Department of Removable Prosthodontics, Tsurumi University School of Dental Medicine
Refractory points and how to approach of Eichner classification C1
Cases of non-vertical stop occlusion between remaining maxillary and mandibular teeth（Eichner classification C１） are among the most refractory in removable partial denture rehabilitation. This paper describes clinical conditions, problems, classification（antero-posterior, right-left, and combined）, and characteristics in regard to them. Design guidelines for keeping dentures from rotational change, breakage, and deformation are suggested, and available removable retainers and structural designs are also proposed for these cases. Furthermore, points are covered regarding clinical care and the effectiveness of implant placement for the rehabilitation of these cases and how to deal with rotational change in dentures subsequent to fitting.
Eichner classification C1, Refractory cases of RPD, Rotational change in dentures
Sugi Dental Clinic, Kanazawa-shi, Ishikawa
General practice oral health management in cancer patients
Supportive care of cancer patients is needed in the form of comprehensive oral health management to mitigate symptoms of oral problems, such as from the side effects of cancer treatment and other oral complications, successfully complete treatment, and improve patient quality of life. Oral health management for cancer patients can be broadly classified into oral function management prior to treatment and during the perioperative period, and attendance to oral problems that arise as a result of treatment. In either case, medical-dental collaboration with the physician in charge of the cancer treatment, home healthcare personnel, and others, is essential for ascertaining the patient’s overall condition and cancer pathology.
Cancer patient, Oral health management, Medical-dental collaboration
Umemura Dental Clinic, Edogawa-ku, Tokyo
Use of platelet rich fibrin（PRF）by general practitioners
PRF is a fibrin gel enriched with platelets, leukocytes and growth factors. Its use accelerates physiological phenomena such as wound healing and soft/hard tissue regeneration. PRF has been used in various applications including extraction sockets and dental implant, due to its high ability to enhance wound healing. Being autologous, PRF is not allergenic and is safe and low-cost. This paper focuses on the properties of PRF and autologous fibrin glue（AFG）, with clinical cases.
PRF, AFG, Tissue regeneration
National Cancer Center Hospital
Treatment strategies for cancer therapy induced oral mucositis : how to use Episil®, a new medical device
Oral mucositis（OM）is a serious and common adverse event associated with cancer chemotherapy and/or radiotherapy. OM is often a dose-limited toxicity condition that leads to dose reduction, interruption, or delays in chemotherapy and/or radiotherapy. Many cancer patients are unable to eat, drink, and speak because of the severe pain OM may cause. Episil® is a new medical device approved in Japan in 2018. It forms a protective film over oral mucosa, which acts as a mechanical barrier to relieve pain. Episil® is useful for pain control of OM.
Oral supportive care for cancer patients, Oral mucositis, Episil®
Department of Preventive Dentistry, Osaka University Graduate School of Dentistry
Biofilm management in preventive dentistry
One cause of caries and periodontal disease is when microbial shift causes ordinarily low-virulence biofilm to become highly virulent. The pathogenicity of biofilm depends on its microbial composition and nutrient environment. Microbial shift can cause biofilm harboring cariogenic or periodontal pathogens to become markedly virulent and cause severe caries or periodontitis. Treatment of caries and periodontal diseases is to bring biofilm back to low virulence, and preventive dentistry involves the prevention of infection by managing the virulence of biofilm.
Biofilm, Microbial shift, High pathogenicity
Yasushi SHIMADA 1，2），Masahiro YOSHIYAMA 1），Junji TAGAMI 2），Yasunori SUMI 3）
1）Department of Operative Dentistry, Graduate school of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University
2）Department of Cariology and Operative Dentistry, Graduate School, Tokyo Medical and Dental University
3）Center of Advanced Medicine for Dental and Oral Diseases, National Center for Geriatrics and Gerontology
Optical coherence tomography（OCT）for the diagnosis of dental diseases and aging changes in tooth
Optical coherence tomography（OCT）is an emerging diagnostic method that can visualize internal structures non-destructively without X-ray exposure. OCT images reflect the difference in optical properties between tissues, including the effects of both optical absorption and scattering. In OCT, sound enamel is almost transparent at the OCT wavelength range, and enamel and dentin can be distinguished from each other with the dentin-enamel junction（DEJ） appearing as a dark borderline. Swept-source OCT（SS-OCT）is a variant of OCT, wherein the light source is a tunable laser that sweeps near-infrared wavelength light to achieve real-time imaging. SS-OCT has a high degree of sensitivity and specificity in detecting dental caries, tooth cracks, and interfacial defects in adhesive restorations.
Optical coherence tomography（OCT）, Dental disease, Diagnosis
Department of Oral and Maxillofacial Surgery, Hyogo College of Medicine
The importance of infection control in medical and dental cooperation from an oral management perspective
Infection control is an important key phrase in medical and dental cooperation, and in dentistry is approached from the twin angles of nosocomial infection control and of oral infection control. Nosocomial infection control does not mean only the application of standard precautions, but includes the issue of appropriate use of antimicrobials. Furthermore, prevention of infectious complications such as aspiration pneumonia and surgical site infection in the perioperative period is becoming increasingly taken for granted in the medical field, so for this reason improving the quality of oral infection control by oral management including dental treatment is indispensable.
Infection control, Oral management, Medical and dental cooperation
Comprehensive Dentistry, Niigata Hospital, The Nippon Dental University
What you need to know for successful treatment of sleep apnea
Obstructive sleep apnea（OSA）is a sleep-related disorder, along with bruxism, that can be treated by a dentist under health insurance. The health insurance coverage for the treatment of OSA using oral appliance began in 2004, and many dentists have treated OSA patients through this system. However, there are still a great many untreated OSA patients. Dentists should acquire accurate knowledge about the sleep-related disorders and start treating these patients, which should be considered their responsibility to society. In this paper, we present cases as a guide to successful OSA treatment.
Obstructive sleep apnea, Dental sleep medicine, Oral appliance
Department of Removable Prosthodontics and Gerodontology, Tokyo Dental College
Oral frailty and Oral Hypofunction
The Japan Dental Association defined oral frailty in May2019. The definition divides oral frailty into ４ levels. In addition, the definition places Oral Hypofunction, as defined by the Japanese Society of Gerodontology, on the ３rd level of oral frailty. It also sets out the relationship between oral frailty and Oral Hypofunction.
Oral frailty, Oral Hypofunction, Elderly person
Department of Pathology, Nihon University School of Dentistry
The starting point for the development of Opdivo, the immune checkpoint inhibitor
Distinguished professor Tasuku Honjo of Kyoto University won the Nobel Prize in Physiology or Medicine2018for “discovery of cancer therapy by inhibition of negative immune regulation.” The author was a member of Professor Honjo’s laboratory２８years ago when programmed cell death-1（PD-1）, the key molecule that contributed to his being awarded the Nobel Prize, was cloned. This paper describes how Honjo’s basic research over the years contributed to humanity in memory of days that cannot be forgotten.
Professor Tasuku Honjo, Nobel Prize, Programmed cell death-1（PD-1）
Tokyo Dental College
Examination and management of Oral Hypofunction
The future of dentistry needs to focus not only on the treatment of caries and periodontal diseases, restorative treatment, and post-extraction prosthetic treatment, but also on the maintenance and improvement of oral function. This paper shows the flow of Oral Hypofunction management and an example of such management. Also presented are an example of an oral function inspection record sheet, a management plan and a management guidance log.
Oral frailty, Oral Hypofunction, Management
Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry
Oral health inequalities as a canary in the coal mine : the40million Japanese with untreated dental caries
Oral diseases are the most prevalent diseases in the world, including Japan. Oral health inequalities are therefore the first signs of inequalities in healthcare, and are apparent into old age. Such inequalities in the many and varied social environments arise from a state in which taking action proves difficult, in spite of there being knowledge present. Therefore, individuals’ efforts to prevent disease are limited. For this reason, policies such as school-based fluoride mouthrinsing programs, regulation of smoking, changes in taxes on sugar-sweetened beverages, and health insurance schemes to increase preventive care and home-visiting care are required.
Health inequalities, Public health, Universal health insurance
Imaizumi Dental Clinic, Shinshiro-shi, Aichi
Dentistry for 0 to 2 year-olds: oral functions from birth
Arrival of a new life to a family is a major event. It is an occasion for involvement by dentists for the purpose of reviewing the family's oral-related environment and building in families a new view of health. In particular, eating is the foundation of the child's life and is often a source of concern in child raising. In this regard, dental clinics should promote regular dental examination of children from birth even before they have developed teeth. This way they can create opportunities to provide support in the form of encouraging good lifestyle habits, starting with caries risk management, and nurturing general oral functionality, starting with eating.
Nurture of oral functionality from birth, Baby food, Caries risk management
Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
Denture treatment to support a super-aged society: points for success
Remaining teeth in the elderly are increasing, with those who achieved 8020 now exceeding 50%. However, due to longer life spans, the demand for large dentures has not greatly decreased, and the proportion of difficult cases has increased. The ultimate large dentures are complete dentures, but their shape and impression are affected by the movement of surrounding soft tissue. In addition, it is necessary to accurately record the maxillomandibular relationship: a diffi cult task in the elderly. This paper describes impression-taking and maxillomandibular relation recording, which are both important steps that affect the clinical condition of complete dentures. Furthermore, it discusses a new soft backing material that has recently become available. The key to improvement is to understand and master these matters correctly and integrate them into practice.
Retromolar pad, Sublingual area, Gothic arch tracing
Roppongi-Ekimae Dental Clinic, Minato-ku, Tokyo
Using outsourced technicians/in-house technicians: what I learned from communication with a dental technician
Daily clinical practice would be easier with a steady supply of prostheses all of consistently high quality; but since dental technicians mainly use the indirect manual method, it is inevitable that the quality will vary. For dentists and dental technicians who provide this current type of prosthodontic treatment, with all its difficulties, two-way communication and hard work with mutual understanding and respect are most important.
Dental technician, Transmission of information by image, In-house dental technician
Tomohiro TSUTSUMI, Toshiyuki WATANABE, Noriyasu UCHIBORI
Aichi Dental Association
Current treatment of patients on bone resorption inhibitors: a survey by the Aichi Dental Association
The number of patients with osteoporosis is expected to increase in today's super-aging society, and the Aichi Dental Association identifies the issue of providing dental treatment to such patients as a major one. In undertaking a revision of Position Paper 2017 of the Japanese Allied Committee on Osteonecrosis of the Jaw, the Association surveyed all its members with the Antiresorptive agents-Related Osteonecrosis of the Jaw questionnaire. Collaboration between medical and dental personnel in treating patients who are on bone resorption inhibitors is important. However, the results of the survey showed that there is still insufficient provision to members of information relating to the pathology and prevention of jaw osteonecrosis, and insufficient understanding by medical personnel and dental personnel in regard to their relationship with each other. It can therefore be concluded from the survey that the treatment environment in which patients find themselves is not ideal. There is now clear evidence from a great deal of research attesting to the relationship between systemic illness and the oral cavity. Therefore, having Association members, as patients' regular dentist, promote collaboration with physicians will contribute to an increase in the systemic and oral health of everyone.
Bone resorption inhibitor-related jaw osteonecrosis, Medical-dental collaboration, Position Paper 2017 of the Japanese Allied Committee on Osteonecrosis of the Jaw
Kameda Dental Clinic, Kawaguchi-shi, Saitama
Selecting and maintaining the prosthetic that is removable dentures in a super-aging society
In a super-aging society, Japanese people retain more teeth than previous generations. However, there are still many cases of missing teeth among the elderly. For many of them, removable dentures are an appropriate solution, considering the level of care they will require. Furthermore, there is currently a shift from complete dentures to partial dentures at end-of-life. In the maintenance care for patients with dentures, not only the dentures, but remaining teeth and implants must also be carefully considered. For that reason, hygienic denture design must take into account projected future aging.
Removable dentures, Care of denture patients, Hygienic design
Kiyoshi NISHIKAWA, Yoshiaki HASEGAWA
National Cancer Center Hospital
16S rRNA metagenomics of denture plaque microbiota and denture care
Denture plaque is a biofilm of microorganisms that grows on the surfaces of dentures. It not only causes stomatitis but also increases the risk of aspiration pneumonia. The development of a high-throughput, next-generation sequencer (NGS) has enabled convenient composition analysis of human microbiota. Using this cutting edge technology, some studies have revealed the bacterial composition of denture plaque, which is difficult with conventional culture methods. In this review we give an outline of 16S rRNA metagenomics using NGS with some applications. The significance of recent studies in denture plaque microbiota is also discussed in terms of denture care.
Denture plaque microbiota, 16S rRNA metagenomics, Next-generation sequencer (NGS)
Mandarin Dental Office, Shinjuku-ku, Tokyo
Diagnosing a vertical root fracture
With improving oral cavity hygiene comes the increasing risk of tooth loss due to root fracturing. If fractures are not diagnosed, mistaken ongoing treatment may fail to facilitate recovery, and the patient may quit the clinic. On the one hand, there are patients who do not understand the need for pulp extirpation or tooth extraction in the case of a fractured tooth. Diagnosing a vertical root fracture is difficult, but can be easy if one knows what distinctive signs to look for. However, care must be taken, as it can be overlooked, and, conversely, identification of a fracture by misdiagnosis is also possible even in the absence of one.
Vertical root fracture, Diagnosis, Apical periodontitis
Satoshi IMAZATO, Haruaki KITAGAWA
Department of Biomaterials Science, Osaka University Graduate School of Dentistry
Management of root surface caries by using Saforide: reconsideration of usefulness of the “old but new” agent, silver diamine fluoride
A 38% silver diamine fluoride solution, Saforide®, commercialized in 1970, has been widely used for preventing and arresting caries in primary teeth. Although the use of Saforide in daily clinical practice has declined in Japan, much attention has been given recently to its use in arresting root surface caries. This review looks at the characteristics and usefulness of this “old but new” agent for the management of root surface caries and how it is once again in the spotlight.
Silver diamine fluoride, Root surface caries, Management
Department of Sports Medicine and Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
Face guards and recovery from sport-induced maxillofacial fractures
It has become widely recognized that athletes can effect a safe and early recovery from maxillofacial fracture by wearing the appropriate protective gear (a face guard). In Japan, most face guards are still made by a prosthetist, but the FDI recommends, in a policy statement, that customized face guards be made by dentists or under professional dental supervision. This paper surveys the basics about face guards, and refers to cases demonstrating how athletes effected a safe and early recovery from maxillofacial fracture by using one.
Maxillofacial fracture, Sports injury, Face guard
Esthetic posterior restorative materials: a materials science perspective
Zirconia ceramics have sufficient mechanical strength for esthetic posterior restorations. High translucent zirconia ceramics used for full zirconia crowns reduce in strength with increasing translucency. Although lithium disilicate glass ceramics are excellent esthetic materials, because of their lower strength care needs to be taken in applying these materials to molars. Clinical problems found in CAD/CAM resin composites are less fracturing of materials and more loss of crown retention, making long-term clinical observation of restorations necessary. Further development in ceramic and polymer technologies is expected to provide more reliable esthetic posterior restorative materials.
Zirconia, Lithium disilicate glass ceramics, CAD/CAM resin composite crown
Department of Removable Partial Prosthodontics, Tokyo Dental College
Removable partial dentures that contribute to QOL improvement
In order to achieve patient satisfaction with removable partial dentures, it is most important to minimize denture displacement during use. Minimizing displacement makes it possible to position the main occluding area—the centerpoint of mastication—over the ideal point: the first molar. The key points in design to achieve denture displacement minimization are: (i) Do not stop denture displacement by using undercut retention, (ii) Do not use a standardized clasp design, (iii) Design dentures in three dimensions, (iv) Align the direction of functional force transmission with the axial direction of the abutment teeth.
Removable partial denture, Oral health-related quality of life, Design principles
Higuchi Family Dental Clinic, Iizuka-shi, Fukuoka
Basic periodontal surgical techniques: mastering incisions and ﬂap elevation surgery
Successful incision or fl ap evelation of periodontal surgery requires an understanding of histology and pathology, and precise investigation of bone defects. How well wounds heal depends on the correct choice of instrument and how it is used. Inter-root distance and gingival thickness should be considered especially for incisions in the interdental papilla. Ligament dissection prior to opening a fl ap, and periosteal elevation, enable minimal invasive flap.
Incision, Flap elevation, Minimally invasive surgical technique（MIST）
Ohkawa Dental Clinic, Kobe-shi, Hyogo
Regeneration therapy using the Three Principles of Regeneration
With the increasing predictability of periodontal regeneration, many dentists have come to perform it, yet it remains a highly skilled procedure. A scientific approach is required in order to succeed and produce the same results regardless of practitioner. This requires the three principles of regeneration: 1) ensuring space, 2) maintaining stable blood clot, 3) protecting the wound site. The most important point in applying these principles is to take an approach appropriate for the condition of hard and soft tissues.
Periodontal guided tissue regeneration, Three Principles of Regeneration, Removal design
Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry
Towards early detection: points not to overlook in the accurate diagnosis of oral cancer
The oral cavity is an organ with important functions such as eating, swallowing, articulation, and taste. Oral cancer treatments should ideally be curative, maintain a patient’s quality of life, and have favorable esthetic outcomes. Early detection and treatment of oral cancer can be expected to shorten the treatment period, maintain high treatment efficiency, and maintain oral functionality in patients. Oral cancer patients often first present to the dental clinic only once they have noticed symptoms. Therefore, for a clinical dentist to notice the signs of oral cancer and detect it in daily practice, it is important to understand the characteristics of oral cancer, and constantly examine patients for possible cancer.
Oral cancer, Early detection, Early treatment
Toshitaka MURAJI1), Noriaki MAEDA2)
1) Department of Oral and Maxillofacial Surgery, Hyogo Prefectural Tamba Medical Center
2) Medical Corporation Koshikai, Osaka-shi, Osaka
Signs of HIV infection in the oral cavity, the key point being a “This isn’t healing, something’s wrong” moment: learning from the dentistry workshop at the 32nd Annual Meeting of the Japanese Society for AIDS Research
As of December 2017, there were over 28,000 people living with HIV or AIDS in Japan. About 1,400 new cases are reported each year, about 30% of which are pre-existing cases where symptoms suddenly appear. Furthermore, in recent years there has been an increasing number of reports of detection of HIV infection from oral lesions. We have therefore already reached the stage where, in the course of daily clinical practice, differential diagnosis for HIV infection should also form part of the response to intractable pathologic changes in oral mucosa. In the light of this, at the 32nd Annual Meeting of the Japanese Society for AIDS Research held in Osaka in December 2018, a dentistry workshop took place on the theme of “cases where a dental consultation has led to the detection of HIV infection.” These writers chaired the workshop, and introduce in this paper an outline of the discussion and consider the role of dentistry in the early detection of HIV/AIDS.
HIV, Oral symptom, Intractable pathologic changes in oral mucosa
Sendagi AOBA Dental Clinic, Bunkyo-ku, Tokyo
Current status of and issues with non-metal clasp dentures
In recent years, there has been increasing demand for esthetic considerations, and a greater need to consider appearance even for partial denture wearers. Demand for non-metal clasp dentures is therefore growing. The Position Paper of the Japan Prosthodontic Society provides clinical guidelines for producing non-metal clasp dentures; however there are still many unclear points, and many cases in which dealing with problems subsequent to fitting is difficult. This paper summarizes the current status of non-metal clasp dentures from recent evidence and clinical experience, and discusses the issues.
Non-metal clasp denture（NMCD）, Removable partial denture, Thermoplastic resin
Iwaya Dental Clinic, Sendai-shi, Miyagi
Paradigm shift for the endodontic treatment of necrotic immature permanent teeth: Revascularization
Apexification is a well-known procedure for necrotic immature permanent teeth. Recently, there has been an increased focus on revascularization as an alternative procedure to apexification. Revascularization is a new treatment method that can help maturation of a root apex while thickening its root structure by inducing progenitor cells into the root canal from the apical area. This paper examines the current status and issues of revascularization through clinical cases.
Revascularization, Immature permanent teeth, Apical lesion
Oral Health Science Center, Tokyo Dental College
New research methods for stem cells that maintain hard tissue
Tissue-specific stem cells exist in vivo and maintain tissue homeostasis by self-renewing and differentiating into other types of cells. The existence of bone marrow mesenchymal stem cells (BM-MSCs), which are thought to regulate bone metabolism by permanently supplying osteoblasts, has long been proposed. However, the in vivo dynamics of BM-MSCs remained unclear due to the lack of a method for observing cells in intact bone marrow. Recent technological advances have made it possible to trace labeled cells in vivo, improving our understanding of the maintenance of hard tissue homeostasis by stem cells.
Bone marrow mesenchymal stem cells (BM-MSCs), Dental pulp stem cells, Tertiary dentin formation
Saida Dental Clinic, Tokorozawa-shi, Saitama
Key points for success of periodontal treatment before selecting periodontal regenerative therapy
Recently, periodontal regenerative therapies such as Regrowth® or Emdogain® have been gaining attention again. Despite their success, there are some key points and the facts we should know. This paper describes the importance and effects of initial periodontal treatment and open flap debridement, and outlines the key points for comprehending the patient’s risks and self-healing ability. Periodontal regenerative therapies should be selected in consideration of these facts and points.
Patient risk, Periodontal initial treatment, Open flap debridement
Tomiyama Dental Clinic, Kitakyushu-shi, Fukuoka
Points for preventing crown detachment for CAD/CAM crowns
The points for preventing crown detachment for CAD/CAM crowns are (1) use Super-Bond C&B for adhesion; (2) prevent contamination of the abutment tooth; and (3) select placement of the resin core or fiber-post core for the abutment tooth.
CAD/CAM crown, Crown detachment, Adhesion
Department of Dentistry and Oral-Maxillofacial Surgery, Faculty of Medicine, Fujita Health University
The role of dentistry in a super-aged society
Nutrition and infection are dentistry keywords in a super-aged society. The mouth is the portal for nutrition but can also be the portal for infection. For oral frailty or oral hypofunction in the elderly, the maintenance or improvement of oral function leads to prevention of malnutrition or frailty. Maintaining oral hygiene can also prevent systemic infections such as pneumonia. That is, the role of dentistry in a super-aged society is not only prevention of deleterious oral diseases but can be expanded to one of prophylaxis for systemic diseases or frailty.
Oral Health Assessment Tool (OHAT), Oral hypofunction, Oral frailty
Department of Oral Anatomy, School of Dentistry, Aichi Gakuin University
The expanding outlook for dental pulp stem cells in cell therapy
Dental pulp stem cells differentiate into fibroblasts or odontoblasts. In treating dental caries, we also performed dental treatments using these dental pulp stem cells. Ex vivo, these dental pulp stem cells differentiate into osteoblasts, adipocytes or chondrocytes. Moreover, mesenchymal stem cells are known to be effective anti-inflammatory, angiogenic, and immunosupressive agents, to name a few. This paper presents the results of our research into the above. Furthermore, although autologous cell transplantation is main, this paper describes the benefits of using dental pulp cells when allogeneic cell transplantation becomes necessary.
Dental pulp stem cells, Cell therapy, Allogeneic cell transplantation
Keisuke SUGAHARA 1,2）, Akira KATAKURA 2）
Tokyo Dental Junior College 1）,Department of Oral Pathobiological Science and Surgery, Tokyo Dental College 2）
Digital fabrication in oral and maxillofacial surgery: Application of 3D printing, Mixed Reality technology
The wave of digitization continues its surge at increasing speed through various fields, including that of dentistry. Devices and techniques that a decade ago were used in just a few institutions have now become the norm in dental clinics. CBCT, high-precision optics scanners, 3D printers and the like are used extensively in dental practice for diagnosis, creating treatment plans, prosthesis repair, and oral and maxillofacial surgery, to name a few. In this paper, we provide an overview of the applications for on-site digital technology in oral and maxillofacial surgery and dental education.
Digital fabrication, 3D printer, Mixed Reality technology
Department of Endodontics, School of Life Dentistry at Tokyo, The Nippon Dental University
The dental microscope provides the dentist with a well-lighted operative field, and the appropriate magnification for the procedure can be selected, enabling the optimum outcome. Moreover, the microscope allows dentists to save what they see during treatment as a clear image. This serves as material for explaining to patients, reviewing treatments, and preparing case reports. With the correct use of a metal mirror, direct observation of an operative field that cannot be directly viewed with the naked eye becomes possible, allowing proper treatment while assuming a natural posture. Precise treatment can thus be carried out accurately, making the dental microscope an integral and much used part of the dental chair unit.
Dental microscope, Mirror view, Precise endodontics
Tomoaki IWAYAMA, Shinya MURAKAMI
Department of Periodontology, Osaka University Graduate School of Dentistry
New classification of periodontal disease
The American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) introduced a new classification of periodontal and peri-implant diseases and conditions. The most significant changes are that the terms “chronic periodontitis” and “aggressive periodontitis” have been replaced by “periodontitis,” and that a new diagnosis framework for periodontal disease has been introduced based on stage (disease severity and complexity of management) and grade (rate of periodontitis progression, and risk of deterioration). The Japanese Society of Periodontology (JSP) has decided to provisionally use a combination of the previous classifications and the stage/grade system.
Diagnosis, Periodontal disease, Classification
Akira HASUIKE, Shuichi SATO
Department of Periodontology, Nihon University School of Dentistry
A quarter of a century has passed since the phrase “Evidence-Based Medicine” (EBM) came into use. Interest in EBM has grown, due to the enormous and exponentially increasing amount of medical and dental literature published. EBM is the integration of best research evidence with clinical expertise and patient-oriented values. This article describes the key principles of EBM and the process of implementing them in dental practice. Subsequently, the challenges of EBM in its current state are presented and their implications for the future of EBM are drawn.
EBM, Systematic review (SR), Clinical practice guidelines
Atsushi KAMIMOTO, Yoshimasa TAKEUCHI
Department of Comprehensive Dentistry and Clinical Education, Nihon University School of Dentistry
Current state of the dental clinical training system
Dental clinical training was made a compulsory part of dental courses in April, 2006 and is now in its 14th year. The aim is to have trainees understand all aspects of patient-centered medical care and acquire the basic medical treatment skills needed by all dentists. It thus serves as the first step in lifelong training. A Ministry of Health, Labour and Welfare study committee is looking into how clinical training can be further improved. Based on the committee's findings, this paper covers the current state of the dental clinical training system, and looks at initiatives by the Nihon University School of Dentistry.
Postgraduate dentist clinical training, Dental care course in remote islands, Training program
Tomohiro TAKAGAKI, Toru NIKAIDO
Department of Operative Dentistry, Division of Oral Functional Science and Rehabilitation, School of Dentistry, Asahi University
Adhesive cementation of indirect ceramic inlays: evidence and methodology to achieve clinical success
The current popularity of tooth-colored ceramic restorations reflects an increase in esthetic-related demand from patients. Compared with cast metal restorations, ceramic materials have inferior fracture toughness; therefore, they need to be bonded to teeth in order to reinforce restorations. The successful use of resin cements depends on several aspects related to the bonding mechanisms of both teeth and restorations. To achieve successful results, scientific knowledge of the materials as well as acknowledgment of their limitations and indications are critical factors.
Ceramic inlay, Resin cement, Adhesion
Kiwakai Shin-Osaka Dental Clinic, Osaka-shi, Osaka
Comprehensive treatment centering on periodontics and restorative therapy for promoting long term stability
In order to restore lost function and esthetics and to obtain a long-term treatment outcome, it is essential to satisfy 3 key elements: cleansable and stable periodontium, precise restoration, and stable occlusion. It is necessary to maintain the same level of peripheral cleanliness when performing implants as with natural teeth. It is also important to understand the differences between natural teeth and implants and fine-tuning occlusal contents in order to achieve healthy coexistence of natural teeth and implants in partially edentulous patients.
Long term stability, Control of inflammation and force, Tissue continuity
Keiyukai Tsukuba Vascular Center, Buerger Disease Research Institute
Periodontal bacteria-induced arterial and venous thrombus in rats: pathology, and pathogenesis for Buerger’s disease and atherosclerosis
Periodontal bacteria have been detected in various vascular diseases and related disorders, for which, statistically, they are believed to be a pathogen. However it has been unclear what kind of lesions they create, what kind of cells aggregate, and what kind of reactions they give rise to. Our rat model clearly indicated inflammatory reactions, including natural immunological reactions. Also, pathological changes were very similar to those in Buerger’s disease (thromboangiitis obliterans). When thrombi caused by periodontal bacteria coexist with atherosclerotic factors other than tobacco, i.e., hypertension, diabetes, and hyperlipidemia, a clinical symptom can be presented that is very close that of major atherosclerotic diseases of the heart, brain, carotid arteries, etc.
Periodontal bacteremia, Buerger’s disease, Atherosclerotic arterial lesions
Kazushi YOSHIKAWA, Kazuyo YAMAMOTO
Department of Operative Dentistry, Osaka Dental University
Laser in caries management
Since laser was first used for cavity preparation in 1964 by Goldman et al., there has been a number of reports of its application in clinical dentistry. Laser is widely used in oral and periodontal surgery for oral soft tissue incision, hemostasis, coagulation, and evaporation. Also, in recent years, reports have been made of its use in caries treatment. This paper reports on the possibilities of laser in the diagnosis, prevention, and selective removal of caries.
Laser, Caries management, Selective removal
Hayakawa Dental Office, Itabashi-ku, Tokyo
Preventing toothbrushing accidents by children: safety measures for toothbrushing in children
We dentists see the toothbrush as a powerful prophylactic tool. Yet, in children, it can sometimes become a owerfully damaging weapon. While, oral injuries are overwhelmingly caused by dining utensils, regrettably, in children up to two years of age, many oral injuries are caused by the toothbrush, and to date there has been no sign of reduction in the number of such incidents. This paper discusses safety measures, focusing on the ndings of conference reports on toothbrush accidents in the Tokyo Metropolis in 2016.
Toothbrushing accidents, Safety toothbrush, Child safety
Department of Rehabilitation Medicine, Yokohama City University Medical Center
Importance of medical-dental collaboration in rehabilitation nutrition
In Japan, a super-aged society, it is necessary to promote rehabilitation nutrition and medical-dental collaboration in order to enhance life functions and quality of life (QOL) as much as possible in older people and people with disabilities. It is important that dentists diagnose and intervene in sarcopenia to prevent and treat dysphagia. In many cases, better clinical outcomes can be achieved by intervention by dental hygienists in convalescent rehabilitation wards. I expect that the medical-dental collaboration will be more properly acknowledged and valued when ward-dedicated dental hygienists work closer with dentists.
Sarcopenia, Sarcopenic dysphagia, Dental hygienists
Yoshitomo HONDA 1), Tomonari TANAKA 2)
1）Institute of Dental Research, Osaka Dental University, 2）Department of Biobased Materials Science, Kyoto Institute of Technology
Extracellular environment control and plant-derived substances: development of a new bone regeneration material using a catechin derived from green tea
Regenerative medicine is a fi eld with extremely high expectations from society. However, are the strategies aiming to strengthen (proliferation/differentiation) cellular functions that have been the focus so far adequate to induce prompt or suffi cient tissue regeneration? The environment outside the cell, which affects the cell’s functions, has a much greater effect on the result than might be expected. This paper presents an overview of extracellular environmental factors and presents an environmental control biomaterial derived from plant matter that has impressive cost effectiveness.
Extracellular environment, Plant-derived substances, Catechin
Mirai Clinic, Fukuoka-shi, Fukuoka
Learn about mouth breathing and use it for patient guidance
Mouth breathing leads to various inimical changes in the body and mind, as it desiccates the airway mucosa and promotes infl ammation in the oral cavity. In addition, focal infections such as periodontal disease or apical lesions cause immune abnormalities. The rate of mouth breathing increases with age. The problem is that mouth breathing in children is increasing: devlopmental failure of oral fanction. In children, early medical intervention is required for devlopmental failure of oral fanction, and physical fi ndings such as changes in facial features and dentition are used for diagnosis. To remedy mouth breathing, it is necessary to correct the position of the tongue. To this end, simple mouth exercises (AIUBE exercise) are useful.
Mouth breathing, Devlopmental failure of oral fanction, Tongue position
Igari Dental Office, Iwaki-shi, Fukushima
Coexistence between periodontal ligaments of natural teeth and dental implants in patients with missing teeth
Periodontal ligaments in natural teeth have five superior functions (in terms of support, feeling, regeneration, homeostasis, and nutrition) making use of periodontal ligaments effective for occlusal reconstruction and functional recovery of missing teeth. In order to utilize these functions, it is important to look at the whole picture in clinical cases of missing teeth.
Dental implants are an option for restoring the functionally lost through missing teeth and supplementing the functions of periodontal ligaments; and removable dentures with abutments onto dental implants are useful for prosthodontic treatment for missing teeth in the presence of natural teeth.
Missing teeth, Periodontal ligaments, Dental implants