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ABSTRACT: We report a case of apical fenestration misdiagnosed as persistent apical periodontitis. The patient was a 55-year-old woman who presented with persistent tooth pain at the right maxillary canine, despite repeated root canal treatment by a general practitioner. When the patient visited Tokyo Dental College Suidobashi Hospital, a CT examination was performed and apical fenestration diagnosed. The patient received an apicoectomy after which the symptoms disappeared. This suggests that dentists should consider the possibility of apical fenestration when examining patients with persistent tooth pain after repeated root canal treatment.
The Bulletin of Tokyo Dental College 01/2012; 53(1):23-6.
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ABSTRACT: This study aimed to investigate retrospectively the outcome of surgical periodontal therapy. Periodontal surgeries implemented at General Dentistry, Tokyo Dental College Suidobashi Hospital during the period of April 2010 through March 2012 were subjected to data analysis. After initial periodontal therapy, 17 clinicians performed a total of 138 periodontal surgeries in 80 patients with moderate to advanced periodontitis (31 men and 49 women; mean age 54). Cases (sites) operated were as follows: open flap debridement=102, periodontal regenerative therapy=29 (17 for intrabony defects, 12 for furcation involvements) and periodontal plastic surgery=7. Enamel matrix derivative or bone graft was used for regenerative therapy. Clinical data were analyzed focusing on the comparison between open flap debridement and regenerative therapy. At 5 months after open flap debridement, mean reduction in probing depth (PD) and gain in clinical attachment level (CAL) was 3.9 mm (range -1.0-9.0) and 2.3 mm (range -1.0-9.0), respectively. The corresponding values with regenerative therapy were 4.0 mm (range 0-8.0) and 2.8 mm (-1.0-6.0), respectively. At sites with initial PD≥8 mm, a significantly greater gain in CAL was obtained with the regenerative therapy than with flap surgery (mean CAL gain 4.3 mm vs. 2.9 mm, p<0.05). Periodontal surgery performed in our clinical setting demonstrated a favorable short-term outcome. Our data suggest the efficacy of regenerative therapy, in particular for the treatment of deep pockets.
The Bulletin of Tokyo Dental College 01/2012; 53(4):189-95.
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Masahiro Furusawa,
Jun-ichi Takahashi,
Motoko Isoyama,
Yoshiko Kitamura,
Tomoko Kashima,
Fumie Ueshima,
Noriko Nakahama,
Misako Araki,
Yasuko Rokukawa,
Yoshikazu Takahashi,
Takemi Makiishi,
Ken-ichi Yatabe
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ABSTRACT: The purpose of this study was to compare the effectiveness of dental checkups incorporating tooth-brushing instruction (TBI) with that of conventional dental checkups. A team consisting of one dentist and three dental hygienists saw an average of 60 employees per day on-site at an airline company. The patient's teeth were stained with a disclosing tablet and the results recorded on a Plaque Control Record (PCR) chart. The patient was then given TBI. After recording the relevant data, including TBI given and PCR scores, the charts were stored. Checkups were performed in a total of 3,854 patients between 2001 and 2005 and changes in annual scores investigated. In addition, annual shifts in mean score in patients receiving checkups over all five years were compared with those in patients receiving checkups for the first time in each of the five years. The mean score in patients receiving a checkup in 2001 was 35.1%, declining by 2.6 points to 32.5% in 2005. Among patients receiving checkups over all five years, the mean score in 2001 was 34.0%, declining by 11.2 points to 22.8% in 2005. Over the five-year period, the mean score in patients receiving checkups was 34.1%. In patients receiving checkups over all five years, the proportion with PCR scores <30% increased each year. This was because the number of patients with PCR scores ≥60% decreased each year. These findings suggest that TBI is effective in reducing poor plaque control. When compared with in patients who had not received TBI, five consecutive years of checkups was clearly effective. These results indicate that checkups incorporating TBI are more effective than conventional dental checkups that simply check for caries. In future, this type of checkup should contribute to improved preventative dentistry with minimal intervention.
The Bulletin of Tokyo Dental College 01/2011; 52(3):129-33.
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ABSTRACT: This study aimed to evaluate the effectiveness of Calvital(®), which is a calcium hydroxide formulation, on persistent apical periodontitis caused by over-enlargement of the apical foramen. The study included patients referred to the Department of General Dentistry at Tokyo Dental College Suidobashi Hospital on a diagnosis of persistent apical periodontitis at an external dental clinic. Of them, 20 showing considerable enlargement of the apical foramina were included in the study. Complete disappearance of symptoms was observed in all patients after intracanal application of Calvital(®). We believe that this was due to effective wound-healing brought about the strong alkaline nature of this formulation. We regard Calvital(®) as a highly effective agent for root canal treatment of teeth with persistent apical periodontitis.
The Bulletin of Tokyo Dental College 01/2011; 52(4):209-13.
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ABSTRACT: The aim of the present study was to investigate the profile of surgical periodontal therapy performed at the Suidobashi Hospital of Tokyo Dental College, during the period of April 2010 through March 2011. A total of 112 periodontal surgeries in 69 patients (mean age: 51.4 years; 28 men and 41 women) were registered for the data analysis. The surgical interventions performed by 17 dentists comprised 79 cases of open flap debridement, 27 cases of periodontal regenerative therapy with enamel matrix derivative and 6 cases of periodontal plastic surgery. Eighty percent of the surgical sites were in the molar region and 41 cases had furcation involvement. In these patients, an improvement in oral hygiene status was observed prior to surgery: the mean plaque score of 45% at initial visit was significantly reduced to 31% after initial periodontal therapy (p<0.01). At sites that subsequently received open flap debridement or periodontal regenerative therapy, the mean probing depth and clinical attachment level after initial therapy was 6.4 mm and 7.6 mm, respectively. These values were significantly lower than those at initial visit (p<0.01). Lower prevalence of sites with positive bleeding on probing was observed after initial therapy. The initial periodontal therapy performed was considered to be effective in improving the periodontal condition of the sites prior to surgery. More effort, however, is indicated in improvement of patient oral hygiene status.
The Bulletin of Tokyo Dental College 01/2011; 52(4):223-8.
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ABSTRACT: Calcitonin gene-related peptides (CGRP) and adrenomedullin (ADM) belong to the calcitonin family of peptides and are structurally related. Both peptides are found in the neurons of the CNS and play a role in many neuronal functions, including the control of blood pressure. The nucleus tractus solitarius (NTS) is known to play a major role in the regulation of cardiovascular, respiratory, gustatory, hepatic and swallowing functions. Recently, hypotension and bradycardia were observed after CGRP and ADM injection in the NTS. Voltage-dependent Ca(2+) channels (VDCCs) serve as crucial mediators of membrane excitability and Ca(2+)-dependent functions, such as neurotransmitter release, enzyme activity, and gene expression. The purpose of this study is to investigate the effects of CGRP and ADM on VDCC currents (I(Ca)) carried by Ba(2+) (I(Ba)) in the NTS, using patch-clamp recording methods. Application of CGRP and ADM caused facilitation of I(Ba) in a concentration-dependent manner. Intracellular dialysis of the anti-Galpha(s)-protein antibody attenuated CGRP-induced facilitation of I(Ba). Intracellular dialysis of the anti-Galpha(i)-protein antibody attenuated ADM-induced facilitation of I(Ba). Pretreatment with SQ22536 (an adenylate cyclase inhibitor) and intracellular dialysis of PKI(5-24) (a protein kinase A inhibitor) attenuated CGRP-induced facilitation of I(Ba). In contrast, pretreatment with PD98,059 (a mitogen-activated protein kinas inhibitor) attenuated ADM-induced facilitation of I(Ba). Mainly L-type VDCCs were facilitated by both CGRP and ADM. These results indicate that CGRP facilitates L-type VDCCs via Galpha(s)-protein involving adenylate cyclase and protein kinase A. In contrast, ADM facilitates L-type VDCCs via Galpha(i)-protein involving mitogen-activated protein kinase in the NTS.
Brain research 02/2010; 1327:47-55. · 2.46 Impact Factor
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ABSTRACT: This report describes a case of orthokeratinized odontogenic cyst arising in the mandibular molar region of a 39-year-old man. Under the initial clinical diagnosis of radicular cyst, root canal treatment was performed on the mandibular right second molar. The treatment that continued for six months did not achieve healing. Subsequently surgical intervention was selected since the tooth fracture was found, and the prognosis was judged to be poor. After atraumatic tooth extraction, the apical cystic lesion was enucleated, and the tooth was replanted. A definite diagnosis of orthokeratinized odontogenic cyst was made by histopathological examination of the biopsy specimen. The radiograph taken seven months after the operation showed an improvement in the radiolucent lesion. No clinical signs of tooth mobility, pain, and swelling were present. The tooth was then successfully retained with the final restoration. Careful follow-up is needed in order to detect any signs of recurrence.
The Bulletin of Tokyo Dental College 03/2009; 50(1):31-5.
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ABSTRACT: The purpose of this study was to examine the apical foramen of root apices extracted during apicotomies. A total of 25 teeth extracted from 25 patients admitted to the Department of Conservative Dentistry at Tokyo Dental College's Chiba Hospital were used for the study. All patients were between 22 to 56 years of age at the time of the study, and each of the 25 cases was determined clinically on radiographs to be chronic apical suppurative periodontitis. Microsurgery was performed on all cases, and the extracted root apices were then observed using SEM. The results demonstrated a wide opening, greater than 350 microns as measured along the major axis, of the apical foramen in 80% of the cases. Various characteristics indicative of resorption were observed around the apical foramen. These features included those believed to have been caused by overinstrumentation during root canal treatment as well as irregularly shaped areas presumed to be apical lesions that had enlarged and eroded. We observed a high frequency of manifestations of cementum resorption surrounding the root apices of teeth with apical lesions. Furthermore, we concluded that in the majority of cases in the present study, due to the fact that the apical foramen exceeded normal opening dimensions as a result of overinstrumentation during root canal treatment or resorption around the root apex, prolongation of the lesions had occurred in response to direct contact of microbial infectious matter and tissues surrounding the root apex over a large area. The above finding suggested that, in cases in which the apical foramen is destroyed through overinstrumentation larger than #35 or in which the apical foramen opens up to dimensions greater than 350 microns due to pathologic resorption, surgical intervention may be indicated. On the other hand, in 64% of the cases, an accessory canal was observed in the root apical lesion. Based on this observation, the presence of an accessory canal in the root apex may contribute to some degree to the prolongation of the lesion.
The Bulletin of Tokyo Dental College 03/2002; 43(1):7-12.
