Implants in Brazil
Andrew Shelley reports on the final part of his dental implant course in London, Paris and Brazil.
Brazil is fantastic. Well the bit I saw of it is fantastic anyway. What do you think of when think about Brazil, carnivals, gangsters, street crime ? Well I didn’t see any of those things but what I did see were happy people going about their business. It really is the Brazilian people that make it such a great place, friendly, charming and uncomplicated. I had arrived in Pindamonhangaba, a small town near São Paulo, for the hands on surgical part of my implant course. Having completed the lecture course in London and the anatomy course in Paris I was very excited about the hands on surgical part of the course.
The course delegates in São Paulo
There are very few implant courses around which make it so easy to gain hands on experience. So many courses rely on the delegates finding their own patients and persuading them to take part in training. For someone just starting out in implantology this seems to me to be a serious barrier to progress. I had been searching for an implant course for some time so I was relieved and delighted to find the courses offered by Perio Implant Europe.
Course delegates placing implants in the clinic
We arrived at São Paulo airport at 5.30am. However I was so confused about the time difference that they could have told me it was any time and I would have believed them. Transport was arranged for us and we started our day with a bus tour of São Paulo city. It is absolutely vast. The beautiful modern city centre stretches out and, as you leave, it slowly takes on a more stark appearance. Driving along the main highway out of the city miles after miles of solemn concrete tower blocks gradually descend into the grim shanty towns that we read about.
Raj Ahlowalia becomes a vegetarian
Pindamonhangaba is about two hours away and in contrast is a small friendly town nestling in the Paraiba valley between São Paulo and Rio de Janeiro. We stayed at the very comfortable Colonial Plaza hotel in Pindamonhangaba which was also unbelievably inexpensive. The first day was spent relaxing as we waited for the second half of our group to arrive the following day. Highlight of the day was a visit to a typical Brazilian restaurant where barbecue is the name of the game. Huge chunks of barbecued meat were delivered to the table. It was relentless, they just kept on coming. I am sure that one of our number turned vegetarian at that very moment.
Infection control protocols demonstrated in the clinic
The more serious business of the course began the next day when we were taken the short distance from our hotel to the FAPI. For the curious, FAPI stands for, “Faculdade de Pindamonhangaba”, the University of Pindamonhangaba. It is a very new modern dental clinic in the town and we were amongst the first to use it. We were introduced to the clinic, the staff and the infection control protocols. Lectures from the University staff ensured that we were up to speed. All were in the English language, sometimes with a translator. They also introduced us to the implant system we would be using, Titanium Fix. This is manufactured in São José dos Campos near São Paulo and is a remarkably close cousin of the Bränemark system.
The Titanium Fix factory
One afternoon we managed to fit in a trip to the Titanium Fix factory so we also got to see how dental implants are manufactured. Back at the University, workshops followed in which we learnt the workings of the Titanium Fix system. We also had a very useful session on suturing techniques using cow’s tongues for practice.
Suturing practice
For the surgery sessions we were in groups of three. In this way we would take it in turns to be surgeon, scrubbed nurse and assistant. Although the intention was that we would place ten implants each, it seemed like more because each of us was involved with around thirty placements. Some of the most useful aspects of the course were the preparation sessions. Study casts and radiographs were used to plan the cases and this is of course the most crucial part of the whole procedure. We made tracings to identify the anatomical landmarks and plan the length and diameter of implants we would place. Of course the magnification of the radiographs had to be taken into account and special transparencies were used to account for this.
Planning cases
I have to confess that your first implant is a bit scary. However once we got started on the surgery we were very closely supervised by the University staff. The first cases were straightforward but more difficult situations were encountered later on. One or two of the patients had nine or ten implants fitted at one time, sometimes with internal sinus lifts and bone augmentation. None of them had sedation and I have to say that Brazilian people can be incredibly stoic. Head of Department was Professor Luis Otavio Palhari. He seemed equipped to cope with any surgical situation presented to him. One case where the upper anterior ridge was paper thin was dealt with by a mixture of ridge expansion and bone augmentation. He became “The man who can find bone where there is no bone”.
The main square in pindamonhangaba
Workshop on the Titanium Fix implant system
This trip was a fantastic and fascinating experience. Aside from learning about implant surgery there was a lot of fun and we laughed our way through most of the week. I am pleased to say that I also made some new friends from England and Brazil and we all still stay in touch. I am now placing implants in my practice and I cannot think of a better way to begin than to take this course.
The swimming pool at the Colonial Plaza Hotel. It's a hard life this implantology!
What do you think of when think about Brazil, carnivals, gangsters, street crime ?
There are very few implant courses around which make it so easy to gain hands on experience
Huge chunks of barbecued meat were delivered to the table. It was relentless, they just kept on coming
The beautiful modern city centre stretches out and, as you leave, it slowly takes on a more stark appearance
Although the intention was that we would place ten implants each, it seemed like more because each of us was involved with around thirty placements
I have to confess that your first implant is a bit scary
None of them had sedation and I have to say that Brazilian people can be incredibly stoic
He became “The man who can find bone where there is no bone”
For more information about Perio-Implant Europe see www.implantsuccess.com
