Title	An Operative Microscope Better Aids in The Success of Surgical Endodontic Therapy Than The Use of Loupes Alone
Clinical Question	With patients in need of a surgical endodontic procedure, will loupes provide sufficient magnification or is an operative microscope necessary to achieve the desired outcome?
Clinical Bottom Line	The use of an operative microscope yields better results in surgical endodontic therapies versus the use of loupes alone. The following systematic review of 18 studies showed that while performing surgical endodontic therapies, loupes are significantly less adequate than the operative microscope. While loupes are readily available to any clinician, an operative microscope is not as easy to obtain and might require special expertise to operate. Patients may accept this route as the ideal method, but adopting this on part of the dentist may require a significant investment of time and capital.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 23402503 Tsesis/2013 18 studies Meta-Analysis Key results The difference between the use of loupes versus the use of an operative microscope was significant (p=.005 overall or p=0.012 in low bias studies alone, please see table 3 in the literature for more information).
Evidence Search	((microsurgery[MeSH Terms]) AND surgical endoscopy[MeSH Terms]) AND dental
Comments on The Evidence	Validity: This systematic review of RCTs, case-controls, and case studies showed similar groups at the beginning that were treated the same, leading to approximately 83% completion or more with adequate follow-up. Recall bias was considered along with competing interests and studies were rated on a low to high risk level, 7 of which fell in the high risk category. Perspective: adequate visibility is a necessity in surgical treatment and can only stand to increase the clinician’s success rate. At the same time, surgical therapies have been highly successful in the past before such equipment was even available. Some would chance to argue that using such resources prematurely stunts the ability of the provider to grow.
Applicability	This study took time to dock the effect of certain factors on the success of treatment as well, both combined and apart from the interventions mentioned above. Factors such as the tooth in need of treatment and its anatomical position in the mouth and the use of certain filling materials and the process by which they were placed.
Specialty	(Endodontics)
Keywords	Operative microscope, loupes, endodontic, microsurgery, endoscopy, surgical endodontic treatment
ID#	2672
Date of submission	03/12/2014
E-mail	aulds@livemail.uthscsa.edu
Author	Kristin Aulds
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Kenneth Hargreaves, DDS, PhD
Faculty mentor e-mail	hargreaves@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available