KDA Today

KDA Today

For Immediate Release

Date: Apr 24th, 2014
Contact: Dr. John Thompson

I Only Have A Loose Screw!

You are on vacation, it is Saturday and you get a call from your friend and longtime patient that the tissue integrated prosthetic (TIP) you placed almost thirty years ago has come loose.  For those not practicing that long ago, it is one of those antique contraptions using the old non hexed Brånemark cylinder implants to support a fixed lower denture.  To make matters worse, it is February and he is on a sunbaked Caribbean Island where everyone seems to be happy and it is not predicated on having money or in many cases, electricity.

But wait, it gets worse!  He is in the villa directly above yours and wants to know, "What are you going to do about it?"  Not a problem!  You are Dr. Karl Lange and you have on hand your Mag light, a steak knife, a safety pin and a small screwdriver for repairing your glasses, a certain recipe for success in a situation such as this.  Your friend/patient, Mike, is now sitting in a kitchen chair in your, what is now, villa office and he correctly identifies the implant position where the screw is loose and the gum is very sore.  One hour later you have picked out the composite plug over the screw with the trusty steak knife with the bent tip, plucked out three very ripe cotton balls with your safety pin and accessed the loose screw.  All of this is accomplished under the watchful eye and helpful comments of your next door neighbor who is there to document this event.  As the operation began to unfold and the magnitude of the problem began to manifest, I reminded Karl, "He is your patient, but if it were me..."

It became apparent that multiple implant screws or bolts were broken in the prosthesis and we were in over our heads when the head of the first screw was spinning freely.  Our best hope now was a dentist on the island that understood antique implants.  While that seemed a long shot, a call to an artist friend who also happened to be a retired dental hygienist (1-800-KAY) provided one name and phone number for Dr. Trevor Connor.  Fortunately, the only mistake Dr. Connor made was answering his phone and agreeing to see Mike, and us, at his Anguilla office on Sunday morning after church services.

Your Worst Nightmare!

The first thing I told Dr. Connor as we entered the back door to his pristine office, "This could be your worst nightmare.  You have an emergency patient on a Sunday morning, accompanied by his regular dentist, as well as another dentist, both of whom have opinions on everything, often conflicting."  I have to report that Dr. Trevor Connor seemed unphased by my remark and he did not see any humor in it, either.  Trevor had never seen this loosely presented implant contraption before, but he fully grasped the situation and knew he was going to remove the prosthetic.  His primary dental assistant had been called into the office to help find long abandoned “tools”.  Kamarla, was now at his side, and while her husband and daughter, along with Trevor's beautiful wife, Josie, waited, he began.  Two and a half hours later under the instruction of Dr. Lange and with drawings provided by me, an unperturbed Dr. Connor had removed the prosthesis that had four bolts broken off in the implant bodies. While our patient was now pain free, he was significantly compromised functionally and certainly esthetically.  At this point, I changed Mike’s name to Rupert to protect his identity and preserve a pretense of HIPAA compliance.

Rupert (aka Mike) now had a decision to make.  He could fly back to a cold and snowy Kentucky in the states and have the prosthesis replaced or restored, or he could remain in a third world tropical paradise and continue to work with Dr. Connor.  Trevor Connor is a native Anguillian and a 1987 and '89 Howard University Dental school graduate with advanced training in both Orthodontics and Implantology who decided to bring his talents back to the people of this truly wonderful and, only now, economically developing 35-square-mile island.  His primary dental practice office is in Charlotte Amalie, US Virgin Islands with a satellite practice in Tortola, British Virgin Islands and his Saturday practice and home on Anguilla, British West Indies.  Commuting is facilitated by the fact that Trevor is an accomplished pilot and has his own twin-engine Beechcraft Baron Aircraft to commute between multiple island offices.  Trevor told Rupert (aka Mike) that if he would take a shuttle flight to his office in the Virgin Islands he would have him stay as a guest in his adjacent apartment, provide him soup and then fly him back to Anguilla at the end of the week. Dr. Connor could provide for the surgical recovery of the broken bolts and then repair or replace the prosthesis.  Karl and I looked at each other and immediately agreed that this was a "no brainer" and that Trevor should take control of this situation NOW and not later!  Rupert (aka Mike) was in good hands and Dr. Lange's records would provide all the information required for replacing the ancient Brånemark parts required by Dr. Connor's New Jersey dental laboratory technician.

What was Dr. Trevor Connors fee for that Sunday emergency?  He refused a fee, saying it was a professional courtesy and a three-hour continuing education course.  I would have to say that this whole event is a reminder of the professional camaraderie I enjoyed as a practicing dentist.  In spite of knowing better, there still remains in me, an underlying subliminal cultural bias that says those who practice in differing modes may be somewhat less a dentist than my expectation.

No longer a practicing dentist, I have become an observer dentist and I see this cultural bias, even in our local dental societies, as a prejudice based on geography, urban-rural, gender-age or practice management mode. Indeed, the finest oral surgery practice I have ever seen provides extensive service for a Medicaid population in Appalachia.  Quality of service is not determined because it is delivered by a solo practice or a large group practice and a dental practice spread across three Caribbean islands is as fine as any practice in the United States. The common denominator of quality is a dentist’s commitment to patients, a love of the profession and involvement with continuing education, whether by on-site attendance or long-distance learning.

You are a very lucky person if you get the opportunity or can make the opportunity to practice this profession where you and your spouse can say, "This is where our heart is".  You are doubly blessed if you can provide a service that makes your fellow man happier, you are in love with what you do and you can make a living at it.  Today I am going to be a starving artist, here on Anguilla, and if I am not having a good day, just shoot me!

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