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Association between Stress and Temporomandibular Disorder
Kanehira H., Agariguchi A., Kato H., Yoshimine S., Inoue H.
Purpose: To evaluate the causes of temporomandibular disorder (TMD) by examining the relationships between 3 major TMD symptoms, parafunction, and stress, a questionnaire survey was performed during dental examinations in corporations.Methods: The survey was performed using 6 questions on the following topics: 1. Trismus; 2. Joint noise; 3. Pain; 4. Clenching in the daytime; 5. Nocturnal bruxism; and 6. Stress.There were 3,225 subjects, 2,809 males and 416 females and the mean age of the subjects was 40.12 years. The relationships between questions 1 to 5 and question 6 were examined by the chi-square test.Results: There were significant correlations (question 1, p=0.001; questions 2-5, p
Co-treatment with Basic Fibroblast Growth Factor and 17.BETA.-estradiol in the Presence of Dexamethasone Accelerates Bone Formation by Rat Bone Marrow Stromal Cell Culture
Ozono S., Fujita T., Matsuo M., Todoki K., Ohtomo T., Negishi H., Kawase T.
Bone marrow stromal cells (BMSCs) are a promising cell source in applications for tissue engineering and regenerative medicine. Optimization and control of the growth and differentiation of cultivated cells can be achieved by the administration of growth factors and hormones in vitro. This study provided experimental information on the enhancement of the osteogenic potential of rat BMSCs in vitro and in vivo.Mineralized nodule formation of rat BMSCs in culture for 3 weeks with dexamethasone (Dex)-treated media supplemented with both basic fibroblast growth factor (bFGF) and 17beta -estradiol (E2) was examined by histology. In porous beta-tricalcium phosphate (beta - TCP), proliferation, migration, and differentiation of BMSCs were examined by histology and transmission electron microscopy. After culturing, the composites were subcutaneously implanted into syngeneic rats. The tissues with implants were harvested after 4 weeks and evaluated microscopically by using histological stain.Dex-treated media supplemented with both bFGF and E2 was the most effective in mineralized nodule formation of BMSCs in vitro. Light and electron microscopy revealed the presence of many cells with developed rough endoplasmic reticulum. Bone formation in the BMSC/beta -TCP composites in cultures in vitro for 3 weeks was observed histologically at 4 weeks after implantation. When BMSC/beta -TCP composites were cultured in Dex-treated media supplemented with both bFGF and E2, the amount of bone formation at implants was substantially greater than that of composites cultured in Dex-treated media supplemented with bFGF.The combined use of bFGF and E2 could effectively improve the bone-forming ability of BMSCs.
Relationship of Pressure Pain Thresholds between the Masticatory Muscles and Styloid Process. Part 2. Healthy Subjects and Patients with Temporomandibular Disorders
Ishiura K., Kimura K., Tanaka M., Tanaka J., Tosa J., Kawazoe T.
Purpose: We previously reported correlations between the pressure pain threshold (PPT) at the styloid process, which represents individual pain sensitivity, and PPTs of the masticatory muscles in healthy subjects, and proposed the 95% confidence interval (95%CI) of the PPT at the styloid process as a reference range. In this study, we evaluated its usefulness as a reference range.Methods: Serial changes in the PPT relative to the 95%CI were studied in 7 healthy subjects. Next, the determination of abnormal sites in the PPT relative to the 95%CI was studied in 7 patients with temporomandibular disorders (TMD).Results: In the healthy subjects, the PPT remained within the 95%CI at all sites. Since the PPT deviated from the 95%CI at some sites in TMD patients, abnormal sites could be determined.Conclusion: The 95%CI of the PPT at the styloid process is useful as a means for the evaluation of muscle symptoms of TMD patients.
Clinical Evaluation of Semi-Adjustable Articulators: Reproducibility of Sagittal Condylar Path Inclination Assessed by a Jaw-Tracking System with Six Degrees of Freedom
Hangai K., Aridome K., Wang C., Igarashi Y.
To validate whether the data for individual patients are correctly reproduced in sagittal condylar path inclination of the articulator, the data obtained by the conventional anterior check bite method and the data obtained by a jaw-tracking system with six degrees of freedom were compared.In 5 subjects (4 males and 1 female) with healthy tooth alignments, 5 anterior check bites were obtained from each subject. Sagittal condylar path inclination was measured using seven types of semi-adjustable articulator. Next, the anterior gliding movement was measured 5 times in all 5 subjects using a jaw-tracking system with six degrees of freedom (MMJI- E, Shofu Inc. Kyoto, Japan. The sagittal condylar path inclination data obtained with semi-adjustable articulators were compared to those obtained by the jaw-tracking system using the two-way analysis of variance and Fisher's PLSD method (alpha = 0.05).In measurements of the same subjects for five types of articulators with the check bite method, significant differences were observed by two-way analysis of variance, and differences in measurements among articulators were found (p < 0.01). Regarding the sagittal condylar path inclinations measured with Hanau-184 Wide-View and Dentatus ARL articulators, significant differences were observed on both right and left sides compared with the jaw-tracking system. With the Denar Centri-Check System and Denar Mark II, significant differences were observed on one side (p < 0.05).Denar Cadiax Compact, Hanau Condyle Repositioner, and Hanau H2O are recommended for more accurate measurements of the sagittal condylar path inclination.
Blood Flow Changes of a Superficial Temporal Artery Before and After Low-level Laser Irradiation Applied to the Temporomandibular Joint Area
Makihara E., Masumi S.
The aim of this study was to evaluate the blood flow changes of a superficial temporal artery before and after low-level laser irradiation was applied to the TMJ area of healthy subjects.Right TMJ areas of six healthy subjects were irradiated with a CO2 laser. Variation of diameter, blood flow rate, and blood flow volume of the vessel, on both the irradiated side and opposite side, before and after irradiation on the TMJ were evaluated by using a Doppler flowmeter.The diameter and blood flow volume of the vessel after irradiation increased significantly compared to that before irradiation.Low-level laser irradiation applied to the right TMJ area caused an expansion of blood vessels and an increase in blood flow volume. The same result on the contralateral side may be caused by the vasodilator reflex via the hypothalamic thermostat.
Metallic Artifacts in MRI Caused by Dental Alloys and Magnetic Keeper
Destine D., Mizutani H., Igarashi Y.
Purpose: To evaluate the artifacts generated by crownshaped dental alloys and a magnetic keeper quantitatively by analyzing digital MRI data.Methods: One pre-fabricated magnetic keeper and four clinical dental alloys (gold-silver-palladium, casting gold alloy Type 3, cobalt-chromium, gold porcelain alloy) were selected. Twenty metal crowns and 5 magnetic keepers were analyzed. The samples were placed in an acrylic phantom (150 mm × 150 mm × 150 mm) filled with agar, and then placed in the MRI apparatus. Various image slices were selected from the center (0 mm) to 70 mm at steps of 5 mm. The distribution of the signal intensity in the region of interest was calculated using ImageJ software and the mean coefficient of variation of each specimen was obtained. Statistical analysis was performed by Dunnett's test (p
Effect of Single-liquid Acidic Primers on Bonding of a Composite Luting Agent Joined to a Prefabricated Alumina Coping Material
Yamada K., Koizumi H., Ishikawa Y., Matsumura H.
Purpose: The aim of this study was to assess the effect of acidic primers on adhesive bonding to prefabricated alumina material designed for fixed restorations.Methods: High-purity alumina disks (Procera AllCeram) were primed with one of the following materials: Acryl Bond, All Bond II Primer B, Alloy Primer, Estenia Opaque Primer, M.L. Primer, MR. Bond, and Super-Bond Liquid. The specimens were bonded with a dual-polymerizing luting composite (Variolink II). Unprimed specimen was prepared as the control. Bond strengths were determined both before and after thermocycling.Results: Average bond strength before thermocycling ranged from 12.0 to 39.1 MPa, whereas average bond strength after thermocycling varied from 0.0 to 26.9 MPa. The statistically highest post-thermocycling bond strength was obtained with the use of the Alloy Primer, Estenia Opaque Primer, and M.L. Primer agents.Conclusion: It can be concluded that the use of either the Estenia or Alloy Primer material, which contain 10-methacryloyloxydecyl dihydrogen phosphate (MDP), or the M.L. Primer, which contains 6-methacryloyloxyhexyl phosphonoacetate (6-MHPA), is recommended for bonding the Procera alumina copings with the Variolink II composite.
In Search of Necessary Mouthguard Thickness. Part 1: From the Viewpoint of Shock Absorption Ability
Maeda M., Takeda T., Nakajima K., Shibusawa M., Kurokawa K., Shimada A., Takayama K., Ishigami K.
Purpose: To date, the minimum thickness required for a mouthguard has been assumed to be around 2 mm to 4 mm. However, this figure is based mostly on experience and is yet to be standardized. The purpose of this study is to determine the minimum thickness required to obtain sufficient energy absorption.Methods: The thicknesses of the tested ethylene vinyl acetate) samples were 1, 2, 3, 4, 5, and 6 mm. The pendulum-type testing equipment used in the present study was also used in a series of earlier studies. Three types of sensors (strain gauge, accelerator, and load cell) and two different impact objects (a steel ball and baseball) were used.Results: The results showed that all the abovementioned mouthguard thicknesses reduced shocks for all the three types of sensors and both types of impact objects; little difference was observed between sensors and clear results were obtained for the steel ball. An improvement in the energy absorption was observed with an initial increase in the thickness. However, a further increase in the thickness from 4 mm to 5 mm and 6 mm tended to yield a smaller improvement in energy absorption.Conclusion: Within the limitations of this study, from the viewp int of energy absorption ability, the minimum thickness required for a mouthguard is 4 mm, which is generally too large from the viewpoint of player comfort. This finding indicates the necessity of improving the impact absorption ability of mouthguards by considering new designs and developing new materials.
Section Showing Minimal Intra-individual Variations in Masticatory Movement
Shiga H., Kobayashi Y., Stohler C.S., Tanaka A.
To clarify the section showing minimal intraindividual variations in the movement of the mandibular incisal point during mastication of softened chewing gum.Twenty healthy subjects were asked to chew softened chewing gum on the habitual side for 20 seconds. The change in the spatial parameters (gape and masticatory width) and temporal parameter (cycle time) were investigated for 20 cycles from the first cycle. The coefficients of variation of these parameters were investigated for each of 10 consecutive cycles (first to eleventh series).The spatial and temporal parameters were maximal at the first cycle, decreased progressively until the fourth or fifth cycle, and then remained almost unchanged thereafter. The coefficients of variation of the parameters were maximal during the first series, decreased progressively until the fourth to sixth series, and then tended to increase gradually thereafter. Minimal coefficients of variation were observed during the fifth and sixth series for the gape, during the fifth series for the width, and during the fourth series for the cycle time.These results suggest that the ten cycles after the fourth to the sixth cycle was the section showing minimal intra-individual variations in the masticatory movement during the chewing of softened chewing gum.
Effects of Resilient Denture Liner in Mandibular Complete Denture on the Satisfaction Ratings of Patients at the First Appointment following Denture Delivery
Kimoto S., Kimoto K., Gunji A., Kawai Y., Murakami H., Tanaka K., Syu K., Aoki H., Tani M., Toyoda M., Kobayashi K.
Purpose: The purpose of this study was to investigate whether edentulous patients with a permanent acrylic resilient liner denture (RLD) in mandibles exhibit significant improvements in their satisfaction ratings at the first appointment following the delivery of RLD dentures when compared to those with conventional heat-activated acrylic resin dentures (ARD) in mandibles.Methods: Seventy-four subjects were randomly allocated into RLD and ARD groups by a random permuted block within the strata method after written informed consent. A parallel-randomized controlled clinical trial at two centers was conducted from April 2004 to July 2006. The outcomes were satisfaction ratings with a 100 mm visual analog scale (VAS) involving general satisfaction as well as satisfaction related to chewing, speaking, cleaning, stability, retention, comfort, and esthetics. The pain rating was also measured by the VAS. The outcomes were analyzed by Student t-test and Pearson's correlation coefficient.Results: A significant difference between the RLD and ARD group in the maxillary denture was only obtained in the satisfaction rating of speaking. A significant difference between the RLD and ARD groups for the mandibular dentures was obtained in every satisfaction rating. The pain rating of the RLD group was significantly lower than that of the ARD group. The satisfaction ratings of mandibular denture functions significantly correlated with ratings of comfort and pain.Conclusion: Despite the limitation of a short-term observation, the mandibular satisfaction ratings were dramatically higher in RLD wearers than in ARD wearers.
Influence of the Functional Improvement of Complete Dentures on Brain Activity
Morokuma M.
To elucidate the influence of the improvement of denture function on brain activity in complete denture wearers.Eighteen complete denture wearers (5 males and 13 females, 63-87 years, mean: 75.2 years) participated in the study. To evaluate denture function, the occlusal contact area and occlusal force were measured for comparison before and after denture treatment using the Dental Prescale Occluzer (GC Co., Tokyo, Japan). To evaluate brain activity, electroencephalogram data obtained using an electroencephalographic measurement apparatus ESA-pro (Brain Functions Laboratory, Inc., Kanagawa, Japan) were analyzed using DIMENSION (Diagnosis Method of Neural Dysfunction). The duration of the measurement was 3 minutes before and after denture treatment.The occlusal contact area significantly increased after denture treatment in all 18 subjects (p
In-Vivo Modal Analysis of Maxillary Dentition in a Maxillectomy Patient Wearing Buccal Flange Obturator Prostheses with Different Bulb Height Designs
Murase I.
The purpose of this study was to apply in vivo modal analysis to the maxillary dentition of the maxillectomy patient using obturator prostheses which were different in lateral wall height of the bulb: specifically a high type (H type), middle type (M type), and low type (L type).The left central incisor was struck with an impact hammer, and the response at each measurement point was detected using a Laser-Doppler vibrometer. The transfer function was then obtained from each measurement point using a fast Fourier transform analyzer. Finally, a computer analysis and simulation were performed based on the measured transfer functions to obtain the natural frequency, modal shape decay rate (DR), and maximum displacement (MDP).The results showed that the natural frequency was different between with and without obturator prostheses, that the modal shapes with M and L type obturator prostheses are more suitable than that with H type. The DR of the maxillary dentition with the L type was significantly higher than that with the H or M types, and the MDP of the maxillary dentition with an obturator prosthesis was significantly lower than without an obturator prosthesis.From the standpoint of vibratory characteristics, the L type obturator prosthesis is the most suitable bulb design for the patient of the three types obturator prostheses. This is the first report to apply in-vivo modal analysis to the maxillary dentition of the maxillectomy patient using obturator prostheses and clarify the vibratory characteristics of the dentition.
Development of Soft Denture Lining Materials Containing Fluorinated Monomers
Kasuga Y., Akiba N., Minakuchi S., Uchida T., Matsushita N., Hishimoto M., Hayakawa I.
Purpose: To develop a new fluorine-containing soft denture lining material, the influences of fluorinated monomers on physical properties and contamination resistance were examined.Methods: Five experimental materials of different chemical compositions in fluorinated monomer and two plasticized acrylics (Supersoft, VertexSoft) were used to evaluate water sorption, solubility, staining resistance, Shore A hardness, and contact angle. Five specimens for each test were fabricated. The results were analyzed with one-way analysis of variance (ANOVA) and Tukey's HSD test using statistical software at p=0.05.Results: The amount of water sorption tended to decrease as the number of the fluorine atoms in fluorinated monomers increased. Similar solubility was shown regardless of the type of fluorinated monomer. The use of fluorinated monomers for immersion in coffee allowed suppression of discoloration. In β-carotene, there were no significant differences in color changes among four experimental materials with fluorinated monomer. Shore A hardness was decreased and the contact angles tended to increase as the number of fluorine atoms in fluorinated monomers increased. When comparing the experimental materials and commercially available materials, the experimental materials containing fluorinated monomers with large numbers of fluorine atoms showed adequate clinical properties except for staining test of β-carotene.Conclusion: Monomers with a large number of fluorine atoms can be used to develop applicable soft denture lining materials in clinical practice.
The Evaluation of Denture Retention and Ease of Removal from Oral Mucosa on a New Gel-Type Denture Adhesive
Sato Y., Kaiba Y., Hayakawa I.
Purpose: The purpose of this study was to evaluate the effect of a new gel-type denture adhesive on denture retention and ease of removal from the oral mucosa after use.Methods: Eleven complete denture wearing patients (3 males and 8 females; age range, 58-84 years; mean age, 73.7 years) with compromised maxillary denture-bearing tissues were included in the study. Denture retention and ease of removal were evaluated for a new gel-type denture adhesive. The results were compared with those obtained with and without a cream-type denture adhesive. Retention was evaluated by measuring unilateral bite force until these dentures were dislodged on the balancing side. Ease of removal was evaluated by scoring the remaining area of colored denture adhesives on the oral mucosa. Denture retention and ease of removal were also subjectively evaluated using questionnaires.Results: A significant improvement in objective denture retention was observed when either the cream-type or gel-type denture adhesive was used (p
CYP24 Promoter Activity is Affected by Mechanical Stress and Mitogen-Activated Protein Kinase in MG63 Osteoblast-like Cells
Toyoshita Y., Iida S., Koshino H., Hirai T., Yokoyama A.
Purpose: For bone homeostasis, vitamin D plays an important role in the regulation of calcium. The enzyme CYP24 inactivates vitamin D and is involved in its regulation. However, the mechanism of expression of CYP24 in osteoblastic cells under mechanical stress is not clear. In this study we investigated CYP24 promoter activity in stretched osteoblastic cells and the participation of mitogen-activated protein kinase (MAPK) in expression of CYP24.Methods: MG63 osteoblastic cells were cultured on silicon-bottomed plates. Cells were transfected with a reporter gene that contained a CYP24 promoter. After activated vitamin D, 1,25(OH)2D3, was added or not added, cells were stretched. Stretched and non-stretched cells were investigated by luciferase dual assay. Cells were also investigated similarly using medium with an ERK1/2 inhibitor or p38 inhibitor.Results: The CYP24 promoter was activated by 1,25(OH)2D3 and the promoter activity decreased in stretched cells. Inhibitor of MAPK decreased CYP24 promoter activity. However, CYP24 promoter activity decreased with mechanical stress after addition of p38 inhibitor, while it did not decrease with mechanical stress after addition of ERK1/2 inhibitor. The CYP24 promoter was not activated without 1,25(OH)2D3 in any case.Conclusion: Mechanical stress and MAPK control CYP24 promoter activity in the presence of Vitamin D in MG63 osteoblast-like cells.
Evaluation of the Masticatory Part and the Habitual Chewing Side by Wax Cube and Bite Force Measuring System (Dental Prescale)
Takahashi M., Takahashi F., Morita O.
This study evaluated the masticatory side as well as which side was the habitual chewing side by the use of wax cubes and a bite force measuring system in normal dentate subjects (ND) and complete denture wearers (CD).Forty two ND subjects (29 males, 13 females; mean age, 24.8 +/- 2.4 years), and 11 CD subjects (4 males, 7 females; mean age, 72.8 +/- 7.0 years) participated in the study. The test food used in this study was wax cubes to determine the masticatory side. The difference in the occlusal contact area and occlusal force between the masticatory side and the opposite side was investigated using Dental Prescale. ND was classified into 2 groups: those whose agreement on the masticatory part was high (ND-H) or low (ND-L). The distribution of the center of the occlusal balance was analyzed by Dental Prescale in ND-H, ND-L, and CD.The occlusal contact area and occlusal force of the masticatory side was greater than the opposite one, and the center of the occlusal balance was wide in ND-H. In ND-L and CD, the occlusal contact area and occlusal force did not differ between the masticatory side and the opposite one, and the center of the occlusal balance developed a tendency to gather in the center.The results of this study suggested that the evaluation of the masticatory side and the use of Dental Prescale were helpful in determining the habitual chewing side.
Influence of Chewing Rate on Salivary Stress Hormone Levels
Tasaka A., Tahara Y., Sugiyama T., Sakurai K.
Purpose: The purpose of this study was to clarify the effect of different chewing rates on salivary cortisol levels as a stress indicator.Methods: The subject group consisted of 16 healthy males. They were required to rest for 30 min, and then given arithmetic calculations to perform for 30 min as stress loading. Immediately after, the first set of saliva specimens (S1) was collected over a period of 1 min to measure cortisol levels. Next, they were asked to chew a tasteless gum base for 10 min, and the second set of saliva specimens (S2) was collected in the same manner. They were then required to rest for 10 min, after which the third set of saliva specimens (S3) was collected. Chewing rates were set to slow, habitual, and fast in time with a metronome. Salivary cortisol levels were analyzed by radioimmunoassay. Changes in salivary cortisol levels comparing S1 with S2, and S1 with S3 were determined.Results: Changes in salivary cortisol levels between S1 and S2 showed a reduction of 4.7%, 14.6%, and 16.2% with slow, habitual, and fast chewing, respectively. A significant difference was observed between slow and fast chewing. Changes in salivary cortisol levels between S1 and S3 showed a reduction of 14.4%, 22.2%, and 25.8% with slow, habitual, and fast chewing, respectively. A significant difference was observed between slow and fast chewing.Conclusion: This study showed that differences in chewing rate affected salivary cortisol levels as a stress indicator, and suggested that the effect on stress release with fast chewing is greater than that with slow chewing.
Significance of Occlusion for Dental Implant Treatment-Clinical Evidence of Occlusion as a Risk Factor-
Hosokawa R.
インプラント周囲の骨レベル低下やインプラントの失敗あるいは上部構造のトラブル発生のリスクファクターとして, 咬合におけるオーバーロードが関与していると信じている臨床医は多い. 確かに, 咬合悪習癖 (パラファンクション) はインプラントに悪影響を及ぼすというのは, 妥当な考えと思われるが, インプラントがオーバーロードによって失敗するというエビデンスはほとんど示されていない. そこで, 本総説は, 咬合がインプラント治療において重要なリスクファクターと言えるかどうかについて現時点での解釈を示し, さらには, 咬合, とくにパラファンクションの術前診断と臨床的対応について論じたものである. なお, 本総説は, 2007年に神戸で開かれた国際補綴歯科学会において開催されたシンポジウムでの講演をまとめたものである.
Relationship between Medicine and Stimulated Saliva and Oral Moisture
Takahashi F., Takahashi M., Toya S., Morita O.
Purpose: The aim of this study was to investigate the relationship between medicine and stimulated saliva and oral moisture.Methods: Fourteen patients with subjective oral dryness and 13 healthy adults were enrolled in this study. Disease, medicine, and medicines that had a side effect of oral dryness were investigated. The Saxon test was performed by chewing a piece of gauze sponge for 2 min. Oral moisture was measured at the lingual and buccal mucosa using an oral moisture checking device. Statistical analysis was performed by the Mann-Whitney U-test and Student t-test.Results: Stimulated saliva and oral moisture did not differ according to the number of diseases. Oral moisture at lingual mucosa was different between a minor medicine group (0-2 types of medicine) (31.3 ± 1.9%) and a major medicine group (≥3 types of medicine) (29.5 ± 2.2%) (p = 0.05). Oral moisture differed between a group not taking any medicine that had a side effect of oral dryness (31.2 ± 1.8% at lingual mucosa and 33.8 ± 1.4% at buccal mucosa) and a group taking such medicine (29.3 ± 2.3% at lingual mucosa and 32.4 ± 1.8% at buccal mucosa) (p < 0.05).Conclusion: The results of this study showed that oral moisture tended to decrease in the subjects who took many types of medicine or who took medicine that had a side effect of oral dryness. The medicine did not influence the amount of stimulated saliva. Therefore, it was suggested that medicine could influence the moisture of the oral mucosa.
Investigation of the Factors Influencing the Outcome of Prostheses on Speech Rehabilitation of Mandibulectomy Patients
Hagino A., Inohara K., Sumita Y.I., Taniguchi H.
The aim of this study was to investigate the factors influencing the outcome of prostheses on speech rehabilitation of mandibulectomy patients.Eleven patients (6 males and 5 females) who underwent mandibulectomy without glossectomy because of a tumor participated in the study. A Speech Intelligibility (SI) test was applied without and with a prosthesis to evaluate their speech ability. The type of resection, whether soft tissue grafting was undertaken or not, the continuity of mandibular bone, and the number of remaining teeth related to the stability of the prosthesis were determined from the medical records. The some of acoustic features, Formant 1 and Formant 2 range, were investigated to evaluate objectively the limitation of tongue movement. Five questionnaires were sent out to evaluate subjectively the difference in sense of discomfort while speaking with and without the prosthesis. These eleven items were entered into stepwise multiple regression models to determine the predictors of the differences in SI score without and with a prosthesis.Three variables, the ease of tongue movements, whether soft tissue grafting was undertaken or not, and whether the mandibular bone was continuous or not, contributed to the recovery of speech ability with prosthodontic treatment.The ease of tongue movement, no soft tissue grafting, and the continuity of mandibular bone contribute to the recovery of speech ability with prosthodontic treatment.
Deformation of Mesh Type Stainless Palatal Plate of Maxillary Complete Denture and the Growth of Microorganisms
Ratnasari A., Hasegawa K., Yoshihara K., Nagaoka N., Kokeguchi S., Nishigawa G., Fukui K., Minagi S.
Patient: An 83-year-old woman visited the hospital for new complete dentures. A mesh type stainless palatal plate (Trutissu plate) was selected, because it enables the patient to experience the taste and temperature of food. Twenty one months after insertion, the patient returned complaining of pain on mucosa under the mandibular denture base. On clinical examination, a small swollen area was observed on the palatine rugae region of the mesh plate. By making a small hole in the swollen part, a creamy mass of dark brown color was discharged from the swollen space between the laminated structure of the Trutissu plate. Three months after the first deformation was corrected, further deformation of the Trutissu plate was observed. The patient admitted that she had not used the ultrasonic cleansing apparatus. A candidiasis-like lesion was observed on the palatal mucosa.Discussion: The formation of Candida biofilms on dentures may assist survival of fungal cells and contribute to the disease process in patients with denture stomatitis. In this case, the patient did not use ultrasonic cleaner, thus resulting in microbial accumulation and morphological change of the laminated mesh plate. However, this is rare in the clinical use of the Trutissu mesh plate, and the only case reported in 20 years. Ultrasonic cleansing was effective in removing microorganisms from the denture.Conclusion: Routine ultrasonic cleansing should be performed to avoid the possible accumulation of microorganisms in the laminated mesh structure.
What Prosthodontic Therapy Should We Select for Periodontall Compromised Patients?-Part 1: A Review of the Literature Focusing on Impact Therapy for Periodontally Compromised Patients-
Kanno T., Nakamura K., Hayashi E., Kimura K., Hirooka H., Kimura K.
目的 : 多くの実験的・臨床的研究から, インプラント治療は, 無歯顎および部分的欠損歯列の患者に対して予知性の高い治療法であることが示されてきている. しかし, 歯周病の既往を有する患者に対してもインプラントを適用できるかどうかは, 不明な部分が多い. 今回は, 歯周病の既往を有する部分的欠損歯列の患者に対するインプラント治療の科学的背景を考察した.研究の選択 : 部分的欠損歯列となった歯周病患者に対してインプラント治療を行い, その成功率あるいは生存率を報告している臨床研究を選択し, レビューを行った.結果 : 今回レビューを行った22本の論文では, 短～中期的予後において, 良好なインプラントの生存率や成功率が示されていた.結論 : 長期的な追跡研究は非常に少ないが, 歯周病の既往を有する患者に対してもインプラント治療が応用できることが示唆された. ただし, どの報告においても, インプラントを埋入する前に口腔内における感染に対する治療を行っており, 埋入後は定期的なメインテナンスを行うことの重要性も強調されている.臨床的に重度歯周炎に罹患していたと考えられる患者に対してもインプラント治療が応用できる可能性が示唆されているが, 少なくとも口腔内の感染源を徹底的にコントロールできる見通しがなければ行うべきではない.
Colonization of Candida Species and Efficacies of Miconazole Gel in Overdenture Wearers
Yoshijima Y., Ichikawa T.
Preliminarily to examine the efficacy of miconazole gel at inhibiting colonization of Candida species in overdenture wearers.The subjects were 26 overdenture wearers. Miconazole gel was used with the following directions: group A was prescribed miconazole gel 1.5 g 4 times daily for 1 week, group B was prescribed miconazole gel 0.5 g 4 times daily for 1 week. As a screening test, Candida species were examined in denture plaque, dental plaque, and pharyngeal mucosa. The number of Candida species, total bacteria, and oral streptococci were counted before and after application of miconazole gel to Candida-positive subjects.Candida species were detected in 18 of 26 subjects and high incidence was found around the abutments under the denture base. All Candida species were sensitive to miconazole gel. Miconazole gel was applied to 13 subjects. The number of Candida was reduced after 1-week use of miconazole gel with few side effects during the application.It is suggested that miconazole gel will be an effective and safe method for oral care and denture plaque control in overdenture wearers.
Mandibular Residual Ridge Shape and the Masticatory Ability in Complete Denture Wearers
Koshino H., Hirai T., Yokoyama Y., Tanaka M., Toyoshita Y., Iwasaki K., Sudo E.
The purpose of this study was to investigate the influence of mandibular residual ridge shape on the masticatory ability in complete denture wearers.The subject group consisted of 199 complete denture wearers. The mandibular residual ridge of each subject was evaluated using a replica of the ridge which was obtained with heavy-body silicone impression material. The basal area of each replica was measured with a digitizer. The volume and the height of each replica were also calculated. The masticatory ability of each subject was evaluated using a-25-item food intake questionnaire method by authors. The masticatory score of each subject was calculated to represent the masticatory ability. Furthermore, all subjects were divided into three groups (S, M, L group) according to the value of the basal area.There were statistically significant correlations between the basal area of the residual ridge and the masticatory score (r = 0.366, p < 0.01), and also the volume of the residual ridge and the masticatory score (r = 0.314, p < 0.01). The basal area of the residual ridge, the volume of the residual ridge, and the masticatory score of the L group (29 persons) were statistically larger than those of the M group (136 persons) and the S group (34 persons) (p < 0.05), and those values in the M group were statistically larger than those of the S group (p < 0.05).It was confirmed that the basal area of denture foundation of the mandible had an influence on the masticatory ability in complete denture wearers.
Establishment of Simultaneous Measurement Method of 8 Salivary Components using Urinary Test Paper and Clinical Evaluation of Oral Environment
Yuuki K., Tsukasaki H., Kawawa T., Shiba A., Shiba K.
目的 : 歯周組織の臨床所見と全唾液中に含まれるグルコース, タンパク質, アルブミン, ビリルビン, クレアチニン, pH, 潜血, ケトン体, 亜硝酸塩, 白血球との相関関係について比較検討した.方法 : 医局員ならびに歯科治療に訪れた患者計57名を対象者とした. 唾液採取は1回目として, 蒸留水1.5mlを15秒間口腔内で含嗽させ, 紙コップに吐き出させる. 2回目として, 蒸留水1.5mlを15秒間含嗽させ, 紙コップに吐き出させる. 3回目として, パラフィンガムを60秒間咀嚼させ, 紙コップに吐き出させる. このように3回に分けて全唾液の採取を行った. 測定法は, 尿試験紙に貼り付けられた10項目の試薬片に, サンプルを8μl滴下し, 専用反射率計で計測した. 歯周組織状態の判定は, 歯槽骨の吸収・プロービング値・動揺度・根分岐部病変を診査し, 4ランクに分類した. 得られた歯周病ランク別の平均値, 各成分との相関をそれぞれ統計処理した.結果 : ビリルビン, ケトン体は測定できなかった. 8項目の成分濃度の平均値は, 歯周病ランクが高くなるに伴って平均値も高値を示した. 歯周病ランクと各成分の相関をみたところ, タンパク質, アルブミン, クレアチニン, pH, 白血球で相関が得られた.結論 : 試験紙による唾液8成分の同時測定法は, 支台歯および残存歯の歯周病診断に有用であることが示唆された.
