歯根破折歯に対して抜歯後即時埋入インプラントを行った1症例

Immediate implant placement following extraction is suggested as a method of implant treatment. As this method is associated with almost no gingival recession or absorption of alveolar bone in the extraction socket, and as the period of treatment can be shortened, its usefulness has been widely reported. In this case, implant placement was performed immediately after extraction of an upper left first premolar in which a root fracture had been discovered, with porcelain fused to a metal crown used as the superstructure. Through implant placement immediately following extraction, postoperative gingival recession and bone absorption were kept to a minimum, and esthetic recovery was achieved. Moreover, the period of treatment up to functional recovery was shortened, showing that this can be an effective method of treatment in prosthetic dentistry when applied to suitable cases

Bone graft on the labial symphysis for the skeletal Class III case

通常臨床歯科医学における骨移植は,その病理学的形態より3壁性骨欠損を有する歯周病患者に対して広く行われている。今回,下顎前歯部(下顎結合部)唇側面歯槽骨の開窓や限局性穿孔は存在するが,歯肉退縮を生じていない骨格型III級不正咬合患者へ顎矯正手術と同時に自家骨移植を付加的に行った。初診時のセファログラム所見より高く幅の狭い下顎結合部とこの薄い骨に直立している下顎前歯が確認された。また,術前矯正歯科治療中,下顎前歯はその捻転の解消と頬舌的な移動が行われた。手術時には下顎前歯部の開窓や限局性穿孔が確認された。下顎前歯部(下顎結合部)唇側面に自己海面骨を移植することによって歯槽骨の開窓や限局性穿孔は覆われた。結果的にセファログラム上での経過所見より,その後4年10か月間移植骨の残留が認められ,さらに臨床的に咬合が安定し通常後戻りしやすいとされる下顎前歯捻転の後戻りも認められず良好な結果を得たので報告した。Bone graft in clinical dentistry prevails in periodontal patients who have three wall infrabony defect around the tooth because of its pathological morphology. In this case report, bone graft on the labial bone surface of the lower incisors (mandibular symphysis) was applied as an auxiliary procedure at the same time of orthognathic surgery to a patient who had fenestrations and circumscribed holes without gingival recession and skeletal Class III malocclusion. The initial lateral cephalometric radiograph revealed a narrow and high symphysis, with an incisor position straight above the thin bone. During the pre-surgical orthodontic treatment, the incisors had been derotated and moved in the minimal labiolingual direction. Some fenestrations and circumscribed holes were found during orthognathic surgery. Through the bone allograft, the labial bone surface of the lower incisors (mandibular symphysis) with fenestrations and circumscribed holes were covered with the patient\u27s cancellous bone. Consequently, a series of the lateral cephalometric radiographs revealed that the grafted bone was kept for four years and ten months after surgery with stable occlusion and no rotational relapse on the lower incisors where it is usually easy to relapse clinically

下顎枝矢状分割術における生体内吸収性ポリ-L-乳酸骨接合ミニプレート固定の術後安定性について

左右非対称のない下顎前突症患者に対する下顎枝矢状分割術において,ポリ-L-乳酸製(PLLA)ミニプレート固定法による術後の顎態の安定性について検討を行った.両側下顎枝矢状分割術(SSRO)を施行し,下顎骨の後退量に左右差のない患者40名(男性17名,女性23名)を対象とした.これらの骨固定に際し,PLLAミニプレートを使用した患者22名(男性9名,女性13名)をPLLAプレート群とし,チタンミニプレートを使用した患者18名(男性8名,女性10名)をチタンプレート群とした.手術直前,手術後1か月,手術後1年に撮影した側面頭部X線規格写真の分析を行い,顎態の安定性について検討した.その結果,手術後1年ではPLLAプレート群およびチタンプレート群両群の男女ともに著しい後戻り様変化は認めなかった.このことから,SSROを用いた左右差のない下顎後退術に対するPLLAミニプレート固定は,術後顎態の安定性の観点からはチタンミニプレート固定と比較して何ら問題点はなく,プレートの除去手術が回避できる点で有益であると考えられる.アレルギーの有無や,顎骨の移動量等を総合的に判断し,PLLAミニプレートかチタンミニプレートを選択することができると考えられる.We studied the postsurgical stability of the mandible using biodegradable Poly-L-lactide bone mini plate fixation undergone sagittal split ramus osteotomy. The forty patients with mandibular prognathism without facial asymmetry (17 males and 23 females) operated from March 2003 to March 2009, were divided into two groups based on the types of osteosynthesis used. 22 patients (9 males and 13 females) using the PLLA mini-plate (PLLA plate group), and 18 patients (8 males and 10 females) using the titanium mini-plate (titanium plate group) were examined. Lateral cephalograms were taken immediately before the surgery, one month, and one year after surgery. Changes in position of the mandible were examined. As a result of this study, remarkable relapses were not recognized at one year after operation for males and females in both groups. It is thought the PLLA mini-plate fixation to the mandible without facial asymmetry setback doesn\u27t present as many problems from the viewpoint of postsurgical stability compared with the titanium mini-plate fixation, and it is profitable that we avoided the plate removal operation. We can select the PLLA or the titanium mini-plate from a comprehensive standpoint

口腔インプラント室における臨床統計観察

In November 1994, the Oral Implant Room was established as a clinic at the Dental Hospital of Iwate Medical University School of Dentistry. Since then, with the cooperation of the implant committee members recommended from each hospital department, we have performed treatment for the recovery of stomatognathic function. Therefore, with the goal of understanding the results of the Oral Implant Center, the clinical statistics of the treatment provided in the 14 years and 5 months between its opening and March 2009 were assembled, and the following results were obtained. 1. There were 148 cases of implantation involving 129 patients (54 men, 75 women). 2. Mean age at time of implantation was 50.6 years. Individuals in their 50s outnumbered those of other decades, and women outnumbered men. 3. A total of 513 implants were implanted (192 maxilla, 321 mandible), with an average of 3.5 implants per person. 4. The average time between primary surgery and secondary surgery was 5 months 24 days for the maxilla and 3 months 17 days for the mandible. 5. Regarding the distribution of implants, 52.6% were mandibular free-end and 29.3% were in the anterior maxilla. 6. Of the implant patients, 10.7% were smokers and 24.8% were drinkers. 7. The survival rate for the implants was 97.9%

Experimental Mouse Model of Lumbar Ligamentum Flavum Hypertrophy.

Lumbar spinal canal stenosis (LSCS) is one of the most common spinal disorders in elderly people, with the number of LSCS patients increasing due to the aging of the population. The ligamentum flavum (LF) is a spinal ligament located in the interior of the vertebral canal, and hypertrophy of the LF, which causes the direct compression of the nerve roots and/or cauda equine, is a major cause of LSCS. Although there have been previous studies on LF hypertrophy, its pathomechanism remains unclear. The purpose of this study is to establish a relevant mouse model of LF hypertrophy and to examine disease-related factors. First, we focused on mechanical stress and developed a loading device for applying consecutive mechanical flexion-extension stress to the mouse LF. After 12 weeks of mechanical stress loading, we found that the LF thickness in the stress group was significantly increased in comparison to the control group. In addition, there were significant increases in the area of collagen fibers, the number of LF cells, and the gene expression of several fibrosis-related factors. However, in this mecnanical stress model, there was no macrophage infiltration, angiogenesis, or increase in the expression of transforming growth factor-β1 (TGF-β1), which are characteristic features of LF hypertrophy in LSCS patients. We therefore examined the influence of infiltrating macrophages on LF hypertrophy. After inducing macrophage infiltration by micro-injury to the mouse LF, we found excessive collagen synthesis in the injured site with the increased TGF-β1 expression at 2 weeks after injury, and further confirmed LF hypertrophy at 6 weeks after injury. Our findings demonstrate that mechanical stress is a causative factor for LF hypertrophy and strongly suggest the importance of macrophage infiltration in the progression of LF hypertrophy via the stimulation of collagen production

Long-Term Survival of Patients Receiving Artificial Nutrition in Japanese Psychiatric Hospitals

Background/Aims: Most patients with dementia suffer from dysphagia in the terminal stage of the disease. In Japan, most elderly patients with dysphagia receive either tube feeding or total parenteral nutrition. Methods: In this study, we investigated the factors determining longer survival with artificial nutrition. Various clinical characteristics of 168 inpatients receiving artificial nutrition without oral intake in psychiatric hospitals in Okayama Prefecture, Japan, were evaluated. Results: Multiple logistic regression analysis showed that the duration of artificial nutrition was associated with a percutaneous endoscopic gastrostomy (PEG) tube, diagnosis of mental disorder, low MMSE score, and absence of decubitus. Conclusion: Patients with mental disorders survived longer than those with dementia diseases on artificial nutrition. A PEG tube and good nutrition seem to be important for long-term survival