Mielscope Case Study – Downtown Dentistry

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Dr. Jang Chou has a background in prosthodontics, and has a successful practice in San Antonio.  He has extensive experience with traditional microscopes, and was finding that he was only really able to use them in very specific situations – which was limiting his return on investment.  He liked to have the high magnification.  However, he often found that during the procedure, he wanted to see different angles or different magnification levels, or even to just see a “birds-eye” view using his loupes.  The traditional microscope really didn’t allow him to do this, and it wasn’t practical to stop what he was doing in mid-procedure, move it to the side, and put on loupes.

He also knew that image and video are so valuable for record keeping and patient communication.  However, all the different options (intraoral cameras, loupe-cams, dental light cameras) were either disruptive to use, lacked stability or had limited resolution to capture great imagery. 

As he researched options, he started investigating the Mielscope.  However, he had many questions.  Would it fit in his operatory?  Where would the screen be located, and where would his assistant stand so that both had visibility?  Would it be difficult to work from a screen?  Would the images and video really be as good as he hoped?

Fast forward a few months, and Dr. Chou says “The Mielscope has been working great!  I think I’ve figured out some of the optimal positioning to make it work, and I’ve been doing a lot of cases with it.  It takes fantastic videos to document cases, and I love how few ‘clicks’ it takes to get to video-taking mode.”

“It is also very unobtrusive” he continued, “so we don’t have any objections from patients when documenting cases. Furthermore, “what is nice is that I don’t have to take loupes off every time I need to look at a different view or to zoom in. Once positioning of the head and the monitor has been figured out, it works fantastically!”

Finally, he mentioned that “I’ve also been having great success with my endo cases. It’s been excellent for finding the MB2.” 

 We had a chance to sit down with Dr. Chou to chat with him about his journey with the Mielscope.  Here are some clips of the discussion.

 Why did you purchase the Mielscope in the first place?
 How often are you using it?
 How do you feel since your implemented the Mielscope?
 Why do the depth of field and arm design matter?
 How does the Mielscope help you move faster?
 Do you use loupes with the Mielscope?
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    The Diagnostic Value of Color

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    A research paper on dental imagery discusses the importance of color when it comes to using digital imaging to maximize diagnostic value.

    “Concerning soft tissues, a correct color rendition is an excellent method for distinguishing between healthy and diseased tissues and for recording pathological changes such as white patches, inflammation, ulceration, burns, lacerations, carcinoma, etc.” (1)

    “Similarly, a correct color rendition of hard tissues reveals enamel translucency, decay, erosion and abrasion, as well as cervical dentine exposure and sclerosis.”

    In representing color, it’s sometimes overlooked that 4K resolution not only has 4 times the resolution of HD imagery, as importantly for dental care, 4K also has much richer color representation than HD.  This depth of color representation can make an enormous difference when the dental professional needs to differentiate subtle shading differences in tissue, see mild inflammation, or locate decay. 

    It’s also worth noting that to fully take advantage of the clinical information that 4K video offers, both the image source and the monitor must both be 4K capable.

    A critical component of the Mielscope’s power is that it offers 4K imaging across the wide array of magnification levels, positions and angles.  This value comes not only from the spatial resolution of 8.3 million pixels, but also a dramatically deeper color pallette. 

     (1) Casaglia A, DE Dominicis P, Arcuri L, Gargari M, Ottria L. Dental photography today. Part 1: basic concepts. Oral Implantol (Rome). 2016 Jul 23;8(4):122-129. doi: 10.11138/orl/2015.8.4.122. PMID: 28042424; PMCID: PMC5159893.

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      See How Dentists are Using the Mielscope Dental Microscope

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      Every single day, the Mielscope helps dental professionals improve:

      • Collaboration:  the assistant sees what the doctors sees, which leads to procedures that are both faster and more successful
      • Control:  don’t miss a detail by getting exactly the right angle and magnification in brilliant 4K resolution
      • Communication:  educating the patient with the most compelling imagery doesn’t disrupt the procedure 

       

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        Learn more about the Mielscope from ImageWorks

        The Mielscope Depth of Field Changes the Game

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        With traditional dental microscopes, sometimes Doctors find that only a part of the field of view is in focus. Furthermore, they may also find that very small movements by the patient may cause everything to drop out of focus, requiring readjustment of the lenses.


         

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        University of Texas School of Dentistry to Implement Next Generation Dental Microscope

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        Dr. David Cochran, Dr. Angela Palaiologou-Gallis and Dr. Motofumi Yamashita

        University of Texas School of Dentistry to Implement Next Generation Dental Microscope

         

        The Department of Periodontics at UT Health San Antonio School of Dentistry has implemented the next generation Mielscope dental microscope as part of its continuing drive to train the next generation of dental professionals on the latest in cutting edge tools. 

        The Mielscope Microscope, implemented by Imageworks based on technology developed by Yoshida, enables the doctor to get the magnification, clarity and ergonomics of a traditional dental microscope without the steep learning curve and limited application of a traditional microscope.

        During the event, Dr. David Cochran, the chairman of the Department of Periodontics shared his view of how the Mielscope will help empower new dentists to care for their patients. 

        Dr. Motofumi Yamashita, who has been using the Mielscope in his practice, then presented a series of powerful cases showing how the Mielscope helps his practice run more quickly and precisely.  He presented stunning videos of a myriad examples including a crack identification, tooth preparation, endodontics, periodontal surgery, PDL visibility, bone grafts, papilla preservation, ridge preservation, sinus lifts and much more.

        He showed that many traditional microscopes have a shallow depth of focus, which can result in only a small portion of the field of view being in focus.  Conversely, the Mielscope’s large depth of focus means the anatomy across the entire screen presents in sharp focus.

        Dr. Yamashita then discussed the eye fatigue that can arise from extended periods of looking through binocular eyepieces or loupes, and explained how the Mielscope’s screen allows the operator to avoid this fatigue.  He further emphasized that avoiding this fatigue means the doctor can better focus on the patient.  Eliminating the eyepieces also means there is almost no learning curve as the Mielscope is intuitive and simple to use.

        He explained how the high-precision articulating arm of the Mielscope allows the doctor to visualize anatomy that would be very difficult to see with a traditional microscope.  In addition, he showed how the high magnification and 4K imagery across large fields of view assists him with laser procedures and implant procedures.

        He also showed how the fantastic imagery can be used to assist in patient communication and can make assisted procedures run faster and more efficiently because the entire team can see exactly what the doctors sees.

        Finally, Dr. Yamashita showed how the Mielscope has even enhanced the profitability of his hygiene program, as it allows the hygienist to perform more effectively and more quickly.  In addition, the fantastic imagery allows high resolution “before” and “after” images which presents compelling evidence to the patient that they should keep their cleaning appointments.

         

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        Dr. Boggess Shares a Unique Case From His Pan Ceph System

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        Dr. Vaughn Boggess is an orthodontist in Lexington, Kentucky.  His pan ceph went down and put him in a bind because he needed to get up and running fast, so he wanted a great solution that his staff would easily be able to use.  He shares his experience getting back online with the Imageworks Pan Ceph system, and shares an interesting pedo case. 

         

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          Medical Applications of Dental Panoramic X-Rays in Cardiac Surgery

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          Dental panoramic X-rays play a crucial role in the medical management of patients undergoing cardiac valve surgery. These radiographic images can help surgeons identify and treat issues that may complicate cardiac procedures. This article explores the importance of dental panoramic X-rays in the context of cardiac surgery, highlighting their role in preventing complications and ensuring optimal patient outcomes.

           

          The Importance of Dental Health in Cardiac Surgery

          Cardiac valve surgery, which includes procedures on both native and prosthetic valves, increases the risk of postoperative Infective Endocarditis (IE).1  IE is an infection of the inner lining of the heart chambers and valves, often caused by bacteria entering the bloodstream from oral infections. Research indicates that approximately 10-20% of IE cases are linked to oral infections, with chronic periodontitis significantly raising the risk, especially in patients with pre-existing heart conditions.

           

          Preoperative Dental Evaluation

          Patients scheduled for cardiac valve surgery should undergo a comprehensive dental evaluation before the procedure. This evaluation includes a detailed medical history review, an examination of medications and allergies, and a thorough oral and dental examination. Panoramic X-rays are essential in this process, providing a broad view of the oral cavity that helps identify any potential sources of infection.

          The initial dental assessment aims to detect and address oral infectious foci, such as caries, periodontal disease, and endodontic issues. By treating these conditions preoperatively, the risk of bacteremia—and consequently IE—during and after cardiac surgery is significantly reduced.

           

          Dental Panoramic X-Rays: A Comprehensive Tool

          Panoramic X-rays are particularly valuable in the dental management of cardiac surgery patients for several reasons:

           

          1. Broad Coverage: These X-rays capture the entire mouth in a single image, including the teeth, jaws, and surrounding structures. This wide coverage is crucial for identifying hidden issues that might not be visible in a standard dental examination.
          2. Early Detection: Panoramic X-rays can reveal early signs of periodontal disease, caries, and other dental problems. Early detection allows for timely intervention, reducing the risk of complications during cardiac surgery.
          3. Surgical Planning: For patients requiring extractions or other dental procedures, panoramic X-rays provide detailed information that aids in surgical planning. They help determine the extent of dental issues and the best approach for treatment, ensuring minimal disruption to the patient’s overall health.

           

          Antibiotic Prophylaxis and Anticoagulant Management

          Patients who have had valve surgery have a high risk of IE, and therefore may require antibiotic prophylaxis before dental procedures. The American Heart Association and the American College of Cardiology recommend this for patients with a history of IE, prosthetic heart valves, congenital heart disease, and heart transplants with valvular dysfunction. The antibiotics are typically administered 30-60 minutes before dental procedures that are likely to cause bacteremia, such as extractions and periodontal treatments.

           

          Conclusion

          Dental panoramic X-rays are indispensable in the medical management of patients undergoing cardiac valve surgery. They provide a comprehensive view of the oral cavity, enabling early detection and treatment of dental issues that could lead to serious complications like Infective Endocarditis. By integrating these radiographic assessments into the preoperative planning for cardiac surgery patients, healthcare providers can significantly enhance patient safety and surgical outcomes. Ensuring optimal dental health through panoramic X-rays and appropriate prophylactic measures is a critical step in the holistic care of cardiac surgery patients.

           

          The Number One Challenge When Adding a Dental Panoramic X-Ray to a Hospital or Urgent Care Clinic

           

          1. Souza AF, Rocha AL, Castro WH, Gelape CL, Nunes MCP, Oliveira SR, Travassos DV, Silva TA. Dental management for patients undergoing heart valve surgery. J Card Surg. 2017 Oct;32(10):627-632. doi: 10.1111/jocs.13211. Epub 2017 Sep 12. PMID: 28898929.

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            8 Reasons Your Dental Panoramic Radiographs Look Horrible (and How To Avoid Them)

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            This is a training module that we provide to all of our offices using ImageWorks cone beam and panoramic modalities.  Dental professionals have told us it’s been very useful to help heir staff make he most of their investments.  We wanted to share with our community, because the lessons hold true regardless of type of equipment you are using.  

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              Dental Cone Beam and Panoramic CDT Codes

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              We are often asked for the applicable CDT codes for Cone Beam and Panoramic Radiographs, so we wanted to share a resources that summarizes these codes for the most commonly used extraoral exams. 

              Current Dental Terminology (CDT) codes are alphanumeric codes used to document dental procedures and report them to dental payers. The American Dental Association (ADA) developed and maintains the CDT codes as a standardized language to help dentists and other healthcare professionals communicate

              You can also download the resource by clicking on the image.

              Click to open

               

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                Viewing Calcification of Carotid Arteries in a Panoramic Radiograph

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                An interesting topic came up in an online dental forum around what to do when the dental professional notices an indication on a panoramic radiograph that resembles calcification in the carotid artery. 

                Based on this, we wanted to provide a few resources that may be useful for dental staff to be aware of this indication along with potential implications.

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                  Carotid artery calcifications (CAC) are hard, calcified deposits that form in the carotid arteries, which are the major blood vessels in the neck. There are two carotid arteries, one on each side of the neck: the right and left common carotid arteries. Each common carotid artery branches into the internal carotid artery, which supplies blood to the brain, and the external carotid artery, which supplies blood to the face and neck.

                  These calcifications can indicate a higher risk of cardiovascular diseases like stroke and heart attack. Detecting these early can be vital for preventing serious health issues.

                  Dental panoramic radiographs can also show the carotid arteries. When dentists review these radiographs, they might notice radiopaque nodular lesions, which can indicate CAC. According to Friedlander et al. [1], these lesions appear separate from the hyoid bone and are adjacent to the cervical vertebrae, usually between the C3 and C4 vertebrae or below. This is close to the location where the carotid artery bifurcates.

                   

                  Research Findings

                  Studies such as Magnus Bladh et. al [2]  have shown a strong correlation between the presence of CAC on panoramic radiographs and more advanced carotid atherosclerosis detected by ultrasound (US). Ultrasound is a well-established method for detecting soft tissue changes and plaques in the arteries, which are significant markers for cardiovascular disease. The findings suggest that if CAC is detected on a panoramic radiograph, there is a high probability that more severe atherosclerotic changes will be found upon further examination with ultrasound.

                  Here are a few sample radiographs from this study:

                   

                  Understanding the panoramic x-ray projection

                  Because all panoramic radiographs are projections, it’s important to be aware that the farther from the focal trough the anatomy is, the more distorted it may appear.  In this situation, distortion is not as important because it’s more a matter of flagging the indication.  However, if you are using a panoramic x-ray machine that has the ability to capture multiple focal troughs, then it is possible to gather additional views from the single scan.  In other words, these panoramic x-ray machines allow the operator to extract more information from the scan by evaluating focal planes that may not be as ideal for the dentition, but more ideal to view the carotid artery.

                   

                  Advantages and Limitations

                  The ability to detect CAC on panoramic radiographs can be particularly useful in both general and specialized dentistry. Dentists who identify these calcifications can recommend that patients seek medical care for further evaluation and preventive treatment. This can help reduce the risk of CVD-related issues.

                  However, it’s important to note that not all carotid plaques are calcified, and sometimes the plaques may be located outside the area captured by the X-ray. Therefore, a negative finding on a panoramic radiograph does not necessarily mean that the patient has no vascular issues.

                  Despite some limitations, the high specificity of CAC detected on panoramic radiographs, coupled with their correlation to ultrasound findings, underscores their importance. While ultrasound can visualize the soft tissue components of plaques that X-rays cannot, panoramic X-rays excel at detecting even small calcifications [2].

                  In some cases, calcifications may not be visible on panoramic radiographs if they are situated below the imaging area. Yet, when CACs are detected, particularly when they are bilateral and outline the vessel, it strongly suggests significant vascular changes that require medical attention [2].

                   

                  Conclusion

                  In summary, panoramic radiographs are a valuable tool in dental practice not only for assessing dental health but also for identifying potential cardiovascular risks. Dentists who recognize CACs on these radiographs can play a crucial role in early detection and prevention of cardiovascular disease. By recommending further medical evaluation for patients with detected CACs, dentists can contribute to improved cardiovascular health outcomes.

                  While panoramic X-rays should not replace traditional cardiovascular screenings, they offer an additional layer of detection that can be lifesaving. For patients, this means that routine dental exams could also provide important insights into their overall health, highlighting the interconnected nature of dental and medical care.

                  1.  AH Friedlander, NR Garrett, EE Chin, JD. Baker; Ultrasonographic confirmation of carotid artery atheromas diagnosed via panoramic radiography; J Am Dent Assoc, 136 (2005), pp. 635-640
                  2.  Magnus Bladh, DDS,a Nils Gustafsson, DDS, PhD, et.al; Defined shapes of carotid artery calcifications on panoramic radiographs correlate with specific signs of cardiovascular disease on ultrasound examination; Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology Volume 137, Issue 4, April 2024, Pages 408-420

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