The Foundation of Oral Rehabilitation (FOR) together with Drs. Kenji Higuchi and Ruben Rosenberg have completed a unique humanitarian mission to Rapa Nui (also known as Easter Island). It is one of the most isolated inhabited islands in the world. Home to a population of approximately 8000, the community is served by just one resident dentist. When in need of dental care, many members of the community are faced with limited resources and severe financial restrictions. In response to this need, Dr. Rosenberg partnered with Dr. Higuchi to initiate this inspiring FOR project. Within the space of one week, eleven patients suffering from mandibular edentulism were treated with the Trefoil system. We asked Drs. Higuchi and Rosenberg to share their experiences.

How did this pro bono project to treat local residents on Easter Island get started?

Drs. Higuchi and Rosenberg: “Dr. Rosenberg suggested the possibility of bringing the benefits of the Trefoil system to the inhabitants of Easter Island. The island is considered to be one of the most remote inhabited locations on earth and has a long history of limited dental care. Studies from Universidad de Chile, Universidad Mayor and other publications have reported on the poor oral status of the island inhabitants, with high incidences of decayed and missing teeth due to unavailable dental services. Until seven years ago, dental services were mostly limited to teeth extractions and presently only one dentist, Dr. Felipe Collao, serves a population of 7,700.

Based upon input from Dr. Collao and previous humanitarian services provided by Dr. Rosenberg, it was evident that a high incidence of edentulism existed amongst the older population. We agreed that the possibility of a humanitarian mission could improve the quality of life for these individuals, and that such a project could also assess the effectiveness of the innovative features of the Trefoil system when used in a location with limited technology.”

Arrival in Rapa Nui

You treated local residents with the Trefoil system. Why did you choose to offer this particular treatment option?

Drs. Higuchi and Rosenberg: “The Trefoil system is a solution for the edentulous mandible or a lower jaw with failing dentition. A definitive full-arch prosthesis with passive fit can be provided on the same day of surgery or within a few days, by using a cost-effective clinical protocol and an adjustable titanium alloy framework.  For any humanitarian mission, time, cost and predictable quality care are critical elements for success.”

How many patients did you treat in total? Were the cases very similar?

Drs. Higuchi and Rosenberg: “A total of 11 adult patients (aged 54-77 years) received treatment during the week of April 16–20, 2018.  Four women and seven men were treated. Nine of the 11 patients were edentulous in the mandible and two had failing mandibular dentitions; all patients had complete, opposing maxillary dentures. Pre-operatively, all patients were administered a standardized quality of life questionnaire and cleared medically and clinically for the treatment.”

“The treatment activities for the 11 patients involved the following:

  • Sunday: Arrival on Easter Island and organization of the operating rooms and establishment of a makeshift laboratory.
  • Monday: Four surgeries and the delivery of one prosthesis.
  • Tuesday: Seven surgeries and the delivery of four prostheses.
  • Wednesday: Six prostheses delivered.
  • Friday: Meeting with all patients for post-treatment dietary and oral hygiene instructions, and reassurance that our team is committed to continuous follow-up in the years ahead.

In summary, we completed the 11 surgeries over two days and all 11 prostheses were delivered successfully within three days. Nine surgeries were provided under local anesthesia and two highly anxious patients received IV conscious sedation with local anesthesia.”

Performing Trefoil surgery

Did you have a particularly memorable case?

Drs. Higuchi and Rosenberg: “One of the most notable patients involved was a 55-year-old woman who presented with a significant essential tremor (motion disorder) and high anxiety. Her anxiety coupled with the motion disorder resulted in movement during surgery. This challenge was quickly forgotten following the delivery of the fixed prosthesis, when the patient and her family expressed unending heartfelt gratitude. Culturally, the Rapa Nui people are welcoming and cordial and on multiple occasions our team received flower leis, numerous shell beads and gifts to express their appreciation for the efforts of our team.”

Did you face any challenges during your stay?

Drs. Higuchi and Rosenberg: “Our team faced challenges on two levels: Limited facilities and building trust with patients who were suspicious of a team from the “outside” world. As a group, we were confident that providing the technical side of the treatment was achievable despite having limited imaging equipment and no dedicated laboratory facility. Two hospital operating rooms were available for use, with the understanding that if an emergency patient needed surgery our procedures would be delayed. A spare hospital storage room with a sink was converted into a laboratory using small tables and a model grinder. Dr. Rosenberg was well known on Easter Island because of past visits and his humanitarian oral and maxillofacial services to the community. Importantly, the inclusion of Dr. Collao in the team improved the trust of the patients.”

Dr. Higuchi (left), Dr. Rosenberg (right)

Dr. Higuchi (left), Dr. Rosenberg (right)

What are the next steps?

Drs. Higuchi and Rosenberg: “The patients will be regularly evaluated by Dr. Collao for the next four months and we are receiving reports on a scheduled basis. To date, patients have not experienced any problems and state they are very satisfied with the treatment results. Dietary and oral hygiene instructions were provided to all 11 patients at the end of the treatment week. We are planning a team follow-up with all patients in August, four months after treatment. Our team is in regular communication with Dr. Collao and the individual patients. A one-year post-treatment assessment is planned, including clinical examinations, imaging and prosthetic assessments. The same quality of life questionnaire will once again be answered by all patients.”

You are both very experienced with the Trefoil system. Do you have any advice for clinicians considering starting with the treatment option?

Drs. Higuchi and Rosenberg: “The effectiveness of the Trefoil system has been validated in the laboratory with performance testing and clinically with successful early results from a 5-year multi-center prospective clinical trial.  It is essential that clinicians using the Trefoil system attend a training program and follow the established clinical protocol. The Easter Island surgical and restorative team had extensive experience with the Trefoil system.”

Foundation for Oral Rehabilitation

“This successful humanitarian project was provided in partnership with FOR and dedicated compassionate individuals, and we would like to extend a big thank you to the entire team involved.

The surgical treatment was provided by Dr. Ruben Rosenberg, Dr. Kenji Higuchi and Dr. Sebastian Baden and the prosthetic treatment directed by Dr. Nicolas Riveros. Additional team members included Catalina Chamorro (surgical nurse), Gustavo Cardenas (office technician), Oscar Cutiño (laboratory technician), Dr. Catarina Pruzzo (patient support), Mary Higuchi (patient support), and Marcella Riveros (patient support).”

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Posted by Suvi Rantanen