The 104th Annual Meeting of the American Academy of Periodontology
in collaboration with the Canadian Academy of Periodontology,
the Japanese Academy of Clinical Periodontology,
and the Japanese Society of Periodontology.

Abstracts of JACP/JSP Poster Session

October 27-30, 2018
Vancouver Convention Centre, Vancouver, BC, Canada
The Japanese Academy of Clinical Periodontology
The Japanese Society of Periodontology

第104回アメリカ歯周病学会共催
カナダ歯周病学会・日本臨床歯周病学会・
日本歯周病学会 2018年大会
The 104th Annual Meeting of the American Academy of Periodontology
in collaboration with the Canadian Academy of Periodontology,
the Japanese Academy of Clinical Periodontology,
and the Japanese Society of Periodontology.

JACP/JSP ポスターセッション抄録集

一般演題（基礎研究，臨床研究），症例報告，歯科衛生士演題

Abstracts of JACP/JSP Poster Session
General (Basic Research, Clinical Research), Case Report, Dental Hygiene

会期：2018年10月27日～10月30日
会場：バンクーバー・コンベンションセンター

October 27-30, 2018
Vancouver Convention Centre, Vancouver, BC, Canada

第104回アメリカ歯周病学会共催
カナダ歯周病学会・日本臨床歯周病学会・
日本歯周病学会 2018年大会 JACP/JSP ポスター発表・若手研究者支援協賛企業
アサヒプリテック株式会社
医歯薬出版株式会社
長田電機工業株式会社
株式会社ガイドデント
科研製薬株式会社
クインテッセンス出版株式会社
サンデンタル株式会社
ストローマン・ジャパン株式会社
タカラベルモント株式会社
デンツプライシロナ株式会社
株式会社ナルコーム
株式会社白鵬ヒューフレディ・ジャパン合同会社
ライオン歯科材株式会社

（50音順）

General（Basic Research）

1

GB-01

Application of S-PRG nanoﬁllers for novel periodontal therapeutic approach
Hirofumi Miyaji＊1,2, Kayoko Mayumi2, Erika Nishida1, Saori Miyata2, Kanako Shitomi2,
Tomokazu Furihata2, Yukimi Kanemoto2, Tsukasa Akasaka3, Tsutomu Sugaya2
1

Clinic of Endodontics and Periodontics, Hokkaido University Hospital.
2
Department of Periodontology and Endodontology,
3
Department of Biomaterials and Bioengineering, Faculty of Dental Medicine, Hokkaido University
Background and objective: Surface pre-reacted glass-ionomer（S-PRG）ﬁllers release six types of ions, such as F, Bo andSr, to exert tooth remineralization and antibacterial effects. In present study, we designed the tooth surface coating techniquewith S-PRG nanoﬁllers and conducted the antibacterial examinations.
Materials and Methods: S-PRG fillers（Shofu Inc., Kyoto, Japan）mixed with distilled water was fractionated by
sedimentation, and the collected supernatant was used as dispersion of S-PRG nanoﬁllers with an average particle size of
500 nm. Ion-releasing ability, cytocompatibility and antibacterial activity of S-PRG nanofillers were evaluated. The
adhesion of the nanoﬁllers on tooth surface was also examined using human tooth block（approval number: 17-222）after
immersion into the nanofiller dispersion and subsequent ultrasonic cleaning（10 sec）. As a preclinical study, nanofiller
dispersion was injected into periodontal pockets of 12 premolars with experimental periodontitis created in beagle dogs, andthe percentage of sites with bleeding on probing（BOP％）was measured postoperatively.
Results: S-PRG nanoﬁllers released 6 types of ions and possessed great antibacterial activity as well as low cytotoxicity. In
adhesion test, nanoﬁllers stably and uniformly adhered to dentin and cementum surface. Preclinical study revealed that the
BOP％ remarkably decreased after S-PRG nanoﬁller application. At 4 weeks postoperation, BOP％ of S-PRG and control（no application）groups was 12.1％ and 52.8％, respectively.
Conclusion: The coating technique with S-PRG nanoﬁllers would acquire the antibacterial tooth surface. This study may
provide a novel treatment strategy for periodontal disease.

GB-02

Effects of parathyroid hormone and neutral self-assembling peptide on periodontal healing
Wataru Yoshida＊1, Takahiro Takeuchi1, Takahiro Bizenjima1, Daisuke Matsugami1,
Toshikatsu Nakazaki2, Fumi Seshima1, Atsushi Saito1,3
1

Department of Periodontology, Tokyo Dental College, 2Nakazaki Dental Clinic,
3
Oral Health Science Center, Tokyo Dental College

Background and objective: Administration of intermittent parathyroid hormone（PTH）has been shown to enhance
periodontal healing. Self-assembling peptides（SAP）hydrogels have similar biological properties to extracellular matrix（ECM）and can be used as a 3-dimentional scaffold. The purpose of this study is to investigate the effects of systemicintermittent administration of PTH and local application of a neutral SAP hydrogel（SPG-178）on the healing of surgicallycreated periodontal defects in rats.
Materials and Methods: Micro-structure of SPG-178 was observed with a scanning electron microscope（SEM）. Ten
weeks-old male Wistar rats were randomly assigned to two subgroups: PTH administration and saline group. In eachanimal, two standardized periodontal defects were surgically created mesially of the maxillary ﬁrst molars. The defects weretreated with SPG-178 or left unﬁlled. Micro-CT, histological and immunohistochemical analyses were performed.
Results: SEM observation showed nanoﬁber and network structures, similar to native ECM. In the unﬁlled group, the PTH
administration yielded signiﬁcantly greater bone volume fraction（BV/TV）than saline control at 4 weeks（p＜0.05）. PTH+ SPG-178 group showed significantly greater BV/TV than saline + unfilled group at 2 and 4 weeks（p＜0.05）. At 4
weeks, histological assessment showed that newly formed bone in the defect area in the PTH + SPG-178 group appeared to
be greater than other groups. Proportion of PCNA-positive cells above newly formed bone in the PTH + SPG-178 groupwas signiﬁcantly greater than that in the saline + unﬁlled at 2 weeks（p＜0.01）.
Conclusion: These ﬁndings suggest that the PTH administration and the SPG-178 application enhance periodontal healing.

JSP/JACP Poster Session AAP2018

2

GB-03

Calcium metabolism in periodontium with experimental periodontitis of rats
Ryutaro Kuraji＊1,2, Ya-Hsin Wu2, Shuichi Hashimoto3, Saki Mishiro2,
Hiroshi Ito2, and Yukihiro Numabe2
1

2

The Department of Life Science Dentistry, The Nippon Dental University,
The Department of Periodontology, School of Life Dentistry at Tokyo, The Nippon Dental University,
3
The Nippon Dental University

Background and objective: A ligature placement for tooth is a method to produce the experimental periodontitis in rodents.
However, previous studies mostly have not reported calcium metabolism in the periodontal tissue inﬂamed. In the present
study, the 45Ca dynamics in the tissue was analyzed after ligature placement.
Materials and Methods: The maxillary right ﬁrst molar tooth（M1）in eight-week-old male Wistar rats was ligated withsilk suture for 1, 3, 7, and 28 days; a ligation side. While the left M1 without ligature placement was utilized as a control
side. 45CaCl2 was applied intraperitoneally 24 hr before the terminal point. The rat left-and-right palatal mucosa, molar
teeth, and maxillas were anatomically separated and collected. The 45Ca concentration in each section was determined with aliquid scintillation counter. Moreover, amounts and bone mineral density（BMD）of the alveolar bone were analyzed byμCT.
Results: At 1 day after ligature placement, 45Ca-levels incorporated into each section in the ligation side significantly
decreased by 10％ as compared with that in the control side, but those at 3 and 7 day conversely increased. The amount and
BMD of alveolar bone in the ligation side were lower than the control side from 3 to 7 days, but increased to near the control
value after 28 days.
Conclusion: There was correlation between the 45Ca-levels incorporated and BMD in the alveolar bone. These results
suggested that 45Ca uptake into the periodontium per 24 hr was consistent with the bone remodeling in the experimental
periodontitis.

GB-04

Cyclic stretch inhibits IL-1β secretion by attenuating NLRP3 inﬂammasome activation
Eiji Nemoto＊1, Kentaro Maruyama1, Yukihiko Sakisaka1, Mizuki Suto1, Hiroyuki Tada2,
Takashi Nakamura3, Satoru Yamada1
1

Department of Periodontology and Endodontology, 2Department of Oral Immunology,
Department of Dental Pharmacology, Tohoku University Graduate School of Dentistry3

Background and objective: Macrophages are immune cells that play diverse roles in host defenses and tissue homeostasis. In
mechanical microenvironments such as periodontal ligament, macrophages receive mechanical signals that regulate various
cellular functions. However, the mechanisms by which mechanical signals influence the phenotype and function ofmacrophages in the process of inﬂammation have not yet been elucidated in detail. We examined the effects of cyclic stretch
on NLR family, pyrin domain-containing 3（NLRP3）inﬂammasome activation in J774.1, a murine macrophage cell line,
and mouse primary bone marrow-derived macrophages.
Materials and Methods: Gene and protein levels were assessed by real-time polymerase chain reaction analysis andenzyme-linked immunosorbent assay（ELISA）or Western blot analysis, respectively.
Results: Cyclic stretch inhibited adenosine monophosphate（ATP）-stimulated interleukin（IL）-1β secretion inlipopolysaccharide（LPS）-primed macrophages using ELISA and Western blot analyses. Cyclic stretch-mediated inhibitionof IL-1β secretion was caused by the suppression of caspase-1 activity. The addition of compound C, a speciﬁc inhibitor of
adenosine monophosphate-activated protein kinase（AMPK）, to LPS-primed macrophages inhibited IL-1β secretion as
well as caspase-1 activation, suggesting that AMPK signaling is involved in ATP-triggered IL-1β secretion. Furthermore,
the phosphorylation of AMPK induced by ATP in LPS-primed macrophages was signiﬁcantly suppressed by cyclic stretch,indicating that cyclic stretch negatively regulates IL-1β secretion through the inhibition of caspase-1 activity by attenuating
the AMPK pathway.
Conclusion: Our results suggest that mechanical stress functions to maintain homeostasis through the prevention ofexcessive inﬂammasome activation in macrophages in mechanical microenvironments such as periodontal ligament.

JSP/JACP Poster Session AAP2018

3

GB-05

LIPUS inhibits IL-1β secretion through NF-κB signaling pathway in macrophages
Mizuki Suto＊, Eiji Nemoto, Kentaro Maruyama, Yukihiko Sakisaka, Satoru Yamada
Department of Periodontology and Endodontology, Tohoku University Graduate School of Dentistry

Background and objective: Low-intensity pulsed ultrasound（LIPUS）, which acts on cells as a mechanical stress, has beenreported that LIPUS treatment has a potential to activate osteogenesis. However, little is known regarding an effects of
LIPUS treatment on inﬂammation. In this study, we examined the effect of LIPUS on J774.1, a murine macrophage cell line,
stimulated with E. coli lipopolysaccharide（LPS）.
Materials and Methods: J774.1macrophages were maintained in RPMI-1640 containing 10％ fetal bovine serum, 100 μg/ml
penicillin-streptomycin. Cells were stimulated using LIPUS-generating device（ITO Co., Tokyo, Japan）. LIPUS signal
consisted of a series of 1.5MHz and was delivered at an intensity of 30 or 60mW/cm2. The cells were treated with LIPUS for
60 min and further cultured up to 6 h and then analyzed by real-time PCR, Western blot, and ELISA.
Results: Real time PCR revealed that treatment of cells for 6 h with LPS upregulated the gene expression levels of proIL-1β. This expression was inhibited by the ﬁrst-60 min treatment of LIPUS under the condition of 60 mW/cm2 and 1.5
MHz. LIPUS treatment significantly inhibited the expression of IL-1β triggered by LPS plus ATP at protein levels asassessed by ELISA and Western blot analysis. Furthermore, LIPUS treatment significantly inhibited the LPS-induced
protein expression of phosphorylated-p65 NF-κB by Western blot.
Conclusion: Those ﬁnding suggest that LIPUS exerts anti-inﬂammatory effects on LPS-stimulated J774.1 by inhibiting
NF-κB signaling. LIPUS may be powerful therapeutic tool for the NF-κB-associated diseases such as periodontal diseases.

GB-06

Application of microperforated titanium mesh for tissue engineered regeneration

Yukihiko Sakisaka＊1, Kentaro Maruyama1, Jingyu Zhang1, Hiroshi Ishihata1, Eiji Nemoto1,
Keiichi Sasaki1, Takeshi Hatsuzawa2, Satoru Yamada1
1

Department of Periodontology and Endodontology, Tohoku University Graduate School of Dentistry,
Laboratory for Future Interdisciplinary Research of Science and Technology, Institute of Innovative Research,
Tokyo Institute of Technology

2

Background and objective: Currently, pore sizes of titanium mesh for the graft retainer applied to osteogenic regenerative
surgery have a range from 50µm up to 5mm. Therefore, it cannot avoid that soft tissues intrude to the ready occupied space
for the bone regeneration. We fabricated a new style retainer as the titanium membrane with piercing pores of 25×25
micron square. This study was aimed to apply the titanium membrane as a tissue barrier and cell-interactive 3D scaffold for
periodontal regeneration therapy. We investigated the performance of migration of cells cultivated on the fabricated material.
Materials and Methods: Mouse pre-osterblastic MC3T3-E1 cells were cultured on the pure titanium membrane with 20μm
thickness and 25μm ×25μm square through-holes at 75μm intervals. We evaluated the growth and characters of cells on thetitanium membrane by immunocytochemistry and observation under SEM.
Results: Histological observations of the cells cultured for 96 hours detected orientation to produce pseudopodiums of thecell bodies to be attached to the edge around the square holes. Certain of cells migrated and gathered their bodies into theholes and retained in the through path. The tissue layer covered with the cells on the titanium surface in a sheet-like
conﬁguration was further organized and thickened for 1 month cultivation without any separation from the titanium mesh.
Conclusion: The morphological effect of micro array of square holes on the titanium membrane assisted growth andmigration of cells. The membrane might be applicable to the periodontal surgery as using a barrier membrane for tissue
regeneration.

JSP/JACP Poster Session AAP2018

4

GB-07

Combination therapy using iPS cells and EMD for periodontal regeneration
Yukino Hisanaga＊1,3, Eiichi Suzuki1, Hideto Aoki1, Masahiro Sato1, Akiko Saito2,3,
Toshifumi Azuma2,3, Atushi Saito1,3

1

Department of Periodontology, Tokyo Dental College, 2Department of Biochemistry, Tokyo Dental College,
3
Oral Health Science Center, Tokyo Dental College

Background and objective: Induced pluripotent stem cells（iPSCs）are a candidate cell source in periodontal regenerative
therapy. We previously reported the combined use of enamel matrix derivative（EMD）with atelocollagen sponge（ACS）
scaffold enhances the early stage of osteoblastic differentiation of mouse induced pluripotent stem cells（miPSCs）in vitro.
In the present study, we evaluated the effect of the combination healing of bone defects in vivo.
Materials and Methods: miPSCs were established from ﬁbroblasts harvested from subcutaneous tissues of 4 weeks old male
ICR mice. Following embryonic body formation, dissociated miPSCs were seeded onto ACS with or without EMD. There
were cultured in osteoblast differentiation medium（OBM）for 14 days. Critical-sized（5 mm）calvarial defects werecreated in the parietal bone of 12 weeks old male mice. Mice were assigned to 4 different groups: unﬁlled, ACS, ACS +miPSCs and ACS + EMD + miPSCs. The healing was evaluated by micro computed tomography, histological analysis（HEand von Kossa staining）.
Results: At 7 days, compared to the unﬁlled group, healing of bone defect was observed in ACS, ACS + miPSCs and ACS +miPSCs + EMD groups. ACS + miPSCs and ACS + miPSCs + EMD groups showed a greater level of von Kossa staining at
14 days compared to the ACS group.
Conclusion: Combined use of miPSCs with ACS and EMD may promote healing of bone defects in vivo.

GB-08

Effect of UV irradiation of titanium and zirconia on cultured cells
Takuya Hama＊1, Hirotsugu Morinaga1, Takumi Sato1, Yuta Shimizu1, Tadashi Yasuda1,
Yasuaki Hotta2, Yukimichi Tamaki3, Toshiaki Shibutani1
1Asahi University School of Dentistry Department of Periodontology,
Asahi University School of Dentistry Central Research Institute of Oral Science,
3
Asahi University School of Dentistry Department of Dental Materials

2

Background and objective: Zirconia is garnering attention as an implant material that could replace titanium for implants.
During implant procedures, it is important to protect the region where epithelial tissues come in contact with the implantmaterial. The aim of this study was to investigate the efﬁcacy of the use of excimer UV irradiated zirconia and titanium
disks for early attachment to epithelial progeny cells.
Materials and Methods: Titanium and zirconia（ZPEX）, were used for this study. Each disk was polished before theexperiment so that both disks had the same surface roughness. The disks were irradiated with excimer UV for 20 minutes
and surface roughness and surface wettability were analyzed. Human gingival epithelial progenitor cells（CELLnTECCO.）were seeded onto each disk. Each disk was then cultured in an incubator using media for 1, 3, 12, and 24 hours. Cells
remaining attached to each disk were analyzed using a scanning electron microscope.
Results: Contact angle measurements indicated that the group in which disks were irradiated with excimer UV showed asigniﬁcantly smaller contact angle and became hydrophilic. Cell counts for attached cells on excimer UV irradiated disks
increased signiﬁcantly compared to the number on disks that had undergone polishing alone between 1 to 24 hours after the
initiation of incubation.
Conclusion: Results showed that excimer UV irradiation of the surface of titanium disks and zirconia disks promotes theearly attachment of human gingival epithelial progenitor cells to the disks, thus suggesting that irradiation is effective for the
early attachment of epithelial cells to the disks.

JSP/JACP Poster Session AAP2018

5

GB-09

Effect of parathyroid hormone on osteoblastic differentiation of iPS cells

Masahiro Sato＊1, Eiichi Suzuki1, Hideto Aoki1, Yukino Hisanaga1, Ayano Nakamura1, Atsushi
Saito1,3, Toshifumi Azuma2,3
1

Department of Periodontology, Tokyo Dental College, 2Department of Biochemistry, Tokyo Dental College,
3
Oral Health Science Center, Tokyo Dental College

Background and objective: Parathyroid hormone（PTH）plays an important role in bone remodeling, and different actions
have been reported depending on its administration method. Induced pluripotent stem cells（iPSCs）are promising as a cellsource for regeneration of periodontal tissue due to their ability of proliferation and pluripotency. However the effects of
PTH on iPSCs remain mostly unknown. The purpose of this study is to investigate the effects of PTH on osteoblastic
differentiation of iPSCs in vitro.
Materials and Methods: Mouse iPSCs（miPSCs）were seeded on unadhesive plate to generate embryonic body（EB）.
EBs were treated with 0.05％ trypsin EDTA and seeded into atelocollagen sponge（ACS）in osteoblast differentiation
medium（OBM）. Cells were divided into three groups: control, continuous PTH exposure（PTH-C）, and intermittent PTH
exposure（PTH-I）groups. Alkaline phosphatase（ALP）staining and real-time PCR were performed on day 0, 7, 14 forevaluation of osteoblastic differentiation.
Results: Degree of ALP staining in PTH-I group appeared to be higher than the control group and PTH-C group. In realtime PCR, expression of Col1a1 in the PTH-I group on the day 14 was signiﬁcantly higher（p＜0.001）than the othergroups. There was a time-dependent increase in the expression of Osx in all groups. On day 14, the level was higher in the
PTH-I group than other groups.
Conclusion: These results suggested that intermittent administration of PTH promotes early osteoblastic differentiation of
miPSCs.

GB-10

HLA genome editing in human dental pulp cells using ZFNShuhei Otari＊1, Hitomi Aoki2, Yuta Shimizu1, Tomoko Kawaguchi3, Toshiyuki Shibata3,
Takahiro Kunisada2,Toshiaki Shibutani1, Ken-ichi Tezuka2

1

Asahi University School of Dentistry Department of Periodontology, 2Gifu University Graduate School of
Medicine Department of Tissue and Organ Development Regeneration and Advanced Medical Science,3
Gifu University Graduate School of Medicine Department of Oral and Maxillofacial Science

Background and objective: Human leukocyte antigen（HLA）plays a role in distinguishing between self and non-self.
Currently, construction of a cell bank for transplants is underway by collecting dental pulp cells from individuals with
HLA-A, B, and DRB1 which are haplotype homozygous and creating iPS cells from the cells. However, large costs andtime are required to create the cell bank. Therefore, construction of cells carrying quasi-HLA haplotype homozygosity andinduction of iPS cells were attempted by genome editing using zinc ﬁnger nucleases（ZFNs）.
Materials and Methods: A ZFN plasmid which speciﬁcally cleaves the HLA-A＊02 locus was introduced into dental pulp
. The cells were ﬂuorescent labelled with anti-HLA-A＊02-FITC antibody
cells（HLA-A＊02, 33; B＊44, -; DRB1＊13,-）＊and the HLA-A 02 minus fraction was isolated using FACS followed by expansion of culture containing the cell fraction.
Genes were ampliﬁed by PCR and analyzed by sequencing. Next, Yamanaka 4 factors were introduced into the cells using
the Sendai viral vector（Cytotune-iPS2.0）to induce iPS cells.
Results: Fraction with decreased expression of HLA-A＊02 molecules was obtained by FACS in the ZFN-treated group.
Results obtained by gene sequence analysis of cells in the fraction revealed presence of deletions and insertions speciﬁc to
the HLA-A＊02 allele, as well as presence of homologous recombination with the HLA-C and H regions. Currently, analysis
of gene sequences of the HLA region in iPS cells induced using the SeV vector is underway.
Conclusion: ZFN specifically cleaved the HLA-A＊02 region and induced deletions, insertions, and homology-directed
repair mutations.

JSP/JACP Poster Session AAP2018

6

GB-11

The effects of theaﬂavins on experimental periodontitis in rats
Ya-Hsin Wu＊1, Ryutaro Kuraji1,2 , Yuji Taya3 , Hiroshi Ito1, Yukihiro Numabe1
1

Department of Periodontology, The Nippon Dental University School of Life Dentistry at Tokyo
2
Department of Life Science Dentisitry, The Nippon Dental University
3
Department of Pathology, The Nippon Dental University School of Life Dentistry at Tokyo

Background and objective: Theaflavins（TF）, the major polyphenol in black tea, has shown the ability to reduce
inﬂammation and bone resorption. The aim of this study was to evaluate the effects of TF on experimental periodontitis in
rats.
Materials and Methods: Thirty Wistar rats were divided into 5 groups: Control（glycerol; without ligation）, Ligature（glycerol; with ligation）, TF1（1 mg/ml TF; with ligation）, TF10（10 mg/ml TF; with ligation）, and TF100（100 mg/ml
TF; with ligation）. To induce experimental periodontitis, ligatures were placed around maxillary ﬁrst molars bilaterally.
After that, rats were topically applied daily with 100 μl of glycerol or TF for 7 days. Bone resorption was assessed by
micro-computed tomography（Micro-CT）. Expression of mRNA for proinflammatory and osteoclastogenesis-related
cytokines were evaluated using real-time RT-PCR in gingival tissue. H&E and TRAP staining were conducted forinﬂammation and osteoclast analysis.
Results: TF10 and TF100 groups but not TF1 caused signiﬁcant inhibition of alveolar bone loss, reduction of inﬂammatory
cells infiltration in the periodontium, as well as significantly reduced the numbers of TRAP-positive osteoclasts whencompared to Ligature group. Furthermore, bone mineral density was increased in TF100 group than in Ligature group.
Correspondingly, TF10 and TF100 groups signiﬁcantly downregulated the gene expression of interleukin（IL）-6, IL-8,
matrix metalloproteinase-9（Mmp-9）and receptor activator of NF-κB ligand（Rankl）, but not that of osteoprotegerin（Opg）.
Conclusion: The present study suggests that topical application of TF reduce inflammation and bone resorption on
experimental periodontitis. Therefore, TF may have therapeutic potential in periodontal disease.
GB-12

Treatment of OPG-deﬁcient mice with WP9QY recovers alveolar bone loss
Yuki Ozaki＊1, Masanori Koide2, Nobuyuki Udagawa2, Nobuo Yoshinari1
1

Department of Periodontology, 2Institute for Oral Science, Matsumoto Dental University

Background and objective: Osteoblasts express two key molecules for osteoclast differentiation, receptor activator of NF-κB
ligand（RANKL）and osteoprotegerin（OPG）. RANKL induces osteoclastogenesis, while OPG inhibits it by blocking thebinding of RANKL to RANK. OPG-deficient（OPG-/-）mice exhibit severe alveolar bone loss with enhanced bone
resorption. WP9QY（W9）peptide binds to RANKL and blocks RANKL-induced osteoclastogenesis. Here, we show thattreatment with W9 restores alveolar bone loss in OPG-/-miceMaterials and Methods: W9 or risedronate（a bisphosphonate）was subcutaneously administered to 12-week-old OPG-/mice. First, we analyzed of alveolar bone loss by in vivo μCT images. Secondary, we analyzed bone morphometry,
histomorphometry, and immunocytochemistry of alveolar bone.
Results: Administration of W9 or risedronate to OPG-/-mice signiﬁcantly decreased the osteoclast number in the alveolarbone. Interestingly, treatment with W9, but not risedronate, enhanced Wnt/β-catenin signaling and induced alveolar boneformation in OPG-/-mice. Expression of sclerostin, an inhibitor of Wnt/β-catenin signaling, was signiﬁcantly lower in tibiaeof OPG-/-mice than in wild-type mice. Treatment with risedronate recovered sclerostin expression in OPG-/-mice, while W9treatment further suppressed sclerostin expression. Histomorphometric analysis confirmed that bone formation-relatedparameters in OPG-/-mice, such as osteoblast number, osteoblast surface and osteoid surface, were increased by W9administration but not by risedronate administration. These results suggest that treatment of OPG-/-mice with W9 suppressed
osteoclastogenesis by inhibiting RANKL signaling and enhanced osteoblastogenesis by attenuating sclerostin expression in
the alveolar bone.
Conclusion: W9 may be a useful drug to prevent alveolar bone loss in periodontitis.

JSP/JACP Poster Session AAP2018

7

GB-13

IL-1β enhances cell adhesion through laminin 5 and β4 integrin in gingival epithelial cells
Masaru Mezawa＊, Yorimasa Ogata
Department of Periodontology, Nihon University School of Dentistry at Matsudo

Background and objective: Junctional epithelium（JE）attaches to the tooth enamel with hemidesmosomes. Laminin 5 and
α6β4 integrin are important adhesion molecules of internal basal lamina of JE. IL-1β is a pro-inﬂammatory cytokine whichmediates degradation of extracellular matrix through the functions of matrix metalloproteinases. The purpose of this study
was to examine the effects of IL-1β on adhesion molecules in gingival epithelial cells.
Materials and Methods: Human epithelial cell line Ca9-22 cells were cultured in α-MEM containing 10% fetal calf serum
until 70-80% conﬂuent. Ca9-22 cells were stimulated by IL-1β（1 ng/ml）and examined mRNA levels of type Ⅳ collagen,α1 type Ⅰ collagen, cadherin 1, β4 integrin and laminin 5 subunits such as laminin-α3, -β3, -γ2 chain. Ca9-22 cells wereco-stained by β4 integrin and laminin 5 antibodies, β4 integrin antibody and phalloidin（actin filaments), respectively.
Immunostained co-localization images were analyzed using a confocal microscopy. The extent of co-localization was
analyzed by Pearson correlation analysis.
Results: β4 integrin, laminin-α3, -β3, -γ2 chain, type Ⅳ collagen, α1 type Ⅰ collagen and cadherin 1 mRNA levels wereincreased by IL-1β（1 ng/ml）at 1 h. Laminin-γ2, type Ⅳ collagen and α1 type Ⅰ collagen mRNA levels were decreased
by IL-1β at 3 h. IL-1β increased 1.4-fold co-localization of β4 integrin and laminin 5 after 1 h stimulation by IL-1β. There
was no change of co-localization of actin ﬁlaments with β4 integrin after IL-1β stimulation.
Conclusion: These results suggest that co-localization of β4 integrin and laminin 5 was increased by IL-1 β.

GB-14Effect of implant placement on ectopically-induced trabecular bone
Shoji Miyazono＊, Yoko Miyazaki, Junro Yamashita
Fukuoka Dental College, Graduate School

Background and objective: We were successful to induce massive cancellous bone formation in the tibial diaphysis byperforming bone marrow penetration followed by daily parathyroid hormone（PTH）administration in rats. However, since
the diaphysis is a hollow structure, it was thought that such an ectopically formed bone would be resorbed. Here, we reportthat implant placement in the ectopically formed bone prevents bone resorption.
Materials and Methods: Fourteen rats received bone marrow penetration using a round bur in the tibiae followed by daily
PTH administration for 14 days. At day-14 half of rats received titanium screw implant placement. The remaining half
received sham surgeries. Rats were euthanized at 21 days after the implant placement. Micro-computed tomographic andhistological analyses were performed to assess the effect of implant placement in the ectopically formed bone.
Results: As anticipated, bone marrow penetration in the tibial diaphysis followed by PTH therapy induced tremendous
cancellous bone formation in the bone marrow cavity of the diaphysis. No new bone was formed in the diaphysis without
marrow penetration. While the ectopically formed bone was mostly resorbed after the cessation of PTH therapy, signiﬁcantbone was observed when implants were placed. Such a bone was not newly formed due to implant placement since implant
placement into the intact diaphysis caused minimum bone formation around the implants.
Conclusion: Implant placement slows bone resorption signiﬁcantly in the ectopically induced bone. Findings suggest thataugmented bone can be maintained by implant placement.

JSP/JACP Poster Session AAP2018

8

GB-15

Acid-resistance and antibacterial properties of laser-processed and ﬂuoride-incorporated
apatite layer
Kanako Shitomi＊1, Hirofumi Miyaji1, A. Joseph Nathanael2, Maki Nakamura2, Ayako Oyane2,
Tsutomu Sugaya1
1

2

Department of Periodontology and Endodontology, Faculty of dental Medicine, Hokkaido University
Nanomaterials Research Institute, National Institute of Advanced Industrial Science and Technology（AIST）

Background and objective: Laser-assisted biomimetic（LAB）process enables rapid and area-speciﬁc calcium phosphate（CaP）coating on the artiﬁcial substrate, by applying low energy pulsed laser irradiation to the substrate immersed in asupersaturated CaP solution. In the present study, sintered hydroxyapatite disc（sHA）was subjected to the LAB process in
a supersaturated solution supplemented with different concentrations of fluoride ions. We assessed acid-resistance andantibacterial activity of the LAB-processed sHA.
Materials and Methods: sHA was immersed in a supersaturated CaP solution supplemented with NaF（0, 1 and 3 mM）andthen irradiated with Nd: YAG laser light（355 nm, 6W/cm2）for 30 minutes. The irradiated surface was characterized by
SEM, TEM, and EDX. To assess acid resistance, the LAB-processed sHA was immersed in a citric acid buffer for 3 days,
and Ca and P in the buffer were quantiﬁed by ICP. To assess the antibacterial properties, Streptococcus mutans（S. m）was
seeded on the LAB-processed sHA and anaerobically cultured for 12 hours. SEM observation of S. m and measurements ofturbidity and colony forming unit were carried out.
Results: CaP layer was formed on the laser-irradiated region of sHA. By adding NaF to the supersaturated CaP solution,
ﬂuoride was incorporated in the CaP layer and its acid resistance was improved. Addition of NaF decreased the number of S.
m on the LAB-processed sHA, turbidity of medium and colony number of bacteria.
Conclusion: Fluoride-incorporated CaP layer fabricated by the LAB process exhibited the acid resistance and antibacterial
effects.

GB-16

Involvement of TRPV4 in bone remodeling by mechanical stress with periodontitis

Yoshimasa Taketani＊1, Takafumi Suzuki1, Joichiro Hayashi1, Kohei Hayashi1, Makiko Ishii1,
Hideharu Otsuka1, Junichi Tatsumi1, Yoshiyuki Hakeda2, Kitetsu Shin1
1

Division of Periodontology, Department of Oral Biology and Tissue Engineering, Meikai University School of
Dentistry,2
Division of Oral Anatomy, Department of Human Development and Fostering, Meikai University School of
Dentistry

Background and objective: In clinical situations, excessive occlusal force with periodontitis can cause rapid alveolar bone
resorption, but the molecular mechanism remains unclear. In this study, we focused on transient receptor potential vanilloid4（TRPV4）, a mechanosensitive ion channel expressed on osteoblasts that is thought to contribute to bone mass
maintenance. We investigated the role of TRPV4 under chronic inﬂammation to clarify the molecular mechanism of alveolarbone resorption with occlusal trauma.
Materials and Methods: Osteoblasts were isolated from the calvariae of 3- to 7-day-old C57BL/6J mice and cultured for 7
days in osteogenic medium（α-MEM containing 10％ fetal bovine serum（FBS）, 0.1％ ascorbic acid, and 0.2％β-glycerophosphate）with or without Porphyromonas gingivalis lipopolysaccharide（P.g-LPS）. The expression level of
TRPV4 and the receptor activator of NF-κB ligand（RANKL）/osteoprotegerin（OPG）ratio at day 7 were determined byreal-time PCR. Subsequently, cell growth was arrested at day 7 by incubation for 12 hours in α-MEM containing 0.5％
FBS, then 4α-phorbol 12-13-dicaprinate（4α-PDD）, a selective agonist of TRPV4, was added to the medium under theassumption of mechanical stress. After 24 hours, the RANKL/OPG ratio was determined.
Results: At day 7, the expression level of TRPV4 and the RANKL/OPG ratio did not differ between the groups. However,after the addition of 4α-PDD, the RANKL/OPG ratio increased signiﬁcantly in the cells cultured with P.g-LPS.
Conclusion: These results suggest that P.g-LPS enhances the response of TRPV4 and increases the RANKL/OPG ratio.
TRPV4 may be involved in the bone remodeling induced by mechanical stress with periodontitis.

JSP/JACP Poster Session AAP2018

9

GB-17

Inﬂuence of antimicrobial photodynamic therapy for LPS and bacteria
Meri Fukaya＊, Yuji Matsushima, Ayaka Suzuki, Yoko Nakano, Satoshi Shirakawa,
Takatoshi Nagano, Kazuhiro Gomi
Department of Periodontology Tsurumi University School of Dental Medicine

Background and objective: Active oxygen is generated by toluidine blue irradiated with the excitation light.These effects areapplied to the dental ﬁeld as the antimicrobial photodynamic therapy（a-PDT）. The purpose of this study is to evaluate thealteration of root surface and organic degradation and antibacterial action by a-PDT treatment.
Materials and Methods: In this study, FotoSan630（FS）and toluidine blue was used for a-PDT. The root surface, which
performed SRP, was treated by a-PDT and observed by SEM. The organic resolution was evaluated by degradation of LPS
and albumin. After a-PDT treatment（1min, 3min, 5min）, LPS was detected using LPS detection kit and albumin was
evaluated by electrophoresis. Antibacterial action was evaluated by bacterial colony count after treatment by a-PDT.
Results: The deposition of root surface was reduced the test group compared with the control. Decomposition of LPS andalbumin was found to be significantly reduced compared with control at 5 min of irradiation but did not completely
decompose. The antimicrobial effect suppressed almost all the bacteria in 5 minutes of light irradiation.
Conclusion: The a-PDT can be applied to periodontal therapy because it is able to clean the root surface without damage, todegrade the LPS and organics and to have bactericidal potency.

GB-18

Replacement of junctional epithelium by oral epithelium
Mayu Kato＊1,2, Ryo Aizawa1, Junichi Tanaka2, Sara Yajima-Himuro1, Tatsuaki Seki1,
Keisuke Tanaka1,2, Kenji Mishima2, Matsuo Yamamoto1
1

Department of Periodontology, School of Dentistry, Showa University
Division of Pathology Department of Oral Diagnostic Sciences, School of Dentistry, Showa University

2

Background and objective: Junctional epithelium（JE）is originated from odontogenic epithelium. JE is believed to be
gradually replaced by oral epithelium（OE）in a lifetime. However, the detailed process of replacement remains still
unclear. The aim of this study was to clarify replacement of JE by OE using a GFP-positive tooth germ transplantation
method.
Materials and Methods: GFP-positive tooth germs were transplanted into the hole of alveolar bone in C57BL/6-KI（ROSAmT/mG）mice, which ubiquitously express tdTomato red ﬂuorescent. On day 50, 140 and 200 after transplantation, JE
around transplanted GFP-positive teeth was histologically analyzed. Next, the palatal region of JE around the transplanted
GFP-positive teeth in C57BL/6 mice were excised. On day 30 after excision, the newly formed JE was histologicallyanalyzed.
Results: In transplanted teeth, the dental pulp, the periodontal ligament and the JE expressed GFP on day 50. On day 140,
GFP-positive JE was partly replaced by tdTomato-positive epithelium and completely replaced on day 200, while there wasno difference in the expressions of integlin β4 and laminin5 between JEs before and after replacement by OE. In addition,
there was no GFP-positive cell in the regenerated JE after excision and the regenerated JE also expressed both integlin β4
and laminin5.
Conclusion: These results confirm that JE derived from odontogenic epithelium are gradually replaced by OE. And thepartly removed JE after gingivectomy is not cured by the surrounding JE, but OE.

JSP/JACP Poster Session AAP2018

10

GB-19

Optical dissection of the mitophagy dynamics in HPDL cells

Motozo Yamashita＊1, Mio Suzuki2, Kuniko Ikegami1, Tomomi Nakamura1, Arisa Nishikawa2,
Koji Miki1, Manabu Yanagita3, Masahiro Kitamura2 and Shinya Murakami2
1

Department of Periodontology, Osaka University Dental Hospital,
Department of Periodontology, Osaka University Graduate School of Dentistry,3
Department of Oral Health, Kobe Tokiwa Junior College

2

Background and objective: Mitochondria is a representative organelle as a power generator for ATP supply and is critical forthe proper cell metabolism. However, defective mitochondria generate excessive Reactive Oxygen Species（ROS）, whichinduce the damage of cellular proteins and DNA. Mitophagy, a part of autophagy is the cell clearance system for thedamaged mitochondria with selective degradation. Previous study revealed that mitochondrial dysfunction correlated withsenescent cells and chronic systemic diseases, involving metabolic syndrome that affect the progression of periodontitis.
Thus, we aimed to dissect the mitophagy dynamics in senescent human periodontal ligament（HPDL）cells at single celllevel, by using the newly developed pH responsive ﬂuorescence probes.
Materials and Methods: Mitochondrial morphology was observed by transmission electron microscopy. Mitochondrial
membrane potential was measured by a cationic dye, JC-1 labeling. Mitophagy dynamics in HPDL cells was evaluated byusing mt-mkeima-Red which is a coral-derived acid-stable ﬂuorescent protein tagged with mitochondria targeting signal
peptide. Basal activity of autophagy in HPDL cells was quantiﬁed with a novel autophagic ﬂux probe, GFP-LC3-RFPLC3∆G. Turnover of the GFP/RFP ratio indicates the autophagy dynamics at single cell scale.
Results: Senescent HPDL cells showed dysregulated mitochondrial morphology and membrane potential. Fluorescent
autophagic probes dissected the defective mitophagy and ROS induction in senescent HPDL cells at single cell level.
Conclusion: Failure of mitophagy may induce the accumulation of damaged mitochondria thereby induce excessive ROS insenescent HPDL cells. Activation of impaired mitophagy may be a promising therapeutic target for the periodontitis inelderly populations.
GB-20

Senescence-associated miR-34a accelerates periodontal stem-cell aging by targeting SATB2
Kuniko Ikegami＊1, Motozo Yamashita1, Mio Suzuki2, Arisa Nishikawa2, Tomomi Nakamura1,
Koji Miki1, Jirouta Kitagaki2, Manabu Yanagita3, Masahiro Kitamura2 and Shinya Murakami2
1

Department of Periodontology, Osaka University Dental Hospital,
Department of Periodontology, Osaka University Graduate School of Dentistry,3
Department of Oral Health, Kobe Tokiwa Junior College

2

Background and objective: Periodontitis is characterized in part as an age-dependent chronic inﬂammatory disease withperiodontal tissue destruction caused by dental plaque. Accumulation of environmental stress, such as bactericidal infection,
Reactive Oxygen Species（ROS）and traumatic occlusal force is thought to induce senescence in periodontal tissue atcellular level. We previously reported that senescent human periodontal ligament cells（HPDL）secrete various
inﬂammatory cytokines, referred to as the senescence-associated secretory phenotype（SASP）. A comprehensive analysisof microRNA identified miR-34a which is preferentially expressed in senescent HPDL as a regulator of inflammation.
Noteworthy, bioinformatics analysis revealed that special AT-rich sequence-binding protein 2（SATB2）, a criticaltranscription factor for osteoblastogenesis and cleft palate deformity as a target of miR-34a. In this study, we aimed to
explore the SATB2 regulation by miR-34a in senescent HPDL with focusing the periodontal stem-cell aging.
Materials and Methods: Replicative senescence was conducted to primary HPDL. Irreversible cell cycle arrest was judged
with population doublings periods. SASP-related genes, IL-6, IL-8 and MMPs were examined by RT-qPCR and ELISA. A
screening of miRNAs was performed using the human miRNAs array（Agilent）. Synthetic double strand mimics orcompetitive inhibitor oligos for hsa-miR-34a were induced in HPDL to clarify the miR-34a function.
Results: Senescent HPDL showed the decreased expression of stem-cell marker, SSEA-3 and hard tissue forming ability.
While miR-34a was elevated, SATB2 expression was decreased in senescent HPDL. Exogenous miR-34a treatment
suppressed the osteoblastic differentiation of HPDL by targeting SATB2.
Conclusion: miR-34a-SATB2 pathway may participate in stem-cell aging in senescent HPDL.

JSP/JACP Poster Session AAP2018

11

GB-21

Concomitant suppression of osteoclasts and macrophages hinders osseous wound healing
Masahiro Hirano＊, Hiroki Fujimoto, Akimichi Sugihara, Junro Yamashita
Fukuoka Dental College Graduate School

Background and objective: Concomitant use of antiresorptives with immunosuppressants increases a risk of osteonecrosts of
the jaw（ONJ）after tooth extractions. However, precise mechanisms are unclear. The purpose of the study was toinvestigate the effect of macrophage depletion on oral osseous wound healing in animals on antiresorptive therapy.
Materials and Methods: Young adult mice received zoledronic acid（ZA）injections for 7 weeks. To suppress macrophages
clodronate liposomes（CL-lipo）were given to mice. Tooth extractions were performed at 4 weeks after the intiation of the
ZA and CL-lipo administration. Visual and micro-computed tomographic（mCT）evaluation was conducted every week toassess wound healing. Flow cytometric analysis of bone marrow and blood cells were performed to assess F4/80（+）Gr1（-）macrophages.
Results: It was conﬁrmed that macrophages decreased in the bone marrow and blood. Bone ﬁll in the extraction sockets wascompromised in the CL-lipo/ZA group compared to control 3 weeks. However, at 2 and 4 weeks after tooth extractions bone
fill was similar between two groups. Soft tissues healing delayed in the CL-lipo/ZA group compared to control.
Monotherapy of either CL-lipo or ZA did not result in a delay in tooth extraction socket healing.
Conclusion: Since the combined administration of CL-lipo and ZA induced impaired osseous wound healing andmonotherapy did not,it was considered that the macrophage depletion and antiresorptive therapy has a synergistic negative
effect on osseous wound healing.

GB-22

α-Cyano-4-hydroxycinnamic acid suppresses bone resorption

Hiroko Imai＊1,2, Kentaro Yoshimura2, Yoichi Miyamoto2, Masahiro Chatani3, Masamichi Takami3,
Ryutaro Kamijo2, Matsuo Yamamoto1
Departments of 1Periodontology, 2Biochemistry, and 3Pharmacology, Showa University School of Dentistry
Background and objective: Monocarboxylate transporters（MCTs）are proton-linked membrane transporters. Among the
14 MCT subtypes, MCT-1, -2, -3 and -4 transport lactate and pyruvate across the plasma membrane. MCTs are involved inenergy metabolism of muscle and nerve cells. However, their roles in osteoclasts are not reported. Here we analyzed the roleof MCTs in osteoclast differentiation.
Materials and Methods: Bone marrow cells（BMC）isolated from 5- to 8-week-old male ddY mice were cultured for 3
days in the presence of M-CSF to obtain macrophages（BMM）. BMM were treated for 3 days with M-CSF and RANKL to
induce osteoclastogenesis. We examined the effects of α-cyano-4-hydroxycinnamic acid（CHC）, an inhibitor of MCTs, on
RANKL-induced osteoclastogenesis. Osteoclastogenesis was evaluated by activity staining of tartrate-resistant acidphosphatase（TRAP）and determination of TRAP activity. Osteoclasts differentiated in co-cultures of BMC and mouse
osteoblastic UAMS32 cells were cultured on dentine disks in the presence or absence of CHC to examine the effect of CHC
on bone resorbing activity of osteoclasts.
Results: BMM and osteoclasts expressed mRNAs for Mct1, Mct2, and Mct4. While the expression of Mct1 was abundant inboth BMM and osteoclasts, that of Mct2 increased after differentiation into osteoclasts. CHC enhanced osteoclastdifferentiation from BMM. However, CHC suppressed bone resorbing activity of osteoclasts.
Conclusion: The results described above indicate that transport of monocarboxylates via MCTs plays important roles indifferentiation and function of osteoclasts. Our findings also suggest a possibility that MCTs become a new therapeutictarget for bone metabolic diseases.

JSP/JACP Poster Session AAP2018

12

GB-23

Effect of Antiangiogenic agents in tooth extraction socket healing
Hiroki Fujimoto＊, Masahiro Hirano, Akimichi Sugihara, Junro Yamashita
Fukuoka Dental College Graduate School

Background and objective: A combined administration of thalidomide（Thal）, bortezomib（Vel）, and zoledronic acid
（ZA）is often used to treat multiple myeloma. In this particular population a risk of osteonecrosis of the jaw（ONJ）, whichis impaired osseous wound healing in the oral cavity, is high. Thalidomide is known to have antiangiogenic effect. There arereports that the use of antiangiogenic agents increases a risk of ONJ. However, how antiangiogenesis plays a role in thedevelopment of ONJ is unclear.
Materials and Methods: Mice received a combination therapy of Thal/Vel/ZA for 7 weeks. In control, mice received a
combination of Thal/Vel for 7 weeks. Tooth extractions were performed at 3 weeks after the initiation of the therapy. Visualand micro-computed tomographic（µCT）evaluation was conducted every week to assess wound healing. Flow cytometricanalysis was performed to assess CD31（+）CD309（+）vascular endothelial cells in circulation. To further confirm
antiangiogenic effects, tumor inoculation（B16F10 cells）were performed in another group of mice. Those mice received
Thal/Vel therapy and tumor blood vessel density was assessed.
Results: Number of circulating CD31（+）CD309（+）cells, which are referred to as vascular endothelial cells, decreased
in mice on Thal/Vel therapy regardless of ZA. Thus, Thal/Vel therapy suppressed angiogenesis. Oral wound closere wasgood in both groups. However, the µCT assessment revealed a signiﬁcant difference in the bone ﬁll at 7-day post-extraction.
Conclusion: Antiangiogenesis may not play a dominant role in the development of ONJ-like impaired wound healing in
mice.

GB-24

The effect of neutropenia and anti-resorptives in tooth extraction socket healing
Hikaru Takeyama＊, Akimiti Sugihara, Hiroki Fujimoto, Masahiro Hirano,
Shoji Miyazono, Junro Yamashita
Fukuoka Dental College Graduate School

Background and objective: Cyclophosphamide is used to suppress immume responses in patients receiving bone marrowtransplant. Bone marrow suppression induces a decrease in neutrophil numbers. Bone trauma and infection cause necroticbone formation. Neutrophil inﬁltration occurs in the connective tissue adjacent to the necrotic bone. Since the neutrophil
infiltration is followed by the resorption of the necrotic bone, there would be interactions between neutrophils andosteoclasts. However, their synergistic roles during osseous healing are unclear. Here, neutropenia and osteoclast suppression
were induced using Cyclophosphamide and bisphosphonate（ZA）and their effect on tooth extraction socket healing wasinvestigated.
Materials and Methods: Mice were administered Cyclophosphamide for 7 weeks. Flow cytometric analysis of F4/80（-）
Ly6c/6g（-）cells in the bone marrow, spleen, and blood was performed to confim neutropenia. Micro-computed
tomographic（µCT）analysis of tibiae was performed to confim the antiresorptive effect of ZA. After the 4 weeks oftreatment, tooth extraction of the maxillary ﬁrst molars were conducted and bone ﬁll in the sockets were assessed using invivo µCT. Mice were euthanized at 4 weeks post-extractions.
Results: In vivo µCT assessment found no difference in bone ﬁll in the extraction sockets between the experimental andcontrol groups although neutropenia and the suppression of bone resorption were observed in the experimental groups.
Epithelial wound closure occurred in 2 weeks post extractions in both groups with no differences.
Conclusion: These results suggest that the combination of neutropenia and the suppression of bone resorption does not havedetrimental effect on tooth extraction socket healing in mice.

JSP/JACP Poster Session AAP2018

13

GB-25

IL-1β induced by dental calculus promotes osteoclastogenesis in RAW-D cells
Atsutoshi Yoshimura＊, Jorge Luis Montenegro Raudales, Ziauddin SM, Kanako Higuchi,
Yukio Ozaki

Department of Periodontology and Endodontology, Nagasaki University Graduate School of Biomedical Sciences
Background and objective: We have shown that cellular uptake of dental calculus triggers nucleotide-binding
oligomerization domain-like receptor family pyrin domain-containing 3（NLRP3）inﬂammasome activation, leading to
the processing of the interleukin（IL）-1β precursor into its mature form in mouse macrophages. The purpose of the present
study was to examine whether IL-1β induced by dental calculus in mouse macrophages can promote osteoclastogenesis in
RAW-D cells.
Materials and Methods: Wild-type and NLRP3-deﬁcient mouse macrophages were stimulated with dental calculus for 8hours and the concentration of IL-1β in the culture supernatants was measured by ELISA. Then, these supernatants wereadded to the culture of RAW-D cells pretreated for 2 days with 10 ng/ml of receptor activator of nuclear factor kappa-B
ligand（RANKL）. After 3 days, tartrate-resistant acid phosphatase（TRAP）staining was performed, and the TRAPpositive cells with 3 or more nuclei were counted as osteoclasts.
Results: Dental calculus induced IL-1β secretion in wild-type, but not NLRP3-deﬁcient, mouse macrophages. RANKLpretreated RAW-D cells incubated with the culture supernatants of wild-type mouse macrophages stimulated with dental
calculus had significantly higher number of TRAP-positive cells compared to the cells incubated with the culture
supernatants of NLRP3-deﬁcient mouse macrophages stimulated with dental calculus.
Conclusion: Dental calculus induced the production of IL-1β via NLRP3 in mouse macrophages. IL-1β contained in theculture supernatants of wild-type mouse macrophages promoted osteoclastogenesis in RAW-D cells. These results suggestthat dental calculus may contribute to periodontal tissue destruction by accelerating alveolar bone resorption.

JSP/JACP Poster Session AAP2018

General（Clinical Research）

15

GC-01

The Clinical Trial of Periodontitis Index Software - PerioPerio -An Interim ReportYoshio Motegi＊
Motegi dental practice

Background and objective: We created periodontitis index software - PerioPerio - based on an algorithm of the following
formula:SL = - 203.9 F + 281.2（correlation coefﬁcient: −0.8826）
SL: Lost periodontal ligament area
F: Anatomical coefﬁcient
For this PerioPerio, we conducted clinical trials for 5 years to investigate the effectiveness in the diagnosis or screening of
periodontitis.
Materials and Methods: We examined two values at 41,281 existing teeth of 916 patients 55 years old or older sufferingfrom periodontal disease. A value at one point of the deepest point of the attachment level of target tooth was measured in
mm unit. Then, the operator independently diagnosed the test target tooth to select a value of 0 to 4 from the ﬁve levels ofguideline values: P0 to P4 of the periodontitis classiﬁcation（Japanese Association for Dental Science, 2007）. 10 clinicians
conducted it once a year for 5 years. Therefore, the target tooth was measured several times. At the time when two and a halfyear has elapsed, intermediate results are aggregated. For the analysis, the PerioPerio values vs. P0 to P4 were compared by
F test and t-test. This clinical trial was conducted with an ethical review of The Japanese Academy of Clinical
Periodontology.
Results: When comparing a PerioPerio value in each periodontitis classiﬁcation of P0 to P4（unpaired t-test）, signiﬁcance（P＜0.01）was observed in all groups.
Conclusion: As a result of comparing, clinical effectiveness of PerioPerio was suggested in diagnosis or screening of
periodontitis.

GC-02

The association of anti-phospholipid antibody with Behcetʼs disease

Mari Mori＊1, Toshiyuki Nagasawa2, Osamu Uehara3, Satsuki Kato4, Izuru Sato5, Kenichi Namba6,
Masayuki Tsutsumi5,6, Nobuyoshi Kitaichi5,6, Yasushi Furuichi4..
1

Division of General Dental Sciences, Department of Oral Rehabilitation, 2Division of Advanced Clinical
Education, Department of Integrated Dental Education, 3Division of Disease Control and Molecular Epidemiology,
Department of Oral Growth and Development, 4Division of Periodontology and Endodontology, Department ofOral Rehabilitation, School of Dentistry, 5Department of Ophthalmology, Health Sciences University of Hokkaido,
6
Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
Background and objective: Anti-phospholipid antibody induces vascular thrombosis, resulting in myocardial infarction,
stroke, and fetal loss. Behcetʼs disease is an inﬂammatory disorder characterized by recurrent oral aphthous ulcers, genital
ulcerations, and ocular manifestations. Several investigators reported that anti-pospholipid antibody was increased inperiodontitis patients, and periodontitis was severe in Behcetʼs disease patients. We have reported that periodontitis induced
anti-pospholipid antibody, thorough the molecular mimicry between oral bacteria and beta-2 glycoprotein I. The purpose ofthis study was to evaluate the anti-pospholipid antibody in Behcetʼs disease patients.
Materials and Methods: Patients with Behcetʼs disease（n=15）and healthy subjects（n=20）were recruited in this study.
Venous blood was collected from the subject, and antibody titer against beta-2 glycoprotein I dependent and/or independentanti-pospholipid antibody was measured. Whole saliva was collected from the patients with Behcetʼs disease. Meta-genome
analysis was performed using DNA prepared from the patientʼs saliva.
Results: Anti-phospholipid antibody was elevated in Behcetʼs disease patients compared with the healthy subjects. Metagenome analysis revealed that bacteria that bear molecular mimicry with human beta-2 glycoprotein I were detected in thesaliva from the Behcetʼs disease patients.
Conclusion: Present study suggested that anti-pospholipid antibody was increased in the Behcetʼs disease patients, andseveral oral bacteria might induce the antibody through the molecular mimicry with beta-2 glycoprotein I.

JSP/JACP Poster Session AAP2018

16

GC-03

Effectiveness of Improved Dental Model for Training of Pocket Probing

Yusuke Harada＊1, Masayo Sunaga1, Yasuo Takeuchi2, Akira Aoki2, Shogo Maekawa2, Yuichi Izumi2,
Atsuhiro Kinoshita1
1Department of Educational Media Development, Graduate School of Medical and Dental Sciences; CurricularManagement Division, Institute of Education, Tokyo Medical and Dental University
2
Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental
University

Background and Objective: Since 2008, we have been developing a training model simulating the structure of the bottom of
periodontal pockets and reported that it is effective for training of periodontal pocket probing. The aim of this study was toevaluate the effectiveness of our latest dental model, which has been improved in terms of manufacturing cost, versatility
and durability.
Materials and Methods: Study participants included 43 fourth year dental students（students）, and 22 dental residents（residents）. We divided 24 artificial teeth into four groups of six teeth each; designated as groups A, B, C, and D.
Participants probed these groups of teeth according to a randomly assigned order. For each group, participants self-veriﬁed
their probing pocket depths against setup depths in order to improve their probing skill. Each Probing time was recorded.
After completing the probing, participants answered a questionnaire to evaluate the improved model.
Results: Probing accuracy rates increased signiﬁcantly from 79％（median）on the ﬁrst probing to 85％ on the last probing
in students, and from 81％ to 86％ in residents（p＜0.01）. Probing time reduced significantly from 423 s on the firstprobing to 295 s on the last probing in students, and from 309 s to 267 s in residents（p＜0.001）. Questionnaire results
showed that most participants, 98％ of students and 100％ of residents, considered the pocket probing training using thismodel effective.
Conclusion: Pocket probing training using this improved dental model was effective for improving probing accuracy and
time.
GC-04

Periodontal status in Japanese institutionalized elderly, covering 10 years
Satoshi Sekino＊1, Takeshi Kikutani2, Fumiyo Tamura2, Yukihiro Numabe1
1

Department of Periodontology, School of Life Dentistry at Tokyo, The Nippon Dental University,
2
Tama Oral Rehabilitation Clinic, The Nippon Dental University

Background and objective: The present study describes periodontal status in Japanese institutionalized elderly over the 10
years.
Materials and Methods: In 2006, a cross-sectional study was performed in 6 nursing home in Taito-ku,Tokyo in Japan. A
total of 123 dentate residents aged 56-101 years were given a clinical examination comprising recording of plaque index（PlI）, bleeding on probing（BoP）, clinical attachment level（CAL）and probing pocket depth（PPD）in 4 sites of allteeth present except third molars. Basic demographic information was also collected. In 2016, another cross-sectional study
was performed in 180 dentate residents in 6 nursing homes in Taito-ku, Tokyo .
Results: The mean number of teeth increased from 12.2±8.2 to14.6±8.8 over 10 years. In 2006, proportion of surface
which harboring visible plaque was 69.3％ ±26.0. It was decreased to 53.6％ ±31.7. The mean proportion of teeth with
CAL ≥7mm in 2006 and in 2016 were 13.9％ ±22.2 and 14.0％ ±20.9, respectively. According to the CDC/AAP casedeﬁnition, prevalence of severe periodontitis were 29.4％ in 2006 and 29.1％ in 2016.
Conclusion: Periodontal disease was still prevalent in current Japanese institutionalized elderly even though oral hygiene
status were improved and the remained teeth were increased comparing with 2006. The new proper public health programs
are necessary to establish.

JSP/JACP Poster Session AAP2018

17

GC-05

Analysis of failed implants with peri-implantitis
Sho Sakamoto＊1, Takashi Kado1,2, Yasushi Furuichi1
1

Division of Periodontology and Endodontology, Department of Oral Rehabilitation,
Division of Dental Education Development, Department of Integrated Dental Education, School of Dentistry,
Health Sciences University of Hokkaido

2

Background and objective: Prevalence of Peri-implantitis is reported as high rates. But we are less well understood thecause of peri-implantitis. In this study, prevalence of various microorganism around failed implants and physicochemical
characteristics of such implant surfaces were investigated.
Materials and Methods: A total of 6 patients with 13 failed implants were recruited. Clinical parameters were obtained prior
to the implant removal surgeries. At the time of implant removal, plaque samples were obtained by inserting sterile paper
points into the sulcus or pockets. The paper points were placed in a sterile tube and the removed implants were putting into
the bottle ﬁlled with formalin. Then, quantitative real-time polymerase chain reaction（PCR）was carried out to analyze
the microbiologic composition. Additionally, X-ray ﬂuorescence analysis（XRF）was performed to analyze the elementsof removed implant surfaces.
Results: The prevalence rate of P.gingivalis（P.g）, T.denticola（T.d）, T.forsythia（T.f ）, F.nucleatum（F.n）andP.intermedia（P.i）around the failed implant sites was signiﬁcantly higher than that of the healthy tooth sites. The presenceof zinc was showed from 10 failed implant surfaces, and only found in the subjects with multiple implant failures.
Conclusion: This study suggested that the amount of Red complex, F. n, and P. i. were associated with failed implants withperi-implantitis. Signiﬁcance of zinc observed on the failed implant surfaces in the initiation and/or progression of periimplantitis should further be investigated.

GC-06

The association between periodontitis and preterm low birth-weight in women with gestational diabetes
Yoko Koide＊1, Anna Osamura2, Kyoko Kohashi2, Tomohiro Oba3, Yoshimasa Okamatsu5,
Katsufumi Otsuki4, Yasubumi Maruoka5, Akihiko Sekizawa3, Tsutomu Hirano2, Matsuo Yamamoto1
1

Department of Periodontology, Showa University School of Dentistry, 2Division of Diabetes, Metabolism, andEndocrinology, Department of Internal Medicine, Showa University School of Medicine, 3Department of Obstetrics
and Gynecology, Showa University School of Medicine, 4Department of Obstetrics and Gynecology, Showa
University Koto Toyosu Hospital, 5Department of Special Needs Dentistry, Division of Community BasedComprehensive Dentistry, Showa University School of Dentistry
Background and objective: There have been little studies about the association between periodontitis and preterm low birthweight infants in women with gestational diabetes（GDM）. The objective of this prospective cohort study was toinvestigate whether periodontal disease was risk factors of the preterm low birth-weight infants in women with GDM.
Materials and Methods: Fifteen women with GDM were enrolled into study. Before treatment of GDM, we performed oral
examinations, and collected samples from blood and saliva. All subjects were received usual treatment of GDM. Afterdelivery, medical records were consulted to determine each infantʼs birth weight and gestational age. Subjects were assigned
to either good or poor periodontal condition.
Results: There was none preterm. 9 subjects were poor periodontal condition. 2 subjects of low birth-weight were all poor
periodontal condition. The number of T. denticola was signiﬁcantly higher in the poor periodontal condition. Triglyceride level
was signiﬁcantly higher in the good periodontal condition. On the other hand, all 5 subjects who had GDM diagnosis in 1sttrimester were poor periodontal condition. Diabetes related markers were not signiﬁcantly different between poor and good
periodontal condition. Glycoalbumin level was signiﬁcantly higher in subjects who had GDM diagnosis in 1st trimester, but totalcholesterol, LDL cholesterol, and triglyceride level was signiﬁcantly higher in subjects who had GDM diagnosis in 3rd trimester.
Conclusion: In this study, the effect of periodontal condition on gestational age was not investigated. It was suggested thatshould be considered time of GDM diagnosis and lipid metabolism in future study.【250 words】

JSP/JACP Poster Session AAP2018

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GC-07

A new screening system for periodontitis using Hepatocyte growth factor

Shogo Maekawa＊1, Shinta Suzuki1, Akira Aoki1, Sayaka Katagiri1, Yuichi Ikeda1, Kenichiro Ejiri2,
Sophannary Kong3, Mizuki Nagata4, Yoko Yamaguchi5, Mitsuhiro Ohshima6, Yuichi Izumi1
1

Department of Periodontology, Graduate school of Medical and Dental Sciences, Tokyo Medical and Dental University,
2
Dental Clinic Eji, 3Dentistry Department, Faculty of Health Sciences, University of Puthisastra, 4Department ofOrthodontics and Pediatric Dentistry, University of Michigan School of Dentistry, 5Department of Biochemistry, Nihon
University School of Dentistry, 6Department of Biochemistry, Ohu University School of Pharmaceutical Sciences

Background and objective: Clinical diagnosis of periodontitis is performed by assessment of probing pocket depth, bleedingon probing, tooth mobility as well as radiographic examination. These conventional procedures are beneﬁcial for precise
diagnosis, however, they are impractical for medical mass screening. The aim of this study was to analyze the relationshipbetween the level of hepatocyte growth factor（HGF）in oral rinse water samples and clinical parameters of periodontitis,
and to evaluate the potential of a prototype HGF immunochromatographic paper test strip（p-HGF-TS）for diagnostic
screening of periodontitis, in comparison with a commercially-available occult blood（hemoglobin）test strip（Hb-TS）.
Materials and Methods: One hundred twenty-five subjects were classified by Biofilm-Gingival Interface（BGI）
classification（Offenbacher et al, 2007）. Rinse water samples were collected and clinical periodontal parameters wererecorded. The presence of HGF and hemoglobin（Hb）in each sample was detected using a p-HGF-TS and an Hb-TS.
And then, the concentrations of HGF and Hb was evaluated.
Results: The HGF concentrations in rinse water samples showed signiﬁcant positive correlations with clinical parameters of
periodontitis. The positive rate and read value on p-HGF-TS showed significantly high values especially in severe
periodontitis compared to healthy subjects. Hb-TS showed generally higher positive rates than p-HGF-TS; however, it also
showed false positive results in healthy subjects.
Conclusion: The concentration of HGF in oral rinse water showed close association with the progress of periodontitis andthe p-HGF-TS has a potential for diagnosis of periodontitis although further reﬁnement of the test strip is required.
GC-08

Accelerated inﬂammation in peripheral artery disease patients with periodontitis
Keitetsu Kure＊1, Norio Aoyama2, Hiroki Sato1, Yuichi Izumi1
1

Department of Periodontology, Tokyo Medical and Dental University
Department of Oral Interdisciplinary Medicine, Kanagawa Dental University

2

Background and objective: Peripheral arterial disease（PAD）is arteriosclerosis in extremity that involves ischemia.
Previous studies report that patients with periodontitis had a high risk of PAD, however evidence regarding the relationshipbetween the two diseases has not yet been fully elucidated. In this cross-sectional study, we investigated the relationship bycomparing the patients with PAD to those with arrhythmia（ARR）as a control.
Materials and Methods: Patients with PAD（n=25）or ARR（n=25）, who visited Tokyo Medical and Dental University
Hospital, were examined. We recorded the dental clinical ﬁnding, which includes probing pocket depth（PPD）, bleeding on
probing（BOP）, clinical attachment level（CAL）and the number of missing teeth, and collected periodontal bacteria andperipheral blood samples. We adjusted age, gender, prevalence of diabetes, hypertension, dyslipidemia, obesity and smoker
rate between PAD and ARR groups. Real-time PCR was performed to detect bacterial counts, and ELISA method was used
to measure anti-bacterial antibody titers and pro-inflammatory cytokine levels in serum. We used Studentʼs t test, Chisquare test and Mann-Whitneyʼs U test for the comparisons.
Results: PAD patients had more missing teeth（18.4±2.0）and higher serum levels of C-reactive protein（1.57±0.85 mg/dl）and tumor necrosis factor-alpha（70.3±5.7 pg/ml）than ARR patients（12.0±1.7, 0.38±0.21 mg/dl, 39.3±4.5 pg/
ml, respectively）. Meanwhile, there was no statistical difference in other dental clinical measurements, bacterial antibody
titers and bacterial counts between the groups.
Conclusion:
It was suggested that PAD patients had worsened oral and periodontal condition with enhanced systemic inﬂammation.

JSP/JACP Poster Session AAP2018

Case Report

19

R-01

Periodontal tissue regeneration around the tooth with orthodontic extrusion
Masahiko Kanenari＊
Crystal Dental ofﬁce

Background and objective: Prolonged retention of deciduous tooth may interrupt developing oral function including
establishing lateral guidance. Attached gingiva of the extruded permanent tooth is reported to be lost after the forced
extrusion, however we experienced the good treatment result with the impacted mandibular canine accompanied with theodontogenic cyst and supernumerary teeth.
Case: The patient was 24-year old female with the spaced maxillary anterior dentition. Impacted mandibular right caninewith the odontogenic cyst and supernumerary teeth was extruded orthodontically. Bone defect and gingival recession withthe loss of attached gingiva have been improved by periodontal regenerative therapy.
Clinical procedure and outcome: The impacted canine was extruded by elastic with the lingual hook on the labial surface
after extracting persistent deciduous tooth and removing odontogenic cyst and supernumerary teeth. Malalignment wascorrected by the full mouth orthodontic treatment. After elevated trapezoidal full- and partial-thickness ﬂap to access bone
defect, root plaining was performed. Enamel matrix derivative was applied and the bone graft material was placed on thelabial side. Connective tissue harvested from palate was ﬁxed more coronal to CEJ with sling suture after the graft site wascovered with resorbable membrane fixed with periosteal suture. Then the flap was repositioned and sutured to coverconnective tissue completely.
Conclusion: Esthetic problem by the lost attached gingiva and bone defect caused by the orthodontic extrusion andsupernumerary teeth extraction was improved by root coverage procedure and periodontal regenerative therapy.

R-02

A case report of comprehensive treatment including periodontal regenerative therapy, implant
treatment, and prosthodontic treatment involving a patient with extensive severe chronic
periodontitis
Hiroshi Funaki＊
Hibiya Dental ofﬁce

Background: Periodontal tissue regenerative therapy, implant treatment, and prosthetic treatment were performed, andfavorable results were obtained.
cases: The patient was a 33-year-old male with chief complaints of repetitive full-mouth gum swelling and pain, andmasticatory disturbance due to the mobility of teeth. Radiographic ﬁndings showed full-mouth horizontal bone resorption,and some vertical resorption. Intraoral ﬁndings included marked mobility of the overall teeth, a large amount of subgingival
calculus, swollen gums, and deep periodontal pockets. The patientʼs general condition was favorable, and he was a nonsmoker.
Clinical Procedures and Outcomes: Regenerative therapy using Enamel matrix derivative（EMDOGAIN）was performed
for the lower preservable teeth, and tooth extraction and implant treatment were performed for the lower non-preservable
teeth. All upper teeth were considered non-preservable, and, therefore, the maxilla was treated with a full-denture.
Conclusion: Gum swelling and pain, which were the patientʼs chief complaints, disappeared as a result of the treatment.
Vertical bone resorption improved after periodontal regenerative therapy. Tooth mobility also improved. Masticatory
disturbance in the edentulous area was improved by implant treatment.

JSP/JACP Poster Session AAP2018

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R-03

Treatment of Chronic Periodontitis with Apically-positioned Flap and Free gingival graft.: A
Case Report
Takahiro Bizenjima＊1, Daisuke Irokawa1, Sachiyo Tomita1, Toshitake Takahashi2, Atsushi Saito1
1

Department of Periodontology, Tokyo Dental College, 2Tokyo Dental Clinic

Background: Apically positioned flap（APF）can be used for pocket elimination and widening the zone of attachedgingiva. When caries or fractures are extensive and subgingival, APF is used to expose intact tooth structure. Free gingival
graft（FGG）case of generalized chronic periodontitis requiring surgical intervention including APF and FGG.
Case: The patient was a 53-year-old woman who presented with the chief complaint of loss of occlusion and bad breath. An
initial examination revealed that 31.8％ of sites with a probing depth（PD）of ≥ 4 mm. The level of plaque control asassessed by the OʼLeary plaque control record（PCR）was 63.1％. Many subgingival caries were found in the cervical areaof the teeth. Radiographic examination revealed horizontal bone resorption in almost region and deposition of subgingival
calculus. A clinical diagnosis of generalized chronic periodontitis was made according to the classiﬁcation of the American
Academy of Periodontology（1999）.
Clinical Procedures and Outcomes: The patient underwent initial periodontal therapy. An improvement was observed inperiodontal conditions at reevaluation. A series of APF were performed on #13, 14 and #21, 23, 24, 25, 27, and 43, 44, 45.
FGG was performed on #34, 35. Following reevaluation, oral function was restored using a fixed bridge prosthesis andremovable partial denture. Then the patient was placed on supportive periodontal therapy.
Conclusion: In the present case of chronic periodontitis, surgical interventions resulted in a decrease in probing depth andreestablishment of the biological width, and improved the architecture of soft tissues.

R-04

Periodontal Plastic Surgery for Altered Passive Eruption: A Case Report
Tokihisa Mizokami＊
Mizokami Dental Ofﬁce

Background: Altered passive eruption causes not only poor esthetic but also difficulty in plaque control due to deep
periodontal pocket. A feature almost always found is thick buccal bone, especially in interdental areas. The surgical
technique for altered passive eruption is a periodontal plastic surgery including osteoplasty and, when necessary, osteotomy.
Based on these facts, the treatment plan should include not only observing gingiva but the consideration on the positional
relationship of the tooth to alveolar bone.
Case: Patient: 37-year old Female, First visit: 2015. 10. 21, Chief complaining: poor esthetics and caries
Diagnosis: 12, 21, 22; Altered passive eruption, 11, 21, 22; Caries
Clinical Procedures and Outcomes: 1.Initial preparation, 2. Re-assessment, CBCT examination, 3. Periodontal plastic
surgery including osteoplasty and osteotomy, 4. Caries treatment, 5. MaintenanceBecause of the usage of surgical guide with the incision line advanced to 2mm coronal to CEJ examined from CBCT data,
the gingival morphology has almost not changed since immediately after the surgery. Excessive buccal marginal bone of #21
was removed and buccal interdental bone of #12, #11, #21,#22 was corrected its shape. The coronal part of the deepithelialized interdental papillae heals by second intention.
Conclusion: Periodontal plastic surgery including osteoplasty and, when necessary, osteotomy for altered passive eruption
contributed to enhancing the esthetic outcome and better plaque control. 2 years since the surgery, no gingival regression has
observed. However, its prognosis may still need meticulous observation and maintenance care.

JSP/JACP Poster Session AAP2018

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R-05

A case report: Regenerative treatment for generalized severe chronic periodontitis
Takafumi Ueyama＊
Ueyama Dental Clinic

Background: Regenerative therapy is known as an effective treatment for intrabony defect. This case report demonstrate thatwill enhance the success of periodontal treatment and improve the patientʼs periodontal problems.
Case: A 56 years-old female presented to our clinic with the chief complaint of tooth mobility. The patient has
hypothyroidism and never smoked. Oral examination revealed that oral hygiene and bleeding score was poor（PCR 76％,
BOP 88％）. Probing depth（PD）≧4mm was 64％ and PD ≧7mm was 22％. Radiographic examination revealed
moderate horizontal bone resorption and a few sites have severe intrabony defects.
Clinical Procedures and outcome: Initial periodontal treatment such as oral hygiene instructions, scaling and root plaining
were performed. After two month, intrabony defect lesions were treated with regenerative therapy using Freeze-Dried Bone
Allografts（FDBA）and Enamel Matrix Derivative（EMD）. Furthermore, resorbable membrane was applied to the onewall defect lesion additionally. SPT was introduced when the recovery of the tissues was conﬁrmed. PD and oral hygiene isstable for three years after surgery（PCR=16％, and BOP=17％, PD ≧4mm=10％ ,PD ≧7mm=0％）.
Conclusion: The present results show the beneficial effects of regenerative therapy using FDBA, EMD, and resorbablemembrane to intrabony defects. And SPT is required to maintain a good periodontal condition.

R-06

Surgical treatment for teeth with furcation involvement: a case report
Daisuke Irokawa＊1, Takahiro Bizenjima1, Sachiyo Tomita1, Midori Oshima2, Atsushi Saito1
1

Department of Periodontology, Tokyo Dental College, 2Oshima Dental Clinic

Background: The main purpose of treatment for furcation involvement is to facilitate maintenance and to prevent further lossof attachment. Here we report a chronic periodontitis case treated for furcation involvements.
Case: The patient was a 43-year-old man who requested treatment of periodontal disease. Baseline examination revealed
30.9％ of sites with a probing depth of ＞4 mm and 29.2％ of sites with bleeding on probing. The level of plaque control asassessed by the OʼLeary plaque control record was 24.1％. Radiographic examination revealed vertical1 bone resorption in
maxillary molars and lower anterior teeth. As for furcation involvements, buccal of #16 had grade 2, distal had grade 1 andmesial of #26 had grade 1. A clinical diagnosis of generalized chronic periodontitis was made.
Clinical Procedures and Outcomes: The patient underwent initial periodontal therapy. An improvement was observed inperiodontal conditions at reevaluation. A series of ﬂap operation were performed on #16, 17 and #25, 26 and #31, 32, 33and#41, 43. Root separation was performed on #16 of distal. Following reevaluation, oral function was restored using a ﬁxed
bridge prosthesis and removable partial denture. Then the patient was placed on supportive periodontal therapy.
Conclusion: In the present case of chronic periodontitis with furcation involvement, surgical interventions resulted in stable
periodontal condition that facilitated favorable level of plaque control.

JSP/JACP Poster Session AAP2018

22

R-07

Effect of orthodontic treatment for periodontitis with anterior crowding
Natsuki Okushi＊
Heart Smile Dental Clinic

Background: Malocclusion is an exacerbating factor in periodontal disease. Toothbrushing on the lingual side tends to beineffective, and the bone and gingiva on the labial side become thickened, without symptoms on the surface. According to
Wennstrom, the gingival width and height maintain a ratio of 1: 1.5, so that a tooth with linguoversion has a high gingivalline, giving rise to aesthetic dissatisfaction. I present a case of a patient with chronic periodontitis and anterior crowding inwhich the periodontal condition and aesthetics were improved by periodontal and orthodontic treatment.
Case: A 34-year-old female presented with aesthetic dissatisfaction with the maxillary anterior teeth. Periodontal
examination revealed swelling and 4-mm pockets in the gingiva of the upper and lower anterior teeth and the upper rightmolar. Minor alveolar bone resorption and poor ﬁt of a prosthetic appliance were observed on X-ray.
Clinical Procedures and Outcomes: After initial periodontal therapy and oral hygiene instruction, the anterior crowding was
improved by orthodontic treatment. The occlusion was checked and a prosthetic appliance with well-ﬁtting margins wasinserted.
Conclusion: The orthodontic treatment made toothbrushing easier, and gingival swelling and bleeding on probing improved.
Aesthetics improved as the gingiva of the lateral incisors moved labially and acquired normal thickness and height.
Orthodontic treatment for chronic periodontitis with malocclusion is effective in improving periodontal disease, and can
assist in ensuring prosthetic appliances are in harmony with the periodontal tissue, thus achieving a more stable prognosis.

R-08

Periodontal regeneration therapy for moderate chronic periodontitis with horizontal bony
defect: a case report
Takao Kannari＊Aozora Dental Ofﬁce

Background: This case report describes improvement of the horizontal bony defect by periodontal regeneration therapy for apatient with moderate chronic periodontitis. Implants and removable partial denture were used for partially edentulous toachieve occlusal support.
Case: This 57-year-female with moderate chronic periodontitis underwent periodontal regeneration therapy after initial
preparation for periodontitis. Enamel matrix derivative（EMD）, bone graft material（Bio-oss®）, and a resorbable collagenmembrane（Bio-gide®）were used to the mesial of #34 with horizontal bony defect. The guided bone regeneration（GBR）
was performed simultaneously for partially edentulous from #35 to #37. Implants were placed after 6 months, and freegingival graft was performed with the secondary surgery.
Clinical Procedures and Outcomes: After 7 years the surgery, clinical evaluation and intraoral radiograph revealed
improvement of horizontal bony defect at the #34, which had undergone periodontal regeneration therapy. And free gingival
graft were performed due to insufﬁcient keratinized mucosa to ensure adequate oral hygiene, no peri-implant inﬂammation
was observed and plaque control remains favorable.
Conclusion: Combination therapy with EMD and bone graft material and membrane would seem to be effective of intrabony
defect with unfavorable architecture. Considering the anatomical differences between the implant and natural teeth, thekeratinized mucosa around implants is necessary. Proper initial treatment and regular maintenance for the patients withperiodontitis are essential prior to implantation.

JSP/JACP Poster Session AAP2018

23

R-09

A case of multiple anterior tooth defects treated using a computer simulation-based guidancesystem
Chujo Kitamura＊1, Mitsuhiro Iwata2, Koichiro Fujibayashi3, Hiroyuki Takino4
1

Kitamura Dental Clinic, 2Sakura Dental Clinic, 3Fujibayashi Dental Clinic, 4Takino Dental Clinic

Background: With the advent of cone beam computed tomography（CBCT）and other diagnostic software, highly accurate
dental implantation and surgical treatment plans are now possible in the field of prosthetic dentistry. We report ourexperience related to the use of a computerized guidance system.
Case presentation: A 56-year-old woman presented with a chief complaint of maxillary anterior ﬁxed partial denture loss.
Positions #11, #12, #23 and #37 could not be preserved due to dental root fracture. The maxillary anterior alveolar ridge
exhibited deﬁcient hard and soft tissues.
Treatment protocol: 1）Initial periodontal therapy, 2）Secondary assessment, 3）Implantation plan development using
software, 4）Guided bone regeneration（GBR）, 5）Implantation using guidance system, 6）Secondary surgery, 7）
Occlusion by temporary prosthetic device/modiﬁcation of crown shape, 8）Delivery of ﬁnal prosthetic device, 9）Tertiary
reassessment, and 10）Maintenance.
Treatment course: After the initial therapy, GBR was performed using a titanium frame, a bone filling agent, and anabsorbable membrane. Implantation/GBR was then performed using the computerized guidance system. Following
secondary surgery by punch-out, the occlusion/crown veriﬁcation was assessed using temporary prostheses. Subsequently,
the ﬁnal prostheses were delivered.
Conclusion: In this case, precise implantation of multiple anterior tooth defects was possible with the help of a treatment
plan to predict ﬁnal prosthetic device conﬁguration, using a computerized guidance system. GBR using a titanium frame
prior to implantation enabled three-dimensional hard tissue reconstruction, and satisfactory results were obtained in terms ofboth functionality and aesthetics.

R-10

Treatment of gingival fenestration with connective tissue graft
Daichi Kita＊1, Takashi Kinumatsu2, Yoshihito Ishii3, Shigeko Yamamoto4, Atsushi Saito1, 5
1Department of Periodontology, Tokyo Dental College, 2Kinumatsu Dental Clinic, 3Mizuno Dental Clinic,
4
Yamamoto Dental Clinic, 5Oral Health Science Center, Tokyo Dental College

Background: Gingival fenestration is deﬁned as the exposure of tooth surface due to loss of the overlying bone and gingiva.
Although information on gingival fenestration is limited, techniques for its treatment such as a connective tissue graft（CTG）, various ﬂap designs, guided tissue regeneration, and orthodontic treatment have been reported. We report localized
chronic periodontitis with gingival fenestration requiring surgical treatment with a CTG.
Case: The patient was a 32-year-old man presenting with the chief complaint of esthetic impairment and gingival twitching
due to gingival fenestration. At baseline, periodontal examination revealed 3％ of sites with a probing depth of ≥ 4 mm and
8.9％ with bleeding on probing. Radiographic examination revealed vertical bone loss in #15 and 36, together with buccal
fenestration in the lower right central incisor（#41）. Baseline examination revealed localized periodontal breakdown,
including gingival fenestration in #41.
Clinical Procedures and Outcomes: Initial periodontal therapy comprised plaque control and scaling and root planing.
Following suppression of inflammation, occlusal adjustment was performed in the anterior teeth. As periodontal plastic
surgery, combined use of an elevated ﬂap and a CTG was applied at #41. Following reevaluation, the patient was placed on
maintenance care.
Conclusion: In the present case of localized chronic periodontitis with gingival fenestration, initial periodontal therapy andsurgical treatment with a CTG resulted in the improvement of the patientʼs periodontal condition. It has remained stable overa 1.5-year period.

JSP/JACP Poster Session AAP2018

24

R-11

A case of regenerative therapy for a true combined endodontic-periodontal lesion
Kazuaki Shinoda＊
Ohana Dental Clinic

Background and objective: Dental pulp and periodontal tissue often determine the fate of teeth, and a disease involving both
can pose a signiﬁcant challenge. Such combined endodontic-periodontal lesions involve difﬁcult decision-making regarding
treatment and operative methods.
Materials and Methods: A 51-year-old male presented with a chief complaint of lower-left swelling and pain. There was aperiodontal pocket（11 mm）reaching the distal root apex of the lower-left ﬁrst molar with bleeding and pus discharge.
Regenerative therapy was conducted using enamel matrix derivative, xenograft（Bio-oss®）, and cytoplast membrane after
the endodontic treatment.
Results: Two months after the endodontic treatment, regenerative periodontal therapy was using a microscope. Follow-up
examinations continued for ten months postoperatively. The ﬁnal prosthesis was inserted after healing periodontal tissue
Conclusion: With appropriate materials, diagnostic techniques, and operative methods, regenerative therapy may improveoutcomes for endodontic-periodontial lesions that were previously difﬁcult to treat.

R-12

Regenerative Surgery of severe periodontal defects Using ﬁbroblast growth factor（FGF-2）.
case report
Taishi Hirose＊, Makiko Hirose, Takahiro Shiomi, Tetsushi Hirose
Yokohama Kannai perio-Implant Institute（Yuraku Dental Ofﬁce）

Background and objective: We report regenerative procedure for severe periodontal defects with ﬁbroblast growth factor（FGF-2）
Materials and Methods: A 50-years old female complained of severe pain of gum on the posterior tooth. The patient is inexcellent health and reports no history of any systemic disease or any problem, which would preclude dental treatment.
Tooth #1, #16, #17, #32 are missing due to the treatment from in the past.
Upon perio-examination of the patient, we formulated a diagnosis of generalized severe periodontitis. Pocket depth ranging
from 3 to 12 mm with some gingival recession. Radiographically, we observed severe horizontal and vertical bone loss
around posterior tooth. After obtaining informed consent and phase 1 therapy, we began a regimen of regenerative treatment
with fibroblast growth factor. Prior to the regenerative treatment, subtraction X-ray were taken and mobile tooth were
splinted.
Results: Pocket depth ranging from 2 to 4 mm with a few gingival recession. Some clinical attachment gain found most of
defective sites.
Conclusion: Regenerative therapy with FGF-2 might be an effective treatment for severe periodontal defects.

JSP/JACP Poster Session AAP2018

25

R-13

A case of regenerative therapy supported by occlusal stabilization
Takeshi Ajioka＊
Ajioka Dental Clinic

Background: It is essential to establish a vertical stop at the molars for occlusal stabilization of the whole jaw.
Here we report a case of attempted occlusal stabilization in a patient with molar furcation involvement. The periodontal
tissue of the molars was stabilized through regenerative therapy using Emdogain.
Case: The patient was a 66-year-old non-smoking female. She was ﬁrst examined in July 2015, presenting with pain in thefront teeth. Class 2 furcation involvement was present in 26 and 46.
The patient was diagnosed with chronic periodontitis.
Treatment and result: Initially, non-surgical therapy was conducted. At the same time, a poorly fitting prosthesis wasremoved, and a provisional restoration was placed. Regenerative therapy was conducted using Emdogain on 26 and 46 withresidual furcation involvement. Follow-up examination was conducted after placement of the provisional restoration. We
proceeded to place the final restoration as no issues were observed during follow-up. Approximately one year
postoperatively, the patientʼs progress was favorable.
Conclusion: For patients with chronic periodontal disease, occlusal stabilization in the jaw with regenerative therapy iseffective for long-term intraoral stabilization.

R-14

Periodontal regeneration using Fibroblast Growth Factor-2 with Minimally Invasive SurgicalTechnique
Kotaro Tsuchida＊
Tsuchida Dental Ofﬁce

Background and objective: The procedures using Enamel matrix derivative with Minimally Invasive Surgical Technique（MIST）for deep intrabony defect have shown good results. These case series were evaluated using Fibroblast Growth
Factor-2（FGF-2）with MIST.
Materials and Methods: 10 intrabony defects in 5 periodontal patients were treated. The sites had a probing depth（PD）≧
8mm and intrabony component depth ≧5mm. MIST approach was utilized for surgical access. Following surgicaldebridement using microscope, FGF-2（Regroth®）was placed into the intrabony defect. After 6 months, the surgical sites
were reevaluated. The effect of therapy was evaluated by assessing Probing Depths（PD）, Clinical Attachment Level（CAL）, and radiographic bone ﬁll.
Results: The mean PD reduction amounted to 6.3mm. Mean gain CAL was 5.3mm. Radiographic bone ﬁll was observed
after 6 months, suggesting possible periodontal regeneration.
Conclusion: Short-term results from these case series indicate the use of FGF-2 with MIST resulted in a favorable outcomein the treatment of deep intrabony defect.

JSP/JACP Poster Session AAP2018

26

R-15

A case of severe periodontitis utilizing interdisciplinary approachKeiichiro Takahashi＊
Takahashi Dental Clinic

Objective: In modern periodontal therapy, a variety of therapeutic options must be skillfully combined to achieve a stablelong-term prognosis. We report a case in which we achieved an excellent long-term effect through a strategic combinationof implant, orthodontic, and periodontal regenerative therapies.
Case report: The patient was a 45-year-old woman who required full-mouth periodontal and occlusal therapies. Occlusal
reconstruction was achieved with orthodontic therapy in conjunction with implant therapy. Improvement in the anterior
dental region was achieved through whole-mouth periodontal-prosthetic therapy, using periodontal regenerative techniques.
We also report her condition 5 years after treatment.
Therapy and results: After the initial whole-mouth periodontal therapy was performed, the patient underwent orthodontic
therapy using a temporary anchorage device. In the molar region, an implant was inserted after performing a sinus lift withextensive guided bone regeneration. Provisional restoration in the anterior region was achieved with periodontal regenerative
therapy using Emdogain, which stabilized the periodontal tissue and bite. Eventually, the patient transitioned to a periodontal
prosthesis.
Conclusion: We used a strategic combination of orthodontic, implant, periodontal regenerative, and prosthetic therapies in acase of periodontitis and occlusal collapse, accompanied by severe bone defects. This technique achieved improvement anda positive prognosis. The effectiveness of a interdisciplinary approach is evidenced by the stability of the patientʼs condition
post-treatment even after 5 years.

R-16

Periodontal regenerative therapy and orthodontic treatment for generalized aggressive
periodontitis: a case report
Takayuki Kurihara＊
Kinen Dental Clinic

Background: Aggressive periodontitis occurs in people from their teens to their 30s. In Japan, one out of every 1,000 to
2,000 people suffers from this disease. Although generally healthy except for their periodontitis, rapid periodontal tissue
destruction can be observed. In most cases, once the patient perceives the symptoms, the periodontal disease has alreadysigniﬁcantly progressed.
Case: Initial visit: May, 2013 Age: 32 Sex: Male Chief complaint: Right lower jaw hurts due to swelling.
Past medical history: N/A Family medical history: Aggressive periodontitis was suspected in his grandmother
Smoking history: 20 cigarettes per day for 14 years
Clinical Procedures and Outcomes: Initial periodontal treatment from June, 2013 to December, 2014
The patient suffered from low motivation, and his oral condition necessitated surgical periodontal therapy. However, as asmoker, the prognosis was not likely to be positive, even with surgery. While conducting the initial periodontal therapy,
efforts were made to motivate the patient. After 18 months, he reduced his cigarette consumption to 5 cigarettes per day.
After the patient's oral condition and gum inflammation improved, and after he requested, we transitioned to surgicalperiodontal therapy.
Conclusion: Currently, orthodontic treatment and prosthodontic treatment have ﬁnished, but some periodontal pockets still
remain. Because smoking is related to the impaired tissue healing, it is suggested that we should continue supportive
periodontal therapy with caution.

JSP/JACP Poster Session AAP2018

27

R-17

A case of autotransplantation 30 years after transplantation
Hiroyuki Kimura＊1, Taro Eida1, Tsuyoshi Kumano1, Makoto Yokota2
1

Kimura Dental Clinic, 2Yokota Jyuku

Background: Recently, autogenous tooth transplantation has received renewed recognition as a predictable procedure forrestoring tooth defects. Here, we report a case of autogenous tooth transplantation that was successful for 30 years.
Case: The patient was a 24-year-old female. On March 29, 1989, she presented for treatment of decay in 37. She had noremarkable medical history and was a non-smoker. Intraoral ﬁndings revealed that 37 showed residual root conditions and38 was semi-impacted. X-ray examination revealed horizontal contact between 38 and 37.
Clinical Procedures and Outcomes: Tooth 37 was diagnosed as periodontally hopeless. We obtained informed consent toperform transplantation. After extracting 37, we successfully transplanted 38 into the 37 site. We then performed root canaltreatment on July 25. After confirming stability of the periodontal tissue, we placed a prosthesis on October 16. Posttransplantation went well and the patient had no complaints. After transplantation, bone condition was good; noabnormalities were observed in X-ray ﬁndings. The patient was shifted to maintenance. Even after treatment for 30 years,
probing pocket depth on transplanted teeth was 3 mm, with no discomfort. Periotest values were 0-5. 3DCT indicated noroot resorption or other abnormal ﬁndings.
Conclusion: In this case, autologous tooth transplantation was performed after tooth extraction; it has been clinically
successful for 30 years. This case showed high predictability, even in molar teeth that experienced strong biting force. As
saving the periodontium helps to maintain natural tooth function, this case suggested that we should consider transplantation
before extraction.

R-18

Use of orthodontic and periodontal therapy to a moderate periodontitis
Shinichi Saika＊
Saika Dental Clinic

Background and objective: Patients suffered by moderate and/or more progressed periodontitis often have pathological toothmigration. For those cases, Orthodontic therapy can contribute to allocate occlusal forces uniformly by recovering the dentalarch continuity and correcting teeth axes so that it enables to recover the masticatory function, stabilize the dentition and to
improve the oral cleansability.
Case: Patient: 61-year old female First visit: June 20th. 2015
Chief complaint: anxious for anterior tooth to fall out
Medical history: Nothing ParticularDiagnosis: Generalized moderate chronic periodontitis
Clinical Procedures and Outcomes: 1）periodontal initial therapy 2）re-evaluation 3）periodontal surgery（ tissue
attachment therapy） 4）re-evaluation 5）orthodontic therapy 6）re-evaluation 7）maintenance. Periodontal surgeryof tissue attachment therapy was performed for the site with deeper periodontal pocket than 4mm after conﬁrming BOP
positive and improvement of PCR following periodontal initial therapy. Orthodontic therapy improved malalignment andcorrected teeth axes. Re-evaluation revealed the satisfactory result of improvement in periodontal tissue and esthetic
recovery.
Conclusion: Tooth malalignment causes poor plaque control and leads to the inﬂammation. In addition, inclined teeth axes,
mal-positioned teeth with abnormal lateral forces and traumatic occlusion are harmful to periodontal tissue.
That may increase the risk of periodontal disease and difﬁculty in treatment.
It suggests that including Orthodontic therapy into periodontal treatment contributes to 1）eliminate the damage toperiodontal tissue, 2）accelerate remodeling of periodontal tissue, and the prognosis with long-term stability by decreasing
the difﬁculty and increasing the efﬁcacy of the treatment.

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R-19

Regenerative therapy and dental implants for severe periodontitis: a case report
Hiroshi Okuda＊
Okuda Dental Clinic perio-implant center

Background: In order to maintain long-term stability following treatment for a vertical bone defect or furcation involvement,
it is important to minimize the depth of periodontal pockets and to regulate the bone and gingival levels of natural andrestored teeth. This will create an environment that is easy to maintain.
Case: Patient: 58-year-old woman
Initial examination: April 2009
Chief complaint: Discomfort in the lower left tooth region
Systemic disease: Nothing of note
Treatment: Regenerative periodontal therapy was conducted to improve residual periodontal pockets following initialperiodontal treatment. Regarding Class II furcation involvement on #17 and #27, although postoperative assessment
conﬁrmed bone regeneration, deﬁnitive surgery was performed to improve the residual periodontal pockets. The
mandibular molars were extracted and guided bone regeneration was performed.
Results: For the maxillary molars, sufﬁcient keratinized gingiva and a shallow gingival sulcus were obtained. As for themandibular molar region, the bone level was successfully matched to the height of the adjacent teeth using guided boneregeneration.
The treatment was successful in matching the bone and gingival levels between natural teeth and implants as well as increating an environment that is easy to maintain.
Conclusion: The patient has good plaque control and has been coming in every 3 months for maintenance. 5 years postoperation, favorable results have been maintained. Maintenance will be continued in the future.

R-20

Five-year follow up of periodontal-guided tissue regeneration for vertical bone loss
Seiji Ozaki＊
Ozaki Dental Clinic

Background and objective: Initial examination: 53-years old male（Februarry 2013）
Chief complaints: swelling, pain, and mobility（#41）
Symptom: Overall redness and swelling of gums
Findings: Bop（+）,P.D: 3mm or less54.8％,4~5mm22.1％,6mm or more23.1％ , vertical bone loss（#36 and 45）andpremature contact（#27 and36）
Diagnosis: Generalized moderate chronic periodontitis. Occlusal trauma
Therapeutic policy: 1）initial preparation, 2）re-evaluation, 3）periodontal surgery, 4）re-evaluation, 5）oral function
recovery, and 6）SPT
Therapeutic goal: 1）periodontal tissue stabilization, 2）establishment of bilateral molar occlusal support, and 3）anterior
guidance
Clinical Procedure: 1）initial preparation, 2）re-evaluation, 3）periodontal-guided tissue regeneration（#36 and 45）, 4）
implant treatment（#46）, 5）oral function recovery, 6）re-evaluation, and 7）SPT［Results］Periodontal tissues became stable（#41）and the alveolar bone condition at the sites where periodontal-guided
tissue regeneration was performed for vertical bone loss（#36 and 45）was stable.
Conclusion: Based on the initial preparation, we improved the periodontal tissues, eliminated premature contact, andestablished bilateral molar occlusal support. This resulted in anterior guidance and allowed for the stabilization of allperiodontal tissues. Cleaning, occlusal examination/adjustment, and maintenance of the patientʼs motivation toward
homecare during SPT every four months were the most important factors in this case.

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R-21

Ridge augmentation using modiﬁed onlay-interpositional graft: a case report
Shu Hoshi＊1, 2, Tatsuya Akizuki2, Takanori Matsuura2, Yuichi Izumi2
1

Hoshi Dental Ofﬁce
Department of Periodontology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental
University

2

Background: Severe periodontitis leads to an extreme reduction of alveolar ridge volume, causing an esthetic and functional
disorders. To resolve these problems, ridge augmentation using modified onlay-interpositional graft was performed andgood clinical results are achieved.
Case: The patient was a 62-year-old man who suffered from severe chronic periodontitis. Alveolar bone resorption reached
the apical part of the right upper central incisor and lateral incisor. The patient had no systematic disease and no history ofsmoking.
Treatment and Results: Soft tissue ridge augmentation was planned to reconstruct the reduced alveolar ridge because thepatient did not want implant treatment. Three months after tooth extraction of the right upper central incisor and lateralincisor, soft tissue ridge augmentation using modiﬁed onlay-interpositional graft was performed. According to the methodof the original onlay-interpositional graft procedure reported by Seibert and Louis, the recipient site epithelium wasremoved on the labial side of the ridge to prepare the recipient bed for the graft segment. The method was modified topreserve the recipient site epithelium to keep the keratinized gingiva width and soft tissue volume. To increase the volume ofsoft tissue, additional connective tissue was harvested from the distal side of the right upper ﬁrst molar mucosa and grafted
into the recipient site. The anterior area was treated with a tooth supported ﬁxed prosthesis. The patient was followed up for
4 years, and the volume of reconstructed ridge was maintained.
Conclusion: The modiﬁed onlay-interpositional graft is an effective procedure to reconstruct the reduced alveolar ridge.
Moreover, the volume of the reconstructed soft tissue could be maintained for a long period of time.

R-22

Gingival Cul-de-sac: Complications Consequential to Root Coverage Procedures using a
Subepithelial Connective Tissue Graft
Makoto Ono＊
Shijo-Karasuma Perio Implant Center

Background: There have been reports of post-operative complications following root coverage treatment for gingival
recession（GR）using a subepithelial connective tissue graft（SCTG）. This case report chronicles the formation of agingival cul-de-sac caused by the creation of a pocket between the flap and graft, a complication which followed the
SCTG-based procedure.
CASE: The patient was male, a smoker, forty-eight years old, and complained of poor esthetics. There were multiple teeth
with GR in the upper anterior area.
Clinical Procedures and Outcomes: The GR was treated with a coronally advanced ﬂap using a SCTG and Enamel Matrix
Derivative. The graft was fully covered by the ﬂap after surgery. However, 2 weeks after the operation, a white, creamy
discharge was observed, indicating that a gingival cul-de-sac had formed. Twenty months after the operation, the separationof the ﬂap and the graft had become obvious, and the discharge was still observed. To excise the cul-de-sac, the outer layerof gingiva was carefully removed. The grafted tissue remained on the denudated root surface and it matured to aconspicuous, unaesthetic appearance.
Conclusion: In cases where SCTG is used in root coverage, a gingival cul-de-sac may occur, even if the graft is fully
covered by the flap. In this case, the cul-de-sac failed to heal naturally over the 20-month period of observation. By
removing the outer layer of the cul-de-sac, the tissue of the graft remained, covering the root surface.

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R-23

Root coverage for multiple recession of natural teeth
Ryuichi Shirane＊
Shirane Dental Clinic

Background and objective: Gingival recession is a common periodontal problem which clinicians are confronted with.
Although root coverage is one of the most valid procedures for gingival recession, the clinical outcome is cruciallyinﬂuenced by technical and site-speciﬁc factors. On this poster, I would like to present you my clinical case of root coveragefor deep and multiple gingival recessions.
Materials and Methods: The patient was 68 years old male. He noticed the change of his gingival margin with age.
Gingival recessions on maxilla and mandibular canine area became advanced near mucogingival junction. There were slight
malalignment on maxilla left anterior teeth, but no attachment loss around gingival recession. Gingival bio-type of thispatient was thick-ﬂat.
After initial treatment, root coverage procedures using coronally advanced ﬂap（CAF）with subepithelium connective tissue
graft（SCTG）were applied three times to #33,34 in August 2016, #23,24 in January 2017 and #12,13 in September 2017.
Tunnel procedure was applied under a surgical microscope.
Results: After three surgeries, the patient did not have any complaint, and SCTG did not undergo necrosis.
90％ of root coverage was obtained using Langer& Langer technique for #33,34.
Tunnel technique for #23, 13 achieved complete coverage, while the same procedure for #23,24 leaded to approximately 60％ root coverage because of teeth malposition.
Conclusion: Root coverage for gingival recession is quite beneﬁcial method from aesthetic and functional point of view.
Meanwhile, the selection of the procedure requires rigorous examination of each case. Therefore, it is essential to consider
accumulated previous evidence and apply careful procedure in order to achieve successful result.

R-24

A case report of class II furcation involvement in the mandibular molar with generalized
advanced chronic periodontitis utilized periodontal regenerative therapy
Misa Satomi＊1, Masahiko Nikaido2
1

Paciﬁc Century Place Marunouchi Dental Clinic, Satomi Dental Clinic, 2Nikaido Dental Ofﬁce

Background: We report a case of a patient with class II furcation involvement of #36 utilized periodontal regenerative, mineralized freeze-dried bone allografts
therapy; growth factor（platelet-derived growth factor: rh-PDGF-BB; GEM21s®）（FDBA）, and absorbable collagen membrane（Bio-Gide®）. Before the treatment, informed consent was obtained from thepatient after explaining the use of unapproved drugs and materials.
Case: A 57-year-old man had the chief complaints of mobility and pain on mastication with #45. His medical history
revealed unremarkable, but he had smoked 20 cigarettes a day for 35 years. Poor plaque control（PC）, gingival enlargement
and redness, supra and subgingival calculus were observed throughout the whole mouth with plaque control record（PCR）
of 100％, bleeding on probing（BOP）of 100％, and average probing pocket depth（PPD）of 4.2 mm. Radiographicalﬁnding revealed that vertical bone resorption and radiolucency in the furcation of the molars were observed for many teeth.
The mesial PPD and lingual midsection PPD of #36 were 6 and 5 mm, respectively, #36 had no mobility and class II
furcation involvement on the lingual side.
Treatment: 1. Initial preparation（oral hygiene instruction（OHI）, scaling/root planing（Sc/Rp）, smoke cessation training,
extraction）
2. Re-evaluation
3. Implant placement（#45-46）
4. Surgical periodontal treatment（#15, #24: rh-PDGF-BB+FDBA, #35-36: rh-PDGF-BB+FDBA+Bio-Gide®）
5. Re-evaluation
6. Prosthodontics
7. SPT.
Conclusions: #36 with class Ⅱ furcation involvement was closed by rh-PDGF-BB, FDBA and Bio-Gide®. #36 was stable
at the post-SPT 6-month follow-up, we will continue to provide SPT to maintain his dentition and implants.

JSP/JACP Poster Session AAP2018

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R-25

Dispersion of occlusal support area in periodontal therapy: A Case Report
Nobuhiko Inagaki＊
Midorigaoka Dental Clinic

Background and objective: Excessive occlusal force has been known as the factor enhancing the degree of periodontal
destruction of periodontally compromised tooth. Occlusal adjustment as a part of periodontal therapy has been controversial
for years. The purpose of this case report is to demonstrate the effects of occlusal adjustment, associated with periodontal
therapy, on periodontal parameters.
Materials and Methods: A 60-year-old female patient presented with discomfort of #24 and 46. #17 has been extracted 7-8
years ago due to poor prognosis. Class III furcation involvement, mobility class II as well as vertical bone loss wereobserved on multiple teeth. Patient was diagnosed as localized chronic moderate periodontitis.
Results: Following initial therapy, #26 was removed due to poor prognosis, but #27 was preserved and well functioned. The
periodontal regeneration, using Enamel Matrix Derivative（EMD）has been applied to vertical bone loss on the mesial of#36 as well as the root separation was performed for the furcation involvement of #46. #48 was transplanted to maxillary
right partial edentulous area and #35 and 45 were moved orthodontically for occlusal force distribution. A significant
improvement of periodontal condition was achieved after therapy.
Conclusion: This case demonstrated the signiﬁcance of periodontal treatment in conjunction with occlusal adjustment to
reduce the progression of periodontal attachment loss. A success to key to treat chronic periodontitis involved occlusal
trauma, especially for patients with multiple missing teeth was to adjust occlusion to increase the number of tooth supporting
occlusion following inﬂammation control.

R-26

Periodontal treatment in localized severe chronic periodontitis: A Case Report
Dai Kawanabe＊
Kawanabe Dental Clinic

Background and objective: The reaction of periodontal tissue to treatment is strongly impacted by the age of the patient andother modifying factors. In the present case, we actively treated a patient who presented with conditions that appearedadvantageous for the performance of periodontal treatment. A significant improvement in the patientʼs condition wasachieved.
Materials and Methods: The patient was a 41-year old woman who complained of discomfort in #13 and #32. Class II
furcation involvement in #17 and #27, and vertical bone loss in #12, #13, #24, and #32 were conﬁrmed through radiographic
examination. There was +2 mobility in #32, and +1 mobility in #13, #14, #17, #23, and #26. Based on the examination, thepatient was diagnosed with localized severe chronic periodontitis.
Results: Reevaluation following the initial treatment led to the extraction of #48.
We performed periodontal tissue regenerative therapy using enamel matrix derivative（EMD）on #12, #13, and #32, which
presented with vertical bone loss. We performed trisection of the furcation involvement in #17 and #27. After treatment, asigniﬁcant improvement in the periodontal condition was observed.
Conclusion: This case veriﬁes the importance of periodontal treatment. Factors that indicate a good response to periodontal
treatment and surgery include young age of the patient, a high level of plaque control, and absence of risk factors such as
smoking.
It is important to carefully examine treatment selection, such as periodontal surgery, considering the patientʼs background in
addition to reevaluation.

JSP/JACP Poster Session AAP2018

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R-27

Effective Management of Periodontal and Peri-implant problems With Er: YAG Laser

Taichen Lin＊1,2,3, Cheng-Chia Yu2,4, Yoichi Taniguchi1,5, Paul Pao-Ying Lin6, Chen-Ying Wang7,
Akira Aoki1, Chun-Cheng Chen2,3
1

Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental
University（TMDU）, Tokyo, Japan, 2School of Dentistry, Chung Shan Medical University, Taichung, Taiwan,
3
Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan, 4Institute of Oral Science,
Chung Shan Medical University, Taichung, Taiwan, 5Taniguchi Dental Clinic, Sapporo, Japan, 6Professors Dental
Clinic, Taipei, Taiwan, 7Department of Periodontology, National Taiwan University Hospital, Taipei, Taiwan
Background and Objective: The Er: YAG laser（ErL: 2,940 nm）is very useful for dental treatment such as soft and hardtissues management as well as dental implant surface debridement. Three patients with different clinical problems were includedin this report, and ErL was applied under various conditions, including ﬂapless esthetic crown lengthening, implant placementwith simultaneous guided bone regeneration, and socket preservation accompanied with implant surface debridement.
Materials and Methods: The ﬁrst patient had an unhormonious gingival contour in the anterior maxillary zone, and ErL wasused to perform gingivectomy as well as ﬂapless bone contouring. The second patient had missing teeth at #36 and #37 sites
with severe bony defects. After bone grafting around the embedded two implants, non-contact ErL irradiation was
performed to induce blood coagulation on the surface and maintain the bone graft. The third patient had a severe bony defectat a missing #26 tooth site and peri-implantitis on the mesial side of #27 implant, and the bony defect and implant surface
were carefully debrided by ErL. Then, the defect was ﬁlled with bone graft and covered with a resorbable membrane forsocket preservation.
Results: Following ErL therapy, the ﬁrst patient obtained a harmonious and esthetic anterior cervical line of teeth, and theother two patients exhibited favorable bone regeneration in the treated bone defects.
Conclusion: Results of the current report suggested that ErL therapy is beneﬁcial and effective in periodontal and periimplantal managemant, leading to a favorable wound healing as well as successful outcomes.
R-28

Treatment in collaboration with otolaryngologist to elevate sinus ﬂoor and implant installation
Akihiro Ishikawa＊
Den-en-chofu Perio-Implant Center, Ishikawa Dental Clinic

Background: A collaboration treatment with an otolaryngologist may be necessary when installing maxillary molar implants
for a patient who has acute or chronic inﬂammation in her maxillary sinus. In this case, the patient who had developed dental
maxillary sinusitis was treated by an otolaryngologist who performed Endoscopic Sinus Surgery（ESS）on the natural
ostium（antrostomy）.
Case: The patient was a 56-year-old female. She presented with # 26 pain and left cheek swelling. Opacity was found in her
maxillary sinus and ethmoid sinus in a CT scan, and the natural ostium was closed. In addition, a paradoxically bent middle
turbinate was recognized. Considering the need for an otolaryngologist, the patient was sent to a specialist. It wasdetermined that the patient needed an antrostomy with ESS.
Clinical Procedures and Outcomes: Septoplasty was performed by ESS under general anesthesia. The natural ostium on theleft side was enlarged. Subsequently, # 26 tooth was pulled out. The maxillary sinus became a normal mucosal. Since # 26
had an insufﬁcient vertical bone, a sinus ﬂoor elevation was performed. The implant was installed after conﬁrming that there
were no problems in the patientʼs CT scan 6 months later.
Conclusion: When attempting to install implants in the maxillary posterior molar region, maxillary sinusitis may be present.
With the closure of the natural ostium, dental treatment alone will not result in a cure. Therefore, it is possible to carry out
implant treatment safely after restoring the maxillary sinus to a normal state through collaboration with an otolaryngologist.

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R-29

Effect of non-surgical periodontal therapy assisted by periodontal endoscope. Report of cases
Masahiko Nikaido＊
Nikaido Dental Ofﬁce

Background and objective: Although there have been numerous articles have been published regarding periodontal nonsurgical therapy, how quality of the therapy impacts outcome of treatment has not been well documented and discussed.
Recently, periodontal endoscope has been introduced and it allows us to meticulously debride a root surface with direct
visualization. We report of cases utilized this new device.
Case: Case 1: A 30-year-old female patient who were diagnosed generalized aggressive periodontitis. Case 2: A 48-yearold female patient, who were diagnosed generalized advanced chronic periodontitis.
Clinical Procedures and Outcomes: After conventional scaling/ root planing, residual periodontal pockets in anterior region
were non-surgically re-treated assisted by periodontal endoscope（Perioscolpy™）. We usually spent 20 to 30 minutes foreach tooth. Re-evaluations were conducted 9 months after initial scaling root planning and 3 months after re-scaling androot planning assisted by periodontal endoscope. Periodontal probing depths were signiﬁcantly reduced from 10mm to 4mm
in case 1 and 12mm to 5mm in case 2. Both periodontal pocket did not show BOP（bleeding on probing）. In radiographic
examination, bone regeneration was observed.
Conclusion: We have conﬁrmed signiﬁcant improvement of patientsʼ periodontal conditions after meticulous re-scaling androot planing assisted by periodontal endoscope In the coming super aged society, efficacy of non-surgical periodontal
therapy has to be re-examined and re-evaluated.

R-30

Teeth auto-transplantation utilizing enamel matrix derivative and bone graft. A case report
Mitsuharu Inoko＊
Inoko Dental Clinic

Background and objective: Teeth auto-transplantation is one of the treatment options to replace missing teeth. However, it
has been considered that enough amount of bone at the recipient site is prerequisite and it limits the application of thistherapy. In this case report, by utilized enamel matrix derivative（EMD）and bone graft, we were able to achieve teeth
auto-transplantation for a case which did not have sufﬁcient bone at the recipient site and maintain for a long term.
Materials and Methods: #11, 21 were extracted due to root fractures and labial plate was already missing. #12 and #22 wereauto-transplanted into the extracted site and reconstruction with EMD, bone graft and collagen membrane were performed
simultaneously.
Results: We have been observed this case for 14 years and auto-transplanted teeth are still functioning well without majorcomplications such as ankylosis. In a recent radiographic examination, periodontal ligament and alveolar bone around twoteeth were observed, suggested long term stable condition of this case.
Conclusion:
Generally, sufﬁcient bone in the recipient site is prerequisite for a teeth auto-transplantation. However, by utilizing biologics
and bone grafts, this therapy could be applied for a case with insufﬁcient bone at the recipient site.

JSP/JACP Poster Session AAP2018

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R-31

Occlusal reconstruction for a patient with advanced periodontal disease. A case report
Takeshi Kamiyama＊
Kamiyama Dental Clinic

Background and objective: In a treatment of advanced periodontal disease, occlusal discrepancies are common problem,
which is associated with the progression of this disease and oral reconstruction is often required. We report a case which we
accomplished comprehensive periodontal therapy and occlusal reconstruction for a patient with chronic advanced
periodontitis.
Materials and Methods: A 64-year-old female patient presented with chief complaints of pain on mastication and esthetic
problem of upper anteriors. Periodontal examination revealed deep intrabony pockets in molars and multiple hyper teeth
mobility. Pathologic teeth migration was noted for upper anteriors. The patient also showed loss of vertical dimension due tosevere teeth wear.
Results: After initial preparation, metal reinforced provisional crowns were utilized to increase vertical dimension and toachieve occlusal stability. Then periodontal regenerative therapies with enamel matrix derivative and bone graft wereapplied to eliminate deep intrabony defects. Upper anteriors were corrected with localized orthodontic therapy（LOT）andﬁnal protheses were placed. After active therapy, the patient has been placed in periodontal supportive therapy for 5 years
without major complications.
Conclusion: In the treatment of this patient, metal reinforced provisional crowns contributed not only to maintain her
occlusal dimension, but also to achieve optimal periodontal regeneration during an active therapy. We also succeeded to givethe patient anterior guidance and canine disclusion by LOT, followed by full mouth reconstruction. Together with esthetic
rehabilitation, whole treatment contributes to improve her quality of life. We continue to pay careful attention to obtain longterm stability.

JSP/JACP Poster Session AAP2018

Dental Hygiene

35

H-01

A Case Report: Importance of Initial Therapy for The Chronic Periodontitis
Masami Sato＊, Kazuyo Ikeda, Masahiko Ikeda
Ikeda Dental Clinic

Background: Normally, surgical treatment would be chosen as an option for the treatment of progressive chronic
periodontitis. However, we experienced an accepted outcome from the treatment, which only chosen initial therapy
expecting the individualʼs healing power on progressive periodontitis, had good time course of 15 years from the ﬁrst visit,
and, thus, report here.
Case: The patient was 40-years female with chronic periodontitis especially in the region of #45. Swelling, 5-9 mm probing
depth, 1.5 of tooth mobility, vertical bone absorption from dental x-ray, were recognized at the ﬁrst examination.
Clinical Procedures and Outcome: We hired the counseling technique tried gaining the motivation for the treatment from thepatient. The physical treatment was done with instruction of teeth brush and occlusal adjustment clarifying the concept ofhealthiness oral hygiene. Only toothbrush was used for the brushing avoiding hurting the gingiva. We carefully performed
scaling and root planing with the use of hand scaler. At the timing of 8 months later from the initial therapy, 2-4 mm probing
depth and a reduction of vertical bone absorption from dental x-ray, were recognized. The tooth was subjected theorthodontic and prosthodontic treatments after the root canal treatment. The patient moved into the recall course and kept theperiodontal condition good for 12 years.
Conclusion: In this case, we observed a signiﬁcant healing with the treatment, which contains non-invasive initial therapy to
the gingiva and dental root. It is suggestive that this method of initial therapy would be an effective option to chronic
periodontitis.

H-02

Microbiological testing for patients in supportive periodontal therapy
Michiko Ogata＊, Shimizu Hiroyasu
Shimizu Dental Clinic

Background and objective: The primary etiology of the periodontal disease is bacterial plaque. The periodontal pathogenic
bacteria greatly contribute to the progression of periodontal disease. This study reports the progression of periodontal disease
and the change of periodontal pathogenic bacteria of patients in supportive periodontal therapy utilizing the microbiologicaltesting.
Materials and Methods: Case#1 is a 50 years old, Asian male. The patient was diagnosed as localized severe chronic
periodontitis. Non-surgical therapy was performed, followed by orthodontic treatment for lower anterior teeth. Finally,
every 3-month supportive periodontal therapy was regularly done. Case#2 is a 53 years old, Asian female. The patient wasdiagnosed as localized severe chronic periodontitis. Non-surgical therapy was performed. After that, regenerative therapies
were applied to three sites where deep periodontal pockets remained. Finally, every 3-month supportive periodontal therapy
was regularly done. In these two cases, the microbiological testing was performed at the first examination and at the
supportive periodontal therapy.
Results: In these two cases, as a result of OHI, deﬁnitive treatment with the regenerative therapy and orthodontic treatment,
the periodontal condition was signiﬁcantly improved. The red complex（Pg, Tf, Td）of periodontal pathogenic bacteria
were observed at the first examination, but it decreased to the tolerance level at the supportive periodontal therapy. P.
intermedia of the orange complex was however increased.
Conclusion: As a result of deﬁnitive treatment with the regenerative therapy and orthodontic treatment, the red complex
decreased to the tolerance level because the periodontal attachment was gained and periodontal pocket became shallower.
But P. intermedia was increased in shallower periodontal pocket. The microbiological testing may help to make proper
supportive periodontal therapy planning and motivate a patient by comparing at the ﬁrst examination and at the supportive
periodontal therapy, because it can exhibit activity of periodontal disease.

JSP/JACP Poster Session AAP2018

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H-03

Orthodontic treatment of periodontal patients
Yuka Ogawa＊, Kotaro Tsuchida
Tsuchida dental ofﬁce

Background and objective: The pathologic tooth migration from periodontal disease may become the chief complaint of thepatients, from aesthetic point of view. The purpose of this study was to investigate the changes in periodontal health after
orthodontic treatment, especially Bleeding On Probing（BOP）, Probing Pocket Depth（PPD）, and the radiographic
analysis.
Materials and Methods: This study was conducted with 15 patients（43 to 75 years old）diagnosed with pathologic toothmigration. After the periodontal treatment people received orthodontic treatment. All patients were investigated the changesof BOP, PPD from initial visit to supportive periodontal therapy.
Results: Compared with the stage of basic periodontal treatment, BOP and PPD got better on the Supportive Periodontal
Therapy（SPT）following orthodontics.
Conclusion: For the patient who is affected by the pathologic tooth migration, the basic periodontal treatment is
indispensable to orthodontic treatment. In addition to the careful removal of infection, we dental hygienist shouldhave the patients recognize the importance of self-care during the orthodontic treatment and Supportive
Periodontal Therapy（SPT）.

H-04

10-year favorable non-surgical prognosis of Generalized Severe chronic periodontitis
Yuko Shimoda＊, Ryousuke Kondo, Rumi Fukamizu, Tetsuya Mizukami
Mizukami Dental Clinic

Background and objective: Short-term, efﬁcient, less-invasive and non-surgical approach for the patients with progressed
periodontal disease is one of the challenges in periodontal therapy. We reported the case study that experienced a good
prognosis in the maintenance phase more than ten years with progressed periodontal disease patients that was treated withmedication of azithromycin before SRP.
Case: Patient: 52-year old female, First visit: July 20th. 2007 Chief complaint: Restoration dislodgement Medical history:
Asthma, non-smoker Diagnosis: Generalized moderate chronic periodontitis Examination and ﬁndings: #37 has chronic
suppurative apical periodontitis. Inﬂammation was observed in gingiva around teeth. Peri-apical radiographs showed boneabsorption. Initial PCR was 68％, PPD＞4mm was 59％, BOP was 100％. Bacteria test by PCR-Invader detected P.
gingivalis.
Clinical procedure and outcome: 1. Initial therapy: Oral hygiene instruction, Scaling, full mouth SRP under medication ofazithromycin and extraction of #37.
2. Re-evaluation
3. Oral function recovering therapy
4. Re-evaluation
5. Maintenance P.gingivalis was not detected after SRP. The value of PCR, PPD and BOP was dramatically improved at theend of treatment phase（PCR; 14％, PPD＞4mm; 0％, BOP; 0％）. Maintenance is performed every two months. Even after
10 years, the patient keeps good prognosis（PCR; 11.5％, PPD＞4mm; 0％ BOP; 0％）and periapical radiograph shows
regeneration of intrabony defect.
Conclusion: SRP with oral administration of azithromycin at the periodontal initial therapy improved periodontal parameters
remarkably in the short period. One-time full mouth disinfection with medication of azithromycin is effective and has
favorable prognosis.

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H-05

A case report of severe chronic periodontitis with an adult bronchial asthma
Eri Otsuka＊
Nadyapark dental clinic

Background and objective: This presentation is to report a positive effect brought about by a comprehensive treatment to a
generalized severe periodontitis with bronchial asthma.
Case: The patient was a 42-year-old male.The ﬁrst visit was in January 2015. The patient had an adult bronchial asthma andan acute hepatitis for medical history.The chief complaint was bleeding of the gum.Clinical examination at the ﬁrst visit
revealed 77％ of sites with a probing pocket depth（PPD）over 4mm and 64％ of sites with bleeding on probing（BOP）.
Plaque control record（PCR）was 68.3％.There were class Ⅱ mobility in #37/#18 and furcation involvement in #16/#2,#1
7/#3,#26/#14,#27/#15,#37/#18,#46/#30,#47/#31.On the X-ray, holizontal bone defect in the molar teeth and vertical born
defect in #12/#7 were observed.P.g., T.d., P.i. were detected in real-time polymerase chain reaction method.The patient wasdiagnosed with severe chronic periodontitis.
Clinical Procedures and Outcomes: Azithromycin and metronidazole were prescribed during the scaling and root planningfor 2weeks.The PPD, BOP and PCR were improved by initial preparation.After the second examination, the number of
periodontal pathogenic bacteria had desreased and supportive periodontal therapy was started.Although the patient had an
adult bronchial asthma from 2009, it was cured after the periodontal initial preparation.
Conclusion: Periodontal disease will relate to respiratory diseases such as pneumonia and asthma. So that, this case indicates
adult bronchial asthma could be relieved by periodontal treatment with antibiotics.

H-06

A Case Report: Effects of Applying Numerical Rating Scale in Treating Halitosis Associatedwith Advanced Periodontal Disease
Sayuri Kida＊1, Isao Ohashi1, Masahiko Nikaido2
1

Ohashi Dental Clinic, 2Nikaido Dental Ofﬁce

Background: Halitosis is one of the major symptoms associated with advanced periodontal disease. We applied Numerical
Rating Scale（NRS）in the treatment of halitosis and could successfully improve it.
Case: 55 year -old female patient visited in our ofﬁce with a chief complaint of halitosis. At the initial examination, she had
82％ of sites with ≧4mm probing pocket depth（PPD）, 91％ of sites with bleeding on probing（BOP）and a plaquecontrol record（PCR）was 89％, was diagnosed as advanced periodontal disease. Her halitosis score with NRS was 10.
Clinical Procedures and Outcomes: Initial preparation was performed for the patient and NRS was markedly improved（NRS
1）. After completion of her dental treatment, she has been placed in a monthly maintenance program for 8 years. In a recent
examination, all PPD are＜4 mm, no BOP and PCR was 6％.
Conclusion: NRS is a unidimensional measure of intensity. A respondent selects whole number（0-10）that best reﬂects theintensity of their feeling. In this case, she was extremely concerned about halitosis at her initial visit, since it impaired theinterpersonal relationship, but as a result of initial preparation, halitosis became almost unnoticeable（NRS 1）. With that,she gained conﬁdence in herself. We could successfully improve her halitosis by utilized NRS together with her periodontal
condition and she is very satisﬁed with this treatment.

JSP/JACP Poster Session AAP2018

38

The 104th Annual Meeting of the American Academy of Periodontology in collaboration
with the Canadian Academy of Periodontology,
the Japanese Academy of Clinical Periodontology,
and the Japanese Society of Periodontology.
Abstracts of JACP/JSP Poster Session
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