbide burs (NTC); group II: magnifying loupe tungsten carbide burs (MTC); group III: naked eye white stones (NWS); and group IV: magnifying loupe white stones (MWS). The initial surface roughness (Ra) T0 was evaluated using a profilometer, and the scanning electronic microscopy (SEM) technique. The metal brackets were bonded and debonded after 24 hours with debonding plier. After adhesive removal, Ra was evaluated again (T1) also the time spent on adhesive removal was recorded in seconds. The samples were finally polished by Sof-Lex discs and Sof-Lex spirals, and the third Ra evaluation was performed (T2). The results of two-way mixed analysis of variance (ANOVA) showed that all burs increased surface roughness at T1 as compared to T0 (p < 0.001) with the highest Ra values shown in group III followed by group IV, group I, and group II. After polishing, no significant difference was noted in Ra values in group I and group II at T0 vs T2 (p = 1.000), while it was significant in group III and group IV (p < 0.001). Regarding the time required for adhesive removal, the shortest time was in group IV followed by groups III, II, and I, respectively. The use of a magnifying loupe affects the quality of the clean-up procedure by reducing the enamel surface roughness and the time spent on adhesive removal. Using a magnifying loupe was helpful during orthodontic debonding and adhesive removal.

Defining the Cervical Line in Face Lift Surgery: A Three-Dimensional Study of the Cervical and Marginal Mandibular Branches of the Facial Nerve.

Continuous subSMAS dissection in the cheek with subplatysmal dissection in the neck is an important feature of many face lift techniques, yet the neural anatomy in this area remains unclear, and recommendations regarding continuous dissection of these adjacent areas vary widely. The purpose of this study is to define the vulnerability of the facial nerve branches in this transitional area from the face lift surgeon's perspective and to specifically identify the location of the cervical branch penetration through the deep cervical fascia. Ten fresh and 5 preserved cadaveric facial halves were dissected under 4X loupe magnification. The skin was reflected followed by elevation of a SMAS-platysma flap with identification of the location of cervical branch penetration through the deep cervical fascia. The cervical and marginal mandibular branches were then dissected retrograde through the deep cervical fascia to the cervicofacial trunk to confirm identifications. The anatomy of the cervical and marginal mandibular branches were found to be similar to the other facial nerve branches, all of which initially course deep to the deep fascia in their post-parotid course. The location of emergence of the terminal branch or branches of the cervical branch through the deep cervical fascia was consistently at or distal to a line from a point 5 cm below the mandibular angle on the anterior border of the sternocleidomastoid muscle to the point where the facial vessels course over the mandibular border (Cervical Line). Continuous dissection of the SMAS in the cheek with subplatysmal dissection in the neck crossing over the mandibular border is possible without jeopardizing the marginal mandibular or the cervical branches if done proximal to the Cervical Line. This study serves as the anatomic justification of continuous SMAS-platysma dissection and has implications for all types of SMAS flap manipulations.

Hallmark of Dentistry: The Evolution and Benefits of the Dental Magnifying Loupe

Background Dental education has increasingly recognized magnification as an integral part of dentistry and based on the advantages and benefits recommends its use as early as in the first year of dental school. Dental students and practitioners have become aware of their enhanced quality of work, while preventing eye fatigue and strain. Thanks to proper ergonomics, long-term bodily afflictions such as MSDs can be prevented and increase the dental students and practitioners’ ability to enhance career longevity.Case Description This review aims to present the evolution and benefits of dental magnifying loupes used to improve diagnosis and treatment outcomes through enhancement of the visual acuity, thus preventing musculoskeletal disorders and improving ergonomics. An overview of the type of magnification is presented discussing single lens loupes, Galilean loupes and prism loupes. Furthermore, visual acuity, working distance and depth of field, declination angle and working angle, field of view and convergence angle, magnification and illumination are explained.Practical Implications Loupes offer the dental profession enhanced visualization of the operating field, while at the same time they reduce eyestrain providing ergonomic advantages, and preventing long-term complications such as musculoskeletal disorders (MSDs). When dental students and practitioners wear dental loupes in an ergonomically correct neutral position, significantly more benefits have been reported compared to operators that do not use magnification. Dental magnifying loupes are becoming the expected hallmark of dentistry; thus, they are considered a new identity and icon of the dental profession.

An assessment of the role of surgical loupe technique in prevention of postthyroidectomy complications: a comparative prospective study.

Eighty patients with thyroid nodules who underwent thyroidectomy procedure were divided randomly into two comparable groups, group A subjected to thyroidectomy by using binocular magnification loupe, group B underwent conventional thyroidectomy without using magnification. Patients' demographics, operation time, and postoperative morbidities were recorded. All cases had preoperative and postoperative vocal cords assessment by video laryngoscopy. Pathology, laboratory, and radiology investigations were also conducted. Out of 80 patients, there were 58 females and 22 males. Benign thyroid pathology was found in 74 patients and malignant pathology in 6 patients. The mean operating time was 106min in group A compared to 138.5min in group B. The mean amount of intraoperative bleeding was 30ml in group A while 50ml in group B. There were no cases of the external branch of the superior laryngeal nerve in both groups; there was better identification in group A. There was only one patient who suffered from a temporary RLN injury in group A, while three cases of temporary and one case of permanent RLN injury were recorded in group B. Permanent hypoparathyroidism was diagnosed in only one patient in group B. The utilization of binocular surgical loupe magnification in thyroid surgery is considered a safe and effective maneuver that has the advantages of decreasing the overall operating time and significantly reducing postoperative complications.

Characteristics of Fossil Wood from Loa Sugarcane Kutai Kertanegara, East Kalimantan

Fossil Wood is wood that has petrified as a result of wood or plant stems being buried by sediment, does not experience decay and the cells in the wood are replaced by minerals over a long period of time but the outer structure of the wood is still maintained. One way to find out the characteristics of fossil wood is by observing or characterizing it both macroscopically and microscopically. This study aims to determine the macroscopic characteristics, hardness values and density of wood fossils found in Loa Tebu Village, Kutai Ketanegara. Observations of macroscopic characteristics included the color of wood fossils which were observed by naked eye and with a loupe magnification of 10x, and observations of other macroscopic characteristics were carried out on three areas of wood namely transverse, tangential and radial planes using a Nikon SMZ 645 Stereo Microscope with a magnification of 30x. The hardness value uses a rock hardness test tool, namely "Diamond Selector II", while the density uses the general calculation standard for specific gravity, namely the ratio of mass to volume. The results showed that the characteristics of the fossil wood from Loa Tebu were light brown, dark brown, white and gray in color. The color found in the wood fossils is probably caused by cells that have been mixed with inorganic elements and mineral constituents around the location of the wood fossils. Another macroscopic structural observation was the discovery of wood cells such as those of broad leaf wood in general, namely the presence of vessel cells (pores), radius cells and clusters of fiber cells. Axial intercellular channels (SIA) were also found in the samples and arranged tangentially. The AIA characteristics found here are common characteristics that are often found in several species of wood from the Dipterocarpaceae family. The results of the measurement of the sample hardness value were 4 on the Mohs scale and the density was 3.26

Partial excision of schwannomatosis with fascicular invasion occurring in the ulnar nerve above the elbow: A 1-year follow-up study

Although not as common as solitary lesions, multiple schwannomas do occur, even in single nerve lesions. We report a rare case of a 47-year-old female patient who presented with multiple schwannomas with inter-fascicular invasion in the ulnar nerve above the cubital tunnel. Preoperative MRI revealed a 10-cm multilobulated tubular mass along the ulnar nerve above the elbow joint. During excision under 4.5° loupe magnification, we separated three ovoid yellow-colored neurogenic tumors of different sizes, but there were still remaining lesions as it was difficult to completely separate lesions from the ulnar nerve due to the risk of iatrogenic nerve ulnar nerve injury. The operative wound was closed. Postoperative biopsy confirmed the diagnosis of the three schwannomas. During the follow-up, the patient recovered without neurological symptom or limitations in range of motion, and there were no neurological abnormalities. At 1year after surgery, small lesions remained in the most proximal part. However, the patient had no clinical symptoms and was satisfied with the surgical results. Although a long-term follow-up is necessary for this patient, we were able to obtain good clinical and radiological results.

Effect of magnifying loupes on tooth preparation of complete coverage crown: A quantitative assessment using a digital approach.

The purpose of this study was to evaluate the use of magnifying loupes (×2.5) on the quality of tooth preparation for complete coverage crowns; performed by predoctoral students using an objective and quantitative digital method. Forty-two predoctoral students were randomly assigned into 2 groups to perform tooth preparation for a complete coverage crown on a mandibular first molar in a manikin, with and without the use of magnifying loupes. All preparations were digitally evaluated by PrepCheck 3.0 (Dentsply Sirona). Parameters including tooth reduction, total occlusal convergence (TOC), undercut, margin quality and surface quality were assessed. Continuous data were analysed using Paired t-tests or Wilcoxon Signed Ranks tests. Ordinal data were analysed by McNemer's tests. To further detect the majority pattern ( > 50%) in each group (with and without loupes), one-sample t-test or one-sample Wilcoxon Signed Rank test was performed. The level of significance was set at p=.001 after Bonferroni adjustments for multiple testing. No significant differences in the measured outcomes were found between the groups with or without the use of magnifying loupes (p > .002). The majority (>50%) of both groups had no undercuts (99.3% and 99.4% both p < .001) and the preparation type was within tolerance (81.6% and 85.3%, both p < .001) with acceptable margin (86.4% and 86.3%, both p < .001) and acceptable surface quality (99.0% and 99.1%, both p < .001). However, the majority of both groups underprepared occlusally (96.0% and 95.4%, both p < .001) and axially (65.3% and 67%, both p < .001). Only 30.0%-42.1% of the participants achieved the TOC within 0-20°. Within the limitations of this study, the use of magnification loupes does not appear to significantly improve the quality of tooth preparation for complete coverage crown. The TOC was also found to be overprepared and occlusally underprepared.