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Straight Talk by Sebastian Baumgaertel, DMD, MSD, FRCD(C)

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Can Your TAD Practice Benefit
from Optical Magnification?
by Sebastian Baumgaertel, DMD, MSD, FRCD(C)

“I should’ve brought my loupes for this!” I’ve heard this or something along those lines more than once in the many hands-on courses and live insertions that I’ve instructed. Reason enough for me to look at this topic a little more in depth. There is sufficient support in the literature that the visual acuity of dentists decreases with age.1,2 It is however, interesting to note that according to a recent study, practitioners with higher natural visual acuity also have higher visual acuity when using loupes.2 It is therefore quite clear that practitioners of all ages can benefit from optical magnification in order to improve their visual acuity. How important is this finding for your TAD practice? First of all, the use of TADs can be subdivided into two stages – the insertion stage and the loading stage, and both stages come with different clinical requirements.3

Since the identification of the proper insertion site and the determination of the most ideal insertion angle require only little visual acuity, tactile sense seems to be the most important sense during the insertion stage and requires training, experience and heightened attention. Things change, however, during the loading stage. Here it is important to visualize the anatomy of the TAD head to securely fixate the auxiliary. While experience with a certain mini-screw implant obviously helps, it is by no means a substitute for visual identification of specific TAD head features that can be more or less intricate depending on the product used. Typically cross-slot-head implants show a more detailed head design (Fig. 1), while simple undercut-head implants show a much less intricate design (Fig. 2).4

The type of biomechanical setup chosen will also have an impact on the decision if the use of loupes makes sense.5 For example, direct anchorage does not have high demands in regard to visual acuity. It simply requires the identification of an undercut. Especially if custom auxiliaries are used, things are quite simple clinically as most of them “snap” right onto the head (Fig. 3). Indirect anchorage on the other hand might require greater visual acuity. If a wire is to be engaged into a cross-slot for instance (Fig. 4), increased visual acuity can be extremely desirable, especially in areas that might come with reduced lighting or are somewhat obscured by saliva. Therefore the decision if loupes are used should be an individual one. While I personally see only limited use of visual magnification during the insertion stage, it certainly makes sense during the loading stage. Particularly practitioners above the age of 40 who have been shown to lack visual acuity relative to younger colleagues and orthodontists intending to use a lot of indirect anchorage could certainly benefit from increased visual acuity.

References
  1. Burton JF, Bridgman GF. Presbyopia and the dentist: the effect of age on clinical vision. Int Dent J. 1990;40(5):303-12.
  2. Eichenberger M, Perrin P, Neuhaus KW, Bringolf U, Lussi A. Influence of loupes and age on the near visual acuity of practicing dentists. J Biomed Opt. 2011;16(3):035003.
  3. Ludwig B, Baumgaertel S, Bowman JS, eds. Mini-implants in orthodontics – Innovative anchorage concepts. London: Quitessence Publishing Co (2008).
  4. Baumgaertel S, Razavi MR, Hans MG. Mini-implant anchorage for the orthodontic practitioner. Am J Orthod Dentofacial Orthop. 2008;133(4):621-7.
  5. Baumgaertel S. Orthodontic Mini-Implants: Status Quo and Quo Vadis. Orthotown. 2008; 1(4):28-31.


Author's Bio
Sebastian Baumgaertel, DMD, MSD, FRCD(C), received his orthodontic education at Case Western Reserve University where he now holds the position of assistant clinical professor and is co-director of the sub-specialty clinic for skeletal anchorage. In addition, Dr. Baumgaertel maintains an active private practice in the Cleveland area. He is a diplomate of the American Board of Orthodontics, a fellow of the Royal College of Dentists of Canada and a certified orthodontic specialist in Germany.
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