Akira Matsuo

Multi-center intervention study on glycohemoglobin (HbA1c) and serum, high-sensitivity CRP (hs-CRP) after local anti-infectious periodontal treatment in type 2 diabetic patients with periodontal disease

The purpose of this study was to examine whether periodontal treatment incorporating topical antibiotic therapy affects on levels of glycohemoglobin (HbA1c) and serum high-sensitivity C-reactive protein (hs-CRP) in type 2 diabetic patients with periodontal disease, and to explore the relationship between CRP and glycemic control. The whole intervention group (n=32), which underwent anti-infectious periodontal treatment, showed only transient reduction in HbA1c levels without any change in hs-CRP, while the control group (n=17) did not show any changes in HbA1c or hs-CRP. Multiple regression analysis of all subjects revealed that BMI and change in hs-CRP correlated significantly with the reduction of HbA1c at 6 months after the periodontal treatment. Based on the results of multiple regression analysis, the intervention group was subdivided into two groups: those in which hs-CRP levels decreased (CRP-D group), and those in which hs-CRP levels unchanged or increased (CRP-N group) (n=16, respectively), and re-analysis was conducted based upon these subgroups. In the CRP-D subgroup, HbA1c was significantly reduced at the end of the study, but it did not decrease in the CRP-N subgroup. The decrease of HbA1c in the CRP-D subgroup following periodontal treatment was significantly greater than that in the CRP-N subgroup. BMI of each group remained unchanged in this study at the end of the study. Thus, the results suggested that periodontal treatment with topical antibiotics improves HbA1c through reduction of CRP, which may relate to amelioration of insulin resistance, in type 2 diabetic patients with periodontal disease.

Clinical application of a custom-made bioresorbable raw particulate hydroxyapatite/poly-l-lactide mesh tray for mandibular reconstruction

Mandibular reconstruction using particulate cancellous bone and marrow (PCBM) allows functional oral reconstruction. Although ready-made titanium trays are the most common material used in this method, they have some disadvantages such as difficulty in making them form a suitable contour for the defect, and the need for removal. A forged composite of raw particulate hydroxyapatite (HA)/poly-l-lactide (PLLA) is a bioresorbable material that is stronger than pure PLLA and induces bone formation more rapidly. We present two cases successfully treated with custom-made bioresorbable HA/PLLA mesh trays for mandibular reconstruction. A 29-year-old woman with recurrent ameloblastoma and a 66-year-old man with a recurrent keratinized odontogenic tumor of the mandible gave informed consent for this reconstruction technique. Mesh sheets of HA/PLLA were customized by a rapid prototyping method based on computed tomography (CT) data. Marginal resection of the tumor was carried out, and PCBM was harvested from the bilateral posterior iliac crests. PCBM and platelet-rich plasma were transferred to the tray, and the tray was fixed rigidly with HA/PLLA screws. In the second case, dental implants were inserted. There has been no bone resorption for over 2 years since reconstruction in these two cases, and the inserted dental implants have been free from any complications 1 year after loading. The average CT value in Hounsfield units (HU) of the implant sites of two cases was 790. In conclusion, the customized HA/PLLA tray was easily adapted to the mandible, and fine bone quality was obtained. These cases show that this tray system contributed to functional oral rehabilitation with dental implants.

Effect of glycemic control on periodontitis in type 2 diabetic patients with periodontal disease

Diabetes mellitus and periodontitis are closely related. A huge number of reports has addressed the effect of periodontal intervention therapy on glycemic control, but no reports have addressed the effect of glycemic intervention therapy on periodontal disease in type 2 diabetic patients. The aim of this study was to examine the effect of improved glycemic control by glycemic intervention therapy on periodontitis in type 2 diabetic patients.

A simple evaluation method for early detection of bisphosphonate-related osteonecrosis of the mandible using computed tomography

OBJECTIVES The aim of this study was to establish a simple method for the early detection of bisphosphonate-related osteonecrosis of the jaw (BRONJ) using computed tomography (CT). MATERIALS AND METHODS CT images of the mandible were obtained from a total of 20 patients with BRONJ and 20 control subjects. BRONJ was classified into 2 groups, with bone exposure (Stage 1-3 BRONJ) or without (Stage 0 BRONJ). In each patient, 15 transaxial CT images were selected and 30 configured regions of interest (ROI) were identified. The ANOVA test was applied to test the relationship between the severity of systemic risk factors. RESULTS Regarding the local status of the mandible, significant differences were observed among the Stage 0 BRONJ, Stage 1-3 BRONJ, non-BRONJ and control groups in the cancellous bone CT radiodensity values, but there were no significant differences between the Stage 0 and Stage 1-3 BRONJ groups. In the cortical bone widths, significant differences were observed only between BRONJ and the controls. CONCLUSIONS Measuring cancellous bone CT radiodensity value has the potential to be a simple and quantitative method to detect the early stages of BRONJ.

Clinical Characteristics in Two Subgroups of Obstructive Sleep Apnea Syndrome in the Elderly: Comparison Between Cases With Elderly and Middle-Age Onset

BACKGROUND Morbidity due to obstructive sleep apnea syndrome (OSAS) is increased in the elderly population. However, the clinical characteristics of OSAS in elderly patients have not been characterized conclusively. The aim of this study was to clarify differences in clinical characteristics of OSAS between patients with middle-age onset and elderly onset of OSAS. METHODS Patients with OSAS aged > or = 65 years were classified into groups according to age at first identification of respiratory pauses during sleep: a middle-age onset group (n = 32) where onset was at age < 50 years and an elderly onset group (n = 31) where onset was at age > or = 60 years. We compared demographic variables; polysomnographic variables; daytime sleepiness measures, including the multiple sleep latency test (MSLT) and the Epworth sleepiness scale (ESS); and adequate level of nasal continuous positive airway pressure (CPAP) between groups. RESULTS BMI and frequency of underlying cardiovascular disorder were lower in the elderly onset group than in the middle-age onset group. No significant differences in apnea-hypopnea index or percentage of the period showing O(2) desaturation were seen between groups. However, arousal index, maximal negative esophageal pressure value, and adequate nasal CPAP level were significantly smaller in the elderly onset group. Mean sleep latency on MSLT was longer, and ESS score was lower in the elderly onset group. CONCLUSIONS Compared with the middle-age onset group, the clinical significance of OSAS in the elderly onset group seemed to remain milder. This finding is possibly because of the smaller physiologic response to respiratory events.

Changes in cerebral hemoglobin indices in obstructive sleep apnea syndrome with nasal continuous positive airway pressure treatment

IntroductionThis study examined both the relationship between the changes in the brain tissue hemoglobin indices and SpO2 during sleep in patients with obstructive sleep apnea syndrome (OSAS) and the effect of nasal continuous positive airway pressure (CPAP) treatment on hemoglobin indices.Materials and methodsPolysomnographic recordings and near-infrared spectroscopy (NIRS) were performed during an afternoon nap on 15 OSAS patients before treatment and 12 healthy controls. Oxyhemoglobin (HbO), deoxyhemoglobin (HbD), and total hemoglobin (HbT) on NIRS were analyzed, and the correlation of these variables and peripheral arterial oxygen saturation (SpO2) were investigated in the OSAS group before nasal CPAP treatment. In nine OSAS patients, the recordings were also compared between the condition with and without using CPAP.ResultsHbO decreased during obstructive respiratory events while HbT and HbD showed adverse increases, and the values of these hemoglobin indices returned to the baseline values at the end of each respiratory event in the OSAS group. The fluctuations in these cerebral hemoglobin indices during sleep were significantly larger in the OSAS group than in the control group. Moreover, in the OSAS group, these changes correlated strongly with the change in SpO2. When using CPAP, not only respiratory events but also the fluctuations in both the cerebral hemoglobin indices and SpO2 were almost completely suppressed.ConclusionArterial oxygen desaturation is clearly related to cerebral oxygenation, and fluctuations of hemoglobin indices can be suppressed with CPAP.

Bone quality of mandibles reconstructed with particulate cellular bone and marrow, and platelet-rich plasma

The purpose of this study was to evaluate the bone quality of mandibles reconstructed with particulate cellular bone and marrow (PCBM) and platelet-rich plasma (PRP). We compared the bone mineral density (BMD) and microstructure of PCBM and PRP-reconstructed bone and normal bone in patients. Bone biopsies were taken of 11 samples of PCBM and PRP reconstructed bone and 16 samples of normal bone using a trephine bur. BMD and microstructures were assessed using microcomputed tomography. The compact bone resulting from the PCBM and PRP reconstruction was extremely thin. Analysis of the microstructures, showed statistically significant differences only in trabecular bone number and trabecular bone spaces between PCBM and PRP-reconstructed bones and normal bones. In the case of BMD, no statistical differences were found between the two groups. Lamellar structures and osteocytes were observed histologically in the trabecular bone in both groups. In conclusion, the BMD and microstructures of the cancellous bone in the PCBM and PRP-reconstructed mandibles resembled those in the normal mandibles.

Analysis of the Pattern of Maxillofacial Fracture by Five Departments in Tokyo: A Review of 674 Cases

Abstract We studied maxillofacial fractures treated by departments of oral and maxillofacial surgery in Tokyo. A retrospective review of records and radiographs for patients admitted during the 5-year period from 2000 to 2004 was conducted at five departments in Tokyo. Date, age, gender, cause of injury, fracture site, concomitant injury, domestic violence against women, and treatment were reviewed. 674 patients with maxillofacial fractures were admitted. Male-to-female ratio was 3.6 : 1. The most frequent age group was 21–25 years. Fractures of the mandible were most frequent (87%), followed by the maxilla (14%) and the zygomatic bone (12%). Thirty-one percent of fractures were due to traffic accidents, 29% to accidental falls, 23% to violence and 14% to sports. The incidence of maxillofacial fractures caused by traffic accidents was lower, and that caused by falls and violence were higher than in other countries. Seventeen percent of the maxillofacial fracture patients had concomitant injuries. The incidence of domestic violence-related maxillofacial fracture was 1.6% of all cases. These cases were mainly caused by a husband (55%) or a sexual partner (36%). Most patients (67%) were treated by open reduction surgery. However, condylar fracture alone was usually treated by closed reduction surgery.

Preventive effect of rebamipide gargle on chemoradiotherpy-induced oral mucositis in patients with oral cancer: a pilot study.

ABSTRACT Objectives To assess the efficacy and safety of rebamipide in preventing chemoradiotherapy-induced oral mucositis in patients with oral cancer. Material and Methods Patients with oral cancer treated with chemoradiotherapy (daily radiotherapy plus docetaxel hydrate once a week) were enrolled for this study. They were assigned in a double-blind fashion to receive either rebamipide gargle or placebo on the days of chemoradiotherapy. Oral mucositis was assessed using the WHO grading system. The primary endpoint of this study was the incidence of grade 3 - 4 mucositis after exposure to 40 Gy radiation (4 weeks). The secondary endpoint was the effect of rebamipide gargle on tumour response to chemoradiotherapy. Results Twenty-four patients were randomly assigned to receive rebamipide gargle (n = 12) or placebo-gargle (n = 12) during chemoradiotherapy. The number of patients with severe mucositis (WHO ≥ 3) was higher in the placebo group than in the rebamipide group (83.3% vs. 33.3%, P = 0.036). In addition, no effect of rebamipide gargle on tumour response to chemoradiotherapy was recognized compared with the placebo group. Conclusions For patients with oral cancer undergoing chemoradiotherapy, rebamipide gargle may contribute to decrease the severity of oral mucositis.

Correlations between alveolar bone microstructure and bone turnover markers in pre- and post-menopausal women.

OBJECTIVE Alveolar cancellous bone biopsy samples were extracted during dental implant preparation for investigating microstructural changes due to menopause and relationships between these changes and bone turnover markers. STUDY DESIGN Subjects were 18 women receiving mandibular implants: premenopausal (n = 5), early postmenopausal (≤5 years; n = 3), and late postmenopausal (>5 years; n = 10). Bone turnover markers were measured and the samples analyzed using microscopic computerized tomography and 3-dimensional bone morphometry. RESULTS The alveolar bone volume was significantly less in late postmenopausal women than in premenopausal ones. The trabeculae in early postmenopausal women were more separated and rod-like than in premenopausal ones (P < .05). Each alveolar bone parameter was significantly (P < .05) related to at least 1 bone turnover marker. CONCLUSIONS Alveolar cancellous bone structure begins changing even in early postmenopausal women, and this structure varies in close relationship to bone turnover markers.