Leaving it in the Operatory

Hockey is a weird sport. You've got two groups of big, tall, testosterone-packed guys that play the game as though the ice is a battlefield and sticks are a sword. They'll slash at each other's shins, throw a cheap cross-check, and maybe even trade blows. At the end of the day though, they can still look one another eye-to-eye, shake hands, and "leave it on the ice."

I always figured that hockey was the only activity where that proverb could ever apply. That was until last Friday when I watched one of the GPR residents place a crown for his second (ever) dental implant.

When I first walked into clinic I did my usual routine - quickly glancing over the schedule and checking to see if there was any cool procedures going on today. Sure enough, there was a LONG 2 hour crown appointment, which I thought was really weird. I mean, the docs normally did crowns (impressions + temporary crown) in a hour and cementing the permanent one on was usually an even shorter procedure. So I asked around and apparently they were planning on placing the abutment and temporary crown onto a single-tooth implant.  

Picture for reference. The implant is the actual part going inside of your gums (bone really).

For those that don't know (aka me before I asked the resident), the main point of not just going straight from implant to permanent crown is because you want to give a lot of time for the bone and gums to heal. The temporary also has the added bonus of giving the gums something to heal around, thus creating a natural-looking smile.

Kinda like this. Just imagine a the implant sticking out where the arrow is pointing.

Anyways, I was able to watch the procedure which was really cool and the crown was looking awesome! However, when the doc was checking the patient's bite he was really concerned with the amount of contact the crown was making (too much contact = lots of pressure on the implant and it's still-healing supporting bone). Long story short, he ended up having to shorten and thin the crown up quite a bit. The implant was on tooth 8, your upper right front tooth, so it was pretty obvious that the tooth was much shorter than the rest. On top of that, the crown's thinness also made the abutment visible, which gave the crown a bit of a darker hue. When the patient first saw it he said something along the lines of "I didn't know this was going to make me look like a hockey player."

After the procedure I was helping the DA clean up while the GPR and overseeing doc were looking at the pictures. It wasn't hard to tell that the doc was kind of down on himself. Of course, there wasn't really anything else he could have done. After all, this was just a temporary crown and allowing the gums and bone to fully heal is the main priority. Still, its obviously gotta be a bummer when, after two hours of drilling and carving, a patient says something like that. 

Fast-forward fifteen minutes, as I'm walking by the operatory I see the same doctor working on an 80 year old patient's filling, still yakking it up with the patient and DA as much as ever. Forty-five minutes later I see him playing I Spy with a toddler whose mother's block was waiting to set. These got me thinking about that old hockey proverb I mentioned in the beginning of the blog - the doctor was able to leave the procedure "on the ice" and move on to help the next patient to the best of his abilities. 

The bottom line here isn't that I think you can't or should't ever get down on yourself. I actually think that's a very natural and almost necessary reaction to a disappointing outcome. After all, dentists aren't just some loop wearing, tooth filling robots! That being said, I think that an even more necessary skill to have would be ability to "leave it in the operatory."