Relationship between antimicrobial protein levels in whole saliva and periodontitis.

BACKGROUND: Antimicrobial proteins are abundant in saliva. The purpose of this study was to determine and compare the amounts of two types of antibacterial protein, cystatin and lysozyme, in saliva between healthy persons and subjects with periodontitis. METHODS: Forty subjects with periodontitis visiting Tokyo Dental College Chiba Hospital, Chiba, Japan, and 27 healthy persons were evaluated. Whole saliva was collected by requiring all subjects to expectorate into a sterile tube. Salivary levels of cystatin SA, cystatin C, and lysozyme were determined by enzyme-linked immunosorbent assay or immunoblot assay. RESULTS: Cystatin SA levels in saliva from the periodontally diseased group showed a mean value of 0.063 +/- 0.026 mg/ml, statistically lower than that in the healthy group (P <0.05). The average cystatin C level in the periodontally diseased group was 2.27 +/- 1.20 ng/ml, markedly lower than that in the healthy group (3.79 +/- 1.28 ng/ml; P <0.05). Average lysozyme levels in the periodontitis and healthy groups were 16.75 +/- 15.31 microg/ml and 30.03 +/- 15.03 microg/ml, respectively. The lysozyme level in the periodontitis group was significantly lower than in the healthy group (P <0.05). CONCLUSION: Specific monoclonal antibodies are useful for the detection of family 2 cystatins in saliva samples, and the amount of antibacterial protein in saliva offers a potential indicator of the risk for periodontitis.

Pre-operative drilling simulation method for dental implant treatment.

The position, depth and direction of implant placement are often planned based on evaluation of radiographs and study casts. Insertion planned in such a manner may not be adequate for precise and safe surgery in some cases due to inadequate working clearance in the oral cavity. In order to obtain high initial stability and ensure osseointegration at the implant-bone interface, careful and precise drilling must be performed at the implant placement site. Therefore, we propose the necessity of evaluating the operability of implant treatment-devices prior to surgery. The amount of handling space needed during implant placement surgery was determined. The results showed that for implants with a length of 7-18 mm, a vertical distance of as much as 50-60 mm was required, depending on the implant platform. These results suggest the necessity of pre-operative drilling simulation in each individual. Handling space was measured with angled heads and probes fabricated on a trial basis for pre-surgical drilling simulation in the oral cavity. We believe that these instruments may be clinically useful in estimating the amount of handling space required prior to surgery and ensuring precise implant placement. Evaluation of the intra-oral environment for handling of treatment devices should be included in the pre-surgical intra-oral evaluation of dental implant cases to avoid changes in treatment planning due to intra-oral interference during the course of surgery.

Multidisciplinary treatment of mandibular prognathism with multiple congenitally missing teeth.

Surgical orthodontic treatment and dental implant therapy were performed on a man (aged 18 years 8 months) with mandibular prognathism and seven congenitally missing teeth: upper canines, first and second premolars and lower right second premolar. After 17 months of preoperative orthodontic treatment at age 20 years 1 month, sagittal split ramus osteotomy was performed using the remaining upper deciduous teeth as an anchor for intermaxillary fixation. In postoperative orthodontic treatment, the remaining deciduous teeth were extracted, and fixture installation was performed. The entire therapy required 4 years to complete (age 22 years 8 months). After completion of orthodontic treatment, superstructures were put in place. This patient had many dental problems, so multidisciplinary care was performed in conjunction with other departments to improve oral function and facial esthetics.

The influence of prosthesis designs and loading conditions on the stress distribution of tooth-implant supported prostheses.

The aim of this study was to observe the influence of prosthesis design and loading condition on the stress distributions of tooth-implant supported prostheses. Six 2D finite element models, two reference models, and four experimental models were computed to simulate different prosthesis designs. Six different loading conditions were applied to investigate the stress distributions of tooth and implant, respectively. The stresses of reference models were considered as 100%; the stresses of experimental models at the same locations were compared with those of reference models. The stresses around implants were higher than those around teeth. When vertical loading was applied only on the implant, the stresses to both the implant and teeth were at their lowest. The highest stress to the tooth was in the model TTPF and the lowest in the model TPFF. The highest stress to the implant was in the model TPPF and the lowest in the model TPFF. These data indicated that the loading on the tooth-implant supported prosthesis was mainly supported by the implant. Minimizing the loading on the tooth decreased the stress to both the tooth and the implant. Adding fixtures as abutment was more effective in decreasing the stress than adding tooth as abutment in tooth-implant supported prosthesis.

Clinical evaluation of osseointegrated implants in Tokyo Dental College Hospital (third report): long-term observation of functioning survival rate of fixtures.

The objective of this report was to review 365 cases of Brånemark Implant Bridge including 1,444 fixtures in patients of Tokyo Dental College Chiba Hospital. The term of implantation was divided into several phases; less than 1 year, from 1 year to 3 years, from 3 years to 5 years, from 5 years to 7 years, from 7 years to 10 years, more than 10 years, and the survival rate was calculated for each phase. The removal rate of fixture after connecting the superstructure was 13% in maxillary cases and 2% in mandibular cases. The functioning survival rate in maxillary cases slightly decreased from 91% in less than 1 year to 87% after more than 10 years; however, the functioning survival rate in mandibular cases was about 99% in all periods. The removal rate of fixtures per patient was 23% in maxillary cases and 6% in mandibular ones. The average removal number of fixtures was 1.8 in maxillary cases and 1.2 in mandibular ones. The removal of the fixture occurred most frequently at less than 1 year in maxillary cases, but there was no tendency for a pattern of removal of fixture in mandibular cases.