Brazil Day 4

Well we've fitted our first implant. Margaret fitted one on the lower and did brilliantly.  In the other groups Victoria, Fez and Keith fitted an implant each.

The course tutors are very concerned that we can suture properly. It seems that this was one of the biggest difficulties with the last group.  Because of this we began the day with suturing practice on cow's tongues.  The cow has one big tongue ! They are so huge that one of us was sitting at one side of a desk and one at another, both suturing the same cow's tongue.  I was working with Victoria and Aalock for this.  Vicky made me go and collect the tongue from the container because she didn't like the look of it.

Arminder at suturing practice

In the second part of the morning we saw the case notes for the patients that we would be working on in the afternoon.  Ours was a lower molar with very little bone to place the implant above the inferior dental nerve.  We planned it all out on x-rays and traced out the relevant anatomical features.  A transparency is used to plan the position and size of the implants.

Margaret making a tracing of our implant case

After a quick lunch we went for a stroll around the town of Pindamonhangaba for most of an hour.  This was interesting because we have been so busy we haven't had the chance to see the town where we are staying yet.  Fez and Arminder wandered into a dental surgery in the town for a chat.  The dentist didn't speak English but Fez assures us that they communicated using the "International language of osseointegration"

Fez, Vicky and Arminder in the main square at Pindamonhangaba

After lunch the serious business of placing implants began.  Every session begins with a prayer lead by the Dean.  This was fantastic.  Everyone prays in their own way and it really sets the mood for the business ahead.  We put the asepsis protocols into action that we had been taught and that seemed to work out fine.  There are a lot of things to worry about other than the mechanics of the surgery and it will be good when they become more second nature so that we can concentrate just on the surgery.  I am sure that is why they chose single implant cases for us today so that we can get familiar with the set up.

Nadeem gave everyone a pep talk before their first implant.  "When I did my first I was s***ing my pants !"  Thanks Nadeem, really helpful mate.

Just before entering the clinic to begin surgery.  We had prayers just after this

Our surgery was supervised by Kelly.  She really is a fantastic teacher.  I only wish that I had been taught oral surgery by someone like that when I was a student. In Manchester in the 1970's it was extraordinarily strict.  I shouldn't say any more about it on a publicly available website but suffice to say that it was many years before I could even speak sensibly to oral surgeons.  It was just plain unpleasant.  Anyway, that's enough reminiscing. Margaret placed an implant in a difficult lower molar site and did brilliantly.  What is also very pleasing is that Margaret, Aalok and I are becoming a tight team. We all want to help each other to do well.

After the surgery we had a discussion with the whole group about what went well, what could have been improved and we got feedback from the tutors. We then got to plan the next mornings cases in the same way as before with x-rays and tracings.  That really is a great technique and I'll definitely be using that when I get back to my practice.

We had a reasonably early finish today.  Arminder invited everyone to a glass of champagne to celebrate our first implants which was brilliant. Thanks Arminder.  We all sat around in Vicky's room making each other laugh and Raj showed us his champagne cork trick.  Difficult to explain on a website but its good. I'll show some of you when I get home but it does mean that you have to open two bottles of champagne!  I responded with my coin drop trick which makes a coin disappear from your hands. I can usually fool someone once with this trick.  It fooled Fez twice which might be a record.

Raj bamboozles Margaret and Karen with the champagne cork trick

Later we sat around in the hotel in the bar area and Marty bought take away pizzas for everybody which was really kind of him.  Thanks Marty!  You can ask the hotel reception here to ring up a pizza delivery place in Pindamonhangaba and they will carry up the pizzas for you, bring you plates, knives and forks and we could have even used the restaurant if we had wanted to.  They can't be too helpful.  I can't imagine that happening in a British Hotel. They'd want to charge you whatever the pizza equivalent of corkage is. That would be "pizza boxage" I think.

Our team has a difficult surgery to do tomorrow involving sinus augmentation, bone grafting and other complications.  Aalok and I are going to do one side each. We then have surgery again in the afternoon so I don't know how much time I will have to complete the diary but I'll do my best.  I am getting so many hits on the site I'm beginning to feel a responsibility to my audience !