Insulin granule morphology and crinosome formation in mice lacking the pancreatic ß cell-specific phogrin (PTPRN2) gene.

We recently reported that phogrin, also known as IA-2ß or PTPRN2, forms a complex with the insulin receptor in pancreatic ß cells upon glucose stimulation and stabilizes insulin receptor substrate 2. In ß cells of systemic phogrin gene knockout (IA-2ß-/-) mice, impaired glucose-induced insulin secretion, decreased insulin granule density, and an increase in the number and size of lysosomes have been reported. Since phogrin is expressed not only in ß cells but also in various neuroendocrine cells, the precise impact of phogrin expressed in ß cells on these cells remains unclear. In this study, we performed a comprehensive analysis of morphological changes in RIP-Cre+/-Phogrinflox/flox (ßKO) mice with ß cell-specific phogrin gene knockout. Compared to control RIP-Cre+/- Phogrin+/+ (Ctrl) mice, aged ßKO mice exhibited a decreased density of insulin granules, which can be categorized into three subtypes. While no differences were observed in the density and size of lysosomes and crinosomes, organelles involved in insulin granule reduction, significant alterations in the regions of lysosomes responding positively to carbohydrate labeling were evident in young ßKO mice. These alterations differed from those in Ctrl mice and continued to change with age. These electron microscopic findings suggest that phogrin expression in pancreatic ß cells plays a role in insulin granule homeostasis and crinophagy during aging, potentially through insulin autocrine signaling and other mechanisms.

A case of apical fenestration misdiagnosed as persistent apical periodontitis.

We report a case of apical fenestration misdiagnosed as persistent apical periodontitis. The patient was a 55-year-old woman who presented with persistent tooth pain at the right maxillary canine, despite repeated root canal treatment by a general practitioner. When the patient visited Tokyo Dental College Suidobashi Hospital, a CT examination was performed and apical fenestration diagnosed. The patient received an apicoectomy after which the symptoms disappeared. This suggests that dentists should consider the possibility of apical fenestration when examining patients with persistent tooth pain after repeated root canal treatment.

Clinical outcome of surgical periodontal therapy: a short-term retrospective study.

This study aimed to investigate retrospectively the outcome of surgical periodontal therapy. Periodontal surgeries implemented at General Dentistry, Tokyo Dental College Suidobashi Hospital during the period of April 2010 through March 2012 were subjected to data analysis. After initial periodontal therapy, 17 clinicians performed a total of 138 periodontal surgeries in 80 patients with moderate to advanced periodontitis (31 men and 49 women; mean age 54). Cases (sites) operated were as follows: open flap debridement=102, periodontal regenerative therapy=29 (17 for intrabony defects, 12 for furcation involvements) and periodontal plastic surgery=7. Enamel matrix derivative or bone graft was used for regenerative therapy. Clinical data were analyzed focusing on the comparison between open flap debridement and regenerative therapy. At 5 months after open flap debridement, mean reduction in probing depth (PD) and gain in clinical attachment level (CAL) was 3.9 mm (range -1.0-9.0) and 2.3 mm (range -1.0-9.0), respectively. The corresponding values with regenerative therapy were 4.0 mm (range 0-8.0) and 2.8 mm (-1.0-6.0), respectively. At sites with initial PD≥8 mm, a significantly greater gain in CAL was obtained with the regenerative therapy than with flap surgery (mean CAL gain 4.3 mm vs. 2.9 mm, p<0.05). Periodontal surgery performed in our clinical setting demonstrated a favorable short-term outcome. Our data suggest the efficacy of regenerative therapy, in particular for the treatment of deep pockets.

Potential impact of surgical periodontal therapy on oral health-related quality of life in patients with periodontitis: a pilot study.

AIM: To gain insight into the impact of periodontal surgery on oral health-related quality of life (QoL) of patients with periodontitis. MATERIAL AND METHODS: Study participants were recruited from moderate to severe periodontitis patients. After initial periodontal therapy, participants received periodontal surgery. Oral Health-related Quality of Life Model for Dental Hygiene (OHRQL) was used to assess participant's QoL at each time point of periodontal evaluation (baseline, at least 3 weeks after initial therapy and 3-4 months after surgery). RESULTS: A total of 21 patients completed OHRQL assessment after surgery. Compared with baseline, a progressive improvement in periodontal parameters was observed during the periodontal therapy. The total mean OHRQL score at baseline (25.5 ± 11.4) was significantly reduced (improved) after initial therapy and after surgery (16.7 ± 9.5 and 15.0 ± 9.7, respectively; p < 0.01). However, no significant difference was found between the OHRQL score after initial therapy and that after surgery. CONCLUSIONS: No significant differences in patients' oral health-related QoL were observed between post-initial therapy and post-surgery intervals, although a tendency of surgery to determine an improvement in QoL was observed when compared with post-initial treatment.

Effectiveness of Calvital(®), a calcium hydroxide formulation, on persistent apical periodontitis caused by over-enlargement of apical foramen.

This study aimed to evaluate the effectiveness of Calvital(®), which is a calcium hydroxide formulation, on persistent apical periodontitis caused by over-enlargement of the apical foramen. The study included patients referred to the Department of General Dentistry at Tokyo Dental College Suidobashi Hospital on a diagnosis of persistent apical periodontitis at an external dental clinic. Of them, 20 showing considerable enlargement of the apical foramina were included in the study. Complete disappearance of symptoms was observed in all patients after intracanal application of Calvital(®). We believe that this was due to effective wound-healing brought about the strong alkaline nature of this formulation. We regard Calvital(®) as a highly effective agent for root canal treatment of teeth with persistent apical periodontitis.

Two-year follow-up of treatment of intrabony periodontal defect with enamel matrix derivative.

The aim of this retrospective clinical study was to evaluate 2-year follow-up results following regenerative periodontal surgery for intrabony defects using enamel matrix derivative (EMD). Thirteen patients (mean age: 53 years) with a clinical diagnosis of chronic periodontitis were subjected to data analysis. A total of 25 sites with intrabony defects received regenerative therapy with EMD. Follow-up continued for a minimum of 2 years. Treatment of intrabony defects with EMD yielded a statistically significant improvement in the mean values of probing depth and gains in clinical attachment level (CAL) at 2 years compared with those at baseline (p<0.001). Sites treated with EMD demonstrated a mean CAL gain of 3.4 mm and 3.2 mm at 6 months and 2 years, respectively. No statistically significant difference in gain in CAL was found between the 6-month and 2-year results. A gain in CAL of ≥3 mm from at baseline was found in 17 sites at 2 years. This gain was achieved with minimal recession of gingival margin and was sustained over a given period of time. A trend toward a progressive increase in radiopacity, suggestive of bone-fill, was observed. In summary, treatment of intrabony defects with EMD resulted in clinically favorable outcomes. The clinical improvements obtained with regenerative therapy with EMD were maintained over a period of 2 years.

Surgical periodontal therapy at Tokyo Dental College Suidobashi Hospital: a statistical profile in 2010-2011.

The aim of the present study was to investigate the profile of surgical periodontal therapy performed at the Suidobashi Hospital of Tokyo Dental College, during the period of April 2010 through March 2011. A total of 112 periodontal surgeries in 69 patients (mean age: 51.4 years; 28 men and 41 women) were registered for the data analysis. The surgical interventions performed by 17 dentists comprised 79 cases of open flap debridement, 27 cases of periodontal regenerative therapy with enamel matrix derivative and 6 cases of periodontal plastic surgery. Eighty percent of the surgical sites were in the molar region and 41 cases had furcation involvement. In these patients, an improvement in oral hygiene status was observed prior to surgery: the mean plaque score of 45% at initial visit was significantly reduced to 31% after initial periodontal therapy (p<0.01). At sites that subsequently received open flap debridement or periodontal regenerative therapy, the mean probing depth and clinical attachment level after initial therapy was 6.4 mm and 7.6 mm, respectively. These values were significantly lower than those at initial visit (p<0.01). Lower prevalence of sites with positive bleeding on probing was observed after initial therapy. The initial periodontal therapy performed was considered to be effective in improving the periodontal condition of the sites prior to surgery. More effort, however, is indicated in improvement of patient oral hygiene status.

Treatment of periodontal defects with enamel matrix derivative: clinical evaluation at early healing stages.

The aim of this retrospective clinical study was to evaluate the treatment of intrabony periodontal defects with enamel matrix derivative (EMD) during the early stages of healing. Sixteen patients aged 38-77 years with a clinical diagnosis of chronic periodontitis were subjected to data analysis. A total of 25 teeth with various osseous defects received regenerative therapy with EMD, and were followed for a minimum of 6 months. Post-operative healing was uneventful in the majority of cases. Treatment of the intrabony defects with EMD led to a statistically significant improvement in the mean value of probing depth at 3 months compared with that at baseline (p<0.001). Mean values of attachment gain at 3 and 6 months were of clinical significance: 3.6+/-1.8mm and 3.2+/-1.5mm, respectively. Reduction in probing depth was achieved with minimal recession of gingival margin and was sustained over a time course of 6 months. A progressive increase in radiopacity, suggestive of initial signs of bone-fill, was observed by 6 months. In summary, the results suggest that treatment of intrabony defect with EMD induces favorable periodontal healing with a high level of predictability.

Effect of initial periodontal therapy on oral health-related quality of life in patients with periodontitis in Japan.

BACKGROUND: It is becoming increasingly important for periodontists and dental hygienists to take a biopsychosocial approach to care when considering periodontal interventions. However, information on how patients perceive periodontitis and its treatment is limited. The purpose of the present study is to gain insight into the patient perception of oral health and the impact that periodontitis and treatment have on self-assessed quality of life (QoL). METHODS: This was a prospective, two-center, clinical study in Japan. Patients with periodontitis were assessed for their perceptions of oral health by using an instrument for oral health-related QoL (OHRQL) before and after initial periodontal therapy. RESULTS: A total of 58 patients (mean age: 53.6 years; 23 male and 35 female) participated in the study and completed initial periodontal therapy. At baseline, 97% of the patients perceived that their oral health status impacted on their QoL in one or more ways. Pain, eating and chewing, and psychologic function were identified as compromised OHRQL domains. More than one-half of the patients rated their overall oral health as poor. Initial periodontal therapy, consisting mainly of oral hygiene instructions and scaling and root planing, significantly improved OHRQL scores (P = 0.0027). The effect size was calculated to be 0.51, indicating a moderate improvement. Compared with baseline, a significantly higher proportion of patients reported rarely or never having a problem regarding OHRQL domains such as pain (P = 0.0049) and eating and chewing (P = 0.0145) after treatment. No significant difference in the OHRQL improvement was found with respect to disease severity. CONCLUSIONS: Periodontitis negatively affected QoL in this population of Japanese patients with periodontitis. Conventional non-surgical periodontal therapy has a potential to ameliorate patient perceptions of oral health.

Assessment of oral self-care in patients with periodontitis: a pilot study in a dental school clinic in Japan.

BACKGROUND: Oral hygiene education is central to every stage of periodontal treatment. Successful management of periodontal disease depends on the patient's capacity for oral self-care. In the present study, the oral self-care and perceptions of patients attending a dental school clinic in Japan were assessed using a short questionnaire referring to existing oral health models. METHODS: A cross-sectional study design was used. The study population consisted of sixty-five patients (age range 23-77) with chronic periodontitis. The pre-tested 19-item questionnaire comprised 3 domains; 1) oral hygiene, 2) dietary habits and 3) perception of oral condition. The questionnaire was used as a part of the comprehensive assessment. RESULTS: Analyses of the assessment data revealed no major problems with the respondents' perceived oral hygiene habits, although their actual plaque control levels were not entirely adequate. Most of the respondents acknowledged the importance of prevention of dental caries and periodontal diseases, but less than one third of them were regular users of the dental care system. Twenty-five percent of the respondents were considered to be reluctant to change their daily routines, and 29% had doubts about the impact of their own actions on oral health. Analyzing the relationships between patient responses and oral hygiene status, factors like 'frequency of tooth brushing', 'approximal cleaning', 'dental check-up' and 'compliance with self-care advice' showed statistically significant associations (P < 0.05) with the plaque scores. CONCLUSION: The clinical utilization of the present questionnaire facilitates the inclusion of multiple aspects of patient information, before initiation of periodontal treatment. The significant associations that were found between some of the self-care behaviors and oral hygiene levels document the important role of patient-centered oral health assessment in periodontal care.

A case of orthokeratinized odontogenic cyst suspected to be a radicular cyst.

This report describes a case of orthokeratinized odontogenic cyst arising in the mandibular molar region of a 39-year-old man. Under the initial clinical diagnosis of radicular cyst, root canal treatment was performed on the mandibular right second molar. The treatment that continued for six months did not achieve healing. Subsequently surgical intervention was selected since the tooth fracture was found, and the prognosis was judged to be poor. After atraumatic tooth extraction, the apical cystic lesion was enucleated, and the tooth was replanted. A definite diagnosis of orthokeratinized odontogenic cyst was made by histopathological examination of the biopsy specimen. The radiograph taken seven months after the operation showed an improvement in the radiolucent lesion. No clinical signs of tooth mobility, pain, and swelling were present. The tooth was then successfully retained with the final restoration. Careful follow-up is needed in order to detect any signs of recurrence.