hardship

People all over the world except for some politicians and bureaucrats are in predicament. We are surrounded by the virus hoax. When will the state of emergency in Tokyo end? I'm getting cabin fever because of hunkering down. Will I forgo a pay for a while until then? 100,000 yen bounty for one person from the government is a drop in the bucket for almost people, though it’s better than nothing.

I am despondent over the order I should not carry out dental implant surgery in the current situation. She (my patient) missed her upper 6 front teeth because of a traffic accident! For her, it is really the state of emergency, losing esthetics. No brainer.

However, I admonish myself, saying in my mind, sort of incantation, “Pull yourself together when the chips are down. Don’t be despondent over hardship. Your focal point is analyzing past and present about your business, preparing for the future, in order to mitigate obnoxious antsy feeling. Do not be tipsy. Don’t waste your time, money, and opportunities.”

Checking a result of tissue regeneration surgery

There is no cure for corvid19. You just have to let run its course, which makes us antsy. If I don't get out of this situation, I'll go stir crazy. After this ceases, I should be raring to go. 

2 weeks ago, the government declared the state of emergency in Tokyo. This morning, a patient, for whom I have been treating gum disease, came to my clinic.  I carried out tissue regeneration surgery for her 5 months ago. The surgery needs a substance called "Emdogain" which was developed in Scandinavian countries for recovering lost tissues around a tooth. It is applied on the root surface of the tooth. After the surgery, it is required strict plaque control. I was worried about the level of her plaque control becomes worse, while she doesn’t come to our clinic for fear of the corvid 19 turmoil. Fortunately, I found out her plaque control was better than I thought, so healing condition was good. Today’s X-ray shows recovery of lost bone, meaning successful regeneration of bones between the premolar teeth, though it’s only 5 months after the surgery (In order to get full recovery, they say it takes 6-12 months). X-ray is just a 2-D image, so I am going to check 3-D structure by CT scan a while later. When I learned and started tissue regeneration therapy 9 years ago, in each time, I checked if new bone generation was achieved by another open flap surgery 1 year after the operation, meaning directly watched new tissues. Recently, considering the reopening flap surgery gives some discomfort to the patients, I check the results only by CT.

 In this case, the patient had missing molar teeth which caused excessive load to the existing neighboring premolars. The major reason of lost supporting bone is infection by plaque. In addition to this, the increased loading may cause the phenomenon. For missing molars, I carried out implants treatment. The premolars, to which I performed tissue regeneration surgery, are covered by plastic temporary crowns now. Fundamental rule is final crows should be applied at least 6 months after the surgery, so I am waiting for the time.

It may be a trivial successful experience, though I can’t say it is complete success yet, I felt excited and a sense of fulfillment, because my character may be simple. However, I may forget it tomorrow and will pursue another success.

 In this case, I performed minor orthodontic treatment, which was intrusion of an upper molar using mini-implants to create space for lower molars’ implants (2 pieces), the opposite side in mandible (2 pieces of implant), an upper front tooth implant, and tissue regeneration surgery in other 2 parts. The treatments which still are not carried out are final crowns and micro tissue regeneration surgery in 2 other parts, which requires microscope, micro scalpels and delicate skill. The process to the goal is enjoyable, however, it will be delayed because of corvid-19 turmoil.  

Challenging case

 Recently, I had a patient who had trouble with dental implants which his former dentist had embedded. At first, I rejected to treat him. Because, the implants were different from ones which our clinic dealt with. I use implants produced by Straumman co. which has been used worldwide. I did not know the product maker of the patients' implants through the appearance and X ray images of them. It is said that there are over 50 implant makers in the world. Some new companies aim niche in the market, struggling to keep up with the technology of the companies already having big share. Sometimes, some companies' implants have kinks though they say their product are fool proof. I wanted to pull out the patient's implants with counter clockwise strength, because they were poorly positioned. Of course, considering patient's agony, I can't carry out it. He asked me to treat many times, and finally, I gave in. Now, I am enjoying the process of reconstruction of his occlusion.

 before

 halfway

(It's like night and day, isn't it?)

 X-ray at the first visit

Pontsuku, Kokura's sweets

Kokura is a smaller than Hakata (the capital city of Fukuoka) but growing town in Fukuoka prefecture Kyushu Japan. Since last September, I have attended a dental seminar held in Kokura, every second weekend in each month. Last week, before going there from Tokyo, a dental hygienist turned to me, “Doctor? Please buy souvenir for our staff”. She is called as a sweets commentator in my office. She gave me a list of sweets made in Kokura. It seems that she researched all day long on the Internet. Considering expiring date of the sweets, I chose Pontsuku (photo) which an old established store has made. It is a sponge cake including custard cream. There are other versions of cream, such as powdered green tea, chocolate, and strawberry. It was amazing, fluffy, fabulous and yummy. All our staff turned cartwheels. When you have a chance to visit Kokura, try Pontsuku, the awesome sweets!

10 years after sinus floor augmentation

 I sometimes encounter patients who don't have enough bone in upper molar teeth missing area for placing dental implants. I learned skills of sinus floor augmentation, surgery of growing new bone in sinus for upcoming dental implants surgery, at University of Michigan in 2002. The reason for going abroad was that I could practice the skills using cadavers in US, which has been prohibited in Japan. Since then, I have overcome the difficulties in placing implants in upper molar. This is one of such cases, CT scan images after 10 years showing stable condition. The more I learn, the more I can contribute.

The boys in the boat

When I was a university student of faculty of dentistry, I belonged to the rowing club. When I was 4th grade, our crew, coxed four, won a race in Japan and selected as a representative of Japan for university students Olympic, held in Italy in 1982. My position was number 3, role of engine in coxed four. We got 4th place in the final heat of 2000m, failed to get medals. After oarsman's era, I coached younger generation for 10 years. I learned not only skills of rowing and coaching, but also leadership. I grew good relationship with the team mates, all are dentists or doctors now, and still have meeting with them, enjoying talking and drinking occasionally. "The boys in the boat", describing Washington university crew winning gold in Berlin Olympic, is the book of rowing I encountered since "True Blue" dealing with the story of Oxford university crew's turmoil and winning the boat race in the end. It was a really page turner. I was moved to know how gung-ho the students were in those days namely Great depression, paying tuition by themselves through working in a quarry or a night pub after home work. The book gives energy to live.

 

Making sushi with warm heart

Dr. Kasugai, who is a professor of the dental implant section of Tokyo Medical and Dental University, invited my clinic's doctors to "Kanpachi",one of famous sushi restaurants in Tokyo (Dinner time;15,000yen~). Many Japanese like to eat sea urchin, but I don't.  Nevertheless, I could eat one with pleasure here for the first time in my life. Other kinds of sushi and sake are all the best. The master, Mr. Yamada, is 81 and has kept this restaurant for 50 years. He can speak English and has some non-Japanese guests, so if you have a chance to come to Tokyo, it's worth enjoying true sushi here in Kanpachi. The photo is his autobiography titled "Making sushi with warm heart". The restaurant is 5 minutes walk from Okacimachi station. Tel:03-3832-7357 

The heart of a leader

http://www.amazon.com/The-Heart-Leader-Insights-Influence/dp/0781445434/ref=sr_1_1?ie=UTF8&qid=1369315871&sr=8-1&keywords=ken+blanchard+the+heart+of+a+leader

A friend of mine sent me a book "The Heart of a Leader".

You don't have to start from scratch, but read any page you like. The most impressive page for me is the page 62 "Never give in! Never give in! Never give in! Never!"-Winston Churchill. I will re-read this book in a daily commuting train until each word soaks deep into my mind.

development of dental materials

 Things have changed dramatically in dentistry like every field of the world. Today, I treated a patient from UK who lost his front tooth crown. In order to fix the new all ceramic crown, I set a fiber core into the root canal with special adhesive. Then, I took a mold for the new crown. I checked the tooth color using lots of color samples to get good match against neighbouring all ceramic crowns.

 20years ago, I always used metal cores. But, for aesthetic purpose and avoiding root fracture, fiber cores had been invented. Since then, I sometimes has applied them. There are several adhesive materials and I have to choose the best. Lots of information makes me confused, but fortunately, my junior doctor knows well through his dental college hospitals' experience.

 As for new dental materials, each dentist has his own thinking. I must not depend on my past knowledge and have to get appropriate information by word of mouth. Because few dental books show what up-to-date material is and what the best is.

possibility of gaining dental license of other countries

 Can a Japanese dentist get a license of dentist in other countries? Each country has its own rule. To get a license in US, you have to study in a dental college for designated years and pass the exam of each state, like a native student. It sounds the long and winding road. But, some countries are giving an easier chance for foreign dentists. In Australia, the number of dentists is said to be relatively small. Actually, Australia has welcome mode to immigrants of dentist from other countries.

  I went to Gotanda Tokyo to attend an explanation meeting from the tour company"M.I Studies Abroad". The shortest way to get a license of Australia is sending the application form, (if it's accepted), sending IELTS score certificate (reading, listening, writing, speaking score must be over 7(1-9) respectively), written exam of dentistry, and final clinical exam. The clinical test takes 6 days. If all procedures are successful, you are enrolled in Dental Board of Australia and can perform there. Visa is necessary to perform. According to the company, no Japanese dentists has got the license through the process. Foreign dentists who could attain the final are always Korean, Indonesian, Chinese, and other south east countries' dentists. The whole fee of the tests is around 1,000,000 yen except for staying fee.

 The staff said "You can maintain three wives if you succeed as a dentist in Australia". hahaha. Sounds intriguing? Me? My bottleneck is age. They say it may be difficult to get Visa for people over 50. The only thing I can do is just study English and get high score in IELTS. Will dream end in dream?

Making a complete denture...It's fun

 Most Japanese dentists don't carry out teeth arranging in making a complete denture. They usually order that to dental technicians. My mentor always says arranging teeth sould be a dentist work, not technician's. It may look painstaking for some dentists. But, for me, it's really fun. Making a useful device(full denture) from nothing(no real teeth in the mouth) is exciting, imagining the patient's smile.
 In the process, I don't totally rely on my instincts (of course, experience can not be ignored). "Shilla system" which is a kind of occlusion analyser is really helpful in setting the 3D positions of teeth. This will guide you to a nice goal due to the standardization.

wax rim

artificial teeth



arranging upper teeth on Shilla 2

arranging lower teeth on Shilla 3

Mikimoto Pearl Museum

 The Mikimoto Pearl Island is an excellent museum about pearls, pearl cultivation and Mikimoto Kokichi, the first person who succeeded in cultivating pearls. The island is located in the Bay of Toba, accessible via a bridge.
Mikimoto Kokichi was born in Toba in 1858 and became the first person to successfully cultivate pearls in the year 1893. He opened the first Mikimoto Pearl Store in 1899. The Mikimoto Kokichi Memorial Hall introduces his life story. Also located on the island, the Pearl Museum provides detailed explanations about pearls and the cultivation of pearls in Japanese and English. In the adjacent Pearl Plaza you can view and purchase a wide variety of pearl jewelry. The Mikimoto Pearl Island also offers hourly performances by female pearl divers, known as Ama (lit. "sea women"), who have traditionally been planting and harvesting the oysters (and other seafood).

Kokichi Mikimoto

 

 

 

 

 

 

 

Ama(Sea woman)

Combination of skills, it's fun!

 Collapsed bite cases, which require wide varieties of skill to fix, are challenging for dentists. However, I am excited whenever I face them. In such cases, thinking process for treatments is really fun for me. The case below is the combination of techniques such as diagnosis of occlusion, implant, orthodontic treatment, gum surgery, and crown restoration. The treatment took 2 years. I want to thank the patient for his understanding and cooperation. Without them, I couldn't have reached the goal. I will describe the prosess, step by step later.

before

after

before(lower jaw)

after(fixed by implants, bracing, crowns)

Pursuit of happiness for the patrients and truth for occlusion

 Occlusion is the most basic factor in dentistry. However, there are several different theories. They look different, but the goal is the same? How can a dentist set an ideal occlusion? What is the landmark in oral anatomy? How can a dentist have an appropriate 3D image of occlusion? Are there really science factors in dentistry? What is the truth? Sounds very confusing? Abe's Shilla system must be a solution. Its philosophy is crystal clear without ambiguous explanations. It's really persuasive and useful in actual planning in treatment. I believe I have helped some patients who had eating problems, using the theory. They said they felt A-one after the treatment. I want to continue pursuit of happiness for my patients.

Today's seminar

 I went to Kanda Tokyo to attend a seminar. Dr. Abe is 77 this year, but he is nicely energetic in his lecture and demonstration. After he graduated from Nihon University 50 years ago, he went to USC in US and had great American mentors. He learned complete denture's theory and skills from them. After he returned home, he opened his own dental office in Sendai Japan. Then, he began complete denture seminars not only in Japan but also in Korea and Taiwan. He knows anatomy well and has great knowledge of dental materials. He arranged former skills adding his own ideas and has established new remarkable theory and techniques called Shilla system. He sometimes changed some parts of procedures for making full dentures, because dental materials have developed gradually. I have learned many theories, but I think Dr.Abe's thinking is the most persuasive and useful.

complete denture demonstration by Dr.Abe

upper jaw analyser (Shilla 1)

mounting upper jaw mold on Shilla 2

face bow transfer procedure

 After the seminar, I could see a festival by Kanda shrine. Unfortunately rainy though.

http://en.wikipedia.org/wiki/Kanda_Shrine

Blade teeth for full denture

upper

lower

 When patients use their complete dentures, are natural shaped artificial teeth enough effective to chew? 80% of all denture wearers want more than what is being offered to them. Sadly, conventional acrylic teeth even if hardened have a tendency to become less efficient in a short amount of time. The patients must chew from side to side to get results.
 The idea of blade teeth is a solution to pursue more effective and enjoyable eating life. Food that posed a challenge for denture wearers in the past (meat, apples,lettuce,carrot) are easily cut up by the blade teeth denture.

Advantages of metal edged teeth compared with conventional ones are
1. easy to get comfortable jaw relationship
2. better chewing since cutting force is better
3. creates more stability in upper and lower dentures
4.less adjustments are required because of less sore spot

This weekend, I can learn the technique of complete denture through my mentor's demonstration, while I work as an instructor in the seminar.



http://www.shouohkai-dental.com/english.html

Alex Ferguson's retire

http://moderntokyotimes.com/2013/05/08/sir-alex-ferguson-to-retire-at-manchester-united-football-history-reshaped/

 My English teacher, from Manchester UK, sent me his article about Alex Ferguson's retire.

 In off-season, there is much news about personnel transfers in football teams. Especially this year, many J-League teams changed their managers. The big upside of changing managers is activation for the teams. Competition for becoming regular players starts from scratch. Players, who had few chances to play in games, will be motivated. Present regular players will be alert. There will be a race.

 The upside of continuously hiring the same manager is accumulation of tactics. That makes possible in step by step approach. Changing players by trades instead of changing managers can activate the team.

 He has succeeded in alternation of generations and activation of Manchester United by being not dependent on big names and adding ambitious young talented players to the team.

 Though my clinic is an small organization unlike Manchester United, there must be some points which should be mimicked in his leadership for organising.