Use Of Loupes Research Articles

O218: Biomechanical and Ergonomic Risks Associated with Cervical Musculoskeletal Dysfunction amongst Surgeons: A Systematic Review

Abstract Introduction Surgeons are at high risk of developing musculoskeletal symptoms due to a range of factors including, maladaptive positioning, surgical ergonomics, and surgeon characteristics. Cervical muscle strain and biomechanical load is most prevalent due to repetitive motions and prolonged static neck positioning1. However, recommendations to improve cervical health of surgeons are limited. This issue is apparent through reports of prevalence between 10 – 74.4% among surgeons2,3. The aim of this systematic review is to provide an objective assessment of the clinical evidence available and a descriptive analysis of the effects of kinematics and surgical ergonomics on the prevalence of surgeons’ cervical musculoskeletal pain. Results A total of 2474 articles were identified on initial search, of which 1046 were duplicates and were removed from review. Abstracts and full texts remaining were then screened, with 9 studies included in the final qualitative analysis. The use of loupes, open surgery and excessive neck flexion (> 30 degrees) were associated with cervical dysfunction. Comparison of study outcomes was challenging due to heterogeneity within study methods and the paucity of methodological quality. This precluded formal meta-analysis. Conclusion The current literature assessing ergonomic and biomechanical factors predisposing surgeons to cervical musculoskeletal dysfunction is insufficient to provide reliable guidance for clinicians. Although the literature has identified factors that contribute to work-related cervical dysfunction, few have attempted to evaluate interventions for improved surgical ergonomics. An objective assessment of interventions that promote postural correction with the aim to improve neck pain scores in surgeon cohorts is warranted.

Surgical Posture with Microscopic Versus Exoscopic Visualization in Anterior Cervical Procedures

BackgroundSurgeons sustain deviated postures during procedures even with the use of loupes or an operative microscope. The surgical exoscope is a new intraoperative visualization technology designed to improve surgical ergonomics; however, no objective data exist to say that surgeon posture is significantly improved. This study aimed to quantify the difference in posture during standard anterior cervical spine procedures performed with the aid of an operative microscope versus an exoscope. MethodsThis was a prospective cohort study utilizing a posture sensing device at the surgeon’s cervicothoracic junction. The primary outcome was the proportion of time under scope spent in a deviated posture, defined as greater than 10 degrees of deviation from neutral in the x- and y- axes (flexion/extension and lateral bending) of the surgeon’s upper torso. Average deviation from baseline for the x-, y-, and z- axes (flexion/extension, lateral bending and axial rotation, respectively), as well as the percentage of operative time spent with the visualization aid was also analyzed. ResultsOverall, 37 anterior cervical procedures were recorded: 18 were performed with an exoscope and 19 with a microscope. Surgeons spent significantly more time in the deviated posture with the operative microscope than with the exoscope (32% vs. 8% with x-axis >10 deg, p <0.005; 20% vs. 6% with y-axis >10 deg, p <0.05). This is also reflected by the significant differences in the average deviation in the x- and y-axes, while under scope. ConclusionUtilizing the exoscope for anterior cervical spine procedures allows surgeons to spend less time in a deviated posture.

Frequency and Outcome of Emergency Oculoplastic Cases with Adaptations in Management during Covid-19 Pandemic

Purpose: To determine whether treating emergency oculoplastic conditions with protective modification have any effect on treatment outcome visiting tertiary oculoplastic service. Study Design: Interventional case series. Place and Duration of Study: Department of Ophthalmology, Lady Reading Hospital, from March to September 2020. Methods: We included all patients operated during pandemic at oculoplastic service. Protective modifications included; use of loupe instead of surgical microscope, avoidance of General Anesthesia, judicial use of cautery, use of absorbable suture and follow up through phone call and minimum visits. Results: A total of 117 patients were eligible with a mean age of 25.399 ± 34.89 years. Majority of the patients were male, 74 (63.2%). The mean follow-up time was 04 months. Satisfactory surgical and functional outcome was seen in 107 (91.5%) patients. There was no statistically significant difference in outcome with reference to gender (p-value of 0.824) and treatment (p-value of 0.168). Similarly, treatment outcome was statistically insignificant (p value 0.342) in different oculoplastic conditions. Unsatisfactory outcome due to various complications was seen in 10 (8.5%) patients at follow up of 01 to 05 months which were then given special treatment at followup. Conclusion: With adopted protocols and modifications in techniques, outcome was acceptable in common emergency oculoplastic conditions. Proper follow up through telemedicine was helpful in picking up the complicated cases for timely intervention to get satisfactory outcome during Covid 19 pandemic.

Hand Surgeon Posture: An Evaluation and Factors That Affect It

ObjectiveApproximately 68% of orthopaedic surgeons report occupational related musculoskeletal pain, with back pain being the most common. Poor posture while operating has been proven to contribute to these high rates of musculoskeletal pain. There is little research regarding intraoperative surgeon posture within the field of hand and upper extremity surgery. This prospective study aims to investigate and analyze hand surgeon posture in the operating room. MethodsPosture of three hand surgeons was recorded using the UPRIGHT GO posture tracking device while performing a prospective series of 223 hand and upper extremity surgeries. This device reports posture in terms of overall percentage of time spent slouched versus upright. For this cohort of 223 cases, data were collected including surgical procedure, whether the surgery was performed in a seated or standing position, whether or not loupes were worn during the procedure, and if the surgeon was the primary or assistant surgeon. These data were then analyzed to look for any contributing factors to poor posture. ResultsThe three hand surgeons in this study spent an average of 40.3% of their time slouched while operating. The average percentage of time slouched was significantly greater with the use of loupes versus no loupes. Additionally, mean time slouching was slightly increased when the surgeon was seated and also when the surgeon was acting as the assistant surgeon. ConclusionThe three orthopaedic hand surgeons in our study spent a significant portion of their operative time slouched. The main variable associated with a significant risk of poor surgical posture was wearing loupes. Slight increases in slouching were seen with operating while seated and as the assistant surgeon. Surgeon awareness of these variables, as well as techniques to improve surgeon posture, should be developed in order to help contribute to better surgeon posture within the field of hand surgery.

Value of including loupes in prosthodontic and endodontic components of dental degrees: a systematic review.

Background It is crucial dental students graduate with sound knowledge of endodontics and prosthodontics. The use of loupes is important for these due to their intricate nature, but there is currently no standardisation of curricula.Objective This systematic review investigates the value of including loupes in completing dental degrees and their benefits to dental students.Methods Literature was searched from inception to February 2022 in PubMed, Embase and Scopus. Articles included were primary studies of dental students studying endodontics or prosthodontics, which had outcomes related to the value of utilising loupes in learning, clinical application and ergonomics.Results A total of 1,489 articles were retrieved, of which 14 relevant articles were identified. These articles discussed student perceptions and the impact on visual acuity, ergonomic practices and dental procedures. Overall, students perceived that loupes increased self-confidence and allowed a greater operative view but were initially difficult to use. Using loupes resulted in greater visual acuity than no magnification and improved ergonomic practices by reducing neck angulation and improving posture. Students also received better grades when using loupes during cavity access preparation or root canal therapy.Conclusion The use of loupes by dental students can be beneficial if there is initial teaching on their use.

Dental Loupe’s Role in Detection of Caries of Molars in Children by Student and Dentists

Purpose: The objectives of this study were to examine the effectiveness of diagnosing occlusal caries in molar teeth in children under the use of loupes and, secondarily, to examine whether there is a difference in the diagnosis between permanent and primary teeth using dental loupes. In addition, to check whether the student’s diagnosis using loupes improves caries diagnosis compared to dentists’ diagnosis in both methods. Methods: The data were collected from 163 patients aged 6–14 who sought treatment in the Pedodontic Department of the Faculty of Dentistry at Tel-Aviv University during 2020–2021. The first and second permanent molars and second primary molars with deep groves were examined. A student and dentists made the diagnosis with and without loupes while using the ICDAS criteria. Results: The student’s examinations without the loupes detected no caries in 60% of the cases compared to 76.9% in the examinations with the loupes and found initial caries without cavitation (ICDAS1) in only 17.6% of teeth without loupes examination compared to 33% using loupes. The dentist correctly diagnosed no caries (ICDAS0) in 82.1% of cases without loupes and initial caries without cavitation (ICDAS1) in 62.5% of cases. The dentist correctly diagnosed distinct caries without cavitation (ICDAS2) in 90.8% of cases. No differences were observed in caries diagnosis between primary and permanent teeth when the examiner was a specialist/intern using loupes; however, there was a statistically significant difference (p = 0.047) when the diagnosis was made by a student using loupes. Clinical significance: The use of dental loupes is an effective method for the correct and early diagnosis of occlusal caries lesions in children’s molar teeth by both dentists and students, and this is in accordance with the principle of minimally invasive dentistry. There is a justification for the use of dental loupes for the diagnosis of initial occlusal caries in primary and permanent molars in children in a precise way. Using loupes especially improves the correct diagnosis of initial caries in primary teeth by students.

Fixing Hands, Breaking Backs: The Ergonomics and Physical Detriment of the Hand Surgeon.

Work-related musculoskeletal disorders in surgeons have been well documented. Hand surgeons, however, represent a unique population of surgical subspecialists due to frequent use of operative magnification. Thus, we aim to examine the contributing factors, types, and frequencies of work-related musculoskeletal injuries experienced by hand surgeons. A Research Electronic Data Capture survey including 12 demographic and 13 Nordic Musculoskeletal Injury Questionnaire questions was emailed twice to all active members of the American Association for Hand Surgery (AAHS). Data collection remained open for 30 days. Ninety-six of 1228 AAHS members (8%) responded. Respondents were predominantly attendings (88, 91.7%), male (67, 69.8%), in academic practice (48, 50%), and in the age range of 35 to 44 years (34, 35.4%). Sixty-nine respondents (71.9%) attribute discomfort to their profession. Pain (56, 82.4%) and stiffness (46, 67.6%) were the most frequent symptoms, most common in the neck and wrist/hand regions. Fifty-nine (61.5%) respondents had acute (<1 week) discomfort, with onset most frequently reported after surgery (45, 48.9%). Thirty-two (34.8%) of the respondents state they worry these symptoms will hinder their ability to perform surgery in future. Sixteen (16.7%) respondents sustained a musculoskeletal injury directly related to work. Exercise was the most popular nonmedical therapy, while over-the-counter medications were the most popular medical therapy. The unique ergonomics of hand surgery, including frequent use of loupes and microscopes, appear detrimental to the surgeons' health and career longevity. Further research will allow for the development of preventative measures, with the goal of facilitating longer, more productive careers for hand surgeons.

Prevalence and risk factors of neck pain in spine surgeons - Are we our own patients?

AimThis survey of spine surgeons aimed to determine the prevalence of neck pain and identify the associated risk factors. The prevalence of neck pain has been reported in various medical sub-specialities including laparoscopy surgeons, dentists, plastic surgeons, ophthalmologist, urologist and orthopaedic surgeons. However, the literature is lacking on prevalence and risk factors for neck pain in spine surgeons. MethodsA survey questionnaire containing demographic, Neck pain and work practice details was administered to 300 spine surgeons (members of an online group) via text message and e-mail. ResultsOne hundred and eighty surgeons responded to the survey (response rate, 60%). Three spine surgeons had previous cervical spine surgeries. The 1-month prevalence rate of neck pain was 74.4% (134/180 surgeons). One hundred and eighteen surgeons (88%) reported only neck pain, 16 surgeons (11.9%) had neck pain with radicular arm pain. Only 20.5% of surgeons used a loupe, 18% of surgeons used a microscope, and 24% of surgeons used operating table height at umbilicus during surgery. There was no significant difference between the mean age (p = 0.65), work experience (p = 0.8), time spent in surgery (p = 0.7), and operating table height preference (p = 0.4) when symptomatic and asymptomatic groups were compared. However, a significantly greater percentage of surgeons had a sedentary lifestyle (p = 0.002) & used loupes as compared to microscopes (p = 0.04) in the symptomatic group. There was significant correlation between the surgeon's lifestyle & use of loupe and the incidence of neck pain. ConclusionSpine surgeons have a higher prevalence of neck pain than general populations and surgeons from other specialties. Considering the high prevalence of neck pain, general health, work, and ergonomic guidelines and recommendations must be formulated to help prevent and decrease the burden of neck pain among spine surgeons.

Surgical ergonomics: Assessment of surgeon posture and impact of training device during otolaryngology procedures.

ObjectiveTo identify factors associated with cervical‐thoracic spine posture in otolaryngology surgeries and evaluate the efficacy of a commercially available posture‐training device in enhancing surgeon ergonomics.MethodsOver 3 months, neck and spine posture from individuals performing otolaryngology surgeries was recorded using UpRight Go 2™. Average baseline posture was first recorded and biofeedback was later introduced to attempt to correct posture. The proportion of time spent in upright/neutral cervical‐thoracic spine posture was correlated with surgeon and procedure characteristics and compared to proportion of upright posture time after biofeedback intervention.ResultsThe proportion of upright operating time was significantly different between procedure subtypes and surgical approaches with best performance in rhinology procedures and worst performance in head and neck surgeries (90% vs. 62%; both p < .001). Female gender, shorter stature, and use of sitting stools were associated with greater proportion of surgery spent upright (all p < .05). Loupes use was associated with less time in upright posture (p < .001). With biofeedback intervention, 8 of 10 subjects demonstrated an average of 5% improvement in operating upright, with most improvement found when performing laryngology procedures (7%) and least improvement in head and neck procedures (2%).ConclusionsWhile surgeon posture varies across otolaryngology surgeries, sitting and minimizing the use of loupes may help promote a more ergonomic operating environment and improve surgeon posture. Although the efficacy of biofeedback intervention from a commercially available posture‐training device differs among otolaryngologists, exploration of alternative interventions and incorporation of an ergonomics curriculum is warranted to address postural issues experienced by many surgeons.Level of Evidence3.

Effects of loupes and microscopes on a dental technician's working posture from ergonomic aspects.

This work aimed to study the effects of loupes and microscopes on a dental technician's working posture during practical operation from ergonomic aspects. The technician's working postures under the conditions of the naked eye, loupes, and microscopes were compared. The practical value of loupes and microscopes was assessed based on the evaluation index of working posture from ergonomic aspects. Three dental technicians who were skilled in using loupes and microscopes from West China Stomatology Technology Department of Sichuan University were involved in this prospective rando-mized controlled trial. Before the operation, cameras were installed in the sagittal position, top-view position, and dorsal position of the operation. Each technician made five porcelain veneers of the right maxillary central incisor following the standard process. A chairside computer-aided design and computer-aided manufacturing (CAD/CAM) system was used to mill and layer the ceramic block under the naked eye (A: control group), 3.5× headwear loupes (B: loupe group), and 9× desktop microscopes (C: microscope group). The working posture was recorded by videos throughout the entire process. After each operation, the investigator used OpenPose to recognize the working posture. The joint angles of the arm, elbow, wrist, neck, and trunk, as well as their corresponding rapid upper limb assessment (RULA) scores, were calcula-ted by MATLAB. The working posture was assessed from ergonomic aspects based on the joint angles, RULA scores, and operation time. Statistical analysis was performed using SPSS 26.0. The RULA score of upper limb joint angles showed that the angles of the arm, elbow, wrist, neck, and trunk under the naked eye were 14.93°±9.44°, 120.19°±2.99°, 23.97°±2.84°, 47.27°±5.72°, and 7.76°±2.30°, respectively. All of the joint angles were significantly different among the three groups (P<0.05). Compared with the control group, the angles of the neck and trunk in the loupe group were reduced by 29.09% and 42.53%, respectively, whereas those in the microscope group were significantly reduced by 43.99% and 87.11%, respectively. Multiple comparisons by LSD for the angles of neck and trunk revealed that the loupe group and the microscope group were significantly different from the control group (P<0.05), and they were also significantly different from each other (P<0.05). The mean RULA scores were 6.24±0.34 in the control group, 5.53±0.35 in the loupe group, and 3.31±0.19 in the microscope group. Compared with the control group, the mean RULA score in the loupe group was lower, and that in the microscope group was significantly lower. The differences between every two groups were statistically significant (P<0.05). The mean RULA score in the microscope group was significantly lower than that in the loupe group (P<0.05). The average operation times of the control group, loupe group, and microscope group were (50.69±36.78), (52.01±34.65), and (59.44±35.81) min, respectively. No significant difference was found among the three groups (P>0.05). Use of loupes and microscopes showed an improvement in ergonomics and working posture of dental technicians. Microscopes had a better effect in the ergonomic convenience of the technician than loupes.

A multinational survey characterizing the use of surgical magnifying loupes in dermatological surgery.

The use of surgical loupes has not been well-documented in dermatological surgery. An online questionnaire was developed to characterize the use of loupes in dermatological surgery. The questionnaire was circulated to the memberships of the British Society of Dermatological Surgery, the European Society of Micrographic Surgery, and the Australasian College of Dermatologists. Responses were analyzed with a mixed methods approach using quantitative data analysis and inductive content analysis. One-hundred twenty-five valid responses were received from 20 nations. Most respondents were from England (40%; 50/125), Australia (16%; 20/125), and the Netherlands (14.4%; 18/125). Overall, 71.2% (89/125) of respondents were consultants/Facharzt/attending. Furthermore, 55.2% (69/125) of respondents were Mohs surgeons. In dermatological surgery 38.4% (48/125) of respondents used surgical loupes routinely. The mode magnification level for loupes was 2.5× (67.5%; 27/40), with 3× second place (12.5%; 5/40). Exactly half (20/40) used through-the-lens style loupes and 40% (16/40) used flip-up-loupes. Inductive content analysis of the 51 free-text responses from nonloupe users uncovered several deterring factor themes, including expense (18/51), can manage without/don't need (14/51), and narrow field of view a(11/51), and uncomfortable/too heavy (9/51). This is the first time the use of surgical loupes in dermatological surgery has been internationally characterized.

Effect of magnification factor by Galilean loupes on working posture of dental students in simulated clinical procedures: associations between direct and observational measurements.

ObjectivesTo determine the effect of different levels of Galilean loupe magnification on working posture as measured by compliance with ergonomic posture positions, angular deviation from the neutral position of the neck, and muscle activation in the neck and upper back region during simulated clinical conditions.MethodsAn experimental laboratory study was performed in which the dependent variables were compliance with ergonomic posture requirements while performing simulated restorative procedures in Restorative Dentistry, angular deviation from the neutral position of the neck, and muscle activation in the neck and upper back. The independent variable was the level of Galilean loupe magnification, which was tested at four levels (naked eye, 2.5× magnification, 3.0× magnification, and 3.5× magnification). The cavity preparations and Class I composite resin restorations were performed on artificial first molars on a mannequin in a dental chair. The Compliance Assessment of Dental Ergonomic Posture Requirements (CADEP) was used for the postural analysis; as was an analysis of the angular deviation from the neutral position of the neck and surface electromyography. Working posture was recorded on video over the course of the procedure. Participants were filmed from three different angles. The Compliance Assessment of Dental Ergonomic Posture Requirements (CADEP) assessed compliance with ergonomic posture requirements. A locally produced posture assessment software analyzed angular deviation. Surface electromyography bilaterally assessed activation of the sternocleidomastoid, descending trapezius and ascending trapezius muscles. Two-factor analysis of variance (ANOVA) and either Tukey’s post-hoc test or the Games-Howell post-hoc test were performed (α = 0.05).ResultsDuring the cavity preparations and restorations, the use of Galilean loupes at all magnifications positively influenced working posture as measured by participants’ compliance with ergonomic posture positions (p < 0.01) and neck angulation (p < 0.01); the use of these loupes did not affect muscle activation in the regions evaluated (p > 0.05).ConclusionThe use of Galilean loupes had a positive effect on dental students’ working posture during the restoration procedures performed.

Characteristics and attitudes of general and pediatric dentists who use loupes.

Dental loupes are used by dental professionals to improve visual performance, reduce eye strain and prevent musculoskeletal disorders. Data on their usage in pediatric dentistry are scarce. We performed a cross-sectional survey to evaluate the approach, knowledge, and frequency of using loupes among 100 general and pediatric dentists. showed that the use of loupes is significantly more prevalent among general dentists (64.3%) compared to pediatric specialists and residents (35.7%). Among dentists who reported that they do not use loupes, 63.6% were pediatric dentists and residents, and 82.5% were dentists working with children. A significantly higher percentage of dentists who self-reported as loupes users perceived that the loupes afford comfortable and stable posture, confidence while working, and contribute to the detection of tooth decay. A significantly higher percentage of dentists who self-reported as non-users of loupes (compared to loupes users), claimed that they weaken the eyes, require long adjustment, and cause discomfort. Although the use of loupes in general dentistry is becoming more prevalent, there is still a need to raise awareness for this vision aid among pediatric dentists while promoting its advantages, to reap benefits associated with their usage.

Enhancing Microsurgical Assistant Experience with Bifocal Safety Glasses: A Low-Cost Alternative to Surgical Loupes.

The standard flap harvest is performed under loupe dissection. It is not infrequently that a medical student or physician assistant participates in the role of first or second assist. Such scenarios have impressed upon us the observation that these surgical assistants seldom use loupes or any other form of visual magnification. The reasons for this are likely multifaceted and may be related to cost as well as perceived opinions of colleagues. The benefit of encouraging optical aid use among surgical assistants encompasses an augmented surgical and learning experience. The aforementioned barriers, however, prohibit the use of loupes. We have found bifocal safety glasses to be an adequate alternative (Fig. 1). As compared to Galilean or prismatic loupes, which utilize multiple lenses and can magnify up to eight times without distortion (in the case of prismatic loupes), single-lens magnifiers can magnify up to 1.5 times without distortion or significant loss of working distance. Although this level of magnification is not acceptable for the primary surgeon, the added benefit of single-lens magnification is certainly superior to total lack of magnification typically utilized by nonresident surgical assistants.Fig. 1.: Standard bifocal safety glasses with +1.00 diopter strength.Bifocal safety glasses need to be selected in order to allow for maximal magnification at the optimal working distance. With this in mind, we recommend lower-powered magnifiers (i.e., diopters between +0.75 and +1.50 diopters), as these allow for crisp magnification and accommodation without causing eye fatigue. It is important to note the conversion of diopter to magnification is described by the equation m = d/4 + 1, therefore a +1.00 diopter would result in m = ¼ + 1 = 1.25× magnification. As compared to surgical loupes, bifocal safety glasses have the added benefit of being lightweight. The detrimental effect of loupes on cervical spine health has been well documented in surgeons of all levels and across multiple specialties; surgeons with severe cervical spine pain can use bifocal safety glasses as an alternative to loupes in cases where high-power magnification is not needed.1,2 In addition, single-lens magnifiers are not cost-prohibitive. They can be purchased for less than $15, which is markedly less than the typical price of loupes.3 The design of bifocals is discreet, as they resemble safety glasses typically worn in the operating room, and this mitigates any worry about eliciting negative opinions from colleagues. Bifocal safety glasses are a cost-conscious, comfortable, and inconspicuous optical aid that should be utilized by microsurgical assistants when loupes are not available. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

Dental Magnification Loupes: An Update of the Evidence

To overview dental magnification loupes and to present the updated scientific evidence supporting its use. The practice of dentistry places considerable stress on the operators' visual acuity and musculoskeletal system. The use of magnification loupes has spanned many decades with claims of supporting visual and postural capacities of dental professionals and enhancing diagnostic and procedural accuracy. Galilean and prismatic loupes both provide lightweight and clinically appropriate magnifications between 2.5× and 5.0×, with beneficial features such as a fixed working distance and downward lens inclinations. Studies have found significantly increased detection and diagnostic abilities due to enhanced visibility and improved treatment outcomes for some investigated procedures. Postural studies have found improved positioning of the upper body when using loupes as compared to the positioning when using the naked eye, with practitioners experiencing reductions in musculoskeletal symptoms when using magnification loupes. The current evidence supports the presence of some visual advantages of loupe magnification in diagnosis and treatment delivery. However, more clinical trials are needed to investigate different procedure outcomes over the long term. Further, there is robust scientific evidence advocating the use of loupe magnification for postural and musculoskeletal support. Dentistry is a visually and physically demanding profession with a high prevalence of musculoskeletal disorders among dental professionals. The use of loupe magnification potentially benefits both the dental healthcare provider and patients. Therefore, there is reason to consider the use of loupe magnification as an integral part of dental education and training, as well as a tool in the dental clinician's armamentarium.

The advantages of the dental operative microscope in restorative dentistry.

Magnification devices improve direct and indirect vision and precision being significantly higher in microscope use compared to the loupes. Dental loupes are the most commonly used devices for magnification, due to the more affordable prices and the ease of use without major changes in the working protocol and ergonomics. Loupes primary benefits reported refers to ergonomics and posture, restoration evaluation/detection and overall treatment quality. There are some disadvantages that limit the use of loupes among dentists: lack of fixed position (fine movements of the dentist’s head disturb the image of the magnified operating field); the need to change the loupes to achieve different magnification. On the contrary, the use of a dental microscope require minimum adjustment and effort so as to reduce postural deviation while working.It has been more than 30 years since dental practitioners raised the issue of using dental operating microscopes (DOM) in restorative dentistry, identifying the benefits of magnification in diagnosis and treatment steps. The growth is evident in recent years, maybe because of the familiarity of dentists with dental microscopes which have already become implicit endowment for endodontic specialists. Fiber optic lighting is the key factor that complements the magnification offered by the microscope so that treatments can now be performed under increased safety conditions and in conditions of significantly higher quality than in the past.Since the beginning of the 2000s the principles of minimally invasive dentistry have been widely promoted in dentistry. These principles are major impetus for the use of microscope by dentists. Working with magnification leads dentists to be more conservative with dental tissues.

Digital assessment of direct and virtual indirect bonding of orthodontic brackets: A clinical prospective cross-sectional comparative investigation

The objective of this report is to use in orthodontic patients the methods of virtual indirect bonding and direct bonding using eye vision or loupes in order to compare their accuracy in the three dimensions of space. Brackets were directly placed by one clinician to 18 patients with a total number of 298 permanent teeth. Then loupes were used to improve bracket positioning. Intraoral scanning of the dental arches was performed before bonding, after direct bonding and after the use of loupes. Subsequently, an orthodontic software was used to virtually indirectly bond the brackets on the first intraoral scanning taken before bonding. A three-dimensional mesh processing software was used to superimpose the three scans and to perform measurements in the mesio-distal and occlusal-gingival dimensions as well as in the mesio-distal angulation. Virtual indirect bonding was more accurate in bracket positioning compared to direct bonding by eye vision or using loupes in all teeth and most of the teeth groups measured. Specific teeth and locations in the dental arch areas exhibited more bonding inaccuracies in the two direct bonding groups as compared to virtual indirect bonding. The use of loupes did not significantly increase the bonding accuracy compared to direct vision. Indirect virtual bonding facilitated accurate bracket positioning compared to direct vision or with loupes direct bonding in the dimensions and angulation measured.

Medial Epicanthoplasty: What Works and What Does Not.

Blepharoplasty is the most frequently performed cosmetic surgical procedure in Asia. The epicanthal fold, which is common in Asians, is characterized by a curved skin fold that partially hides the caruncle and lacrimal lake. The epicanthal fold may cause weakening of the esthetic appearance after blepharoplasty. It makes the palpebral fissure height narrower and the length shorter horizontally. Blepharoplasty with epicanthoplasty can enhance the esthetic appearance, but no gold standard surgical technique has been established for epicanthoplasty. Surgeons can choose the surgical technique according to their preference and the patient's characteristics. A carefully designed and fine surgical technique, especially with the use of loupes and tension-free skin closure with the thinnest needle, is required to avoid scarring.

Perceptions and Attitudes toward Use of Loupes among Dental Hygienists

The aim of this study was to examine the perceptions and attitudes of dental hygienists on the use of dental loupes. A questionnaire survey was conducted to 180 dental hygienists working at dental institutions and public health centers. 4.6% of all respondents answered that they use dental loupes currently, and 38.9% answered that they need to introduce dental loupes in the dental clinic. About half indicated that loupes were a benefit to improved vision(53%) and Improved clarity(44%). The most commonly reported disadvantages to loupes wear were limited depth of vision(39%) and overall dependency. It was confirmed that most dental hygienists did not use loupes, there was little interest in loupes. More research is needed on the effects of loupes in dental practice.

Intraprocedural ergonomics of vascular surgeons

ObjectiveThe objective of this study was to estimate the ergonomic postural risk (EPR) for musculoskeletal posture of vascular surgeons performing open and endovascular procedure types and with various adjunctive equipment using wearable inertial measurement unit (IMU) sensors. The hypothesis was that EPR will increase with increased physical and mental demand as well as with procedural complexity. MethodsA prospective, observational study was conducted at a large, quaternary academic hospital located at two sites. Sixteen vascular surgeons (13 male) participated in the study. Participants completed a presurgery and postsurgery survey consisting of a body part discomfort scale and a modified NASA-Task Load Index. Participants wore IMU sensors on the head and upper body to measure EPR during open and endovascular procedures. ResultsVascular surgeons have increased EPR scores of the neck as measured by the IMUs and increased lower back pain when performing open surgery compared with non-open surgery (P < .05). Open procedures were rated as more physically demanding. The use of loupes resulted in increased EPR scores for the neck and torso (P < .05), and they were significantly associated with higher levels of lower back pain during procedures (P < .05) as well as with higher levels of physical demand (P < .05). The use of headlights also resulted in increased subjectively measured levels of physical demand and lower back pain. In comparing survey responses with IMU data, surveyed physical demand was strongly and significantly correlated with the neck (r = 0.61; P < .0001) and torso (r = 0.59; P < .0001) EPR scores. The use of lead aprons did not affect EPR or most surveyed measures of workload but resulted in significantly higher levels of distraction (P < .01). The data presented highlight the potential of using wearable sensors to measure the EPR of surgeons during vascular surgical procedures. ConclusionsVascular surgeons should be aware of EPR during the performance of their duties. Procedure type and surgical adjuncts can alter EPR significantly.