Aim: To overview dental magnification loupes and to present the updated scientific evidence supporting its use.
Background: 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.
Review results: 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.
Conclusion: 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.
Clinical significance: 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.
Wynne L. The selection and use of loupes in dentistry. Dent Nurs 2014;10(7):390–392. DOI: 10.12968/denn.2014.10.7.390.
Kriss TC, Kriss VM. History of the operating microscope: from magnifying glass to microneurosurgery. Neurosurgery 1998;42(4):899–907. DOI: 10.1097/00006123-199804000-00116.
Aboalshamat K, Daoud O, Mahmoud LA, et al. Practices and attitudes of dental loupes and their relationship to musculoskeletal disorders among dental practitioners. Int J Dent 2020:8828709. DOI: 10.1155/2020/8828709.
Low JF, Dom TNM, Baharin SA. Magnification in endodontics: a review of its application and acceptance among dental practitioners. Eur J Dent 2018;12(4):610–616. DOI: 10.4103/ejd.ejd_248_18.
Shanelec DA. Optical principles of loupes. J Calif Dent Assoc 1992;20(11):25–32. PMID: 1284393
Kroll A. The use of optical loupes in dentistry. Dent Items Interest 1947;69(3):267–269. PMID: 20294285
Apotheker H, Jako GJ. A microscope for use in dentistry. J Microsurg 1981;3(1):7–10. DOI: 10.1002/micr.1920030104.
Heft MW, Fox CH, Duncan RP. Assessing the translation of research and innovation into dental Practice. JDR Clin Trans Res 2020;5(3):262–270. DOI: 10.1177/2380084419879391.
Mulimani P, Hoe VC, Hayes MJ, et al. Ergonomic interventions for preventing musculoskeletal disorders in dental care practitioners. Cochrane Database System Rev 2018;10(10):CD011261. DOI: 10.1002/14651858.CD011261.pub2.
Fals Martinez J, Gonzalez Martinez F, Orozco Paez J, et al. Musculoskeletal alterations associated factors physical and environmental in dental students. Braz J Epidemiol 2012;15(4):884–895. DOI: 10.1590/s1415-790x2012000400018.
Kumar VK, Kumar SP, Baliga MR. Prevalence of work-related musculoskeletal complaints among dentists in India: a national cross-sectional survey. Indian J Dent Res 2013;24(4):428–438. DOI: 10.4103/0970-9290.118387.
Lietz J, Ulusoy N, Nienhaus A. Prevention of musculoskeletal diseases and pain among dental professionals through ergonomic interventions: a systematic literature review. Int J Environ Res Public Health 2020;17(10):3482. DOI: 10.3390/ijerph17103482.
Lietz J, Kozak A, Nienhaus A. Prevalence and occupational risk factors of musculoskeletal diseases and pain among dental professionals in Western countries: a systematic literature review and meta-analysis. PLoS One 2018;13(12):e0208628. DOI: 10.1371/journal.pone.0208628.
Hayes MJ, Smith DR, Cockrell D. An international review of musculoskeletal disorders in the dental hygiene profession. Int Dent J 2010;60(5):343–352. https://doi.org/10.1922/IDJ_2514Hayes10
Hayes MJ, Smith DR, Taylor JA. Musculoskeletal disorders and symptom severity among Australian dental hygienists. BMC Res Notes 2013;6:250. DOI: 10.1186/1756-0500-6-250.
Morse T, Bruneau H, Dussetschleger J. Musculoskeletal disorders of the neck and shoulder in the dental professions. Work 2010;35(4):419–429. DOI: 10.3233/WOR-2010-0979.
Perrin P, Eichenberger M, Neuhaus KW, et al. Visual acuity and magnification devices in dentistry. Swiss Dent J 2016;126(3):222–235. PMID: 27023468
Perrin P, Neuhaus KW, Lussi A. The impact of loupes and microscopes on vision in endodontics. Int Endodont J 2014;47(5):425–429. DOI: 10.1111/iej.12165.
Burton JF, Bridgman GF. Presbyopia and the dentist: the effect of age on clinical vision. Int Dent J 1990;40(5):303–312. PMID: 2080952
Rucker LM, Beattie C, McGregor C, et al. Declination angle and its role in selecting surgical telescopes. J Am Dent Assoc 1999;130(7):1096–1100. DOI: 10.14219/jada.archive.1999.0343.
Meraner M, Nase JB. Magnification in dental practice and education: experience and attitudes of a Dental School Faculty. J Dent Educ 2008;72(6):698–706. https://doi.org/10.1002/j.0022-0337.2008.72.6.tb04535.x
van As GA. Magnification alternatives: seeing is believing, Part I. Dent Today 2013;32(6):82–87. PMID: 23802377
Mamoun JS. A rationale for the use of high-powered magnification or microscopes in general dentistry. Gen Dent 2009;57(1):18–26; quiz 27–18, 95–16. PMID: 19146139
Eichenberger M, Perrin P, Neuhaus KW, et al. Influence of loupes and age on the near visual acuity of practicing dentists. J Biomed Opt 2011;16(3):035003. DOI: 10.1117/1.3555190.
Perrin P, Neuhaus KW, Eichenberger M, et al. Influence of different loupe systems and their light source on the vision in endodontics. Swiss Dent J 2019;129(11):922–928. PMID: 31460731
Eichenberger M, Perrin P, Ramseyer ST, et al. Visual acuity and experience with magnification devices in Swiss dental practices. Oper Dent 2015;40(4):E142–E149. DOI: 10.2341/14-103-C.
Branson BG, Abnos RM, Simmer-Beck ML, et al. Using motion capture technology to measure the effects of magnification loupes on dental operator posture: a pilot study. Work 2018;59(1):131–139. DOI: 10.3233/WOR-172681.
Wajngarten D, Garcia P. Effect of magnification devices on dental students’ visual acuity. PLoS One 2019;14(3):e0212793. DOI: 10.1371/journal.pone.0212793
Pazos JM, Wajngarten D, Dovigo LN, et al. Implementing magnification during pre-clinical training: effects on procedure quality and working posture. Eur J Dent Educ 2020;24(3):425–432. DOI:: 10.1111/eje.12517
Urlic I, Verzak Z, Vranic DN. Measuring the influence of Galilean loupe system on near visual acuity of dentists under simulated clinical conditions. Acta Stomatol Croat 2016;50(3):235–241. DOI: 10.15644/asc50/3/6
Goel D, Sandhu M, Jhingan P, et al. Effectiveness of air drying and magnification methods for detecting initial caries on occlusal surfaces using three different diagnostic aids. J Clin Pediatr Dent 2016;40(3):221–226. DOI: 10.17796/1053-4628-40.3.221.
Gupta N, Sandhu M, Sachdev V, et al. Comparison of visual examination and magnification with DIAGNOdent for detection of smooth surface initial carious lesion-dry and wet conditions. Int J Clin Pediatr Dent 2019;12(1):37–41. DOI: 10.5005/jp-journals-10005-1588.
Vasundhara V, Lashkari KP. An in vitro study to find the incidence of mesiobuccal 2 canal in permanent maxillary first molars using three different methods. J Conserv Dent 2017;20(3):190–193. DOI: 10.4103/0972-0707.218308.
Mamoun J. Use of high-magnification loupes or surgical operating microscope when performing prophylaxes, scaling or root planing procedures. N Y State Dent J 2013;79(5):48–52. PMID: 24245463
Deepa D, Mehta DS, Munjal V. Periodontal microsurgery: a must for perio-aesthetics. Indian J Oral Sci 2014;5(3):103–108. DOI: 10.4103/0976-6944.144505.
Eichenberger M, Perrin P, Sieber KR, et al. Near visual acuity of dental hygienists with and without magnification. Int J Dent Hyg 2018;16(3):357–361. DOI: 10.1111/idh.12341
Maggio MP, Villegas H, Blatz MB. The effect of magnification loupes on the performance of preclinical dental students. Quintessence Int 2011;42(1):45–55. PMID: 21206933
Narula K, Kundabala M, Shetty N, et al. Evaluation of tooth preparations for Class II cavities using magnification loupes among dental interns and final year BDS students in preclinical laboratory. J Conserv Dent 2015;18(4):284–287. DOI: 10.4103/0972-0707.159724.
Braga T, Robb N, Love RM, et al. The impact of the use of magnifying dental loupes on the performance of undergraduate dental students undertaking simulated dental procedures. J Dent Educ 2020. DOI: 10.1002/jdd.12437.
Eichenberger M, Biner N, Amato M, et al. Effect of magnification on the precision of tooth preparation in dentistry. Oper Dent 2018;43(5):501–507. DOI: 10.2341/17-169-C.
Pecheva A, Tsanova S, Raycheva R. In vitro evaluation of the impact of optical magnification on the preparation for veneers. J IMAB 2020;26(2):3155–3159. DOI: 10.5272/jimab.2020262.3155.
Wong AW, Zhu X, Zhang S, et al. Treatment time for non-surgical endodontic therapy with or without a magnifying loupe. BMC Oral Health 2015;15:40. DOI: 10.1186/s12903-015-0025-7.
Taschieri S, Del Fabbro M, Testori T, et al. Endodontic surgery using 2 different magnification devices: preliminary results of a randomized controlled study. J Oral Maxillofac Surg 2006;64(2):235–242. DOI: 10.1016/j.joms.2005.10.033.
Juggins KJ. The bigger the better: can magnification aid orthodontic clinical practice? J Orthod 2006;33(1):62–66. DOI: 10.1179/146531205225021420.
Baumann DF, Brauchli L, van Waes H. The influence of dental loupes on the quality of adhesive removal in orthodontic debonding. J Orofac Orthop 2011;72(2):125–132. DOI: 10.1007/s00056-011-0010-y.
Dadwal A, Kaur R, Jindal V, et al. Comparative evaluation of manual scaling and root planing with or without magnification loupes using scanning electron microscope: a pilot study. J Indian Soc Periodontol 2018;22(4):317–321. DOI: 10.4103/jisp.jisp_139_18.
Mohan R, Agrawal S, Gundappa M. Atomic force microscopy and scanning electron microscopy evaluation of efficacy of scaling and root planing using magnification: a randomized controlled clinical study. Contemp Clin Dent 2013;4(3):286–294. DOI: 10.4103/0976-237X.118347.
Yadav VS, Salaria SK, Bhatia A, et al. Periodontal microsurgery: reaching new heights of precision. J Indian Soc Periodontol 2018;22(1):5–11. DOI: 10.4103/jisp.jisp_364_17.
Cortellini P, Tonetti MS. Microsurgical approach to periodontal regeneration. Initial evaluation in a case cohort. J Periodontol 2001;72(4):559–569. DOI: 10.1902/jop.2001.72.4.559.
Karaca IR, Gündoğdu M. Magnification devices in dentistry: a review. Ortadogu Tıp Derg 2018;10(3):374–380. DOI: 10.21601/ortadogutipdergisi.334951.
Moro M, Souto ML, Rovai E, et al. Effect of magnification on root coverage surgery. Braz J Oral Sci 2020;19. DOI: 10.20396/bjos.v19i0.8658221.
Kato M, Watanabe A, Watanabe S, et al. Cleft lip and palate reapair using a surgical microscope. Arch Plast Surg 2017;44(6):490–495. DOI: 10.5999/aps.2017.01060.
As GA. The use of extreme magnification in fixed prosthodontics. Dent Today 2003;22(6):93–99. PMID: 12847849
Winter RR, Cornell DF, Vingoren GJ, et al. Use of magnification in dental technology. J Esthet Restor Dent 2003;15(7):409–415. DOI: 10.1111/j.1708-8240.2003.tb00967.x.
Corbella S, Taschieri S, Cavalli N, et al. Comparative evaluation of the use of magnification loupes in supragingival scaling procedures. J Investig Clin Dent 2018;9(2):e12315. DOI: 10.1111/jicd.12315.
Del Fabbro M, Taschieri S. Endodontic therapy using magnification devices: a systematic review. J Dent 2010;38(4):269–275. DOI: 10.1016/j.jdent.2010.01.008.
Ma L, Fei B. Comprehensive review of surgical microscopes: technology development and medical applications. J Biomed Opt 2021;26(1):010901. DOI: 10.1117/1.JBO.26.1.010901.
Roll SC, Tung KD, Chang H, et al. Prevention and rehabilitation of musculoskeletal disorders in oral health care professionals: a systematic review. J Am Dent Assoc 2019;150(6):489–502. DOI: 10.1016/j.adaj.2019.01.031.
Carpentier M, Aubeux D, Armengol V, et al. The effect of magnification loupes on spontaneous posture change of dental students during preclinical restorative training. J Dent Educ 2019;83(4):407–415. DOI: 10.21815/JDE.019.044.
Plessas A, Bernardes Delgado M. The role of ergonomic saddle seats and magnification loupes in the prevention of musculoskeletal disorders. A systematic review. Int J Dent Hyg 2018;16(4):430–440. DOI: 10.1111/idh.12327.
García-Vidal JA, López-Nicolás M, Sánchez-Sobrado AC, et al. The combination of different ergonomic supports during dental procedures reduces the muscle activity of the neck and shoulder. J Clin Med 2019;8(8):1230. DOI: 10.3390/jcm8081230.
Ludwig E, Tolle S, Jenkins E, et al. Magnification loupes influence on neck and trunk flexion of dental hygienists while scaling—a pilot study. Int J Dent Hygiene 2021;19(1):106–113. DOI: 10.1111/idh.12470.
Lin S, Wu Z, Tang W, et al. Ergonomic risk exposure and work ability among young dental professionals in China: a cross-sectional study. J Occup Health 2020;62(1):e12154. DOI: 10.1002/1348-9585.12154.
Lindegård A, Nordander C, Jacobsson H, et al. Opting to wear prismatic spectacles was associated with reduced neck pain in dental personnel: a longitudinal cohort study. BMC Musculoskelet Disord 2016;17:347. DOI: 10.1186/s12891-016-1145-1.
Pejčić N, Petrović V, Marković D, et al. Assessment of risk factors and preventive measures and their relations to work-related musculoskeletal pain among dentists. Work 2017;57(4):573–593. DOI: 10.3233/WOR-172588.
Reinhardt JW, Romine JJ, Xu Z. Factors contributing to student satisfaction with dental loupes and headlights. Eur J Dent Educ 2020;24(2):266–271. DOI: 10.1111/eje.12493.
Bud M, Pricope R, Pop RC, et al. Comparative analysis of preclinical dental students’ working postures using dental loupes and dental operating microscope. Eur J Dent Educ 2020. DOI: 10.1111/eje.12627.
Zwicker DH, Price RB, Carr L, Li YH. Disinfection of dental loupes: a pilot study. J Am Dent Assoc 2019;150(8):689–694. DOI: 10.1016/j.adaj.2019.03.008.