Magnification loupes

If there is one item you can buy to improve your dentistry virtually overnight, it is a pair of high quality loupes. Even routine procedures such as examinations and simple restorations can be improved by doing them under magnification. It is just common sense that if you can see better, you will work better. The advanced magnification systems available are just about mandatory to practice at a high level. They allow you to achieve a degree of perfection that is impossible with the unaided eye. And the ability to see what you are doing more clearly makes clinical practice less stressful and more enjoyable. 

Loupes allow you to see margins better, both at the preparation and finishing stages, with incredible clarity. When finishing margins of restorations, magnification permits you to clearly distinguish restorative material from tooth structure. You get the feeling that you are on the leading edge of dentistry, which of course gently prods you to practice at a higher level. This concept raises your self-esteem and gives you more confidence to expand your practice by trying new procedures. 

One of the unusual corollary effects of wearing loupes is the feeling that you are watching someone else doing the procedure, especially at the higher ranges of power. This is due to the fact that you may only see, for example, several teeth, the head of the handpiece, and your gloved fingertips in your field of vision. You could be watching a closed circuit video of the procedure, only you are doing it! 

Partly because of the exposure loupes get on TV medical shows, they give your patients the feeling that you are doing everything you can to provide them with the highest level of care. They are truly amazed at the lengths you are willing to go to achieve excellence. And magnification should help with musculoskeletal problems since they allow you to practice more ergonomically. 

On the other hand, there are some downsides to wearing loupes, with weight being the first one since they are heavier than regular corrective or plain safety glasses. This problem, however, only bothers new users and can be usually overcome quickly by using eyeglass straps. Another issue with new users is disorientation. When you start wearing magnification, you can lose your perspective and feel somewhat out of control, even dizzy. While this problem also dissipates very quickly, it is a good idea start with a lower power loupe and then progress up to a higher power if you prefer to see even more detail. Finally, talking to patients can be strange when wearing loupes, but choosing a specific design can minimize this issue. 

Items to Consider

Power

Some clinicians are very comfortable at only 2x (this usually means the image through the magnification lenses is twice as large compared to unaided vision), while other practitioners extol the virtues of the higher ranges. The 2x lenses are a good place to start if you are not currently using any form of magnification. They normally give you a relatively wide field of vision and require less break-in time than the higher powers. 

However, be aware that, as the power of magnification increases, the field and depth of vision typically decreases. This means you will see a fewer number of teeth through the higher power lenses and small movements of your head will interfere with focusing as compared to those with lower power. It may take you some time to get used to this smaller field of vision. You may find yourself bumping into noses, cheeks, lips, etc. until you get oriented to the smaller vision field. This problem can be largely overcome by using an expanded field prism loupe.  

The higher powers, starting at 3.5x, take you to another level that is hard to believe until you experience it. Even though we feel 2x-2.5x is helpful, the real benefits of magnification start to become evident at 3.5x. This does not mean you will be wasting your money purchasing a lower power system since it can be used by an assistant or hygienist assuming you have non-customized flip-ups. These staff members also need vision enhancement for their clinical procedures. Hygienists will marvel at how well they can see during root smoothing procedures while assistants will be able to precisely refine the margins of provisionals under magnification. 

NOTE

It is sometimes difficult to tell if loupes with the same power designation actually have the same level of magnification. Two factors that can interfere with apples-to-apples comparisons are field of view (how many teeth can you see when looking through the loupes) and working distance. This means that 2.5x from one company may not appear to be equivalent to 2.5x from another. Therefore, use the magnification designation only as a guide.  

Weight

The weight measurements were done on a digital scale without the retainer straps. These weights may vary based on the type of frame you select. However, you can use them for comparison. 

Working Distance

Measured from your eyes to the patient at the position where you are most comfortable working. This is one reason that it is better to be measured in your own office rather than in a convention booth at a dental meeting. 

Field of View

How many teeth you can see when looking through the loupes. Usually, a wider field of view is better. 

Depth of Field

How far you can move before the teeth get out of focus, similar to focusing a camera when taking clinical photos at a fixed magnification. 

Declination Angle

Determines how much you have to bend your neck and/or back to see the teeth through the loupes. A steep declination angle usually allows you to keep your neck relatively straight as you look downward toward the patient, but if it is too steep, you will not be able to see through the loupes. This factor is one of the most important ones in preventing or minimizing musculoskeletal problems. 

Cleaning and Disinfection

Even though flip-ups (see below) are much easier to clean, all of these products require special care. None of the magnification systems should be immersed in cold sterilization solutions. Consult with each company for its specific recommendations for disinfection. 

Staff

You may choose to buy one system for yourself and another one to be shared by your staff. But do not be surprised if you end up purchasing several loupes for your staff, since enlightened auxiliaries also get excited about magnification virtues. 

Types of Loupes

Through-The-Lens (TTL)

The actual telescopes are mounted through holes drilled into the lenses of the eyeglasses hosting them. These are available in standard field (usually called Galilean) or wide field (usually called Prisms). TTL loupes have no adjustments to worry about, they are usually lighter, and, with the optics being closer to your eyes, they typically result in a larger field of view. 

On the other hand, TTLs cannot be shared with other staff members since they are custom-made for one person and you may have to remove them to communicate properly with patients during consults. They also make it difficult to take clinical photographs while wearing them. This means that, if you are documenting a procedure step-by-step through photography, you must be constantly removing the telescopes to shoot the image. This changing of lenses during a procedure becomes very cumbersome, is a nuisance, and challenges even the most devout practitioners of asepsis. 

Furthermore, they are more difficult to clean, compared to flip-ups. You must return them to the manufacturer if your eyeglass prescription changes. In addition, the declination angle is limited, which may force you to bend your neck more than what is comfortable. 

Flip-Ups

Telescopes are mounted on a bracket attached to the bridge of the frame of the eyeglasses. This bracket, which may be a simple hinge or a hinge with a vertical adjustment, allows the telescopes to be flipped up when they are not needed. They can be regular field (Galilean) or wide field (Prisms). 

Flip-ups do not interfere with communication with patients and will be less likely to interfere with photography. They are also easier to clean than TTLs and can sometimes be shared with other staff members if eyeglass lenses are not corrective. In addition, prescription changes for corrective lenses can be done at any optician and the declination angle may be more adjustable for proper ergonomics. 

However, flip-ups tend to be heavier than TTLs and, since they are adjustable, they can get out of kilter if one of their tightening screws becomes loose. This means you could be constantly readjusting them. The flip-up mechanism can also become loose and cause the telescopes to fall down over your glasses at inopportune times. 

Choosing the System for You 

The final decision as to which design will best suit you is a personal one. No system is perfect and you should list your objectives prior to buying. If you do not plan on sharing your telescopes with other staff members, do not mind having to remove your lenses for patient communication or merely looking over the telescopes, and want the lightest in weight option (for prisms), then the through-the-lens versions will be your better purchase. However, if you want increased flexibility, much easier cleaning, and possibly more options in declination/viewing angles, then you should buy flip-ups. 

Since all of the products are available via a free trial period in your office, we advise all dentists and auxiliaries to take advantage of this valuable opportunity. Try one or more and pick the one which "feels right" for you. These companies are very accommodating and have received high marks from our evaluators for their excellent customer service.

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